The Primacy of Better Sleep

How about a post that is more conventional and all about your good? Let's talk about sleep. I was working on sleep issues the other day and it reminded me there is so much we can do to improve our sleep. And, because good sleep is a moving target, all of us can always be working on better sleep. Dr. S's Big Three for behavior change include sleep, exercise, and nutrition. Of those, sleep is primary.

The following will be behavioral advice, and not medical advice. My behavioral advice may be best directed by a physician. Also, my goal is not "good" sleep, but "better" sleep. I am interested these days in helping people get better sleep not just from one night to the next, but across time. To that end, none of these are a quick fix even if some will have immediate, positive results.

Alcohol: ...disrupts sleep, for lots of reasons. If you are a daily drinker, or drink mainly when you're stressed, try about two weeks of abstinence and see what happens to your sleep (and stress). If you think you need help with abstinence, talk to a psychologist or physician for recommendations.

Bathroom: Using the bathroom at night is a common cause of nighttime waking. Consider cutting off water at night (3 hours before bedtime). Also, talk to your physician if you find yourself getting up a lot, or routinely.

Bedtime: Always go to bed at the same time each night, +/- 30 minutes. Our brains have an internal clock that can be trained making sleep easier.

Dehydration: Proper hydration is connected to "sleep efficiency." Dehydration seems to be an efficient way to throw off your sleep.

Drugs and Substances: The vast majority of us have bodies that are well equipped to fall asleep, stay asleep for about 8 hours, and wake up. This is a complex neuro/bio/chemical process and anything we add to support any individual part of that process also affects other parts of the process. If you use drugs (legal or otherwise) or other substances (alcohol, supplements) as a necessary part of sleep, you should consult a physician for an explanation about why you find such things necessary.

Eating: Research recommends fasting at least 3 hours before bedtime.

Exercise: All adults need at least 30 minutes of exercise every day. Exercise has a homeostatic effect on the body and can even help regulate sleep. So, if you start exercising you can expect to also have improved sleep (which will improve your exercise, which will improve your sleep-a positive loop).

Heat: Our body has a thermostat which is active during sleep. To this end, cold actually improves sleep, up to a point. I've seen 60F-67F listed as the optimal temp. Higher temps can cause sleep disruptions.

Light:  There are a number of sensory-based causes to poor sleep. Too much light is one. This should be evidence that we have been sleeping at night and awake in the day for a very, very long time. Try using a sleep mask. It takes about three nights to really get used to it.

Mattress: Good mattresses are good, and bad ones are bad. Old ones are bad, too. Bad mattresses can cause pain, leading to more waking, among other things.

Morning Routines:  I've heard about people who stay in bed because they're trying to avoid morning chaos or drudgery. Create an enjoyable morning routine so you have something to help get you out of bed (and avoid oversleeping which is linked to death; or breaking your standard wake-up time which can make falling asleep harder).

Naps: Research (and society) is mixed on napping. Naps as part of a person's routine seems to be beneficial. Naps to make up for a bad or insufficient nighttime sleep seem to be problematic. Naps are the easiest way to throw off one's sleep routine. Eliminating naps is an effective way to help regular bedtime and wakeup time.

Noise: I like white noise over ear plugs to help with noise issues that cause sleep problems. Historically, we've kept alert for nighttime danger through noise more than any other sense. We rely on smoke alarms, dog barking, and our own alarm clock to help us manage during this very vulnerable time of day. White noise smooths out the irregular or obnoxious noises at night so we can remain alert for the alarms. Ear plugs can block all noise, even the good ones.

Pain: Chronic pain disrupts sleep. Deal with chronic pain if you have it.

Racing Thoughts: Look for ways to address racing thoughts (anxiety) in the evening or morning. Some people are more vulnerable to this at night, others more-so in the morning. At night it leads to wakefulness. In the morning it leads to avoidance. There are lots of behavioral strategies for managing racing thoughts, so do some research or check with your local psychologist.

Screens: The link between screens and sleep is not as strong as we think it is. If you are on a screen at night, make sure it's a calming, and not activating activity. If you're having trouble falling asleep when you want to and are on a screen, consider stopping screen use an hour before bed. If you're not on a screen and having trouble falling asleep, I cannot recommend using a screen.

7-9 Hours:  Adults need between 7 and 9 hours of sleep per night. Too little is bad, but too much is also bad. For instance, "oversleeping" is more correlated with death than under-sleeping. If you need less than 7 hours or more than 9, you're in a statistical minority and might want to see your physician just to be safe.

Sleep Hygiene: Create a 20-minute routine you do every night before bed. Do it the same way every night. The brain and the body are linked in many ways, and behavior can actually signal the brain to start the falling-asleep process.

Sleep position:  Did you know there are better positions for sleeping than others? Do the research.

Sleep Study: Sleep studies are getting easier to administer and cheaper to pay for. Ask your physician for a referral.

Sleeping in: Don't plan to sleep in. If you routinely (i.e., weekly) need to sleep in to catch up on sleep, you need to sleep more in general. If sleeping-in is fun for you, consider the statistic linking oversleeping and death, from above.

Snooze:  The snooze button might be the worst invention in the history of sleep. From a research and behavioral perspective, the snooze button is all bad and no good. This is sad, too, because I know many people who love their snooze button. But the love isn't mutual.

Stress: Stress effects our whole experience, so it tends to affect sleep first (since it's a complex, daily process). A lot of chronic stress deadly. It's not uncommon for my clients to track stress by how they sleep. For many, increasingly low quality sleep means chronic stress. Poor sleep is the canary in the coal mine, so to speak.

Stretching: I have found daily stretching to be the most effective way to deal with common body pain (associated with aging, among other things). Less pain means better sleep. It also means more exercise (pain and stiffness can be an exercise deterrent) which also means better sleep.

Track Your Sleep:  There are lots of ways to do this, including wearables, apps, and sleep journals. Look for trends. In general, if something works, do it more. Lots of research suggests tracking sleep is sufficient to initially cause some improvement in sleep, so if you've never tracked your sleep, expect your sleep to improve once you start tracking.

Wake-up Time:  I get up the same time every day, even on weekends. If you're trying to adjust your sleep schedule, I highly recommend focusing on wake-up rather than bedtime.

Your Bed: Make sleep the only thing you do in your bed. This is about the most behavioral advice I can give you because I remember this intervention from grad school. If you plan to sleep for 8 hours, you should only be in your bed for 8 hours a day, plus any part of your 20 minute sleep routine which must happen in bed.