How to Fall Back Asleep After Waking Up in the Middle of the Night
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Dr. Michael Bruce, the Sleep Doctor, addresses a common concern: waking up in the middle of the night and struggling to fall back asleep.
Understanding the Wake-Up
Firstly, why are we waking up during the night?
Waking up between 2 AM and 3 AM is said to be normal, and linked to your core body temperature. As your body core temperature drops, to trigger melatonin release, and then rises again, you get into a lighter stage of sleep. This lighter stage of sleep makes you more prone to waking up.
Note, there are also some medical conditions (such as sleep apnea) that can cause you to wake up during the night.
But, what can we do about it? Aside from constantly shifting sleeping position (Should I be sleeping on my back? On my left? Right?)
Avoid the Clock
The first step is to resist the urge to check the time. It’s easy to be tempted to have a look at the clock, however, doing so can increase anxiety, making it harder to fall back asleep. As Dr. Bruce says, sleep is like love—the less you chase it, the more it comes.
It may be useful to point your alarm clock (if you still have one of those) the opposite direction to your bed.
Embracing Non-Sleep Deep Rest (NSDR)
Whilst this may not help you fall back asleep, it’s worth pointing out that just lying quietly in the dark without moving still offers rejuvenation. This revujenating stage is called Non-Sleep Deep Rest (otherwise known as NSDR)
If you’re not familiar with NSDR, check out our overview of Andrew Huberman’s opinions on NSDR here.
So, you can reassure yourself that whilst you may not be asleep, you are still resting.
Keep Your Heart Rate Down
To fall back asleep, it’s best if your heart rate is below 60 bpm. So, Dr. Bruce advises avoiding void getting up unnecessarily, as moving around can elevate your heart rate.
On a similar vain, he introduces the 4-7-8 breathing technique, which is designed to lower your heart rate. The technique is simple:
- Breathe in for 4 seconds.
- Hold for 7 seconds.
- Exhale for 8 seconds.
Repeat this cycle gently to calm your body and mind.
As per any of our Video Breakdowns, we only try to capture the most important pieces of information in text; the rest can be garnered from the video itself:
Wishing you a thorough night’s rest!
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The Not-So-Sweet Science Of Sugar Addiction
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One
LumpMechanism Of Addiction Or Two?
In Tuesday’s newsletter, we asked you to what extent, if any, you believe sugar is addictive; we got the above-depicted, below-described, set of responses:
- About 47% said “Sugar is chemically addictive, comparable to alcohol”
- About 34% said “Sugar is chemically addictive, comparable to cocaine”
- About 11% said “Sugar is not addictive; that’s just excuse-finding hyperbole”
- About 9% said “Sugar is a behavioral addiction, comparable to video gaming”
So what does the science say?
Sugar is not addictive; that’s just excuse-finding hyperbole: True or False?
False, by broad scientific consensus. As ever, the devil’s in the
detailsdefinitions, but while there is still discussion about how best to categorize the addiction, the scientific consensus as a whole is generally: sugar is addictive.That doesn’t mean scientists* are a hive mind, and so there will be some who disagree, but most papers these days are looking into the “hows” and “whys” and “whats” of sugar addiction, not the “whether”.
*who are also, let us remember, a diverse group including chemists, neurobiologists, psychologists, social psychologists, and others, often collaborating in multidisciplinary teams, each with their own focus of research.
Here’s what the Center of Alcohol and Substance Use Studies has to say, for example:
Sugar Addiction: More Serious Than You Think
Sugar is a chemical addiction, comparable to alcohol: True or False?
True, broadly, with caveats—for this one, the crux lies in “comparable to”, because the neurology of the addiction is similar, even if many aspects of it chemically are not.
In both cases, sugar triggers the release of dopamine while also (albeit for different chemical reasons) having a “downer” effect (sugar triggers the release of opioids as well as dopamine).
Notably, the sociology and psychology of alcohol and sugar addictions are also similar (both addictions are common throughout different socioeconomic strata as a coping mechanism seeking an escape from emotional pain).
See for example in the Journal of Psychoactive Drugs:
On the other hand, withdrawal symptoms from heavy long-term alcohol abuse can kill, while withdrawal symptoms from sugar are very much milder. So there’s also room to argue that they’re not comparable on those grounds.
Sugar is a chemical addiction, comparable to cocaine: True or False?
False, broadly. There are overlaps! For example, sugar drives impulsivity to seek more of the substance, and leads to changes in neurobiological brain function which alter emotional states and subsequent behaviours:
The impact of sugar consumption on stress driven, emotional and addictive behaviors
However!
Cocaine triggers a release of dopamine (as does sugar), but cocaine also acts directly on our brain’s ability to remove dopamine, serotonin, and norepinephrine:
The Neurobiology of Cocaine Addiction
…meaning that in terms of comparability, they (to use a metaphor now, not meaning this literally) both give you a warm feeling, but sugar does it by turning up the heating a bit whereas cocaine does it by locking the doors and burning down the house. That’s quite a difference!
Sugar is a behavioral addiction, comparable to video gaming: True or False?
True, with the caveat that this a “yes and” situation.
There are behavioral aspects of sugar addiction that can reasonably be compared to those of video gaming, e.g. compulsion loops, always the promise of more (without limiting factors such as overdosing), anxiety when the addictive element is not accessible for some reason, reduction of dopaminergic sensitivity leading to a craving for more, etc. Note that the last is mentioning a chemical but the mechanism itself is still behavioral, not chemical per se.
So, yes, it’s a behavioral addiction [and also arguably chemical in the manners we’ve described earlier in this article].
For science for this, we refer you back to:
The impact of sugar consumption on stress driven, emotional and addictive behaviors
Want more?
You might want to check out:
Beating Food Addictions: When It’s More Than “Just” Cravings
Take care!
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Topping Up Testosterone?
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The Testosterone Drop
Testosterone levels decline amongst men over a certain age. Exactly when depends on the individual and also how we measure it, but the age of 45 is a commonly-given waypoint for the start of this decline.
(the actual start is usually more like 20, but it’s a very small decline then, and speeds up a couple of decades later)
This has been called “the male menopause”, or “the andropause”.
Both terms are a little misleading, but for lack of a better term, “andropause” is perhaps not terrible.
Why “the male menopause” is misleading:
To call it “the male menopause” suggests that this is when men’s menstruation stops. Which for cis men at the very least, is simply not a thing they ever had in the first place, to stop (and for trans men it’s complicated, depending on age, hormones, surgeries, etc).
Why “the andropause” is misleading:
It’s not a pause, and unlike the menopause, it’s not even a stop. It’s just a decline. It’s more of an andro-pitter-patter-puttering-petering-out.
Is there a better clinical term?
Objectively, there is “late-onset hypogonadism” but that is unlikely to be taken up for cultural reasons—people stigmatize what they see as a loss of virility.
Terms aside, what are the symptoms?
❝Andropause or late-onset hypogonadism is a common disorder which increases in prevalence with advancing age. Diagnosis of late-onset of hypogonadism is based on presence of symptoms suggestive of testosterone deficiency – prominent among them are sexual symptoms like…❞
…and there we’d like to continue the quotation, but if we list the symptoms here, it won’t get past a lot of filters because of the words used. So instead, please feel free to click through:
Source: Andropause: Current concepts
Can it be safely ignored?
If you don’t mind the sexual symptoms, then mostly, yes!
However, there are a few symptoms we can mention here that are not so subjective in their potential for harm:
- Depression
- Loss of muscle mass
- Increased body fat
Depression kills, so this does need to be taken seriously. See also:
The Mental Health First-Aid That You’ll Hopefully Never Need
(the above is a guide to managing depression, in yourself or a loved one)
Loss of muscle mass means being less robust against knocks and falls later in life
Loss of muscle mass also means weaker bones (because the body won’t make bones stronger than it thinks they need to be, so bone will follow muscle in this regard—in either direction)
See also:
- Resistance Is Useful! (Especially As We Get Older)
- Protein vs Sarcopenia
- Fall Special (How to Proof Yourself Against Falls)
Increased body fat means increased risk of diabetes and heart disease, as a general rule of thumb, amongst other problems.
Will testosterone therapy help?
That’s something to discuss with your endocrinologist, but for most men whose testosterone levels are lower than is ideal for them, then yes, taking testosterone to bring them [back] to “normal” levels can make you happier and healthier (though it’s certainly not a cure-all).
See for example:
Testosterone Therapy Improves […] and […] in Hypogonadal Men
(Sorry, we’re not trying to be clickbaity, there are just some words we can’t use without encountering software problems)
Here’s a more comprehensive study that looked at 790 men aged 65 or older, with testosterone levels below a certain level. It looked at the things we can’t mention here, as well as physical function and general vitality:
❝The increase in testosterone levels was associated with significantly increased […] activity, as assessed by the Psychosexual Daily Questionnaire (P<0.001), as well as significantly increased […] desire and […] function.
The percentage of men who had an increase of at least 50 m in the 6-minute walking distance did not differ significantly between the two study groups in the Physical Function Trial but did differ significantly when men in all three trials were included (20.5% of men who received testosterone vs. 12.6% of men who received placebo, P=0.003).
Testosterone had no significant benefit with respect to vitality, as assessed by the Functional Assessment of Chronic Illness Therapy–Fatigue scale, but men who received testosterone reported slightly better mood and lower severity of depressive symptoms than those who received placebo❞
Source: Effects of Testosterone Treatment in Older Men
We strongly recommend, by the way, when a topic is of interest to you to read the paper itself, because even the extract above contains some subjectivity, for example what is “slightly better”, and what is “no significant benefit”.
That “slightly better mood and lower severity of depressive symptoms”, for example, has a P value of 0.004 in their data, which is an order of magnitude more significant than the usual baseline for significance (P<0.05).
And furthermore, that “no significant benefit with respect to vitality” is only looking at either the primary outcome aggregated goal or the secondary FACIT score whose secondary outcome had a P value of 0.06, which just missed the cut-off for significance, and neglects to mention that all the other secondary outcome metrics for men involved in the vitality trial were very significant (ranging from P=0.04 to P=0.001)
Click here to see the results table for the vitality trial
Will it turn me into a musclebound angry ragey ‘roidmonster?
Were you that kind of person before your testosterone levels declined? If not, then no.
Testosterone therapy seeks only to return your testosterone levels to where they were, and this is done through careful monitoring and adjustment. It’d take a lot more than (responsible) endocrinologist-guided hormonal therapy to turn you into Marvel’s “Wolverine”.
Is testosterone therapy safe?
A question to take to your endocrinologist because everyone’s physiology is different, but a lot of studies do support its general safety for most people who are prescribed it.
As with anything, there are risks to be aware of, though. Perhaps the most critical risk is prostate cancer, and…
❝In a large meta-analysis of 18 prospective studies that included over 3500 men, there was no association between serum androgen levels and the risk of prostate cancer development
For men with untreated prostate cancer on active surveillance, TRT remains controversial. However, several studies have shown that TRT is not associated with progression of prostate cancer as evidenced by either PSA progression or gleason grade upstaging on repeat biopsy.
Men on TRT should have frequent PSA monitoring; any major change in PSA (>1 ng/mL) within the first 3-6 months may reflect the presence of a pre-existing cancer and warrants cessation of therapy❞
Those are some select extracts, but any of this may apply to you or your loved one, we recommend to read in full about this and other risks:
Risks of testosterone replacement therapy in men
See also: Prostate Health: What You Should Know
Beyond that… If you are prone to baldness, then taking testosterone will increase that tendency. If that’s a problem for you, then it’s something to know about. There are other things you can take/use for that in turn, so maybe we’ll do a feature on those one of these days!
For now, take care!
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As The Summer Gets Hotter Still…
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝I would love to see an article about heat dehydrated illness….so much of the US is under hot conditions. I had an fainting sweating episode and now trying to recoup from it. What should we do? Drink water,rest…???❞
We have done some of this, but it’s always a good one to revisit! Last summer (N. Hemisphere summer), we wrote this:
Stay Safe From Heat Exhaustion & Heatstroke!
…and this year, it’s getting hotter still (and is already the hottest summer on record), with certainly much of the US seriously affected, as you say. Next year, it will probably be worse again; climate change is getting predictable like that, and likely will continue until fixed. We are but a health science publication, so we can’t fix the world’s climate, but we can reiterate the above advice, and urge everyone to take it seriously.
Note: heat exhaustion and heatstroke kill. Yes, we’re including heat exhaustion in that, because by the time you get heat exhaustion, you’re often not in the best state of mind to take the correct steps to avoid the heatstroke that follows.
To think otherwise would be akin to thinking “falling never killed anyone; it’s only when you stop falling that it’s dangerous”.
This summer, we did also write this more niche article:
…whose advice won’t apply to everyone, but will be helpful to some, and honestly, some of that advice does go for everyone.
One thing we didn’t write about in those articles that we’ll add here:
Humidity is dangerous:
- Dry heat: you sweat, the sweat evaporates, cooling you. As well as losing heat, you’ve also now lost water and salts, which you’ll need to replenish, but your body is operating correctly.
- Humid heat: you sweat, and now you are just sweaty until further notice. It doesn’t evaporate because the surrounding humidity doesn’t provide the physics for that. Not only are you not losing heat through evaporating sweat, but also, if you’re wearing clothes, that’s now an insulating layer you’re wearing.
…so that means, watch the humidity as carefully as you watch the temperature, and when it’s high, get extra serious about finding ways to keep yourself cool (e.g. shade, rest, cooling showers etc if you can, that kind of thing).
Take care!
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The Web That Has No Weaver – by Ted Kaptchuk
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At 10almonds we have a strong “stick with the science” policy, and that means peer-reviewed studies and (where such exists) scientific consensus.
However, in the spirit of open-minded skepticism (i.e., acknowledging what we don’t necessarily know), it can be worth looking at alternatives to popular Western medicine. Indeed, many things have made their way from Traditional Chinese Medicine (or Ayurveda, or other systems) into Western medicine in any case.
“The Web That Has No Weaver” sounds like quite a mystical title, but the content is presented in the cold light of day, with constant “in Western terms, this works by…” notes.
The author walks a fine line of on the one hand, looking at where TCM and Western medicine may start and end up at the same place, by a different route; and on the other hand, noting that (in a very Daoist fashion), the route is where TCM places more of the focus, in contrast to Western medicine’s focus on the start and end.
He makes the case for TCM being more holistic, and it is, though Western medicine has been catching up in this regard since this book’s publication more than 20 years ago.
The style of the writing is very easy to follow, and is not esoteric in either mysticism or scientific jargon. There are diagrams and other illustrations, for ease of comprehension, and chapter endnotes make sure we didn’t miss important things.
Bottom line: if you’re curious about Traditional Chinese Medicine, this book is the US’s most popular introduction to such, and as such, is quite a seminal text.
Click here to check out The Web That Has No Weaver, and enjoy learning about something new!
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Stretching for 50+ – by Dr. Karl Knopf
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Dr. Knopf explores in this book the two-way relationship between aging and stretching (i.e., each can have a large impact on the other). Thinking about stretching in those terms is an important reframe for going into any stretching program. We’d say “after the age of 50”, but honestly, at any age. But this book is written with over-50s in mind, as the title goes.
There’s an extensive encyclopedic section on stretches per body part, which is exactly as you might expect from any book of this kind. There is also a flexibility self-assessment, so that progress can be measured easily, and so that the reader knows where might need more improvement.
Perhaps this book’s greatest strength is the section on specialized programs based on things ranging from working to improve symptoms of any chronic conditions you may have (or at least working around them, if outright improvement is not possible by stretching), to your recreational activities of importance to you—so, what kinds of flexibilities will be important to you, and also, what kinds of injury you are most likely to need to avoid.
Bottom line: if you’re 50 and would like to do more stretching and less aging, then this book can help with that.
Click here to check out Stretching for 50+, and extend your healthspan!
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Healing Arthritis – by Dr. Susan Blum
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We previously reviewed another book by this author, her Immune System Recovery Plan, and today it’s more specific: healing arthritis
Of course, not all arthritis is rooted in immune dysfunction, but a) all of it is made worse by immune dysfunction and b) rheumatoid arthritis, which is an autoimmune disease, affects 1% of the population.
This book tackles all kinds of arthritis, by focusing on addressing the underlying causes and treating those, and (whether it was the cause or not) reducing inflammation without medication, because that will always help.
The “3 steps” mentioned in the subtitle are three stages of a plan to improve the gut microbiome in such a way that it not only stops worsening your arthritis, but starts making it better.
The style here is on the hard end of pop-science, so if you want something more conversational/personable, then this won’t be so much for you, but if you just want the information and explanation, then this does it just fine, and it has frequent references to the science to back it up, with a reassuringly extensive bibliography.
Bottom line: if you have arthritis and want a book that will help you to get either symptom-free or as close to that as is possible from your current condition (bearing in mind that arthritis is generally degenerative), then this is a great book for that.
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