Why Your Ketogenic Diet Isn't Working Part 2: Sleep and Circadian Rhythm

Written by Megan Roberts, MSc

June 8, 2018

What if there was one thing you could do that improved:

  • Athletic performance
  • Mood
  • Testosterone levels
  • Blood glucose regulation
  • Fatigue
  • Productivity
  • Stress tolerance
  • Gut health

AND was 100% free?

You’re probably thinking: One simple thing for all those benefits?? Impossible! Shouldn’t my ketogenic diet take care of everything mentioned?

The truth is that although diet is important, honoring your circadian rhythm and getting quality sleep is perhaps even more critical to your health. If you’re struggling to reap the benefits of a ketogenic diet or battling with sleep in general, continue reading to discover:

  • What a circadian rhythm is
  • Why sleep is so important
  • Why you might not be getting the quality or quantity of sleep you need for health and performance
  • How to optimize your sleep and circadian rhythm

What is a circadian rhythm?

Circadian rhythm refers to the biological 24-hour cycle that is intrinsic to each of us. In fact, circadian rhythms are so crucial to health that they are conserved across all organisms [1]. Circadian rhythm and desire to sleep are not the same, however, they are intrinsically connected. Our biological clock tells us when it’s time to sleep and when it’s time to be awake while our sleep drive tells us how much we desire and need to sleep. The goal is for the two to be in sync. However, in a world of too much to do and (the perception of) too little time, many of us find ourselves out of touch with our circadian rhythm and constantly fighting our desire to sleep, never actually getting the quality rest we need.

Having a healthy circadian rhythm is also very different from getting “enough sleep.” For example, a shift worker can ensure he or she gets 8 hours of sleep each 24-hour period but still suffer from a dysregulated circadian rhythm. This is why there are so many adverse health effects associated with shift work [2].

Why is sleep so important?

Rather than asking the question “what does sleep do for us?” a better question might be “what doesn’t sleep do for us?” Because the fact of the matter is that there is not a single part of physiology, or life for that matter, that sleep deprivation doesn’t hurt and sleep restoration doesn’t help heal [3]. But for those who don’t believe this, consider the following areas of health and performance for which sleep plays a pivotal role.

  • Athletic performance [4]
  • Insulin resistance [5,6]
  • Glucose tolerance [7]
  • Obesity [8]
  • Hunger and satiety hormones [9]
  • Gut microbiota [10,11]
  • Cognitive and motor performance [12]
  • General hormonal balance [13]
  • Male and female reproductive hormones [14,15]
  • Cortisol production [16]  
  • Cardiovascular function and disease risk [17]
  • Perceptions of attractiveness [18]
  • Mood [19]
  • Cancer [20–23]
  • Immune function [24]
  • Alzheimer's disease [25,26]
  • Neurogenesis [27]
  • Aging and its associated diseases [28]

And this is by no means a comprehensive list! By the end of this article hopefully it will become clear that sleep is critical to just about every aspect of health [29].

How do I know if I’m getting enough quality sleep?

  • You don’t fall asleep the moment your head hits the pillow
  • You don’t lay in bed for an hour trying to fall asleep
  • You don’t wake up multiple times during the night
  • You wake up feeling refreshed (men, testosterone meter points north)
  • Your energy level is consistently good throughout the day

Why might you suffer from poor sleep or a disrupted circadian rhythm?

While there are many reasons that you might sleep poorly or have a disrupted circadian rhythm, we’ll focus on the most common culprits in the next section.

Too much light at night and/or lack of light in the morning

Of all the reasons for a disrupted circadian rhythm, this might win the prize for both most common and easiest to fix. Blue light is the kind of light emitted from most electronics and energy-efficient light bulbs. It has a shorter wavelength than something like red or orange light and is therefore considered higher energy. While natural blue light exposure outdoors during day can increase alertness, boost mood, and positively affect sleep quality [30], too much blue light in the evening after the sun goes down suppresses melatonin - a hormone critical to sleep and general health [31,32]. The circadian mismatch we create with artificial light at night and lack of sunlight exposure has been implicated in many chronic diseases [33].

Stress or a general inability to wind down

Stress from the fast-paced life most of us live can manifest itself in many ways. Often times, people find it difficult to wind down at night and once their head hits the pillow, they simply cannot quiet their thoughts. The level of hormones as well as the responsiveness of their target tissues also fluctuate in a circadian manner [34]. Chronic stress, whether that be from kids, work, or training, can result in cortisol dysregulation and feeling “tired and wired” at night. The adrenal glands have their own natural circadian clock, which when dysregulated can cause chronic sleep issues [35]. Additionally, if the body senses low blood glucose during the night, cortisol will get released in order to stimulate glucose production in the liver, bringing blood levels back up to what the body perceives as safe [36]. This drop in blood glucose and subsequent spike in cortisol may be the underlying cause of sleep disturbances for some people, especially those who are under-eating.  

Shift work

Shift work may be one of the worst offenders in disrupting circadian rhythm and has been linked to not only poor performance but also to adverse health outcomes such as metabolic dysfunction, cardiovascular disease, and even cancer [2].

Caffeine too late in the day

We know that caffeine affects sleep and that everyone responds and metabolizes caffeine differently [37]. This is due to a combination of genetics and habitual intake. While some people may be able to drink a cup of coffee at 2pm with no negative effects on sleep, others might need to time caffeine intake earlier in the day. This may be especially pertinent for athletes training in the afternoon or evening and consuming caffeine prior for its ergogenic effects.


Alcohol is one of the most commonly used sleep aids in the world. However, using it as such may not be a smart idea. There is a critical difference between going to sleep and passing out and too much alcohol too late at night can ruin your sleep. Specifically, while a drink or two (or three) might help you fall asleep faster, it will cause more disrupted sleep during the second half of the night [38]. Alcohol may also negatively influence sleep quality by suppressing melatonin secretion and changing core body temperature [39]. In general, one standard drink takes about one hour to metabolize [40], so a good rule of thumb is to stop drinking at least one hour before bed for every glass of alcohol you consume.

Neurotransmitter imbalances

Neurotransmitters are small chemical messengers that help transmit signals throughout the body via the nervous system. Healthy sleep/wake physiology is dependent on balance of specific neurotransmitters. As such, sleep disturbances may be a consequence of neurotransmitter imbalance. For example, depletion of both tryptophan and serotonin can cause sleep disruption [41] and stress of any kind, including overtraining, may contribute to the underlying cause of neurotransmitter depletion and/or imbalance [42]. This is an especially important point to note for athletes partaking in many hours of intense training every week on top of other life stressors and simultaneously suffering from poor sleep.

Your bedroom environment

Trying to get quality sleep in a noisy room with bright street lights peeking through the curtains can be a frustrating endeavor. While there is some debate about whether extraocular light (i.e. light that is not coming through the eyes) has a detrimental effect on sleep, most people anecdotally report sleeping better in a dark room [43–45].

Obstructive sleep apnea

During sleep, the upper airways can become blocked, ultimately reducing or completely stopping airflow. Sleep apnea can cause awakenings throughout the night and lead to poor sleep quality [46]. Risk factors for sleep apnea include alcohol consumption, smoking, and overweight and obesity. Suspiciously high hemoglobin levels can be a clue that obstructive sleep apnea might be an issue. If you think it is, using a simple pulse oximeter is an inexpensive (but imperfect!) self-diagnostic technique before investing in an official sleep study.


Waking up in the middle of the night to use the bathroom may be common, but it’s not normal. There are some simple explanations for why you might be waking up with the urge to urinate such as large quantities of fluid too late in the evening or medications with a diuretic effect. However, there are also some underlying stress pathologies that might be at play. Dysregulation of the renal circadian clocks has been hypothesized to be an underlying cause [47]. Aldosterone, a hormone that helps regulate fluid and mineral balance as well as blood pressure, should be high at night, causing retention of sodium and fluid. If aldosterone is too low, you might wake up in the middle of the night with a full bladder. And to make things worse, sleep deprivation alone can decrease aldosterone secretion at night, making it a vicious cycle [48].

Theoretically, if cortisol spikes while you’re sleeping due to something such as low blood glucose, it will inhibit ACTH, which will cause a subsequent decrease in aldosterone and promote nocturia. Additionally, a sleeping body should produce less urine (i.e. the glomerular filtration rate decreases). If someone is not truly asleep, perhaps for one of the reasons discussed above, your kidneys will continue to produce urine at a waking rate, leading to nocturia.

Now that we’ve covered the most common reasons why people aren’t getting enough sleep, let’s discuss some practical tips to help optimize sleep and circadian rhythm.

How to optimize your sleep and circadian rhythm and get better sleep

Avoid blue light at night

One of the easiest ways to avoid blue light at night is to wear blue-blocking amber-tinted [49,50]. Switching to orange light bulbs and/or candles when the sun goes down is another option. But while amber glasses might help sleep quality, they don’t make you invincible! The brain stimulation you get from simply taking in a lot of information prior to bedtime may also make it difficult to fall asleep. Therefore, it’s best to try to avoid screens altogether. Reading something less stimulating before bed can be a nice way to wind down, but ditch the blue-light emitting eReader and go for a real paper book [51]!

Go outside in the morning

As far as setting your circadian rhythm is concerned, morning sunlight will always trump coffee! Try to get bright (ideally outdoor) light as early in the morning as possible. Not only does light suppress melatonin production, making you feel more awake, but light during the daytime hours improves sleep quality at night [30,52].

Optimize your vitamin D by embracing sunlight

Embracing sunlight will not only jumpstart your circadian clock, but will also help optimize your [53,54]. Despite the fear-mongering tactics used by some industries, there is no need to slather on 50 SPF every time you go outside. In fact, avoidance of sun exposure is a risk factor for all-cause mortality [55]. Furthermore, sunlight may have cardiovascular benefits that go beyond vitamin D [56]. So use a natural sunblock when needed to make sure you don’t burn but don’t be afraid of a little color.

Eat when the sun is up

There are many health benefits of consuming the majority of your calories during the day when the sun is up and you’re active [57]. While people embracing intermittent fasting may find skipping breakfast convenient, ending your meals earlier in the day and eating breakfast in the morning may be the better option for both circadian rhythm entrainment and overall health [58–60]. The body also responds to calories and macronutrients differently depending on the time of day, and despite the popularity of carb-backloading, insulin sensitivity is highest in muscle in the morning [61,62]. There may be situations in which consuming carbs later in the day is a smart strategy, for instance, if you’re training in the evening, trying to boost sleep-promoting neurotransmitters, or just trying to increase carbs and/or calories in general. However, there is also a great deal of science and physiology to support front-loading carbs. Ultimately, when it comes to nutrient timing, everyone needs to do their own n=1 experiment and find what works best for performance and health.

Stop consuming caffeine after 12 pm

As discussed above, having a cup of coffee too late in the afternoon can be partly responsible for that insomnia. For the average person, a good rule of thumb is to stop the caffeine consumption before noon. Depending on your habitual caffeine intake, sensitivity, and genetics, you might need to stop even earlier in the day (or altogether) for optimal sleep, given that the half-life of caffeine can range from 2.5-10 hours [63]. If you start to feel that all-to-familiar afternoon slump come on at the office, skip the caffeine, get up, and move - even if it’s just for a few minutes [64].

Have an evening routine

About one hour before bed, start winding down. Create an evening routine that puts your body into a parasympathetic (i.e. rest and relax) state and try to avoid stimulating activities such as checking social media or email. If falling asleep is a struggle due to a racing mind and thinking about the next day, consider writing a To Do list before bed, which may help decrease the time it takes to fall asleep [65].

Ditch the alarm clock

If your lifestyle allows, try to ditch the alarm clock. Sleep cycles are about 90 minutes on average and waking up in the middle of a cycle will result in less refreshing sleep. Alternatively, you can try a dawn-simulator alarm clock, which may improve alertness and cognitive and physical performance upon waking [66].

If you do wake up in the middle of the night, do yourself a favor and don’t look at the clock! This will help you avoid one of two scenarios:

  1. Oh no! It’s 2 am and I’m still awake! (And you continue to lay awake and worry about not sleeping.)

  2. It’s 3:45 am and I’ll be getting up soon anyway… (And you just get up and lose out on another precious hour or two of sleep.)

Drink bone broth or chamomile tea

Bone broth has many health benefits, one of which is its high glycine content. Glycine is an amino acid that is lacking from the modern Western diet and has been shown to improve sleep quality [67]. If an evening cup of bone broth isn’t your thing, consider chamomile or [68,69].

Unplug the WiFi and use airplane mode

While the evidence is far from conclusive, electromagnetic radiation may negatively impact circadian rhythm [70]. Some individuals will likely be more sensitive to this than others, however anecdotally, many people report better sleep when they simply unplug the WiFi and put their cell phone on airplane mode at night.  

Install blue light blocking software

Your brain takes in a lot more information that just light to decide whether it’s time to be awake or asleep. For this reason, it’s best to just avoid screens altogether at night, however sometimes work makes that impossible. (Although in reality, there probably isn’t an email that’s so important it can’t wait until the morning. It will be there when you wake up.) This is where f.lux, Iris, Twilight, and iOS Nightshift come in handy. Once installed on your computer or phone, these programs will control the color of your screen according to the time of day, blocking out the blue light when the sun begins to go down. It’s not perfect, but definitely better than staring at a brightly lit screen right before bed.

Don’t bother tracking sleep

The jury is out as to whether sleep trackers and smartphone apps can accurately track sleep [71]. Even more sophisticated devices such as the OURA ring aren’t perfect, at least in the context of tracking deep sleep [72]. Regardless of any data these devices provide, it’s not unusual to feel a concomitant increase in stress and anxiety with their usage. Orthosomnia, the “perfectionistic quest for the ideal sleep in order to optimize daytime function”, is sadly becoming more prevalent, arguably due to increased sleep tracker use [73]. Thus, we encourage people to track the behaviors that lead to good sleep and subjective feelings (overall energy, mood, concentration, performance) rather than sleep itself.

Time your workouts

For the majority of the busy population, the best time to exercise is when you have the time. However if your lifestyle provides you with the luxury to be flexible with your training, consider doing your more intense workouts earlier rather than later in the day. While there are are potential advantages to exercising later in the afternoon, such as peaking of core body temperature and coordination [74], if optimizing sleep is the goal, workouts (especially those that are intense) are better done earlier in the day [75].

Honor seasonality

Just as sleep cycles naturally change with the seasons [76], allow your lifestyle to adapt as well. In the (northern hemisphere) winter when days are shorter and fresh produce is less available, you may feel like going to bed earlier, waking up later, and eating more protein and fat. However in the summer, when days are longer and fresh fruit is abundant, you might enjoy staying up slightly later, waking up earlier, and eating more seasonal carbohydrates. Additionally, melatonin secretion fluctuates with the seasons [77]. This fact may be particularly important because some evidence suggests that it is the onset of melatonin secretion, rather than clock hour, that determines the optimal timing of food [78].

Outsmart jet lag

When traveling across time zones, slowly start adjusting your biological clock a few days before you leave. Adjust the timing of your food and sleep accordingly and strategically use either blue light or amber glasses (depending on which direction you travel) to get your body prepared for the new time zone. The average person will naturally adjust one time zone per day, so if you’re an athlete traveling for a race, plan ahead! This might be one scenario in which a very low dose of supplemental melatonin is useful, which can help re-adjust the circadian clock to the new time zone [79]. A safe starting place is 0.3-1.5 mg 90-120 minutes before bed.

Go camping

Going camping is another great (and fun) way to reset the circadian clock [80]. The power of exposure to only natural light highlights just how important blue light (or lack thereof) is to establishing a healthy circadian rhythm.

Make your bedroom environment conducive to sleep  

Sleeping in a room that is too warm or too cold can ruin what would have been an otherwise restful night’s sleep. Optimal sleeping temperatures are between 62 and 66 degrees Fahrenheit (or about 17 - 19 degrees Celsius) [81]. Keep your room as dark as possible using blackout curtains and/or a sleep mask. If traveling, carry some dark tape to block the annoying bright lights emitted from electronics around the room. Earplugs or white noise may also help sleep quality, depending on your personal preferences.

Avoid sleeping pills

If you’re following the recommendations presented here, there is no reason you should have to resort to pharmaceutical sleep aids. If they are currently a crutch in your life, do everything you can to find healthier ways to promote restful shuteye [82].

Consider supplements

While not ideal to rely on in the long-term, some people may benefit from acute and targeted supplementation to get their sleep back on track. Magnesium [83,84] has been shown to be helpful for age-related insomnia and may also help due to its anti-anxiolytic effects [85]. Other supplements that may be beneficial include: 5-HTP, L-theanine, L-carnitine (if deficient), glycine or collagen hydrolysate, melatonin microdose, and Dr. Kirk Parsley’s Sleep Remedy.

Stick to a schedule

It’s important to minimize day to day variability in sleep timing [86]. Even on weekends, try to stick to the same bedtime and wake time plus or minus about 30 minutes. If you sleep poorly one night, go to bed at your usual time the following night. A few nights of catch-up sleep might help when life gets chaotic [87], but generally sticking to a schedule will be optimal for your physiology.

Practice gratitude and believe in your higher purpose

Most people have experienced worry or anxiety trigger insomnia. Implementing a gratitude practice can benefit just about everyone, but may be particularly useful for those struggling to get restful sleep [88,89]. Additionally, having a higher level of meaning and purpose in life is associated with better sleep quality [90].

Consider your chronotype and adjust accordingly

Just as it’s important to personalize medicine, it’s also important to personalize circadian rhythm. Some people will naturally wake up early and go to sleep early (larks) while others will naturally wake up late and go to sleep late (owls), but the majority of the population will fall somewhere between the two extremes. If your inherent chronotype suggests you might fall into one of the extreme categories, experiment and adjust the above recommendations to find what works for you. But make sure this is actually true to your disposition rather than a discrepancy between your social and biological clock!

Hopefully, by now you’re convinced that proper sleep and circadian rhythm entrainment are critical to health, performance, and longevity. But as a parent, athlete, student, or entrepreneur living in a busy modern world, you might still have an objection or two lingering in the back of your mind...

Objection 1: I have to get up early to train

Sacrificing sleep, even if it’s just an hour, for training is not a smart idea. While your individual chronotype may impact athletic performance [91] and busy schedules sometimes necessitate early morning workouts, training at the expense of sleep will almost certainly have detrimental effects on your performance and health in the long run. If you’re one of those people who need to do their fasted early morning workout, plan ahead and get to sleep earlier. Additionally, if building muscle is your goal, it might even behoove you to train later (but not too late, as discussed above) to elicit a greater anabolic signal [92].

Objection (question) 2: How do I know exactly how much sleep I really need?

Most adults require 7-9 hours of sleep [93]. If you’re an athlete or someone recovering from a chronic health condition, you’ll probably be on the higher end of that range. And if you’ve been sleep deprived for a while, you might find yourself requiring more sleep at first and less when you have paid off your sleep debt. Some simple math will help you determine how much sleep you personally require.

Let’s assume the average person needs 8 hours of sleep.

  • Count backwards 8 hours from your socially-determined wake time and go to bed at that time. Add about 15 minutes extra to account for the time it takes to fall asleep.
  • Go to bed at this time consistently for two weeks and determine when you wake up on average. This will tell you how much sleep you need. In a perfect world, you would naturally wake up five minutes before your alarm.

Some people might think they only need five or six hours of sleep each night, however, there are very few people who can actually thrive on less than seven hours. You might feel like you function just fine if six hours is your norm, but once you make the time to start sleeping more, it’s highly likely you’ll find that you perform a lot better given adequate rest. In fact, chronic sleep restriction of six or less hours per night might be as bad for your cognitive function as two days of total sleep deprivation [94]!

Objection 3: I’ll sleep when I’m dead

If you don’t sleep enough, you’ll be dead sooner [95]. Period.

Summary and next steps

Hopefully, if you’ve read this far, it has become crystal clear that proper sleep and circadian rhythm entrainment are right up there with quality food and appropriate movement when it comes to peak performance and optimal health. If you’ve let your sleep fall by the wayside and have been lead to believe that diet and exercise are the only things that truly matter, yet you still struggle to look, feel, and perform your best, then take some time to honestly evaluate your sleep habits. Use this article to help you 1) decide what is holding you back from quality sleep and 2) take simple steps to improve your circadian rhythm.

Having said that, we know that sleeping well is much easier said than done. If you have already tried many of the suggestions above and still struggle to get restful sleep, then perhaps it’s time to dig a little deeper. This is just the thing we love to do with our Elite Performance clients at Nourish Balance Thrive. We’ve helped over 1,000 athletes identify and resolve the root causes killing their sleep. Book a free consultation, and we’ll take a look at your history and share how we’d work with you as part of our “Elite Performance Program.”

→  Click here to book your free Elite Performance Program Starter Session


1.     Panda S, Hogenesch JB, Kay SA. Circadian rhythms from flies to human. Nature. 2002;417: 329–335

2.     Arendt J. Shift work: coping with the biological clock. Occup Med . 2010;60: 10–20.

3.     Luyster FS, Strollo PJ Jr, Zee PC, Walsh JK, Boards of Directors of the American Academy of Sleep Medicine and the Sleep Research Society. Sleep: a health imperative. Sleep. 2012;35: 727–734.

4.     Fullagar HHK, Skorski S, Duffield R, Hammes D, Coutts AJ, Meyer T. Sleep and athletic performance: the effects of sleep loss on exercise performance, and physiological and cognitive responses to exercise. Sports Med. 2015;45: 161–186.

5.     Rao MN, Neylan TC, Grunfeld C, Mulligan K, Schambelan M, Schwarz J-M. Subchronic sleep restriction causes tissue-specific insulin resistance. J Clin Endocrinol Metab. 2015;100: 1664–1671.

6.     Broussard JL, Ehrmann DA, Van Cauter E, Tasali E, Brady MJ. Impaired insulin signaling in human adipocytes after experimental sleep restriction: a randomized, crossover study. Ann Intern Med. 2012;157: 549–557.

7.     Morris CJ, Yang JN, Garcia JI, Myers S, Bozzi I, Wang W, et al. Endogenous circadian system and circadian misalignment impact glucose tolerance via separate mechanisms in humans. Proceedings of the National Academy of Sciences. 2015;112: E2225–E2234.

8.     Koo YS, Song J-Y, Joo E-Y, Lee H-J, Lee E, Lee S-K, et al. Outdoor artificial light at night, obesity, and sleep health: Cross-sectional analysis in the KoGES study. Chronobiol Int. 2016;33: 301–314.

9.     Spiegel K, Tasali E, Penev P, Van Cauter E. Brief communication: Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann Intern Med. 2004;141: 846–850.

10.     Benedict C, Vogel H, Jonas W, Woting A, Blaut M, Schürmann A, et al. Gut microbiota and glucometabolic alterations in response to recurrent partial sleep deprivation in normal-weight young individuals. Mol Metab. 2016;5: 1175–1186.

11.     Konturek PC, Brzozowski T, Konturek SJ. Gut clock: implication of circadian rhythms in the gastrointestinal tract. J Physiol Pharmacol. 2011;62: 139–150.

12.     Williamson AM, Feyer AM. Moderate sleep deprivation produces impairments in cognitive and motor performance equivalent to legally prescribed levels of alcohol intoxication. Occup Environ Med. 2000;57: 649–655.

13.     Bedrosian TA, Fonken LK, Nelson RJ. Endocrine Effects of Circadian Disruption. Annu Rev Physiol. 2016;78: 109–131.

14.     Leproult R, Van Cauter E. Effect of 1 week of sleep restriction on testosterone levels in young healthy men. JAMA. 2011;305: 2173–2174.

15.     Takasu NN, Nakamura TJ, Tokuda IT, Todo T, Block GD, Nakamura W. Recovery from Age-Related Infertility under Environmental Light-Dark Cycles Adjusted to the Intrinsic Circadian Period. Cell Rep. 2015;12: 1407–1413.

16.     Guyon A, Balbo M, Morselli LL, Tasali E, Leproult R, L’Hermite-Balériaux M, et al. Adverse effects of two nights of sleep restriction on the hypothalamic-pituitary-adrenal axis in healthy men. J Clin Endocrinol Metab. 2014;99: 2861–2868.

17.     Morris CJ, Purvis TE, Hu K, Scheer FAJL. Circadian misalignment increases cardiovascular disease risk factors in humans. Proc Natl Acad Sci U S A. 2016;113: E1402–11.

18.     Sundelin T, Lekander M, Sorjonen K, Axelsson J. Negative effects of restricted sleep on facial appearance and social appeal. R Soc Open Sci. 2017;4: 160918.

19.     Obayashi K, Saeki K, Iwamoto J, Ikada Y, Kurumatani N. Exposure to light at night and risk of depression in the elderly. J Affect Disord. 2013;151: 331–336.

20.     Thompson CL, Larkin EK, Patel S, Berger NA, Redline S, Li L. Short duration of sleep increases risk of colorectal adenoma. Cancer. 2011;117: 841–847.

21.     Jia Y, Lu Y, Wu K, Lin Q, Shen W, Zhu M, et al. Does night work increase the risk of breast cancer? A systematic review and meta-analysis of epidemiological studies. Cancer Epidemiol. 2013;37: 197–206.

22.     Papantoniou K, Castaño-Vinyals G, Espinosa A, Aragonés N, Pérez-Gómez B, Burgos J, et al. Night shift work, chronotype and prostate cancer risk in the MCC-Spain case-control study. Int J Cancer. 2015;137: 1147–1157.

23.     Haus EL, Smolensky MH. Shift work and cancer risk: potential mechanistic roles of circadian disruption, light at night, and sleep deprivation. Sleep Med Rev. 2013;17: 273–284.

24.     Lange T, Dimitrov S, Born J. Effects of sleep and circadian rhythm on the human immune system. Ann N Y Acad Sci. 2010;1193: 48–59.

25.     Sprecher KE, Koscik RL, Carlsson CM, Zetterberg H, Blennow K, Okonkwo OC, et al. Poor sleep is associated with CSF biomarkers of amyloid pathology in cognitively normal adults. Neurology. 2017; doi:10.1212/WNL.0000000000004171

26.     Ju Y-ES, Ooms SJ, Sutphen C, Macauley SL, Zangrilli MA, Jerome G, et al. Slow wave sleep disruption increases cerebrospinal fluid amyloid-β levels. Brain. Oxford University Press; 2017;140: 2104–2111.

27.     Fernandes C, Rocha NBF, Rocha S, Herrera-Solís A, Salas-Pacheco J, García-García F, et al. Detrimental role of prolonged sleep deprivation on adult neurogenesis. Front Cell Neurosci. 2015;9: 140.

28.     Mander BA, Winer JR, Walker MP. Sleep and Human Aging. Neuron. 2017;94: 19–36.

29.     Touitou Y, Reinberg A, Touitou D. Association between light at night, melatonin secretion, sleep deprivation, and the internal clock: Health impacts and mechanisms of circadian disruption. Life Sci. 2017;173: 94–106.

30.     Figueiro MG, Steverson B, Heerwagen J, Kampschroer K, Hunter CM, Gonzales K, et al. The impact of daytime light exposures on sleep and mood in office workers. Sleep Health. 2017;3: 204–215.

31.     Green A, Cohen-Zion M, Haim A, Dagan Y. Evening light exposure to computer screens disrupts human sleep, biological rhythms, and attention abilities. Chronobiol Int. 2017; 1–11.

32.     West KE, Jablonski MR, Warfield B, Cecil KS, James M, Ayers MA, et al. Blue light from light-emitting diodes elicits a dose-dependent suppression of melatonin in humans. J Appl Physiol. 2011;110: 619–626.

33.     Smolensky MH, Sackett-Lundeen LL, Portaluppi F. Nocturnal light pollution and underexposure to daytime sunlight: Complementary mechanisms of circadian disruption and related diseases. Chronobiol Int. 2015;32: 1029–1048.

34.     Gamble KL, Berry R, Frank SJ, Young ME. Circadian clock control of endocrine factors. Nat Rev Endocrinol. 2014;10: 466–475.

35.     Leliavski A, Dumbell R, Ott V, Oster H. Adrenal clocks and the role of adrenal hormones in the regulation of circadian physiology. J Biol Rhythms. 2015;30: 20–34.

36.     Gais S, Born J, Peters A, Schultes B, Heindl B, Fehm HL, et al. Hypoglycemia counterregulation during sleep. Sleep. 2003;26: 55–59.

37.     Clark I, Landolt HP. Coffee, caffeine, and sleep: A systematic review of epidemiological studies and randomized controlled trials. Sleep Med Rev. 2017;31: 70–78.

38.     Ebrahim IO, Shapiro CM, Williams AJ, Fenwick PB. Alcohol and sleep I: effects on normal sleep. Alcohol Clin Exp Res. 2013;37: 539–549.

39.     Danel T, Touitou Y. Chronobiology of alcohol: from chronokinetics to alcohol-related alterations of the circadian system. Chronobiol Int. 2004;21: 923–935.

40.     Cederbaum AI. Alcohol metabolism. Clin Liver Dis. 2012;16: 667–685.

41.     Voderholzer U, Hornyak M, Thiel B, Huwig-Poppe C, Kiemen A, König A, et al. Impact of experimentally induced serotonin deficiency by tryptophan depletion on sleep EEG in healthy subjects. Neuropsychopharmacology. 1998;18: 112–124.

42.     Mora F, Segovia G, Del Arco A, de Blas M, Garrido P. Stress, neurotransmitters, corticosterone and body-brain integration. Brain Res. 2012;1476: 71–85.

43.     Campbell SS, Murphy PJ. Extraocular circadian phototransduction in humans. Science. 1998;279: 396–399.

44.     Hébert M, Martin SK, Eastman CI. Nocturnal melatonin secretion is not suppressed by light exposure behind the knee in humans. Neurosci Lett. 1999;274: 127–130.

45.     Eastman CI, Martin SK, Hebert M. Failure of extraocular light to facilitate circadian rhythm reentrainment in humans. Chronobiol Int. 2000;17: 807–826.

46.     Balakrishnan G, Burli D, Behbehani K, Burk J, Lucas E. Comparison of a Sleep Quality Index between Normal and Obstructive Sleep Apnea Patients. Conf Proc IEEE Eng Med Biol Soc. 2005;2: 1154–1157.

47.     Kim JW, Moon YT, Kim KD. Nocturia: The circadian voiding disorder. Investig Clin Urol. 2016;57: 165–173.

48.     Kamperis K, Hagstroem S, Radvanska E, Rittig S, Djurhuus JC. Excess diuresis and natriuresis during acute sleep deprivation in healthy adults. Am J Physiol Renal Physiol. 2010;299: F404–11.

49.     Burkhart K, Phelps JR. Amber lenses to block blue light and improve sleep: a randomized trial. Chronobiol Int. 2009;26: 1602–1612.

50.     Ostrin LA, Abbott KS, Queener HM. Attenuation of short wavelengths alters sleep and the ipRGC pupil response. Ophthalmic Physiol Opt. 2017;37: 440–450.

51.     Chang A-M, Aeschbach D, Duffy JF, Czeisler CA. Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness. Proceedings of the National Academy of Sciences. 2015;112: 1232–1237.

52.     Kozaki T, Kubokawa A, Taketomi R, Hatae K. Effects of day-time exposure to different light intensities on light-induced melatonin suppression at night. J Physiol Anthropol. 2015;34: 27.

53.     McCarty DE, Chesson AL Jr, Jain SK, Marino AA. The link between vitamin D metabolism and sleep medicine. Sleep Med Rev. 2014;18: 311–319.

54.     Gominak SC, Stumpf WE. The world epidemic of sleep disorders is linked to vitamin D deficiency. Med Hypotheses. 2012;79: 132–135.

55.     Lindqvist PG, Epstein E, Landin-Olsson M, Ingvar C, Nielsen K, Stenbeck M, et al. Avoidance of sun exposure is a risk factor for all-cause mortality: results from the Melanoma in Southern Sweden cohort. J Intern Med. 2014;276: 77–86.

56.     Weller RB. Sunlight Has Cardiovascular Benefits Independently of Vitamin D. Blood Purif. 2016;41: 130–134.

57.     Zarrinpar A, Chaix A, Panda S. Daily Eating Patterns and Their Impact on Health and Disease. Trends Endocrinol Metab. 2016;27: 69–83.

58.     Kessler K, Hornemann S, Petzke KJ, Kemper M, Kramer A, Pfeiffer AFH, et al. The effect of diurnal distribution of carbohydrates and fat on glycaemic control in humans: a randomized controlled trial. Sci Rep. 2017;7: 44170.

59.     Lombardo M, Bellia A, Padua E, Annino G, Guglielmi V, D’Adamo M, et al. Morning meal more efficient for fat loss in a 3-month lifestyle intervention. J Am Coll Nutr. 2014;33: 198–205.

60.     Jakubowicz D, Barnea M, Wainstein J, Froy O. High caloric intake at breakfast vs. dinner differentially influences weight loss of overweight and obese women. Obesity . 2013;21: 2504–2512.

61.     Johnston JD. Physiological responses to food intake throughout the day. Nutr Res Rev. 2014;27: 107–118.

62.     Ribas-Latre A, Eckel-Mahan K. Interdependence of nutrient metabolism and the circadian clock system: Importance for metabolic health. Mol Metab. 2016;5: 133–152.

63.     Magkos F, Kavouras SA. Caffeine use in sports, pharmacokinetics in man, and cellular mechanisms of action. Crit Rev Food Sci Nutr. 2005;45: 535–562.

64.     Randolph DD, O’Connor PJ. Stair walking is more energizing than low dose caffeine in sleep deprived young women. Physiol Behav. 2017;174: 128–135.

65.     Scullin MK, Krueger ML, Ballard HK, Pruett N, Bliwise DL. The effects of bedtime writing on difficulty falling asleep: A polysomnographic study comparing to-do lists and completed activity lists. J Exp Psychol Gen. 2018;147: 139–146.

66.     Thompson A, Jones H, Gregson W, Atkinson G. Effects of dawn simulation on markers of sleep inertia and post-waking performance in humans. Eur J Appl Physiol. 2014;114:1049–1056.

67.     Bannai M, Kawai N. New therapeutic strategy for amino acid medicine: glycine improves the quality of sleep. J Pharmacol Sci. 2012;118: 145–148.

68.     Abdullahzadeh M, Matourypour P, Naji SA. Investigation effect of oral chamomilla on sleep quality in elderly people in Isfahan: A randomized control trial. J Educ Health Promot. 2017;6: 53.

69.     Chang S-M, Chen C-H. Effects of an intervention with drinking chamomile tea on sleep quality and depression in sleep disturbed postnatal women: a randomized controlled trial. J Adv Nurs. 2016;72: 306–315.

70.     Lewczuk B, Redlarski G, Ż, Ak A, Zi , &#x, et al. Influence of Electric, Magnetic, and Electromagnetic Fields on the Circadian System: Current Stage of Knowledge. Biomed Res Int. Hindawi; 2014;2014. doi:10.1155/2014/169459

71.     Kolla BP, Mansukhani S, Mansukhani MP. Consumer sleep tracking devices: a review of mechanisms, validity and utility. Expert Rev Med Devices. 2016;13: 497–506.

72.     de Zambotti M, Rosas L, Colrain IM, Baker FC. The Sleep of the Ring: Comparison of the ŌURA Sleep Tracker Against Polysomnography. Behav Sleep Med. 2017; 1–15.

73.     Baron KG, Abbott S, Jao N, Manalo N, Mullen R. Orthosomnia: Are Some Patients Taking the Quantified Self Too Far? J Clin Sleep Med. 2017;13: 351–354.

74.     Atkinson G, Reilly T. Circadian variation in sports performance. Sports Med. 1996;21: 292–312.

75.     Morita Y, Sasai-Sakuma T, Inoue Y. Effects of acute morning and evening exercise on subjective and objective sleep quality in older individuals with insomnia. Sleep Med. 2017;34: 200–208.

76.     Stothard ER, McHill AW, Depner CM, Birks BR, Moehlman TM, Ritchie HK, et al. Circadian Entrainment to the Natural Light-Dark Cycle across Seasons and the Weekend. Curr Biol. 2017;27: 508–513.

77.     Wehr TA. Melatonin and seasonal rhythms. J Biol Rhythms. 1997;12: 518–527.

78.     McHill AW, Phillips AJ, Czeisler CA, Keating L, Yee K, Barger LK, et al. Later circadian timing of food intake is associated with increased body fat. Am J Clin Nutr. 2017; doi:10.3945/ajcn.117.161588

79.     Srinivasan V, Singh J, Pandi-Perumal SR, Brown GM, Spence DW, Cardinali DP. Jet lag, circadian rhythm sleep disturbances, and depression: the role of melatonin and its analogs. Adv Ther. 2010;27: 796–813.

80.     Wright KP Jr, McHill AW, Birks BR, Griffin BR, Rusterholz T, Chinoy ED. Entrainment of the human circadian clock to the natural light-dark cycle. Curr Biol. 2013;23: 1554–1558.

81.     Onen SH, Onen F, Bailly D, Parquet P. [Prevention and treatment of sleep disorders through regulation] of sleeping habits]. Presse Med. 1994;23: 485–489.

82.     Kripke DF, Langer RD, Kline LE. Hypnotics’ association with mortality or cancer: a matched cohort study. BMJ Open. 2012;2: e000850.

83.     Held K, Antonijevic IA, Künzel H, Uhr M, Wetter TC, Golly IC, et al. Oral Mg(2+) supplementation reverses age-related neuroendocrine and sleep EEG changes in humans. Pharmacopsychiatry. 2002;35: 135–143.

84.     Abbasi B, Kimiagar M, Sadeghniiat K, Shirazi MM, Hedayati M, Rashidkhani B. The effect of magnesium supplementation on primary insomnia in elderly: A double-blind placebo-controlled clinical trial. J Res Med Sci. 2012;17: 1161–1169.

85.     Boyle NB, Lawton C, Dye L. The Effects of Magnesium Supplementation on Subjective Anxiety and Stress-A Systematic Review. Nutrients. 2017;9. doi:10.3390/nu9050429

86.     Gooley JJ. How Much Day-To-Day Variability in Sleep Timing Is Unhealthy? Sleep. 2016;39: 269–270.

87.     Killick R, Hoyos CM, Melehan KL, Dungan GC 2nd, Poh J, Liu PY. Metabolic and hormonal effects of “catch-up” sleep in men with chronic, repetitive, lifestyle-driven sleep restriction. Clin Endocrinol . 2015;83: 498–507.

88.     Wood AM, Joseph S, Lloyd J, Atkins S. Gratitude influences sleep through the mechanism of pre-sleep cognitions. J Psychosom Res. 2009;66: 43–48.

89.     Jackowska M, Brown J, Ronaldson A, Steptoe A. The impact of a brief gratitude intervention on subjective well-being, biology and sleep. J Health Psychol. 2016;21: 2207–2217.

90.     Turner AD, Smith CE, Ong JC. Is purpose in life associated with less sleep disturbance in older adults? Sleep Science and Practice. 2017;1: 14.

91.     Vitale JA, Weydahl A. Chronotype, Physical Activity, and Sport Performance: A Systematic Review. Sports Med. 2017; doi:10.1007/s40279-017-0741-z

92.     Bird SP, Tarpenning KM. Influence of circadian time structure on acute hormonal responses to a single bout of heavy-resistance exercise in weight-trained men. Chronobiol Int. 2004;21: 131–146.

93.     Hirshkowitz M, Whiton K, Albert SM, Alessi C, Bruni O, DonCarlos L, et al. National Sleep Foundation’s sleep time duration recommendations: methodology and results summary. Sleep Health. 2015;1: 40–43.

94.     Van Dongen HPA, Maislin G, Mullington JM, Dinges DF. The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep. 2003;26: 117–126.

95.     Medic G, Wille M, Hemels ME. Short- and long-term health consequences of sleep disruption. Nat Sci Sleep. 2017;9: 151–161.

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