By Ben Kligler, MD
A good laugh and a long sleep are the two best cures for anything.
--Irish Proverb
Innocent sleep. Sleep that soothes away all our worries. Sleep that puts each day to rest. Sleep that relieves the weary laborer and heals hurt minds. Sleep, the main course in life's feast, and the most nourishing.--Shakespeare (Macbeth)
Here’s a quick question for you: what activity occupies roughly 30% of our time, is essential for cardiovascular health, and is very rarely discussed as part of routine health care? The answer is: sleep.
Despite decades of research, we know almost nothing about why sleep is so essential to overall health, and even to survival. In our modern world, we tend to focus on doing, accomplishing, making lists and checking things off. So why would the 30% of our time when we cannot consciously “do” anything be something we should pay attention to? For starters—and this is the part most of us would come up with easily because we have experienced lack of sleep at one time or another in our lives—sleep is essential to mental health and well-being. In a recent survey of over 273,000 adults, people reporting less than six hours of sleep per night were 2.5 times as likely to describe their mental health as “not good.”1 Anxiety, depression and a number of other mental health conditions can be worsened by lack of sleep. Most experts agree that on average adults need a minimum of seven hours of sleep per night. According to the Centers for Disease Control, though, over a third of American adults are sleeping less than seven hours a night.2
Sleep contributes to our health in other ways too. For example, blood pressure goes down during sleep—which over time reduces the risks that high blood pressure carries for cardiovascular events and heart failure. Sleep contributes to healthy blood sugar levels by supporting regulation of insulin levels, and people who get less than seven hours of sleep on a
regular basis are at increased risk for diabetes.3 Sleep also improves athletic performance, weight control and immune function.
So knowing now how important sleep is to so many areas of our health, what can we do to improve the quality and quantity of our sleep? We are all familiar with some of the standard advice for improving sleep: a consistent sleep schedule, exercise during the daytime hours, avoiding screens immediately before bed, and minimizing caffeine. But there are a number of complementary and integrative health approaches which can also be very helpful. Although the evidence for some of these is still somewhat inconsistent, all of them are so safe that giving them a try makes perfect sense.
For starters, if falling asleep is the issue, a number of mind-body techniques can be very helpful. Progressive relaxation, guided imagery, mindfulness-based stress reduction, and music-assisted relaxation have all been shown to improve both quantity and quality of sleep.4 Cognitive behavioral therapy—which teaches skills for identifying and then defusing unhelpful and negative thought patterns which can interfere with falling asleep--is one of the most effective strategies for addressing insomnia and also for learning how to fall back asleep after midnight awakenings related to anxiety.5
A number of herbs and supplements can be used safely to promote sleep as well. Melatonin, a hormone manufactured by the body which helps regulate the sleep-wake cycle, can be very helpful, especially in people who are shift workers alternating between day and night shifts.
Some small studies have shown it can also be helpful (at a low dose) for children with sleep issues, though it should be used for a limited period of time in kids as the safety of long-term use has not been adequately studied. In terms of herbals to promote sleep, there is an ancient tradition of using plants like chamomile, skullcap and valerian to promote better sleep. I have a personal preference for using these not as capsules or pills, but actually in tea form as an “infusion.” A warm cup of chamomile tea is one of the best sleep promoters I have found, both in children and adults.
A favorite approach of mine during my years of practice—one which I think is very much underutilized—is acupressure for sleep.6 Acupressure is a type of massage consisting of a firm pressure on specific acupuncture points to elicit certain effects. As it turns out it can be very effective for promoting sleep, especially in older people and in young children. Holding a series of acupressure points on the feet for a child having trouble falling asleep can be a lifesaver for a tired parent of young children at the end of the day. Sleep well!
Dr. Kligler is the Medical Advisor for The Deirdre Imus Environmental Health Center®. He is also the National Director of the Integrative Health Coordinating Center for the Veterans Health Administration and Research Director for the Office of Patient Centered Care & Cultural Transformation. He was the founding Director of the Beth Israel Fellowship Program in Integrative Medicine, and teaches in the Beth Israel Residency Program in Urban Family Practice. Dr. Kligler is the author of Curriculum in Complementary Therapies: A Guide for the Medical Educator, and co-editor of Integrative Medicine: Principles for Practice, a textbook published by McGraw-Hill. He is also Co-Editor-in-Chief of the peer-reviewed journal Explore: The Journal of Science and Healing.
1 Blackwelder A, Hoskins M, Huber L. Effect of Inadequate Sleep on Frequent Mental Distress. Prev Chronic Dis
2021;18:200573.
2 https://www.cdc.gov/media/releases/2016/p0215-enough-
sleep.html#:~:text=The%20American%20Academy%20of%20Sleep,optimal%20health%20and%20well%2Dbeing.
3 https://www.sleepfoundation.org/how-sleep-works/benefits-of-sleep
4 https://www.nccih.nih.gov/health/sleep-disorders-in-depth
5 Rossman J. Cognitive-Behavioral Therapy for Insomnia: An Effective and Underutilized Treatment for Insomnia.
Am J Lifestyle Med. 2019 Aug 12;13(6):544-547. doi: 10.1177/1559827619867677. PMID: 31662718; PMCID:
PMC6796223.
6 Waits A, Tang Y, Cheng, H, etal Acupressure effect on sleep quality: A systematic review and meta-analysis,
Sleep Medicine Reviews,Volume 37,2018,Pages 24-34,