Today we are joined by Abhinav Singh, MD, MPH. He discusses the impact of diet and lifestyle on sleep quality, including how raw foods, and foods rich in fiber, vitamins, and antioxidants, can help lower inflammation and improve sleep. Additionally, Dr. Singh explains why it is important for providers to determine whether patients have trouble falling asleep or staying asleep, as these issues may have different causes and require different solutions.  

I’m Abinav Singh. I’m a sleep physician and an internist, double boarded in internal medicine and sleep medicine. I have been practicing in the Indianapolis area for the last 15 odd years. I’m also an associate professor at Marion University. I’m also the sleep specialist for the NBA team, the Indiana Pacers. And I treat a wide variety of all kinds of sleep disorders, insomnia, sleep apnea, snoring, sleepiness, and I’m also the medical director of the Indiana Sleep Center. The findings, they’re saying in vegetarians and vegan sleeps 36 minutes more per night than average. There are a few things here that we have to unpack here, and folks who don’t follow any particular diet, they have said have slept 12 minutes less. There is something the vegetarians and vegans will have more fiber in their diet by design. So that’s the first step—they’ll have more fiber and natural ingredients.

Fiber helps the gut. The gut has obviously links with serotonin. So I’m just now thinking through pieces of physiology here as to have that aspect. Vegetarians and vegans generally will have hopefully less processed food in general, less dense sugars as we say in general. And so that’s the first piece that comes to mind. Again, all this needs to be scientifically verified. This is all just me and my understanding. The other thing is there are many natural food products compared to non-vegetarian meat products that have a natural content of possibly sleep promoting substances, right? So if you start looking at all these things that they mentioned, Kiwis, tar cherries, there is some interest raised on foods such as omega fatty acids, vitamin D. Then you talk about these foods having more serotonin and melatonin precursors, tryptophan. All these three things are tryptophan, melatonin, serotonin, they’re very similar molecules.

They all eventually become a melatonin chain. And then melatonin, as we know, is a natural sleep hormone that releases in the evenings and make us drowsy. So, if these people eat these foods, there is a theory that they may aid their own natural melatonin process. Now remember, it doesn’t mean that having a few kiwis is suddenly going to put you to bed, the melatonin that will be produced because of you eating Kiwis. You may have to eat a lot of Kiwis to produce a therapeutic melatonin. But the habit-forming nature of such, meaning the habit of eating these healthy sleep, promoting, let’s call them foods or sleep supporting foods, I think is a better word than sleep promoting foods because to say sleep promoting, you have to really demonstrate a case controlled study with a placebo to say that this even worked.

So that’s one piece. And then less inflammation in folks who have a plant-based diet that we know. And then less inflammation is less cortisol, less cortisol is better sleep. Cortisol is sort of the enemy of sleep because it increases all the markers which keep us more hyper and alerted because it’s fighting kind of stress. And then there is some small papers that say that people who have plant-based diets, vegans, vegetarians, have a lower risk of developing sleep disorders such as insomnia and sleep apnea. Again, is it an indirect or a direct link? We don’t know that whether it’s a weight-based or a heart health-based or a stress or an inflammation-based answer, we don’t know that. But this has been seen, it’s an observational piece as they tend to have lower body weights in general compared to folks who don’t have necessarily plant based. And then that study from Shanghai, I believe there was, I think in May, there was another paper in Nature Scientific reports that demonstrated that sleep efficiencies are better in vegetarians and vegans compared to their omniverse counterparts.

And this was in May that came out. I was looking at that. That also caught my attention. So there you have it as some of the possible postulates of why they may sleep better if they’re vegan and vegetarian. So raw food, what do raw foods contain, right? You’re back to tryptophan fiber, B six, calcium, magnesium, vitamin D, antioxidants in a low glycemic index. Foods such as fiber foods, right? Because if it’s uncooked, it’s in its native form. And look at what all these things do. So we know tryptophan, we know vitamin B six from avocados, bananas, green vegetables. We know calcium from dark leafy vegetables, kale and broccoli. We found that it aids in certain REM sleep. There are some reports that show that it can help you with some REM. Sleep, again, needs to be verified on larger studies. Magnesium we know helps our muscles feel more relaxed and the cramps are often associated with lack of magnesium and people tend to feel better with leg cramps. And vitamin D found in mushrooms we’ve seen helps sort of stabilize sleep patterns. It’s been said all these things are smaller studies. So raw food has all of them, right? Starting from fiber vitamins to antioxidants, and again, lowering inflammation is improving sleep. Just as if to say, if I heated the room temperature of where an individual is sleeping, do you think they’ll be comfortable, or would they be comfortable in a cooler environment? So that’s what inflammation will do inside your body and disrupt sleep.

And the last thing is that raw foods have naturally a low glycemic index because there are lots of fiber in them. Low glycemic index means their glucose levels don’t fluctuate as sharply as the processed foods do, and therefore it’s better for stability of your internal glucose levels and therefore stabilizes sleep and doesn’t disrupt it. People who sleep well eat well generally, and people who eat well sleep well, right? So there was a paper on exercise as well that people who exercise well regularly will have a good time. I mean, they’ll sleep well and people who sleep more consistent times will be more inclined to exercising more regularly. So the one-sided link seems easier to understand than the other, but both are true. And I advise. So you can control the controllables, right? So here it is. So it’s routine and regularity is probably the biggest tip. If you do something repeatedly, your body naturally starts to derive habit out of it.

And consistent sleep schedules, right? So don’t sway for more than an hour. Listen to your body’s cues. If it’s giving you a signal to sleep, don’t switch on a Netflix binge at that point, right? So accept it, reduce the stimulation, create a relaxing bedtime routine, optimize your sleep environment. Usual stuff sounds boring, but I can’t tell you how powerful this is. Limit your screen time before bed, no screens in bed. Please avoid large meals before bedtime, caffeine, alcohol, large calorie foods I would avoid after late afternoon or so. Alcohol is another culprit that people will often think as a sleep supporter, but it’s really, it disturbs your sleep more than it helps in the net equation. Mindful eating attention to hunger cues. Eat in a time restricted window. Don’t eat too heavy after sunset. Stay hydrated through the day and consider some sleep promoting snacks and foods at the end, whether it’s pistachios, tryptophan, containing certain nuts, magnesium, and you repeat this, right?

So you keep doing this and you sort of perform supportive behaviors as well as remove the culprit slash villain behaviors through the day. And the sum of that is a routine good sleep habit forming cycle. But the intermittent fast time restricted eaters, the adjustments would be such if they’re suffering from sleep issues, their time restricted window should end two to three hours before bedtime. So the time eating window, whatever they’re eating, should end at least two to three hours before bedtime. So don’t eat too late because some of these time restricted eaters will choose their six hours and will eat from two to eight or three to nine or something like that. So I wouldn’t do that. I would make that window end two to three hours before bedtime. Pick your bedtime, end your eating window three hours before. That’s the first piece. Second is again, having some eggs and cheese and some tryptophan rich foods in your last meal.

And then they also say that in a small amount, like a handful of a dense carbohydrate may actually help with sleep. There are some papers that came out that may reduce sleep latency and may help people fall asleep faster. So that’s for the faster the gluten-free folk focus on gluten-free whole grains. So rice is probably the biggest gluten-free hack that there exists. And you get rice in different forms. I have one favorite of mine, which is have you seen these rice paper wraps in a Thai restaurant? So I love those. And so that’s a gluten-free wrap right there. You have your vegetables of choice. You can throw in some peanut sauce in there, gluten-free peanut sauce if they want. And there you go. That’s one of my favorite things to eat actually when we go out. And that’s again, rich with sleep, promoting gluten-free ingredients and nuts and seeds.

Make sure that you’re taking your B vitamins and calcium rich alternatives. Leafy greens and non-dairy milk can also help some stabilize a little bit of sleep. For diabetics, it’s really fiber. It’s about fiber and limiting your simple carbs to an acceptable stable minimum. Lean proteins, opt for lean proteins throughout the night to support blood sugar stability. That’s been sort of written about too. And magnesium rich foods, spinach, pumpkin seeds, fish, all these will help as well. And for evening meals, especially low glycemic index foods. So stuff such as has lots of fiber, which will raise your blood sugar slowly. Keep it there at a stable level, one four ds, one fifties, one sixties, and drop it slowly in the daytime rather than processed foods that’ll spike up your blood sugar. Then you’ll drop hard and you’ll wake up hungry and mad and want to eat more carbs.

That’ll mess your sleep rhythms as well. Whereas something stable, it’s like saying, Hey, we’re going to take a flight from here to whatever London, you’re going to pick one path with lots of turbulence, and the flight pilot keeps changing altitude, whereas the other pilot says, oh, 38,000 feet we’re going to cruise without a bump on the road, bump on the road. So that’s how you want that sleep to be in the latter example. So I think, yeah, supplements are supplements, but you’ve got to get to the root of, first of all, you have to describe the problem. If the patient says, I just have intermittent mild insomnia at times, then of course, clean up your food, clean up your routines in the evening, make sure you’re not overstimulated in the evenings. That’s an important one. Practice good sleep habits.

And then you have a slew of these sleep promoting foods to offer. You can even put a list out in your room, whether it’s the fruits, the nuts, the supplements, they can all help plus minus. But you’ve got to get to the root of the problem. And the many times it’s behaviors that you need to separate from the individual. So if it’s a perpetuating behavior, which is if the individual struggles to sleep and struggles hard, so they’re laying in bed racing thoughts and takes an hour or two to shut down, then there’s a problem there. Then you’re beyond the supplements at that point. So in my clinic, I rarely see those patients who are luckily being helped by a minor adjustment in supplements, but I wish I saw more folks like that by the time they come to my clinic. They’re really well deep into their insomnia journey, and most of it is perpetuation, meaning they’ve learned certain adapting behaviors, which is stimulation, which is trying hard to sleep, and then they try harder and harder, and no one sleeps better by trying harder.

So cognitive behavioral therapy is what I use to unplug some of those, separate them from the struggle and the catastrophizing of sleep. Whereas to the primary care, I’d say, Hey, okay, ask them, is it a falling asleep issue? Is it a staying asleep issue, number one. If it’s both, then we must address both separately because staying asleep could be other things. Iron, lack of supplements, sleep apnea, snoring, spouse disruption, child, pet. Whereas falling asleep is there in their mind. Usually they’re either stress or taking too much of stimulation to bed and the mind keeps spinning where the body’s trying to sleep.