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THIS IS PART 1 OF A 3-PART INTERVIEW. Check out part 2 by clicking HERE! Click here for part 3!
Sleep quality is an undervalued part of overall wellness. But it is SO important. Our sleep quality affects pretty much all aspects of our waking life, so learning how to improve it can be a game-changer.
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My guest today is my colleague, Michelle Nilan, CNS. Michelle is a clinical nutritionist, yoga teacher, and ACSM-certified personal trainer. She is the associate clinical nutritionist in my private practice and has been working with me since June 2020!
She has a master's in human nutrition from the University of Bridgeport and a bachelor's in philosophy from Humboldt State University.
Through her work with me, Michelle has developed an extensive understanding of the complex relationship between the skin, gut, and overall health, and values being able to turn this into practical, actionable guidance to help others become well. She is additionally well-versed in metabolic conditions, insulin resistance and diabetes, and nutrition for high-risk pregnancies.
Michelle also has a history of her own skin struggles with severe cystic acne, fungal acne, and tinea versicolor, as well as with managing thyroid, hormone, and autoimmunity issues, and knows all too well what it feels like to have significant life-impacting symptoms completely dismissed and be told by doctors that she’d “just have to live with it.”
She is grateful for the opportunity to help others avoid the years of suffering she had to endure while trying to find and address the root causes on her own. Due to her work in philosophy, as well as her personal history of childhood trauma, she has a deep appreciation for the invisible mental and emotional suffering of skin and health issues that aren't obvious from the outside, and allows this to guide her approach of seeing a whole person rather than merely a collection of symptoms or a problem to fix.
When she’s not working with clients, Michelle enjoys staying updated with the latest nutrition research, lifting weights, reading, going to museums, spending time in nature, drinking coffee while people-watching, and playing with her cat Daoshi.
Join us for part 1 of a 3-part interview all about sleep and the skin. In this series, we'll be discussing circadian rhythm, sleep hygiene, why sleep is important, and so much more! Today, we'll focus on sleep quality.
Do you try to practice good sleep hygiene? Let me know in the comments!
CHECK OUT PART 2 of this conversation HERE!
Click here for Part 3!
In this episode:
- Why is sleep quality so important?
- What are some indications of good sleep quality?
- What can interfere with sleep quality?
- Why is mouth-breathing problematic?
- How does circadian rhythm impact liver detox abilities?
Quotes
“Sleep quality is where the restoration takes place. And that's why a lot of times, if someone uses a sleep medication to go to sleep or uses alcohol as a nightcap, you'll still wake up tired in the morning.” [2:02]
“If you're waking up multiple times a night, that's a big indicator that you're not getting good sleep quality.” [5:53]
Links
Book an Assessment Call with Michelle to become a client in my clinical practice
Healthy Skin Show ep. 049: Why Are My Skin Rashes Making Me So Tired?
Diurnal Oscillations in Liver Mass and Cell Size Accompany Ribosome Assembly Cycles
234: How Sleep Impacts Your Skin (Tips + Strategies) PT 1 w/ Michelle Nilan, MS, CNS FULL TRANSCRIPT
Jennifer: Michelle, I'm so glad to have you back on The Healthy Skin Show. Thanks for being here.
Michelle: I'm so happy to be here.
Jennifer: I know. And we had such a great conversation the last time. And now, so the reason I had you come back is because I feel like, and I was saying this to you before we started that sleep is so important. And a lot of times, nobody really thinks about how important it is until you can't sleep, and you feel horrible, which is what happened to me when my back has been over the last year, have had a lot of back problems. And also, people in our community who have TSW for example, where their circadian rhythm gets really, really messed up and a lot of times end up within insomnia. Or just for whatever reason you have insomnia, it can really feel like a nightmare when you cannot sleep.
Michelle: Yeah.
Jennifer: So let's talk about this. We have so much to discuss around just sleep quality, why is sleep important. So let's start there. Why do you think, not me because I have my own opinions, because I just want to feel good during the day. But why do you think that sleep quality is something that people need to consider when they're thinking about just that whole timeframe of literally sleeping at night?
Michelle: So first off, sleep is one of my favorite topics. You're absolutely right. It's really one of those things that you don't realize how vital it is to your waking wellbeing until it's taken away from you.
Michelle: So sleeping enough time is one thing. Long enough, we all heard you need seven, eight hours a night on average. But sleep quality is where the restoration takes place. And that's why a lot of times, if someone uses a sleep medication to go to sleep or uses alcohol as a nightcap, you'll still wake up tired in the morning. And it's because yeah, you were unconscious maybe for eight hours, but all of the cleanup that your body does in the night wasn't happening efficiently.
Michelle: And I have a lot of personal experience with not being able to sleep. About eight months ago or so, I was a woman on a mission to figure out how to sleep. Because for years, I either was sleeping for 12 hours and still waking up tired, or I was just waking up constantly during the night, not being able to get back to sleep, waking up really early in the morning, not being able to fall asleep. And then the funnest was the combination of those last three things.
Michelle: And about eight or nine months ago, I was on literally three different prescription medications to sleep. And I was still tired. My sleep was still bad. I was still often waking up in the night. And not even just to pee because I drank too much water, but just, “Oh okay. I'm awake. I guess I might as well pee since I'm up, should do something.” So I decided I'm just going to do all of the things that I've ever heard can help sleep.
Michelle: And I learned a lot about just through experimenting on myself really about how much of sleep quality is a lot of little things. There's no magic bullet. And not having restorative sleep, even if you're sleeping long enough, it's really like when you try to grow a plant, it's like you're trying to grow a plant, but in the dark. You're giving it water. It's in the soil. Maybe you play it classical music, you talk nice to it, you do all of the things. But it doesn't have any sunlight. It's not getting the nutrients.
Michelle: So no matter how much water you give it, no matter how much of anything else you give it, if you don't give it that sun, you're not going to have a beautiful, healthy plant.
Jennifer: And also too, for those of us who've had trouble sleeping, we know how awful that feels. But what should you look for in terms of, just to give somebody a sense, what would be a good indication of a good sleep quality?
Michelle: So according to the National Sleep Foundation, good sleep quality, two really big ways that you know that you have good sleep quality is one, falling asleep in 30 minutes or less. Ideally, it should be less than 15 minutes. But then also not waking up more than once a night. Waking up once, sometimes I'll wake up in the night and I think my bladder is going to break. I also drink a lot of water in the evening. That's normal. But if you're waking up multiple times a night, that's a big indicator that you're not getting good sleep quality that for some reason, you are waking up in the night. And not getting good sleep, it's problematic pretty much in every aspect of your wellbeing, both physical and mental.
Michelle: So getting bad sleep, it goes really beyond just being tired, or unmotivated, or groggy the next day. Irritability goes way up. Your tolerance for stress in general really decreases. And you have less patience both with yourself and other people. You might find yourself snapping at other people more, or just being less kind to yourself, just having a shorter fuse.
Michelle: And then also, your mental fatigue is just way up you have. And you have less ability to do things that require any kind of willpower or conscious effort, which includes sticking to good habits, keeping a positive attitude, and then managing any anxiety or depression, if that's an issue for you. Besides the fact that bad sleep itself can contribute to developing anxiety and depression. So it's this cyclical thing.
Michelle: Memory will be worse, worse ability to focus. And if all of these things are already an issue for you, for example if you have or ADHD, it will just exacerbate all of it. It will put it under or magnifying glass.
Michelle: And then on the physical side, you basically increase your risk for every single chronic disease. For obesity, diabetes. Like I said, mental disorders like depression and even bipolar disorder, heart disease and heart attacks, high blood pressure, strokes. All of that risk goes way up. And the worse your sleep and the more chronic the bad sleep, the more pronounced that risk is and the higher likelihood that you have.
Michelle: And then also, I mentioned about willpower and conscious effort, sticking to good habits. In addition, if one of your goals is weight loss, poor sleep impacts your hunger hormones because sleep is a made regulator of that. So if you're getting poor sleep, not only are you going to feel hungry, but you're going to have less ability to appropriately manage it. And even if you're extremely hungry, to choose some fruit or a healthy alternative, as opposed to the plate of cookies that someone kindly placed right in front of you.
Michelle: And then something I think that might resonate with a lot of people with skin conditions is your immune system is decreased. Your healing ability is decreased. And even for people with gut infections, it makes it harder for your body to combat that and to heal from it.
Jennifer: Yeah. And I'll also add to that list too. Our skin has that circadian rhythm of its own. And I personally have found that when people are not sleeping well, which happens in really severe, when things are really severe for someone within their rash issues, or they're in TSW, that the skin gets worse the less they're able to sleep. It's almost like the skin is throwing a temper tantrum at your inability to sleep, but you're also mad at yourself and your body for not being able to sleep. Right? You just want to sleep, that's it. You just want to sleep.
Jennifer: I've had clients say, and I'm sure they've probably also voiced the same concerns or wishes to you. They're like, “If I could just sleep six hours, that would be amazing. Uninterrupted six hours. Or uninterrupted four hours of sleep. If I could just get there, that would be a great start.”
Jennifer: So it's interesting in working, because as we do with people who are dealing with a lot of these chronic skin issues, that sleep dysfunction a lot of times can go hand in hand with how flared and irritated, irritated basically your skin is, and how dysfunctional to some degree the skin barrier itself is. So that's my two things.
Michelle: Absolutely. I've heard that a lot and I've had those same wishes and dreams myself. If I can just sleep for any extended period of time without waking up. That would be great.
Jennifer: Would be awesome. I know. So let's talk a bit about what can interfere with sleep quality. I know that everybody's probably like, “Well, I've heard the blue light from my devices.” That's the most obvious one that everybody hears about, but there's some other things that can as well. So you want to talk about those?
Michelle: Absolutely. And there are a lot of things that can interfere with sleep. It's a lot of little things. Like I said, there's no one thing. If you just stop the blue light, that's it, you're good.
Michelle: So poor sleep hygiene is what the category basically is of all of these things that can interfere with sleep. And I'm just going to run through a list of things that contribute to poor sleep hygiene. So that's sleeping in a hot or a warm room, sleeping with any light or sound. So it's not just the blue light that you'll see on your screen before you go to bed, but even tiny lights like the tiny LED lights on your TV, or on your alarm clock, or just any tiny lights being emitted from devices. Those also actually will interfere with sleep. Even light that's coming in under the door or through window blinds. Any kind of noisy sleep environment. Even if you are physically asleep, it'll be interfering with the quality while you're sleeping, because it's not allowing you to have that stable, calm, peaceful environment for your brain and your body to actually rest.
Michelle: I already mentioned the screens. Looking at any screens, phone, computer, TV within one to two hours of bed. Not having a relaxing bedtime routine, that wind down is really important to get yourself in a state where you're receptive to getting the good sleep quality. Drinking caffeine within six hours of bed, drinking alcohols within four hours of bed. Intense exercise within four hours of bed. Any kind of stressful or emotional conversations right before bed, that'll ramp you up and that interferes with sleep.
Michelle: And then food. Having a larger heavy meal within three hours of bed or going to bed hungry. So both of those are problematic. You can't decide, “Okay, I'm just not going to eat for hours before bed,” and be starving when you go to bed because there's no way that you'll sleep well. And also, not having a consistent sleep and wake time. Because you mentioned circadian rhythm, and we'll go into that a little bit more. It's really important, but that really messes with your body knowing that it's time for sleep.
Michelle: And then along those same lines of your body knowing that it's time to sleep, using your bed for activities besides sleep or sex. Like working during the pandemic, everyone's working from home, and possibly a lot of people are working in bed. And that's a big problem for-
Jennifer: And it's also bad posturally.
Michelle: It is bad posturally.
Jennifer: Yeah, it's bad posturally. And even to go along with that, if you have an uncomfortable mattress, or I'm just going to flat out say that most people have too soft of mattresses, that are really unsupportive of an appropriate spinal position for back. I know, I was one of them. So I think considering that you might have to invest in a new mattress and looking at it thinking about it, I spend what, six to eight or nine hours a day here. It is a well spent investment in my opinion.
Michelle: Yeah, absolutely. And along with that, if your mattress is over eight years old and you don't know if it's uncomfortable, get a new mattress. That's about the time. Yeah. Napping for a long time during the day, that'll just make you not tired enough to sleep appropriately. You mentioned the mattress.
Michelle: And also, uncomfortable sleep material whether that's your bedding or your clothing. Sleep is about comfort. If you're on some kind of awful polyester synthetic fabric, or maybe you're kind of hot or it's kind of itchy, if you're not already naturally itchy, that'll make it worse of course. You just can't have that comfort to sleep. And then something I think that's really, really underestimated that's not usually in the category of sleep hygiene is the ability to breathe in sleep.
Jennifer: Thank you for bringing that up. I'm glad that you're raising this point. It's so important.
Michelle: Yes. And to just quickly about why it's important, so obviously we breathe because we need oxygen. But when I'm talking about breathing during sleep, I mean breathing specifically through your nose, not breathing through your mouth. Your mouth should be closed during sleep. Because the way the oxygen is converted when it goes in through your nose compared to your mouth, when it goes to your nose, it's converted appropriately to nitric oxide to get to your brain. And through your mouth, it's not. And that conversion is really important for your brain to be oxygenated so that you have that focus in the morning, so that your brain can do all the appropriate up so that it gets appropriately to your cells.
Michelle: So mouth breathing is really problematic because it interferes with that proper brain oxygenation. And there's an extreme type of mouth breathing basically that's called sleep apnea. I'm sure a lot of people have heard of it. And symptoms of sleep apnea would be the big red flag, snoring. If you snore, really look into sleep apnea. But there are really other smaller indicators that people might not expect just like loud breathing at night. Episodes in the night where you stop breathing or gasp for air during your sleep, or waking up with a dry mouth or a drier sore throat. That is a sign your mouth has been open all night. Difficulty staying asleep because even if you don't notice that you stop breathing, your body notices and it wakes you up to keep you alive.
Jennifer: It does. Yep.
Michelle: Morning headaches too are a sign that you've not been breathing appropriately in your sleep. Feeling tired after a full night of sleep, that's a general red flag for poor sleep quality for whatever reason. Nightmares, because when you're not breathing properly or when you stop breathing, your body panics. It elevates your cortisol, which I don't know if this is an established theory. This is a big theory I have, that that cortisol spike in the night is what contributes to nightmares or weird, disconcerting dreams.
Michelle: Just excessive daytime sleepiness, falling asleep during regular activities. If you're falling asleep at the computer in the middle of the day at work, or while driving, or just while watching TV. Dizziness when you wake up, that also could be due to that lack of oxygen. Difficulty paying attention, irritability, mood swings, forgetfulness.
Michelle: So there's all these really small indicators. And if you do have any of these symptoms, in particular the snoring, the episodes where you stop breathing or gasp for air, morning headaches, a dry mouth and sore throat when you wake up, get assessed by a doctor for sleep apnea. It's really important. Sleep apnea is actually really dangerous for all those health conditions I mentioned earlier. And there are both in-office sleep tests and at home sleep tests you can do. So you can discuss with your doctor, which is appropriate. And then you can take appropriate action for that. There's different types of devices. Maybe you've heard of a CPAP machine. That's not the only option. There are different types of things.
Jennifer: And I think Michelle, one thing I should raise is that I think people underestimate the frequency of sleep apnea that you don't have to be an old person to have it.
Michelle: Right. And you don't have to be overweight either.
Jennifer: Right. So if you suspect it, it may be worthwhile to get assessed for it because it does have such a dramatic impact on your health and wellbeing night after night. It's sort of like I'm really bad at shutting down my computer. I know you're supposed to do it once a day. I don't do that. And then two weeks later, and the computer is slow as molasses. And I get mad at the computer. And as I was thinking about the importance of sleep many years ago, I realized my behavior with how I treat my computer is essentially what happens when you don't get good quality sleep night, after night, after night. And you don't necessarily notice it because you're in it. But with time, you do start to feel increasingly almost ragged, like you just can't be fully present to things. Like you had shared, you have a very short fuse. You don't have the tolerance to do things. Even things that aren't that big of a deal feel like a mountain that you just can't climb. So you just don't do it. So I think it's really worthwhile if you suspect it at all, please talk to your doctor.
Michelle: Yeah. It's really important. If you don't sleep well, you can't be awake well.
Jennifer: Right. Exactly. Exactly. I like that. I like that quote. I'm going to quote you on that. So let's talk really quickly about the circadian rhythm. I think most people know what that is, but I know that you also have some really, you had a couple of cool studies that I think people will find interesting that are worthwhile to consider how the cortisol rhythm is, or cortisol. The circadian rhythm impacts other, like our liver, and our mitochondria and whatnot.
Michelle: Yeah. It's wild. As I was looking into this, we think of circadian rhythm as just okay, I get tired at a certain time of the evening. And I wake up at a certain time of day and this just seems to be the rhythm that I'm on. But circadian rhythm is actually, it's a cellular mechanism that is in every cell, tissue, and organ in your body. Every organ of your body has a circadian rhythm that's pretty closely aligned with all its friend organs in your body where your whole body works together. So it does control when you wake up and get tired, usually on that 24 hour cycle. There are some rare conditions where you're maybe not in a 24 hour cycle. But all of your body works on this rhythm just for your organs, and cells, and tissues to do their day-to-day jobs.
Michelle: So circadian rhythm, it's related to digestion and temperature regulation. I mentioned earlier with the hunger hormones. And I know you've talked Jen a lot about liver detox and how vital that is for the skin and honestly for everything else, for the gut, for mental health. And circadian rhythm also impacts liver detox abilities. And I think the coolest thing that I read about this is that your liver, and it's the only organ that does this on circadian rhythm. It actually expands and shrinks. It almost doubles in size during the daytime.
Jennifer: The liver itself?
Michelle: The liver itself. The liver cells and proteins in it actually physically increase, because all of the stuff that's happening in your body, it's building up. It's creating these proteins. So everything increases and physically expands during the day, and then shrinks back down at night when your liver identifies and degrades any of these cellular components that have been excessively made. So it's literally cleaning and shrinking because everything is being cleaned up. So when you disrupt that biological clock, that circadian rhythm when you're not getting good quality sleep, your liver cannot clean itself appropriately. So it doesn't matter how much milk thistle or NAC you're taking, or what liver support you're doing. If you're not sleeping well, your liver can't function 100%. It just can't.
Michelle: And something really interesting. I wasn't able to find a lot about this, and I'm not an expert in traditional Chinese medicine by any means. But in TCM, they have a kind of traditional organ body clock where organs are assigned to specific times of night. The time for the liver is between 1:00 to 3:00 AM. And I thought that was interesting because that is actually a vital time for the liver to clean itself, to do its detox stuff and so it can work well the whole rest of the hours of the day.
Michelle: And then even your mitochondria work in the circadian rhythm. So when you're awake, they're in this active phase where basically all of the free radicals are increased. Kind of similar to the liver where it's doing all this stuff. All this stuff is happening to, these free radicals are going up. And there's a lot of cell turnover and breakdown. And then in their rest phase while you're asleep, it increases the regeneration. It prevents the loss of all the important components of the mitochondria. So it also does this cleaning process during sleep.
Michelle: And, breathing comes in here too because mitochondria actually use 90% of the oxygen that you take in your body. So if you're not breathing properly in your sleep, your cells cannot function well. You're not feeding your mitochondria.
Jennifer: And that's a huge-
Michelle: That is huge. That is huge.
Jennifer: Yeah. And for everybody who's like, “Wait, mitochondria.” Just remember I have that one episode for everybody listening, and I'll link it up in the show notes. Your mitochondria are your cells' power plants. They make energy. Not your adrenals, your mitochondria. And it is very well documented that sleep is an integral part of improving mitochondrial function, as well as protecting your mitochondria. So chronic poor sleep makes it really difficult for those power plants to operate the way they're supposed to, and actually make your body and your cells the energy that they need in order to thrive and support you, as well as your skin. So just my little aside there.
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