Most people have heard of sleep hygiene. Melatonin's role in regulating the circadian rhythm of sleep is well established as evidenced by the increasing sales of the hormone as a sleep medication. The other half of the sleep formula is a bit more obscure, yet it is essential in treating sleep issues such as insomnia, sleep latency, waking during the night, and sleepiness during the day. Let me introduce the other sleep hormone/neurotransmitter, the one that regulates sleep drive—adenosine.

Sleep drive is our ability to accumulate adenosine throughout the day so that when we are winding down in the evening, we become sleepy. Sleep drive is replete with paradoxes. Deborah Patterson, a physical therapist and instructor of the Reframe Sleep course, asserts that while we are accumulating adenosine, the sleep center in our hypothalamus (suprachiasmatic nuclei or SCN) that regulates sleep and other circadian cycles sends out signals that block adenosine receptors until our circadian rhythm and changes in natural light dims them. Then, adenosine fills the receptors, causing us to become sleepy. It plays a large role in initially getting to sleep.

Caffeine blocks adenosine receptors, preventing drowsiness until the buzz wears off five to seven hours later. By this time, adenosine may have diminished as it is used in many other processes in the body, and we may not have enough to get a good night’s sleep. In the morning, our sleep debt causes us to be fatigued and fuzzy, so we drink more caffeine and the cycle of poor sleep and its side effects continues. Short-term sleep debts can be “caught up” while chronic sleep deficits will shorten our lifespan.

There are two ways to increase our sleep drive: exercise more during the day and stay awake longer. Nick Wignall, a clinical psychologist, points out that adenosine is a natural byproduct of the production of adenosine triphosphate (ATP), which happens when muscles work. One way to increase sleep drive and thereby improve sleep is to move your body or exercise more during the day. If you have ever had that great night's sleep after a hard day's physical labor, you know how well it can work.

This brings us to sleep compression or staying awake longer. For some people, small increases in waking time, sometimes as little as 15 minutes more wakefulness, can improve sleep quality. The change can happen on either end—bedtime or waketime—although for most, due to work schedules, it makes sense to stay up later. It is often a temporary change that can be altered later, after one achieves a greater sleep efficiency.

Sleep efficiency reflects the percentage of time one spends in bed sleeping compared to total time in bed. Sleep efficiency should correlate with how refreshed one feels the next day. This is why naps are so controversial—they drain our sleep drive. While some people need naps (to heal brain injuries or for the elderly), they diminish adenosine and can interfere with sleep quality. Naps should be no longer than 20 minutes and should be completed before 2 p.m. to preserve sleep drive.

Sleep medications, including melatonin, were never meant to be used for more than two weeks at a time and they are considered second-line treatments. First-line treatment is cognitive behavioral therapy for insomnia (CBTi). Using a sleep diary with validated sleep surveys and changing one's habits over time are the best ways to effect better sleep.

While we all have genetic predispositions to individual sleep patterns (yes, there actually are genetic night owls and morning glories), we can use sleep science to deliver us to a more sound sleep. We do not all need to go to bed at 10 p.m., but we do all need to sleep well and get rested.

Melissa Cathcart, LAc, provides acupuncture, manual therapies, corrective exercise, lifestyle counseling and pelvic floor rehab to people who want a better quality of life. For more information, call 612-735-9993 or visit DynamicFunctionalHealing.com