Well-Being//

Trouble Sleeping?

See if you're following these essential rules for good sleep hygiene.

Courtesy of Vadim Georgiev/Shutterstock
Courtesy of Vadim Georgiev/Shutterstock

This is an excerpt from my book, Let’s Talk About Sleep, published in 2018 by Rowman & Littlefield.  It is available on Amazon (https://www.amazon.com/Lets-Talk-about-Sleep-Understanding/dp/1538103982) and was recently re-released in paperback form.  I hope this helps!

  • Daniel A. Barone, MD, FAASM

Sleep disorders come in many forms: insomnia, sleep apnea, other things you’ve undoubtedly heard about, and others that may be new to you. Sometimes trouble stems from the fact we’ve become a twenty-four–hour society. We work when we get home at night. We’re constantly on the Internet. We’re constantly on the phone. We think about problems when we get into bed. We do everything but sleep.

As a society, we sleep one hour less per night than our ancestors did, and while that may not sound like much, it actually is very significant. I’ll explain. The average adult needs seven to nine hours of sleep each night,[i] and when deprived, the short-term consequences can be just what you’d think: poor concentration, irritability, and daytime sleepiness and/or fatigue. Now, let’s suppose a person only gets six hours per night through the week (when they really need eight). After a week of this, the sleep “debt” adds up to the equivalent of one night without sleep. And that, as you might imagine, can have a deleterious effect not only on one’s concentration and mood, but also on one’s health over time.

Lack of sleep can cause blood pressure to go up and increase the risk of cardiovascular illness later in life. It can have other ill effects, including, as was confirmed in a study from 2016, increasing the risk of catching a cold.[ii] There’s also an association between how sleep deprived we are and our cognitive performance. People who are sleep deprived are at an increased risk for car accidents. In fact, the day after daylight savings is the number one day for car accidents in America[iii].  That’s because we are sleep deprived to begin with, and pushing the clock ahead takes another hour out of our sleep time.

So what can we do about it? We will be talking about many of the causes that reduce sleep quality and/or quantity throughout this book, as well as the treatments for them. To start off, however, I thought it would be a good idea to relay some sleep hygiene tips. Sleep hygiene, as you may recall from the introduction, is a strange term that we use to describe a collection of practices that aid in healthy sleep. You can think of them as sleep guidelines. Proper sleep hygiene is not direly needed in those without sleep problems, but I do recommend everyone trying to incorporate them into their daily/nightly routine to prevent such issues in the future. And as for those suffering with insomnia or other chronic sleep disorders, good sleep hygiene is a must:

  • Avoid caffeine, alcohol, nicotine, and other chemicals that interfere with sleep. Ideally, these all should be eliminated. If you want a drink, maybe a glass of wine with dinner would be okay. And what I tell my patients if they have trouble sleeping, no caffeine or even decaf coffee after 1 p.m. Same thing with nicotine; if you’re not able to eliminate it completely, as least limit it to the daytime.
  • Turn your bedroom into a sleep-inducing environment. You want the bedroom to be a little on the cool side and as dark as you can make it. I recommend blackout shades. When the sun starts coming up, the little bit of light that creeps in can wake you or, if you’re already up, it can make it very hard to get back to sleep.
  • The TV, tablet, computer, smartphone and all aspects of the work environment should be out of your bedroom. Thirty to sixty minutes before you plan to get into bed, shut off all “blue light” devices—that includes all of the above. The blue light refers to the type of light that these devices produce. Blue light sends a message to our brain to shut off its production of melatonin. As we will see later, melatonin production begins the process of allowing us to sleep.
  • Regarding the blue light issue, some companies have incorporated blue light “blocking” technology into their devices. These devices are able to produce screen images without use of blue light (by using other colors). While the science behind it makes sense, I always tell my patients to just stop with the devices altogether, as I mentioned above. A quick rule of thumb is that if the screen can be seen without an external light (in other words, if it is back lit), it’s better to shut it off thirty to sixty minutes prior to bedtime.
  • Establish a soothing pre-sleep routine. For example, utilizing mindfulness or guided meditation, listening to soft music and taking a warm bath or stretching before bed can all be effective. Or, do as Mom says, and give a glass of warm milk a try.
  • Go to bed when you’re truly tired. Sometimes, patients with insomnia will get into bed early in an attempt to try to get extra sleep. This unfortunately rarely works, and you’re actually better off delaying your bedtime until you’re really tired.
  • Don’t be a clock watcher. This is a big thing. Patients who have insomnia often lie there, continuously looking at the clock, counting down the minutes, getting frustrated. If you want to set an alarm, that’s fine, but turn it away from you or put it face down. You don’t want the temptation of checking the clock to see what time it is, as doing so may make you more anxious and not be of any help.
  • Use light to your advantage. When you wake up in the morning, particularly if you have trouble sleeping, getting twenty minutes or so of sunlight can really help; ideally this should be done outside and as close to wake time as possible. Then, when you go to sleep, sleep in a dark environment.
  • Keep your internal clock set with a consistent sleep schedule. I find one common problem is with weekends, when people go to bed a little later and then sleep in. If you go to bed late Saturday, then sleep in on Sunday, you might have difficulty getting to sleep on Sunday night, which then can throw your entire sleep schedule off. You want to be as consistent as possible, maybe within an hour or so, with your sleep and wake-up times. They should be the same on weekdays as on weekends.
  • Start a “worry” journal that you use at least a few hours before your planned bedtime. If you have things on your mind, write them down in two columns. List the problems or things you’re worrying about in the left column, and write the solutions in the right column. Say, for example, tomorrow you’ve got a meeting with your boss. In the right column, list the things you did to prepare for the meeting. You did all the things you needed to do, so you don’t have to worry about that. There seems to be some benefit getting it out into the open, leaving less chance you’ll take it with you to bed. Keep a paper and pen next to your bed so if you wake from sleep worrying or thinking about something, you can write it down and address it in the morning.
  • Nap early or not at all. If you absolutely need a nap, it should be only fifteen to twenty minutes, maybe thirty minutes in length, and as early in the day as possible. After getting home from work, eating dinner and watching the evening news, some people doze off and sleep for fifteen minutes. This is technically a nap. As we stay awake throughout the day, our brain gets tired and sleep pressure builds up, which is our drive to fall asleep. When we take a nap in the evening, we may reduce our sleep pressure for the night, making it difficult to fall asleep. By avoiding that, you help your body fall asleep at nighttime.
  • Lighten up on evening meals. You do not want to go to bed with a full stomach, but you also don’t want to go to bed hungry. If it’s close to bedtime and you’re hungry, try a small snack, maybe like a few nuts, something to fill your stomach but nothing too heavy.
  • Cut back on fluids toward the end of the day. You want to drink eight glasses of water a day, but it’s good to cut back as the evening goes along. Try not to drink anything an hour or two before bed because that can trigger an awakening.
  • Exercise regularly. It has been shown that regular cardiovascular exercise can help with sleep,[iv] but try to do it at least a few hours before you are planning to go to bed. Early in the morning is best.
  • You should think of the bedroom as your temple of sleep, and anything that can “desecrate” this temple should be removed. Essentially, the bed and even the bedroom should only be used for sleeping or for being intimate. Anything else may confuse the brain as to what the bed environment is really for and can make sleeping problems harder to fix.
  • Avoid snoozing. The process of waking up is not like an on-off switch; it is based on neurochemicals being released at the right times. Therefore, when we snooze and head back to sleep (which does feel good, I agree) we are reversing this process abruptly. Waking up once again will then throw off the brain’s chemistry, and you may feel worse or “out of it” for a few hours. It is better to just set your alarm for the latest time you can wake up, and then just get up at that time.
  • Last but far from least, follow through on all the above. These improvements do not work immediately. It may take a couple of weeks for the body to adjust to them. So it’s necessary to follow through with all the recommendations as best you can.

[i]. M. Hirshkowitz, K. Whiton, S. M. Albert, et al. National Sleep Foundation’s updated sleep duration recommendations: Final report. Sleep Health: Journal of the National Sleep Foundation. 2015; 1 (4):233–43.

[ii]. A. A. Prather, D. Janicki-Deverts, M. H. Hall, and S. Cohen. Behaviorally assessed sleep and susceptibility to the common cold. Sleep. 2015; 38 (9):1353–59.

[iii]. J. Varughese and R. P. Allen. Fatal accidents following changes in daylight savings time: The American experience, Sleep Medicine 2001; 2 (1):31–36.

[iv]. S. Abedelmalek, H. Chtourou, A. Aloui, et al. Effect of time of day and partial sleep deprivation on plasma concentrations of IL-6 during a short-term maximal performance, European Journal of Applied Physiology. 2013113 (1):241–48; K. J. Reid, K. G. Baron, B. Lu, et al. Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia, Sleep Medicine 2010; 11 (9):934–40.

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