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As the “I’ll sleep when I’m dead” mantra recedes from public discourse, more and more people are coming to understand sleep as a core element of good health with benefits metabolically, emotionally, and to their mental health.

To Sudha Tallavajhula, MD, a professor at McGovern Medical School and the medical director of the TIRR Memorial Hermann Neurological Sleep Medicine Center in Houston, the importance of quality sleep can be compared to other processes that are mandatory in order to live.

“I would look at it as [similar to] the health benefits, for example, of eating good food or drinking the right amounts of water or breathing the right kind of air, which means it’s indispensable,” Tallavajhula tells us. 

What’s the Link Between Sleep and Chronic Disease?

When you’re not getting good sleep it can be difficult to show up as your best self and sleep deprivation can put you at risk for severe health consequences.

• Mental health issues: According to the National Heart, Lung, and Blood Institute, that sleep deprivation has been directly linked to severe concerns including increased rates of depression and suicidality. Alex Dimitriu, MD, a psychiatrist and the founder of Menlo Park Psychiatry and Sleep Medicine, says that while the effects may not be immediately obvious to other people, the mental health impacts of poor sleep can be heavy for those experiencing them. 
• Risk factor for stroke: A 2018 study found that many patients who have had a stroke also have a sleep disorder and research is ongoing to establish what the relationship between the two may be. 
• Link to Alzheimer’s disease: Other studies have found that Alzheimer’s progression and development may well be linked, in part, to poor sleep. 

Why Sleep Is Essential for Good Health

According to Tallavajhula, it’s not just about a few of your body’s systems that benefit from long-term and short-term sleep. 

“It’s really where we not just rest, but we also revive many of the other processes that are integral to human functioning,” she says. “Memory, for example, immune system functioning, hormonal balance. When we sleep, many of these hormones reach a sort of equilibrium, and then they restart for [the] next day’s processes. I mean, name it, pretty much every cell in the body sleeps and does what it’s supposed to do during sleep.”

Sleep—and a deep commitment to rest in general—can also be vital for those with conditions like myalgic encephalomyelitis or chronic fatigue syndrome. 

Why Getting Treatment for Sleep Issues Is Difficult

Because sleep quality is an issue for many people, it doesn’t mean they’re always getting the care they need. William Lu, MD, a practicing physician and medical director for digital sleep clinic Dreem Health, says that there are a variety of factors why people might not be receiving adequate sleep-related care—whether that’s cultural expectations about pushing through fatigue or a general lack of focus on the topic at the family medicine level. 

He says that, in some cases, the patient may be less concerned about the data or risk factors and more focused on how a lack of sleep impacts their interpersonal relationships.

“I can tell somebody statistics about, like, ‘Hey, you have untreated sleep apnea, and 20 years later, you might have an increased risk for a heart attack or stroke.’ They might not care, right? What they really care about is, ‘Well, my wife says that she can’t sleep.’”

Another less discussed aspect of poor sleep is how conditions like sleep apnea show up differently in women than men and how hormonal differences can change how people sleep. One example Tallavajhula gives is how pregnant people have a natural shift in their sleep patterns.

“During the third trimester of pregnancy, there is a physiologic [change] which means the body prepares you for the arrival of the child by causing you to wake up multiple times, because that’s how you’re going to need to be when the child comes in.” 

Can You Really Catch Up on Sleep?

It’s a popular concept that you can get away with a few hours of sleep and catch up at a later time. But is it real or just a tale to make us (the chronically sleep-deprived) feel better?

Well, it may work, to a point. Those hours you’re losing are commonly known as sleep debt and can accrue, just like an overdue credit card bill or a pesky student loan payment. 

“It’s always ‘later,’ I’ll do it later, or I’ll catch up later. And the real answer is it kind of needs to be happening, and a priority, every day. The data on catching up sleep, sure, we can catch up to some degree, but it’s really not the same, and it doesn’t really replace getting a good night of sleep every night.”

Lu sees that dynamic changing in some areas of our online culture, from the badge of honor that used to come from announcing how little sleep you can get to still function, to being awarded for having good metrics when it comes to your sleep. 

“[People] want to feel better, they want to live longer,” says Lu. “They want to live healthier lives, right? And I think sleep is just now starting to get its time in the spotlight.”

How to Lower Your Risk and Get Better Sleep

Getting better sleep can come down to two key factors. Sleep architecture and sleep hygiene. 

• Sleep architecture: This refers to the way you sleep physiologically and the cycles your body goes through. For example, if you suspect you have a sleep disorder, a sleep specialist may use tests to monitor your sleep patterns over the course of a night, and the depth of your sleep throughout each stage.
• Sleep hygiene: These are the routines and actions you take to improve your sleep. Some common examples include not ingesting caffeine later in the day, reducing the use of screen-based devices as your day winds down, and going to bed at a consistent time each night. 

For Dimitriu, it’s important to point out to patients that there is no quick fix or standard solution to sleep problems and that if a lack of sleep is impairing their lives, they should seek treatment.

“Everybody wants to take a supplement, not a medication,” Dimitriu explains. “Everybody wants some kind of hack that’s going to fix it… I’ve seen people suffering for 5, 10, 20 years, and there comes a time to…seek professional help at that point, ideally, sooner.”

Our quality of sleep affects everything from our ability to fight off disease to how easily we process information. But did you know that sleep also affects our gut health?

The Role of Sleep on the Gut-Brain Axis

It might seem surprising, but how much and how well you sleep directly affects your gut health. Not sleeping enough directly worsens your digestive system, while sufficient quality sleep can help keep it in better working order. “Sleep deprivation leads to dysfunction of gut microbiota, and sleep disorders are accompanied by altered gut microbiota composition,” says Dr. Fouzia Siddiqui, neurologist and medical director of the Sleep Center at Sentara Health.

All parts of our body need rest, and our digestive system is no exception. “The gut-brain axis is now known to be so important in keeping the body in good shape, and it is fascinating to realize that even the microbiome needs a rest period,” Dr. Charles Akle, chief medical officer of immy, tells us. He adds that “sleep is a vital component of ‘resetting’ and repairing almost all metabolic processes in the body.”

How Disrupted Sleep Impacts Digestion and Inflammation

Our gut is where the bulk of our microbiome, or the microorganisms we house inside, lives, which plays a massive role in our wellness. “These organisms are also affected by the need for rest and recuperation, manifested during the sleep cycle,” says Akle.

• When we don’t get good rest, our diet can suffer. “Lack of sleep can affect dietary choices,” and “poor food choices can negatively impact gut health and overall health,” says Siddiqui.
• Not sleeping enough can lead to poor digestion through reflux. Siddiqui tells us that “lack of the sleep hormone, melatonin, may be related to GERD.” She adds that “melatonin also helps regulate gastrointestinal mobility.”
• Lack of sleep can send out an inflammatory response in your body. “Sleep deprivation disrupts the natural, healthy balance of immune cells, causing them to become overactive and trigger inflammatory responses,” explains Siddiqui. From there, she says that “this can lead to long-lasting genetic changes in immune stem cells, increasing the risk for chronic inflammatory disorders and cardiovascular disease.”

Going back to our jet lag example, the icky feelings of traversing time zones and sleeping worse when we do can have lasting negative effects on our health. “It is why jet lag often goes hand in hand with an increased risk of viral infections after a long journey,” warns Akle. Getting rest was always the go-to for illness, and that shouldn’t have changed.

Gut Bacteria Vs. Sleep Hormones

Melatonin is our big-deal sleep hormone, and—no surprise—if we don’t make enough of it, it’s less likely for our gut bacteria to thrive. According to Siddiqui, the gut is “a major site of melatonin synthesis, with some studies finding melatonin levels at least 400 times greater than in the pineal gland (another site of melatonin production).”

“The gut microbiome can also influence the activity of the enzymes responsible for melatonin synthesis,” says Siddiqui. It works the other way around, too. “An imbalance or disruption in the gut microbiome, known as dysbiosis, can impair the body’s ability to produce melatonin, contributing to sleep disturbances,” she explains.

Tryptophan is another important hormone here because it is a precursor to melatonin. It also can be converted to serotonin, which we need to feel emotionally sound. Akle tells us that “tryptophan is also a precursor of serotonin (the happy molecule) and part of the key tryptophan/kynurenine cycle which feeds several critical neurological pathways.” And we can’t convert tryptophan to melatonin outside of our guts.

Siddiqui notes, “One of the key ways in which the gut microbiome influences melatonin production is through the synthesis of tryptophan, an essential amino acid that serves as a precursor for melatonin.”

Tips for Gut and Sleep Hygiene

Whether you’ve been suffering from poor sleep, inflammation, poor digestion, or all three, improving your sleep and gut hygiene can help turn things around for you. Here are our top tips.

Be Consistent

Keeping a regular schedule for sleep and eating is the quickest way to ensure a better night’s rest. “Aim for seven to nine hours nightly,” recommends Siddiqui. Try not to eat dinner too close to bedtime or indulge in late-night snacks. Avoid heavy meals late at night,” suggests Akle. He says, “This especially applies to fatty meat intake because it takes longer to digest and uses more energy that could be needed elsewhere.”

Eat a Varied Diet

There are countless reasons for adding variety to your diet, as we know it can lead to a more diverse microbiome. It can also lead to better sleep in turn. Akle suggests. “It should be rich in seasonal fruit and vegetables and fermented foods. Avoid ‘junk’ food and other ultraprocessed material.” And of course, “go easy on the alcohol.”

Set the Bedroom Scene

Prepping your bedroom to be as conducive to sleep as possible should help you drift off more easily. Siddiqui says to “make your bedroom dark, cool, and quiet” and to “avoid screens at least an hour before bedtime to reduce blue light exposure, which suppresses melatonin production.”

You’ll also want to head to bed in as de-stressed a state as possible. “Stress can keep you awake and impact gut health via the gut-brain axis,” says Siddiqui. She suggests we “incorporate mindfulness practices such as meditation, yoga, or ‘worry time‘ before bed to offload anxieties.”

It can take some practice, but the good news is that with some intentional changes, you can improve your sleep while helping your gut-brain axis work more efficiently.