Vicki was 54 when we first met. She was an empty nester who lived in the Chicago suburbs and worked as an event planner. Her brother, Mark, had developed advanced cardiovascular disease and had undergone bypass surgery and multiple cardiac stenting procedures, and he was taking numerous medications. Mark was two years older than Vicki, but he looked much older. Vicki wanted to avoid her brother’s path, if at all possible, and she wanted to make sure she was doing everything possible to remain healthy.
I explained to Vicki that modern medicine is “great” at treating symptoms, but if we could understand why the symptoms occurred in the first place, we would have a better chance of preventing them, because the bypass grafts and stents do not remove the problem.
Vicki wasn’t having any symptoms of active cardiovascular disease. She was experiencing nothing out of the ordinary—no symptoms on exertion, no shortness of breath, no palpitations or dizziness. After reviewing her medical history and doing a careful examination, we started exploring the cause—the why—of disease. This included “bad genes,” factors causing gene activation, the different stressors of life, and so on.
Stress can come from various sources: poor nutrition (too much fat, protein, or sodium), lack of water, a sedentary lifestyle, mental stress from a myriad of sources, toxins, and lack of rest. Chronic stress can activate physiology, which eventually can age the weakest gene-causing symptoms.
Vicki’s main stressor
The stress could be cumulative and originate from many different sources. An individual’s response to different stressors can also vary because of genetic differences. As we explored Vicki’s different stressors, she identified a major stressor: lack of sleep.
The body is designed for rest. There are different kinds of rest: physical, mental, social, and spiritual. Vicki wanted to focus first on strategies to improve her physical rest. Without physical rest, stress, to some degree, follows. This causes a cascade of stress chemicals to be produced, which can change gene expression, aging the body.
She had rested poorly for years, spending hours trying to go to sleep. Her attempts to sleep were a struggle: tossing and turning and finally falling asleep from sheer exhaustion. Vicki felt she was in a nightly wrestling match and actually dreaded going to bed. The next morning, she would wake up fatigued and turn to stimulants to get her going.
Vicki had tried numerous sleep strategies, and nothing was helping all that much. She’d even tried sleep medications, but she experienced their side effects. Vicki felt that if she could deal successfully with this major stressor, her other stressors would be easier to address. Oh, for a night of good rest!
The human body is designed to rest. It needs an average of seven to eight hours of sleep a day. We spend one-third of our time sleeping. Some animals, such as giraffes, need only 1.9 hours of sleep per day, while brown bats spend 19.9 hours in sleep each day. Unfortunately, 79 percent of individuals don’t get enough sleep. Without this rest, health and safety are compromised. Approximately 1,500 motor-vehicle deaths yearly are attributed to sleep deprivation. How many times have you felt drowsy at the wheel? Vicki admitted to at least three noncritical accidents from lack of sleep.
As we talked, Vicki understood she was stressing her genes by not sleeping well. Fortunately, she was not yet to the point of having cardiovascular symptoms. She was motivated and needed a path to follow on her journey for rest. We started with circadian rhythms.
Circadian rhythms are a biological process regulating the sleep-wake cycle, and light and stress are important in maintaining these rhythms. Stress can cause oxidation, inflammation, epigenetic modifications, and many physiological changes that disrupt these rhythms. Light helps to regulate these rhythms. When the circadian rhythms are disrupted, sleep and the rest it provides are compromised. I explained to Vicki that the path to healing must include maintaining these natural rhythms.
If one broke an arm, it would be enclosed in a cast to immobilize the limb so it could rest. Likewise, the brain, heart, gastrointestinal system, and, indeed, the entire body need rest. This rest allows recovery and growth. Keeping these rhythms intact will optimize the potential for rest.
Unfortunately, through the years, our culture has put stress on these circadian pathways. Our ancestors would work from sunup to sundown and then go to sleep. Today, with the lights, the screens, and the activities, these rhythms are being disrupted.
The treatment plan
I suggested several things Vicki could do to improve her sleep patterns, and many people would no doubt consider the first one quite unconventional.
WORSHIP. I wanted to make sure that Vicki was worshiping each day. Worship is step one on the path to rest. Jesus said, “Come to me, all you who are weary and burdened, and I will give you rest” (Matthew 11:28).
Jesus is interested in every aspect of our lives. He has promised that if we come to Him, He will give us rest. In the path to better sleep and rest, keep coming to Him in worship. I wanted Vicki to focus on worship first, so we developed a plan of worship. I explained that worship needed to be a daily activity in her life. Worship lowers stress chemistry. She had worshiped in a church setting before, but she’d never included intentional, daily, personal worship as a way to lower stress. But I knew that this would improve her rest and lower her chance of developing an active cardiovascular disease like her brother.
I explained to Vicki that we all have “bad genes,” and therefore, we all need a healing Savior. His grace gives us power and makes up for our weaknesses. In the path to rest, worship can help on many levels.
I told Vicki that her worship experiences needed to include prayer—inviting Jesus to sit on the throne of her heart, asking for forgiveness, and accepting Him as Lord and Savior.
Next, I encouraged her to include praise and thanksgiving in her daily worship activities—to be thankful to God for everything in her life, including its trials.
I also showed Vicki a number of Bible reading plans that she could incorporate in her worship. She chose to use a worship app called Biblical Prescriptions for Life. This app would lead her in ten minutes of worship every day. In addition, reminders would be sent to her throughout the day, along with the encouragement to find a Bible-based community for fellowship and support in worship.
I urged her to take a moment to slowly read verses in the Psalms every night as she prepared to sleep.
Vicki was a bit surprised by these recommendations, but she was willing to give the plan a try.
MEDICAL PROBLEMS. Her next step was to evaluate the many medical conditions that can disrupt sleep, including urinary problems, heartburn, kidney and liver disease, and the use of stimulants. We also explored mental health problems that can interrupt good sleep, including anxiety, phobia, panic, and depression. And lastly, we evaluated her for pain, arthritis, heart failure, lung disease, and thyroid conditions.
We reviewed some of the common medications that can affect sleep, such as beta-blockers, which cross the blood-brain barrier, steroids, diuretics, cold medications, theophylline, and thyroid medications. After going over the list, Vicki identified one of these medications that she was taking.
LIFESTYLE. Next, we looked at lifestyle factors that can alter sleep rhythms, such as caffeine, alcohol, television, cellular devices, exercising before bed, erratic work schedules, eating late in the day, and blue light from computers and cell phones. After going over the list of lifestyle factors that can disrupt sleep, we identified several factors in Vicki’s life that were adversely affecting her rest and circadian rhythms.
making the changes
Once we identified Vicki’s unique physical and lifestyle factors, we began to focus on change. We made an initial list of steps to try. I also asked her to journal her progress and make this a part of her daily worship. After two months, we would reevaluate her sleep patterns. Following are the recommendations I gave Vicki:
- TRY TO GO TO SLEEP AT THE SAME TIME EVERY DAY. This will help your body get into a pattern. Choose a time when you feel tired. If you’re getting enough physical rest, you should wake up naturally without an alarm. You may find you need an earlier bedtime.
- AVOID SLEEPING IN. If you have a late night, try a daytime nap rather than sleeping in. This helps to maintain natural rhythms. Sleep habits are important.
- EXERCISE DAILY, including movement every hour and a stretching routine followed by 45 minutes of aerobic activities and 15 minutes of easy weights. If you’re having sleep difficulties, avoid exercise in the evenings.
- NO EATING AFTER FIVE O’CLOCK IN THE EVENING.
- NO DEVICE USE IN THE EVENING, including cell phones. Say no to television and backlit devices. This will help with light and mental stimulation.
- GET OUTSIDE in the early morning sunshine. This will wake you up. Spend time outside whenever possible. Let natural light into the workplace and at home. Light helps regulate sleep rhythms.
- TURN OFF THE LIGHTS as much as possible when the sun sets. This helps maintain circadian rhythms.
- EAT FOODS THAT CONTAIN MELATONIN, such as tart cherries, pistachios, walnuts, bananas, oats, and tomatoes. Melatonin is an important hormone made in the pineal gland that helps to maintain the daily sleep-wake cycle.
- PERFORM DEEP BREATHING EXERCISES before and on arrival in bed. This is very important. Lie down and close your eyes. Breathe in through your nose as much as you comfortably can. Hold your breath for three seconds and blow the air out slowly. Repeat this at least ten times. You will feel your body began to relax. This will help turn down the sympathetic nervous system.
- OPTIMIZE SLEEPING CONDITIONS. This includes a dark, quiet room with the temperature around 70 degrees. Be sure the bedding is comfortable, including the mattress and pillow.
I encouraged Vicki to move through these steps one at a time, starting with worship. I reminded her that with God, all things are possible, and I assured her that by following these steps, she would improve her rest and enjoy many other benefits, especially her growing relationship with God.
In her two-month follow-up, Vicki was experiencing six hours of uninterrupted sleep. Her blood pressure and cholesterol all showed improvement. More important, she had accepted the gift of rest from her Savior.
We prayed and made an appointment to meet again in two months.
James Marcum, MD, is a cardiologist who lives in Ooltewah, Tennessee, USA. He is a specialist in cardiovascular disease and interventional cardiology.