Catch All the ZZZZZs….

Steps for Good Sleep Hygiene

Most of us have experienced sleep disturbances of varying degrees from time to time. Research shows that there are two general sources of disturbed sleep patterns. In a simplified model, sleep disturbances are caused by arousal of the central nervous system or by emotional arousal. Emotionally, we are aroused by stress, depression, anxiety, internalization of emotion and fear of sleeplessness. Physiologically, this occurs because of hormonal changes, such as menopause, through genetic influence, or from consumption of central nervous system stimulants like caffeine or nicotine. In this post, I will share some basic information on how to manage those factors that we can change through application of the concept of sleep hygiene.

When I was an Army behavioral health provider, one of the most common complaints from soldiers was the inability to sleep (either falling asleep or staying asleep through the night-or worse, a combination of both). It was such a common problem, that our health team put together a class on sleep hygiene that we still use in our practice today.

Good sleep hygiene is beneficial for regulating mood (especially combatting irritability and feelings of sadness) and improving alertness. Sleep loss reduces your ability to interact socially, and studies have shown that people who don’t get enough sleep actually misread facial cues, of anger and happiness.

Sleep is important because it enables the body to repair cellular damage, helps maintain a healthy weight, maximize athletic performance, reduce the risk of diabetes and it improves immune function. Getting adequate rest may also help prevent excess weight gain, heart disease, and increased illness duration.

Sleep hygiene can be broken into categories. Let’s start with the physical environment:

• Making sure that the sleep environment is pleasant. Mattress and pillows should be comfortable. The bedroom should be cool – between 60 and 67 degrees – for optimal sleep. Light exposure is an essential influence on circadian rhythm, which is closely aligned with the day-night cycle. When the eyes are exposed to light, the brain sends signals associated with wakefulness. When light exposure decreases at night, the signals switch to promote relaxation and sleep. Consider using blackout curtains, eye shades, ear plugs, “white noise” machines, humidifiers, fans, and other devices that can make the bedroom more relaxing.
• If you share a bed with others, make sure there is adequate room to move around as you sleep. Some people are sensitive to movement and startle easily, thus waking them up throughout the night.
• Ensure adequate exposure to natural light. This is particularly important for individuals who may not venture outside frequently. Exposure to sunlight during the day, as well as darkness at night, helps to maintain a healthy sleep-wake cycle.
• Reduce blue light from electronic devices. Bright light from LED and fluorescent lamps, cell phone and TV screens can make it difficult to fall asleep, so turn those lights off or adjust them when possible. Ideally, we should avoid blue light sources within 2-3 hours of sleep.
• Cell phones are a fixture of modern life. Unfortunately, they also interfere with sleep hygiene. To reduce this, turn the ringer and alerts off at bedtime. Even better, charge the phone in another room altogether if possible. This prevents taking one last look at messages before bedtime.
• Another important part of good sleep hygiene the development of healthy habits.

Another important part of good sleep hygiene the development of healthy habits.

• Avoiding stimulants such as caffeine and nicotine close to bedtime. And when it comes to alcohol, moderation is key. While alcohol is well-known to help you fall asleep faster, too much close to bedtime can disrupt sleep in the second half of the night as the body begins to process the alcohol.
• Steering clear of food that can be disruptive right before sleep. Heavy or rich foods, fatty or fried meals, spicy dishes, citrus fruits, and carbonated drinks can trigger indigestion for some people. When this occurs close to bedtime, it can lead to painful heartburn that disrupts sleep.
• Limiting daytime naps to 30 minutes. Napping does not make up for inadequate nighttime sleep. However, a short nap of 20-30 minutes can help to improve mood, alertness, and performance.
• Exercising to promote good quality sleep. As little as 10 minutes of aerobic exercise, such as walking or cycling, can drastically improve nighttime sleep quality. For the best night’s sleep, most people should avoid strenuous workouts within 2 or 3 hours of bedtime. However, the effect of intense nighttime exercise on sleep differs from person to person, so find out what works best for you.

Establishing a reliable sleep schedule is a big factor in maintaining good sleep hygiene and one of the most difficult foremost people.is a principal driver of your sleep routine. Humans follow a circadian rhythm which is a 24-hour cycle that is part of the body’s internal clock. Circadian rhythm is crucial to managing the delicate balance between sleep and wakefulness, helping us be alert or drowsy at the appropriate time

• Create (if possible) regular relaxing bedtime routine. A regular nightly routine helps the body recognize that it is bedtime. This could include taking warm shower or bath, reading a book, or light stretches. When possible, try to avoid emotionally upsetting conversations and activities before attempting to sleep. Consider aromatherapy to promote relaxation.
• Pick a bedtime and a wake-up time—and stick to them as much as possible. Life will inevitably interfere but try not to sleep in for more than an hour or two, tops, on Saturdays and Sundays so that you can stay on track. That way, your body’s internal clock will get accustomed to a new bedtime, which will help you fall asleep better at night and wake up more easily each morning.
• Adjusting your sleep routine starts by making consistency a priority. Habits and routines are powerful precisely because they are repeated to create a pattern. A key first step is to reset your sleep schedule. Pick a bedtime and wake-up time that you can stick with and that offer ample time for the sleep you need. Ideally if your schedule permits, you will want this to be between 7-9 hours. Follow this schedule every day, even on weekends. To gradually adjust to a new sleep schedule, you can adjust in 15- or 30-minute increments over a series of days. You can also focus first on the wake-up time, creating one fixed part of your schedule, and then modify your sleep habits so that you can incrementally get used to falling asleep at your scheduled bedtime.

Sometimes, despite best efforts, it is hard to get sleep habits under control. If you are following all the tips above and still not sleeping, it may be time to seek medical help.

Speak with your primary care provider if:

• Symptoms of insomnia last longer than four weeks or interfere with daytime activities and ability to function.
• You have noticed (or others have reported) signs of sleep-based parasomnias such as sleep walking, sleep eating, sleep paralysis, etc…
• You feel an uncomfortable, painful, “crawling” sensation in your legs when trying to sleep or if you have had prolonged periods when your legs are not moving (such as when driving or on an airplane flight).
• You snore excessively and wake up gasping for air or a partner has noticed that you stop breathing during sleep.
• You wake up or can’t fall asleep due to physical pain.
• You notice excessive heart burn that makes it extremely uncomfortable to sleep.

Hopefully, these tips will help establish a better sleep routine which will result in improved physical symptoms and mental flexibility. Our next blog post will address nonprescription aids to help improve sleep quantity and duration.