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Staying HealthyNancy Lee Nelson, MPH, BAN, RNJune 3, 2020Supporting Your Immune System in the Era of the PandemicQuality Sleep StrategiesLast week we began a brief discussion and identification of various components that are crucial to a healthy immune system. Going forward, each week we will focus on one of these components. The focus shall be healthy strategies for each component. During this Pandemic, our goal is to build a strong healthy immune system to decrease our susceptibility to COVID-19 and increase our immune system’s ability to fight COVID-19 if we become infected. This week, we will focus on the first of these components – quality sleep.Sleep plays a critical role in the healthy functioning of our immune systems. Most people need 7-9 hours of good sleep each night. Getting too much or too little sleep is not as healthy as getting the right amount of sleep. During sleep we go through cycles of REM and non-REM stages. During a deep sleep stage, the body repairs and regrows tissue, builds bone and muscle, and strengthens the immune system. Getting less sleep or non-quality sleep can adversely affect our immune system. Strategies to Get Quality SleepStrategy 1. Go to Bed at the Same Time each Night and Get up at the Same time Each Day. A critical strategy to sleeping well is to keep a regular sleep schedule, i.e. going to bed at the same time each evening and getting up at the same time each morning. This has been proven to result in feeling more alert and energized and building a strong immune system. Keeping the same schedule of going to bed at 10 or 11 p.m. and arising at 6 or 7 a.m. results in a consistent and healthy internal clock (circadian rhythm) related to sleep. Circadian rhythm is an internal process that regulates the sleep and wake cycle. Daylight and darkness impact our circadian rhythm along with a regular schedule – both promote a healthy consistent internal clock. Notice that when we change our regular bedtime to watch a late movie or work late or study late, the next day we will usually experience an interruption to our regular circadian rhythm. When this happens, we are not as clear-headed and feel less energized and alert. Our bodies act best when our internal clock is working well because of a regular routine. A haphazard schedule like playing catch-up on our sleep at different times of the day and night is not healthy for our immune system. Interestingly, if you stick to a regular schedule, you will not need an alarm clock since going to bed and getting up at the same time optimizes your sleep experience and internal clock. You wake when you have had enough sleep. However, if you follow a regular schedule and do not wake up at 6 or 7 a.m. then you may need to increase your sleep time beginning with an increase of 30 minutes a night. Other Pointers to Prevent Messing up Your Circadian Rhythm: !) Do not sleep in on the weekends since this can upset up your internal clock; 2) If you have to take a nap, try hard not to nap more than 15-20 minutes and only in the early afternoon; and 3) If you get tired right after dinner, instead of napping, find something stimulating that works for you such as going outside for a walk, taking a bike ride, weeding the garden, or calling a friend. Strategy 2. Exposure to Natural Light in the Morning and Darkness at Night. Research has shown that exposure to sunlight during morning hours aids in better sleep at night. As an aside, it also leads to a lower stress level and less incidence of depression.Even a window with natural light can be helpful to obtaining exposure to sunlight. If you are in an office or indoors, focus on utilizing light during the day by opening the curtains or shades, sitting in front of a sunny window or going outside during your lunch hour. Note that some studies have shown that blue light emitted from electronics during the daytime can be helpful to sleep. However, there are also studies that find blue light has harmful effects, so best to use natural light. When it is time for bed, make sure the room is dark. Black out shades or thick curtains can be helpful to make the room dark but If that does not work for you consider a sleep mask. In addition, it is good to keep the lights low if you get up during the night. If you need to get up during the night consider a small flashlight or a night light, Keeping the lights low will make it easier for you to fall back asleep. Exposure to more natural light during the day and less light at night help to keep our internal clock (circadian rhythm) working at its best for our immune system.Strategy 3. Develop a Relaxing Bedtime Ritual. Develop a traditional ritual that relaxes you before bedtime. You might have an idea what will work for you, but if not, you could try listening to relaxing music or using aromatherapy such as lavender and/or damask rose in an essential oil diffuser. Some people read a book (not an electronic book since it emits a light that can reduce melatonin making it hard to fall sleep), others drink warm milk or noncaffeinated tea or another soothing beverage. Meditation can be a great relaxing bedtime ritual. You could also try the 4-7-8 breathing method known to relax the body. See the attached Exhibit for a 10 minute meditation online link and an explanation of how to do the 4-7-8 breathing method.Strategy 4. Exercise for Quality Sleep. We have heard many times that exercise is good for both your mind and body, However, research has shown that exercise also helps you fall asleep faster and have a higher quality sleep. Interestingly, researchers have not yet learned exactly why exercise has this type of quality impact on sleep. Researchers do know that moderate aerobic exercise increases the amount of slow wave sleep (deep sleep). They also know that exercise raises your core body temperature, but after 30-90 minutes that core temperature begins to drop and this fall of temperature results in sleepiness.It is important to remember that exercise results in a release of endorphins that can keep us awake. Therefore, it is recommended that we exercise at a time of day that works for us but no later than two hours before bedtime. To get the positive results of exercise on sleep, we need to get at least 30 minutes of aerobic exercise each day. Again, observe the time of day you exercise and pay attention to the impact on your sleep. By carefully observing the results, it will help you determine the best time to exercise. Listening to your body is important to good health.Think about what works for you. For some people, it works to go to the gym. Others like to walk. I know someone who loves to dance to ‘60s music. Another friend combines exercise with seeing a friend. Find what works best for you.Strategy 5. Make the Most of Your Natural Melatonin Production. Melatonin use has been growing in our country. It is important to know that melatonin does not put you to sleep, but it does put you in “a state of quiet wakefulness” that is believed to promote sleep. Generally, melatonin naturally increases approximately two hours before bedtime. This is the best time to create conditions to assist natural melatonin in doing its job. We can do this by keep the room lights low two hours before bed. Since electronics can negatively impact melatonin, we can stop using electronics including television two hours before bedtime. You can also help your body produce melatonin if you get sun exposure by going for a walk or weeding your garden in the daylight, etc. You can also get sit by a sunny window to increase your melatonin. A Johns Hopkins sleep expert recommends using a melatonin supplement for occasional insomnia or jet lag. He states “less is more” in recommending 1-3 milligrams of melatonin two hours before bedtime, but only if needed. If you use a melatonin supplement and it does not work in a week or two, stop taking it. Using melatonin is generally temporary, If you find it is helping your sleep it is safe to take melatonin for a month or two.Do not take a melatonin supplement if you are pregnant, breastfeeding, have an autoimmune disorder, a seizure disorder or depression. Discuss the use of melatonin with your physician or nurse practitioner if you have diabetes or hypertension. They also may have other ideas to improve the quality of your sleep without using a melatonin supplement. Strategy 6. Turn off Electronics Two Hours before Bedtime.The gradual dimming of light that prepares us for sleep no longer occurs with the advent of electronics. Instead, we are exposed to the light emission from our televisions, computers, iPads, iPhones and electronic books almost constantly. This emission of light promotes wakefulness rather than sleep and disrupts our natural internal clock (circadian rhythms). Of course, the problem is that electronics are very popular with most of us. Electronics are likely here to stay. They can be very positive – opening a whole new world for us. Yet, this makes it difficult for us to make health changes that address the harmful parts of electronics. As addressed above, the exposure to light in the daytime and darkness in the nighttime results in a normal circadian rhythm that provides alertness in the daytime and the ability to fall asleep at night. What we miss with electronics is low light and darkness. Without exposure to regular amounts of darkness at appropriate times, our internal clock and immune system are negatively impacted. It is also important to know that for children and teenagers, good sleep is critical. Research has shown that children are getting less than adequate sleep for growth, learning, mood and creativity as a result of electronics.If you have a teen or child that doesn’t seem to be doing well, take a look at their electronic use. That means electronic use for school or pleasure such as watching television, gaming, social messaging, etc.Being on electronics has been found to cause insomnia and depression. Electronics emit an artificial blue light that can suppress our sleep-inducing melatonin. It can also interfere with our internal clock (circadian rhythm). As a result, adults, children and teens may have difficulty falling asleep and staying asleep. When this happens over time, it can result in a faulty internal clock and other physical and emotional issues.To promote health, do not allow electronics in the bedroom of adults, teens or children. In addition, restrict the use of electronics for two hours before bedtime. This can result in an improvement in the quality of sleep. However, that means that after a certain time at night, there is no computer work – all office work, schoolwork must be done earlier, i.e. no gaming, no messaging, etc. Adults, teens and children, who understand the rationale related to the negative impact on their health, may be more understanding when we require a tech-free bedroom and the discontinuation of electronics two hours before bedtime. Getting quality sleep is essential to optimal health and a strong immune system. We have the ability to enhance our immune system with healthy strategies.If you try these strategies and your sleep does not improve, please consult your physician to make sure there is not an underlying health issue that is causing you to not sleep well. EXHIBIT TO STAYING HEALTHY Strategies to Get a Good Night’s SleepMEDITATIONClick link to try a10 minute meditation: Guided Mindfulness Meditation. 4-7-8 BREATHING METHODTo practice 4-7-8 breathing, find a place to sit or lie down comfortably. This method promotes calmness and relaxes the nervous system. Be sure you practice good posture, especially when starting out. If you’re using the technique to fall asleep, lying down is best.Prepare for the practice by resting the tip of your tongue against the roof of your mouth, right behind your top front teeth. You’ll need to keep your tongue in place throughout the practice. It takes practice to keep from moving your tongue when you exhale. Exhaling during 4-7-8 breathing can be easier for some people when they purse their lips.The following steps should all be carried out in the cycle of one breath:?First, let your lips part. Make a whooshing sound, exhaling completely through your mouth.Next, close your lips, inhaling silently through your nose as you count to four in your head.Then, for seven seconds, hold your breath.Make another whooshing exhale from your mouth for eight seconds.When you inhale again, you initiate a new cycle of breath. Practice this pattern for four full breaths.?The held breath (for seven seconds) is the most critical part of this practice. It’s also recommended that you only practice 4-7-8 breathing for four breaths when you’re first starting out. You can gradually work your way up to eight full breaths.This breathing technique shouldn’t be practiced in a setting where you’re not prepared to fully relax. Also, don’t this breathing routine if you have to be alert following it. Use this routine for falling asleep.References“Crucial ways you can support a healthy immune system,” Harvard Health Letter, Vol. 45, No. 8, June 2020.“How Sleep Affects Your Immunity,” Sleep Foundation (2020). “The Effects of Sleep Deprivation on Your Body,” Healthline (2020).“Lack of Sleep: Can it Make You Sick?” Mayo Clinic COVID-19 Resources, “The Effects of Sleep Deprivation on Your Body,” Healthline, May 2020. .“Morning Daylight Exposure Tied to a Good Night’s Sleep,” Health News (May 18, 2017). “The Science of Sleep: Stages and Cycles,” Harvard Health Beat (2020). Leavitt, M.Ed., “The 9 Best Breathing Techniques for Sleep,” Healthline (2018). “Screen Time and Insomnia: What it means for Teens,” Sleep Foundation (2020).“Exercising for Better Sleep,” Johns Hopkins Health, 2020. “Melatonin for Sleep: Does it Work?” Johns Hopkins Health (2020). “Electronics in the Bedroom: Why it’s Necessary to Turn off before You Turn in,” ................
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