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Dr. Michael Grandner at Dietary Supplement Caucus on Capitol Hill

Congressional Supplement Caucus Learns Americans Out of Rhythm with Sleep

<p>University of Arizona Sleep Expert Dr. Michael Grandner talked to Congressional staff about the dietary and lifestyle factors contributing to sleep issues and the effect being tired has on public health and performance.</p>

tThe Congressional Dietary Supplement Caucus briefing held Sept. 13 on Capitol Hill, featured a talk by Michael Grandner, Ph.D., director of the sleep and health research program at the University of Arizona, on how lack of sleep affects health and performance, and how nutrition may play a role in improving sleep.

“We were so delighted to have Dr. Grandner speak to the Dietary Supplement Caucus yesterday, as his remarks underscored the importance of sleep and the interaction sleep and nutrition have with each other," said Steve Mister, president and CEO of the Council for Responsible Nutrition (CRN), one of the trade associations that helps coordinate caucus education.

Americans are losing too much sleep, which is negatively influencing public health and costing people and businesses in terms of lost efficiency and performance, according Grandner. He reported about 10 percent of middle-aged adults suffer from insomnia disorder, and 10 to 15 percent of the population have moderate to severe sleep apnea.

Grandner told staffers that chronic lack of sleep appears to increase the risk of numerous health problems, including obesity, high blood pressure, diabetes, heart attack and stroke. He presented research and statistics showing 7 to 8 hours of sleep is the healthy sweet spot, with less sleep increasingly linked to adverse health outcomes, including mortality. Too much sleep also appears to negatively affect health, indicating sleep is not a linear, straightforward event.

On performance, Grandner noted lab research has shown lack of sleep is associated with decreased vigilance, stamina and reaction time and increased attention lapses and fatigue. In the real world, lack of sleep results in diminished attention and physical/mental performance and increased errors and accidents.

The alarming problem, Grandner said, is that these effects on performance are cumulative, as the data has indicated the longer people go without sleep, the worse their performance gets. “There is no levelling off," Grandner said, referring to the misconception that people get used to operating on less sleep. Unfortunately, research also has revealed people think their sleepiness and impairment is not as bad as they really are.

“We are not a good judge of how sleepy we are," Grandner said.

The health and performance problems associated with poor sleep trends are impacting the economy, Grandner told the staffers. Lack of good sleep can lead to increased missed days of work, lower overall productivity and higher healthcare costs.  While an employee with good sleep habits costs a company about US$1,200 per year, those with poor sleep habits (e.g. insufficient sleep, insomnia etc.) cost upwards of $3,000-plus annually.

Unfortunate for many is that the caffeine and other stimulants so popular throughout the world may be relatively safe for long term use, but can promote poor sleep-awake cycles. Caffeine’s negative effects on sleep last about 4 to 6 hours, but can extend by up to 10 or even 12 hours.

One issue with caffeine and other sleep-wake aids is timing; taking it too early or too late can mess up the sleep-wake cycle or rhythm. Research on so-called chronotherapeutics (timing of delivering aids) is still in early stages, but it may be the key to the usefulness of caffeine and even a cache of dietary supplements used to promote sleep.

“Like the diet, sleep is driven by behaviors, choices, beliefs and attitudes," Grandner reported, noting sleep exists at a critical nexus, upstream of many important physiologic processes. He talked about engaging some of these processes via the use of nutritional products to help the body prepare for and induce sleep, as well as address nutritional deficiencies that affect sleep.

For instance, melatonin is a hormone produced by the body and used to signal when it is night. However, he noted most people do not realize the body releases melatonin for this purpose a few hours in advance of night; melatonin levels build over those hours to a crescendo at about the midpoint of sleep. Thus, melatonin does not work in a dose-response manner, but it is a clock shifter—it doesn’t extend sleep, but shifts the circadian rhythm or sleep curve. Thus, taking supplemental melatonin in accordance with this release and build relative to the circadian rhythm of sleep—may be most effective.

Grandner said the well-known sleep supplement valerian has shown some promise, but the research is not robust, and the herb’s usefulness may be tied to formulation specifics that address bioavailability and metabolism obstacles.

On the popular herbal product chamomile, Grandner acknowledged there are compounds in the flower that can affect the brain and potentially sleep. However, he said there is a shocking lack of clinical trial data on the benefits to sleep.

Similarly, compounds in hops have shown active sedative properties, including modulating the neurotransmitter GABA (gamma-aminobutyric acid)—most sedative drugs work by increasing brain levels of GABA. It may also increase serotonin and melatonin and elevate adenosine, the modulator that promotes sleep and is blocked by caffeine. However, more research is needed to confirm and elucidate these mechanisms.

GABA itself is commonly marketed as a supplement, but Grandner conveyed his doubts that exogenous GABA can cross the blood-brain barrier to affect sleep.

His opinion was higher of branched chain amino acids (BCCAs), which can promote a good sleep-wake cycle. He detailed some animal research showing supplementation at bedtime with the BCAA glycine may improve sleep and daytime function.

On the flip side, deficiencies including melatonin, magnesium, vitamin D and iron can contribute to poor sleep, insomnia, dysregulated circadian rhythms and even restless leg syndrome. Supplementation could help address these deficiencies and restore good sleep-wake characteristics.

Grander speculated one issue with the research on natural products for sleep may be that studies focus on the wrong population: clinical insomnia. A better approach for natural products research may be on mild insomnia, transient sleep problems and even relaxation. Another valuable target could be the physical and mental recovery of sleep, such as in animal trials showing BCAAs before sleep can enhance recovery from traumatic brain injury. The recovery angle would also be good for sports nutrition products.

Grandner ended by offering the Congressional staffers some policy considerations, including offering incentives for labeling caffeine and melatonin amounts in food, beverages and supplements. He also asked that Congress consider recognizing sleep loss and nutrition as a health equity issue, and even consider issuing sleep guidelines, similar to the dietary guidelines and those for physical activity.

“Particularly as the election gets closer, sleepless nights become a common occurrence, and we’re sure that the attendees of the caucus briefing found his insights on melatonin, valerian, and tryptophan valuable," Mister said. “This is a continuing effort from the Dietary Supplement Caucus to educate members of Congress and their staff on nutrition and wellness."

 

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