When the alarm rings, Laura groans and hits the snooze button. She feels dead on her feet before she is even on them. As she eases out of bed, she is aware of her stiff back, sore hips, and tight neck and shoulders. She shuffles to the bathroom and, looking in the mirror, notices that her puffy eyes don’t look as clear as they once did. Her hair and skin have become dull. She heads to the kitchen for her breakfast, usually some combination of caffeine, carbs and sugar (or maybe nothing at all). As she eats her breakfast, she is assaulted with the daily TV or newspaper report of the latest tragedy or celebrity or political infight. And then the daily scramble begins in earnest — getting the kids off to school; going to work; fending off and managing emails, phone calls and work projects; fighting traffic on the commute home; dealing with children’s homework; making dinner and doing other household errands; and trying to tend to her marriage and other relationships.
She does whatever it takes to get through the day: eats sugary snacks, drinks coffee or soda, exercises, calls her therapist for an antidepressant. But none of these quick fixes lasts very long (if having any effect at all). Before she knows it, fatigue and stress overwhelm her.
Laura is so tired these days, in fact, that she can’t seem to find pleasure in things that used to energize her, such as spending time with her family and friends or going out to see a movie. Even sex feels like too much of an effort. So, she spends her evenings draped on her couch, barely awake in front of the TV or her laptop. Then, like a cruel joke, when it is time for bed, she can’t fall asleep — no matter how exhausted she feels. Underslept and overtired, she wakes up in the morning and the cycle begins again.
Laura decides to see a couple of doctors, both of whom say nothing is wrong with her and that she is just getting older and stressed out. One prescribes the latest anti-inflammatory pill; the other, a different antidepressant. Laura knows that something is not right, though, and that’s when she comes to see me.
I tell Laura that I know what this bone-weary funk is because I see it all the time.
Since I began practicing medicine in New York City in the 1980s, after practicing for many years in and around Johannesburg, South Africa, where I grew up, I started seeing an increasing number of patients in their 30s, 40s and 50s coming to me feeling exhausted, overwhelmed, depressed, achy, rundown, older than their years — and generally feeling like they were running on empty.
Patients were falling through the cracks of Western medicine because they didn’t have an obvious disease and were told it was just stress.
These patients were falling through the cracks of Western medicine because they didn’t have an obvious disease and were told it was just stress. I started calling these patients “spent” because that’s how they felt.
I put on my thinking cap to try to work out why so many of my patients were suffering. I thought about the only time I never saw patients who had these symptoms, and that was when I worked “in the bush” 30 years ago, in Kwandebele, a rural area in South Africa.
There, I certainly saw diseases symptomatic of poverty and malnutrition, but I saw none of the problems I see today in New York City. I think it has less to do with the difference in financial resources than with the difference in life rhythms.
In Kwandebele at the time, there was no electricity, indoor heating or refrigeration. People went to bed when it got dark, arose with the sun and ate whatever foods were available in season. Community, music and dance also played an integral role in bringing rhythm into their lives. In short, they lived in accordance with nature’s cycles and rhythms. They had no other choice.
I remembered a tidbit I picked up from a wildlife ranger as a child and never forgot — animals that live in the wild don’t get chronic diseases, he told me, whereas caged animals do. I also thought about what I had learned when studying Chinese medicine, that we humans are microcosms of nature and that the human body behaves according to the same natural laws that govern all living processes.
We evolved over the millennia as people who lived in harmony with day and night and the seasons. As a result, these cycles and rhythms became imprinted in our genes. Scientists know that our genes are almost identical to our ancient ancestors’. Yet, we are living at a pace and rhythm that would be completely foreign to them.
Scientists know that our genes are almost identical to our ancient ancestors’. Yet, we are living at a pace and rhythm that would be completely foreign to them.
Simply put, in contrast to my patients in rural South Africa, we in the West have a hard time respecting the circadian rhythms that govern our lives.
Circadian rhythms are the various biological changes our bodies experience over a 24-hour period in response to important cues, such as whether it is day or night. Every system in the body is affected by circadian rhythms, such as brainwave activity, hormone production, cell regeneration and other biological activities.
Although Western medicine discovered circadian rhythms about 300 years ago, most of us fail to appreciate their power in determining our health and fitness. In Western medicine, we doctors are so locked in to our various specializations that we fail to see large-scale relationships, especially those between the body and its environment. Physicians treat specific symptoms, but many of their patients’ afflictions stem from broader patterns of asynchronous living. We get spent because our modern lifestyle has removed us from nature and we have become divorced from its cycles.
For most of us, probably the only time we become aware of body rhythms and their importance is if we have jet lag. Anyone who has flown over a few time zones knows what I am talking about. You get tired easily, feel sluggish, and you struggle to concentrate or think clearly. Your body aches, you have trouble sleeping and you may even have digestive problems.
In daily life, we get out of tempo because we continually give our bodies the wrong cues. We eat the wrong foods at the wrong times, and we are continually stressed, both emotionally and mentally. We don’t get enough natural light during the day, and we get too much artificial light around the clock, which detaches us from nature’s cadences.
Given the critical importance of sleep to restoring your daily rhythms, I am going to focus, in the tips that follow, on how to live more naturally with light — throughout the day and night — in order to get the rest you need and reset your internal clock.
Of course, I’m not recommending that we all go live in huts without electricity. I am saying, however, that if you get in touch with your body’s rhythms, little by little, you can change your life.
(For more detailed suggestions on other ways to improve your daily rhythms — through improved nutrition, appropriate exercise and relaxation techniques, and healing music — see my book, Revive: Stop Feeling Spent and Start Living Again.)
The process of returning to your natural genetic rhythm is not a quick fix. It involves making some profound changes with powerful, long-term consequences. If you take the suggestions one day at a time, you will soon be able to hear your own rhythm, the beat that your body and mind need to feel healthy and strong again.
A patient of mine described the experience well:
She said it was as if her body were a glass of muddy water and every day we stirred it up, took out a teaspoonful, and added a teaspoon of fresh, pure water. Each day the contents became a little clearer, and, eventually, she had a glass of clean, sparkling water.
The “Are You Spent?” Questionnaire
If you answer yes to three or more of the below questions, you are probably spent. As the name suggests, you are burned out — physically, mentally and spiritually — and you need help.
- Do you wake up in the morning and not feel refreshed?
- Do you feel unusually tired most of the time?
- Do you need coffee, soda or sugary snacks to get going and keep going?
- Although you feel physically exhausted, does your mind continue to race?
- Do you feel as if you are aging too quickly?
- Do you have gas, bloating, constipation and/or indigestion?
- Is it a struggle to lose weight in spite of dieting and exercise?
- Do you have achy muscles and/or joints or tension in your body — particularly your neck and shoulders?
- Do you have a diminished sex drive?
- Do you often feel depressed or have trouble concentrating, focusing and remembering things?
- Have you found that little or nothing seems to rejuvenate you?
- Do you lack motivation to accomplish even small tasks?
- Do you find that you get sick more frequently and that it takes longer to recover?
Here’s the good news: With a few simple lifestyle changes, you can enjoy a healthier, more vibrant and happier you.
Reclaim Your Rhythm
How to reset your internal clock and get the rest you need.
When it comes to getting back in sync and renewing vitality, many people focus solely on bedtime and catching some more z’s. And, although I agree that a good night’s rest is essential to our health and well-being, it’s important to understand that it’s not just what you do at night that affects your sleep. I’ve put together some general sleep-friendly tips to help you reclaim your rhythm throughout the day and the night.
During the Day:
Wake Up Right
Alarm clocks interrupt the sleep cycle and prevent sleep from completing naturally, pushing sleep problems into succeeding days. Dawn-simulation devices, which mimic the sunrise by gradually increasing the amount of light in your bedroom, are much more effective at establishing a healthy sleep cycle and gently rousing you from sleep.
Take Mindfulness Breaks
Close your office door, or find a quiet spot somewhere and get comfortable. Take five-minute breaks throughout your day to focus on your breath and become aware of it.
Get Some Natural Sunlight Every Day
As sunlight enters our eyes, it regulates and resets our biological clocks, which involves triggering our brains and bodies to release specific chemicals and hormones that are vital to healthy sleep, mood and aging. Try to get at least half an hour of regular exposure to natural sunlight a day.
Exercise is one of the best defenses against insomnia, because it increases the amplitude of our daily rhythms and signals the body to promote deeper sleep cycles. The best time to exercise is four to six hours before bedtime, but studies also show that people are more likely to stick to a routine if they exercise first thing in the morning. Try to avoid exercising after 8 p.m., since it may be too stimulating to your body.
Say No to Caffeine
Caffeine, even in small doses, blocks sleep neurotransmitters, the calming chemicals your body produces to make you sleepy. If you have a problem with sleep, you must cut out all caffeinated beverages, even your morning cup of coffee.
Try an Elimination Diet
For two weeks, eliminate sugar, corn syrup, sodas, refined grains and processed foods. These are metabolic disruptors, which overstress the organs involved in hormone regulation and can seriously affect your sleep cycles. In addition, avoid dairy and gluten products, especially wheat, since these can cause food sensitivities that can affect your sleep cycle, too. (For more, see “The Institute for Functional Medicine’s Elimination Diet Comprehensive Guide and Food Plan“.)
Eat in Accordance With Your Body Rhythms
Your digestive-system function peaks at lunchtime, so most of your food should be eaten by then. Your metabolism slows down in the late afternoon, leaving you poorly prepared to digest a large dinner, so make a smaller evening meal your standard. Eat at least three hours before going to sleep. Give your body a chance to recover and rebuild, instead of having to work on digestion while you sleep. What you eat at what time of day also makes a big difference. Prioritize proteins and fats throughout the day — they are essential for steady energy — and include healthy carbohydrates at night since they facilitate relaxation.
Review the Medications You Are Taking
Medications such as antihistamines, diuretics, antipsychotics, antidepressants, decongestants, asthma medications and some blood pressure medicines can cause sleeplessness.
Create an Electronic Sundown
By 10 p.m., stop sitting in front of your computer or TV screen and switch off all other electronic devices. They are too stimulating to the brain and inhibit the release of sleep neurotransmitters.
Prepare for Sleep
Dim the lights an hour or more before going to bed, take a warm bath, and listen to calming music or soothing sounds.
Practice a Relaxation Technique
Many people tell me they can’t switch off their racing minds and therefore have trouble sleeping. Do some breathing exercises, restorative yoga or meditation to shift your brain into a more relaxed, receptive mode. (Try this yoga sequence to help you wind down.)
Create a Regular Routine
Going to bed around the same time, even on weekends, is the most important thing you can do to establish good sleep habits. The body clock’s ability to regulate healthy sleep patterns depends on consistency.
Keep the Room as Dark as Possible
Our bodies need complete darkness for production of the important sleep hormone melatonin. Even the tiniest bit of light in the room can disrupt your pineal gland’s production of sleep hormones. Cover all the lights of any electronic device — alarm clocks, computers, charging indicators on cell phones, etc. — and use dark shades to cover the windows.
Keep the Room Cool
Lowering ambient temperature sends a feedback signal to the brain’s sleep center that it’s nighttime, and that it needs to release more sleep hormones. A sleeping temperature of 60 to 65 degrees F is best for most people, even in the winter.
Block Out Noise
If noise from the street, an upstairs neighbor, pets or a snoring bed partner is a problem, try using earplugs, an electronic device that makes “white noise” or a fan to drown out the sound.
Do Not Rely on Sleeping Pills
Sleeping pills mask sleep problems and do not resolve the underlying causes of insomnia. Many sleep studies have concluded that long-term use of sleeping pills can do more harm than good. They can be highly addictive, and studies have found them to be potentially dangerous.
Don’t Use Alcohol to Fall Asleep
Although alcohol induces sleep initially, as the body breaks it down, it sends the wrong metabolic signals, which can cause you to wake up later on. It usually impairs sleep during the second half of the night, leading to a reduction in your overall rest.
Take Nutrients That Calm Down the Nervous System
Instead of sleeping pills or alcohol, try some mellowing supplements or herbs. Magnesium can be helpful, as can calcium and melatonin (see below). The amino acids L-theanine, 5 HTP, taurine and GABA, and herbs like lemon balm, passionflower, chamomile, magnolia and valerian root, can also help. Take them about 30 minutes before bedtime.
Try Some Melatonin
For some people, melatonin can be extremely helpful. The dosage I usually use is anywhere between half a milligram to 3 milligrams right before bedtime. Tablets that dissolve under your tongue are preferable to those you swallow. Please note, however, that melatonin is good for initiating sleep, not maintaining it.