Better Sleep

  • As a country, we are sleeping less than we used to:
    • Average hours of sleep have gone from 7.9 in 1942 to 6.8 in 2013
    • The percentage of people sleeping fewer than 6 hrs/night has gone from 11% in 1942 to 40% in 2013
  • Many of my patients report difficulty falling asleep, staying asleep, waking up feeling tired, and feeling fatigued throughout the day.
  • Many people are hooked on sleep meds, yet they’re still not feeling rested.
  • Our treatments for insomnia are marginally effective and potentially harmful:
    • Sedatives/hypnotics are associated with what we call increased all cause mortality (i.e., shorter life span), even when someone is prescribed only 18 pills per year
    • Benzodiazepines are associated with an increased risk of dementia
    • The British Medical Journal declared in 2014: “Unwarranted longterm use of these drugs should be considered as a public health concern.”
  • Let’s try a new approach to sleep. First, trust the system. Your body wants to sleep and knows how to sleep. So then what’s causing all this insomnia?
    • There are 3 main factors preventing us from getting enough restful sleep:
      • We don’t prioritize sleep
      • Aspects of our lifestyle and environment prevent good sleep
      • Stress
    • We can easily achieve better sleep by making sleep a priority, managing stress, and getting informed and strategic about lifestyle and environmental influences on sleep, such as light, bedtime and caffeine.

 

Step 1: Make Sleep a Priority

  • There is no single factor more closely correlated with health and well being than sleep:
    • Sleep impacts immunity, mood, cognitive ability, appetite, metabolism, and our risk for obesity, insulin resistance, diabetes, cardiovascular disease, cancer, fatty liver, depression, anxiety and dementia.
    • Sleep deprivation impairs focus, productivity, creativity, memory formation, problem solving and capacity for empathy, patience and kindness.
    • Sleep deprivation makes us worse at tolerating stress and makes pain hurt more.
    • And sleep deprivation shortens lifespan.
  • Many of us sacrifice sleep in favor of getting more done, reading on our phones, watching TV, or going out and having fun, and some of us even set the alarm early to avoid feeling lazy or slothful. Most of the time, sacrificing sleep for just about anything else ends up being a misguided decision.
  • Sleep is free, it feels good, and it will improve your relationships, work, health and wellbeing. Make sleep the

 

Step 2: Correct the Lifestyle and Environmental Factors Preventing Good Sleep

Light

  • Light regulates our circadian rhythm (our sleep-wake cycle), and these days our light exposure is destructive to sleep. If you can get strategic about light exposure, you will have better sleep.
  • We evolved being outside in bright light during the day, and in total darkness at night; the only light we saw after sunset was moonlight and fire.
  • Our modern environment sends confusing signals to the brain. We sit in windowless cubicle mazes during the day, and we stare at bright computer screens at night. It’s no wonder our sleep is messed up.
  • Steps to correct this:
    • Get bright light first thing in the morning and throughout the day.
      • Open your blinds as soon as you wake up.
      • Get outside during the day. Can you walk to work or go outside during lunch? Consider not wearing sunglasses.
      • For a therapeutic dose of light, talk to your doctor about trying bright light therapy (sitting by a 10,000-lux light box for 30 minutes in the morning).
    • Experience darkness at night.
      • Get the phone out of the bedroom. Set up your charger in another room, buy a regular alarm clock, and say goodnight to the phone well before bedtime. Think of it this way: looking at your phone right before bed is like taking a shot of espresso at bedtime.
      • Put away electronics. Set a time every night when you shut the computer and put away the phone. Ideally this is at least 30 minutes before bedtime.
      • Dim the lights in your home starting around sunset to avoid melatonin suppression.
      • Download lux on your computer (dims your computer screen in the evening) and nightshift mode on your phone.
      • Consider wearing orange-tinted glasses for 30-60 minutes before bed to block blue spectrum light (recommendation: Uvex Ultra-Spec 2000 Safety Glasses).
      • At night, consider brushing your teeth, taking a bath or shower and reading by candlelight (recommendation: GoodLight non-toxic candles).
      • If your room isn’t completely dark when you sleep, wear an eye mask or get blackout shades.
      • If there’s light from electronics in the bedroom, cover it (use cloth, duct tape or orange tape); or, even better, get the electronics out of the bedroom.
      • If you’re up in the middle of the night, try not to let your eyes “see” any light (try an orange nightlight in the bathroom or go (carefully) in the dark).

 

Caffeine

  • We often underestimate the relationship between caffeine and insomnia.
  • Even if you have coffee in the morning, it lingers in your system. Caffeine has a half-life of ~5-7 hours. Think of it this way: if you drink a coffee at 3pm, it’s as though you just drank half a coffee at 9pm.
  • Reduce overall caffeine consumption and stop caffeine by 12pm.
  • If you require medication to sleep and you consume any caffeine, drop the caffeine (otherwise we’re just chasing our tail).
  • Don’t get me wrong—coffee and tea have benefits; they’re not all bad. But if you suffer from insomnia, you owe it to yourself to do a trial 100% off caffeine.
  • If you love the ritual of coffee, then keep the ritual, but drop the caffeine. Move to decaf.
  • Note: even if you don’t have trouble falling asleep, caffeine can impair sleep quality overnight.
  • Important: reduce caffeine gradually to avoid withdrawal symptoms (irritability, fatigue):
    • Coffee -> half-caf -> black tea -> green tea -> herbal tea

 

Missing the Window, Getting Overtired

  • Taking a page from the infant sleep playbook, it’s important to get to bed during that elusive window when you’re tired, but not overtired.
  • Overtired? That’s a thing? Yes, there’s a window of time when you’re tired in the evening. If you stay awake past that window, your body responds by secreting the stress hormone cortisol. This creates an agitated state known as overtired.
  • The body is trying to help out. It thinks, Oh, we must be awake for a good reason, perhaps we’re at war, or running from a tiger. Let me help out by secreting cortisol. That way we’ll be able to meet the challenge that’s keeping us up.
  • You might recognize the feeling of being overtired:
    • Feeling wired or suddenly wide-awake in the evening
    • Feeling flushed or warm
    • You might find yourself going down an internet rabbit hole
    • If you’re awake with the lights on, you might feel productive and get involved with “projects” around the house
    • If you’re lying in bed, you might experience racing thoughts
  • The key is to get to bed while you’re still tired, and before you get overtired. If you miss the tired window, you’ll get a shot of cortisol and you may not be able to fall asleep.
  • Look for your tired window approximately 3 hours after sunset.

 

Stable Blood Sugar

  • The American diet promotes a blood sugar roller coaster.
  • Blood sugar fluctuations disrupt your sleep, causing middle of the night awakening.
  • If your blood sugar crashes in the middle of the night, your body responds by secreting adrenaline and cortisol (the stress hormone). This is activating, and can make your sleep restless. You might start to toss and turn or wake up in the middle of the night feeling “wired.”
  • If you don’t have difficulty falling asleep but you have difficulty staying asleep, think of this as a blood sugar issue until proven otherwise.
  • Here’s how to maintain stable blood sugar:
    • Eat more protein and healthy fats (olive oil, coconut oil, grass-fed butter and ghee)
    • Avoid sugar, refined carbohydrates and alcohol
    • Take a spoonful of coconut oil or almond butter before bed

 

Obstructive Sleep Apnea

  • Obstructive sleep apnea (OSA) is a very common condition that interferes with our ability to breathe while we sleep.
  • In OSA, you experience apneic episodes (moments where the body stops breathing), which compromise the body’s oxygen supply, preventing the body from dropping into deep sleep and resulting in superficial and interrupted sleep throughout the night.
  • Sleep apnea is associated with significant health issues. If you suspect you may have sleep apnea (snoring, daytime fatigue, morning headache), talk to your doctor about having a sleep study.

 

Magnesium

  • Many of us are deficient in magnesium, and this can interfere with restful sleep.
  • You can replete magnesium in a few ways:
    • Magnesium supplementation (recommendation: Seeking Health Magnesium Plus at bedtime)
    • Epsom salt bath (extra credit if you take a bath by candlelight)

 

Alcohol

  • While alcohol is notorious for making it easier to fall asleep, it disrupts sleep architecture, causing restless sleep, especially in the second half of the night.
  • Monitor your sleep quality when you drink. If you find that you toss and turn on the nights when you drink, or wake up tired the next day, reduce or eliminate alcohol consumption, especially closer to bedtime. As a long-term solution, perhaps take weeknights off from drinking.

 

Sleep Aids and Other Medications

  • Sleep aids, while potentially useful in the short-term, can exacerbate insomnia in the medium and long-term, most likely due to down-regulation of our receptors for GABA, a brain chemical messenger involved in our ability to feel relaxed and sleepy.
  • Other medications, such as stimulants, psych meds, steroids, and supplements, such as rhodiola, vitamin D, B vitamins and multivitamins can be stimulating and should be taken in the morning (unless otherwise instructed by a doctor).

 

Step 3: Manage Stress

Relaxation

  • This should come as no surprise: stress is a primary factor wrecking our sleep.
  • The biochemical state of stress is incompatible with deep sleep.
  • If we don’t give our minds a chance to relax during the day, then lying in bed is the first opportunity for your mind to take stock of the day; this can feel like “racing thoughts” while you’re trying to fall asleep.
  • We need a balance of activity and relaxation during the day in order to sleep deeply at night. Here’s how:

 

  • Wind down before bed:
    • Have a relaxing evening ritual (take a bath, stretch, read by candlelight)
    • Count back 8.5 hours from wake-up time–that’s when you need to get in bed and read a book
    • Read a book in bed while wearing orange glasses until you feel sleepy
    • Lie in bed with your hands on your belly; inhale for 4 counts, hold, then exhale for 4 counts
  • Unplug:
    • Spend more of your free time unplugged (away from TV and internet)
    • Don’t let yourself be on autopilot, checking the phone compulsively, habituated to going home and opening the computer or turning on the TV. Make these choices
    • Stop using electronics by 9pm or 10pm
      • This means turning off the TV and not checking your phone (I know, it’s a tall order!)
      • Set your phone on a do-not-disturb schedule, perhaps 11pm-7am
      • Get an analog alarm clock, and declare the bedroom a no-phone zone
    • Rest:
      • As a culture, we value productivity and we don’t value rest. This mindset makes it difficult for us to drop into a relaxed state for sleep.
      • Have a “willingness to let go of exhaustion as a status symbol and productivity as self-worth” – Brené Brown
    • Play:
      • Spend time playing with animals or children
      • Be goofy with your significant other or a friend
      • Play games, make music, create art
      • Don’t just numb out with TV or internet. Invest your time in activities that truly refuel you: being in fresh air, sunshine, nature, engaging with art and creative pursuits.
    • Breathe
      • Breathing exercises can instantly switch the tone of your nervous system from stress to relaxation
      • Lie down, place your hands on your belly, and inhale for 4 counts, hold for 2, and exhale for 4
    • Meditate
      • Demystify this. It can be very simple. Sit and observe your thoughts. Try to cultivate a patient and compassionate attitude toward yourself and your thoughts.

 

Suggestions for Daily Relaxation

  • Yoga
  • Meditation
  • Breathing exercises
  • HeartMath
  • Tai Chi
  • Epsom salt bath by candlelight
  • Journal
  • Be in nature (you can take the train to Cold Spring and hike or just go to the nearest park)
  • Get acupuncture or other energy work
  • Take a walk
  • Prioritize a creative outlet (draw, paint, play with children, play with animals, dance, make music)
  • Turn on music, turn off the lights, light a candle, lie down and enjoy

 

Tech Support for Meditation (kind of a contradiction!)

  • HeadSpace: getsomeheadspace.com
  • HeartMath: heartmath.com
  • Zencast: zencast.org
  • Buddhify
  • calm.com
  • Breath2Relax
  • Deep Sleep and Relaxation, Guided Meditation and Affirmations (Sleep Learning System) by Joel Thielke
  • Use free guided progressive muscle relaxation on YouTube and Spotify

 

© Ellen Vora, MD. Do not duplicate or distribute without permission. This content is for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment, and does not constitute medical or other professional advice.

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