Get Better Sleep
Poor sleep is awful and can make everything else just that much harder. Problems falling asleep, waking in the middle of the night, and waking earlier than we want can be torturous. Certain mental health problems can cause poor sleep, like the nightmares and jumpiness of trauma disorders or the early-morning waking of depression. Perimenopause, menopause, and sleep disorders like sleep apnea, will also interfere with sleep and warrant additional treatment.
While this is true, our habits are typically what determines our sleep quality and many of us will sleep significantly better by changing a few small things.
Sleep Science
Let’s first start by appreciating our glorious and complex biology. Our circadian rhythm - our body’s internal clock - is largely determined by light exposure, eating, and physical activity, but impacts nearly every system in our body. It is the primary driver for sleep and all hormones related to sleep function.
Waking in the morning and falling asleep at night happens because of a series of hormones in the brain. Corticotropin-releasing hormone (CRH), adrenocorticotropic hormone (ACTH), and other hormones signal cortisol from the adrenal cortex to be at its highest point near waking and supports alertness, blood pressure, glucose availability, and cognitive readiness. Cortisol then gradually declines over the day while melatonin rises as the sun sets, ultimately, hopefully, tucking us into bed for a good night sleep. Skipping meals, late caffeine, increased blood glucose from sugar and simple carbohydrates, lights and back-lit screens, and late dinners, all can interfere with this hormone cascade resulting in poor sleep. By respecting our physiology and practicing some smart habits throughout the day, we can support a blissful, restorative slumber.
The Art of Sleep Hygiene: Simple Habits for Restful Nights
Sleep hygiene, the recommended behavioral practices that set us up for a delightful night of sleep, is an art and requires intention long before bedtime.
Here are the best recommendations to help you sleep well:
Get Up. Get out bed when you wake in the morning, ideally within a few hours of sunrise. Avoid lounging in bed to train the mind that the bed is used only for sleep (and sex). Try to get up close to the same time each day.
Sunlight to start the day. Our circadian rhythm and thus our sleep, is driven by exposure to sunlight. The sunlight our eyes receive in the first part of our day anchors the timing of the rhythm. This helps the release of cortisol and other hormones, which directly benefits sleep quality, energy, and focus.
Eat Well. All of those hormones don’t run on air. They require minerals, B-vitamins, and other micronutrients for synthesis. Eating whole and nutrient dense foods most of the time is essential for mental wellness, energy, and sleep. Meals with protein, fiber, and healthy fats will stabilize your blood sugar throughout the day and allow cortisol to have its expected and physiologic arc mentioned above and give your body the nutrients it needs to fuel your day and nighttime. See note below on meal timing.
Get cardiovascular exercise every day, ideally in the morning. Humans do best when we move our bodies daily. Exercise helps us sleep, reduces stress, improves concentration, and improves mood. We recommend 30 minutes every day (or 45 minutes every other day) of moderate cardiovascular activity like a hike, basketball, a bike ride, weight lifting, or a fast walk. All exercise is great - but for sleep, get a little sweaty and bring your heart rate up!
Support Meal Timing. It seems silly but the timing of when we eat really matters. Studies indicate that delayed or skipped meals, especially eating within three (3) hours of bedtime, is strongly associated with poor sleep quality, problems falling asleep, and waking in the night. Eating late disrupts our circadian rhythm and is linked to insomnia, fatigue, and lower sleep efficiency. Conversely, eating a sizable breakfast, a good lunch, and dinner around 6 PM, support optimal circadian timing. If you want to fast or restrict your eating window, the data recommends eating early and restriction in the evening.
Skip the nap. Some people can nap and get a satisfying amount of uninterrupted sleep at night. If you’re not one of them, hold out until evening and plan to go to bed early if needed.
Create a cool, dark, quiet sanctuary. Turning down the heat, using heavy, black-out curtains, and using a brown or white-noise app or machine can help protect you from noises in the night - like the neighbor’s dog barking or the heater kicking on.
A bed is not a sofa. Keep your bed for just sleeping. Remove any television or screens from your bedroom. Watch television, work, text, and read in other areas to help your body associate only sleep with your comfy bed. If you are not ready for sleep, asleep, or having sex, get out of the bed.
Televisions, computers, and gadgets. Electronics with backlit screens emit a type of light that mimics daylight. This type of light stops our brain from releasing the chemical melatonin, the hormone that promotes health and a regular sleep cycle. Not tired while on your phone or computer?Most of us will not feel tired with a phone or laptop in front of us. Turn off the TV and put down your phone one to two hours before you would like to be asleep. If getting off the phone is hard - like it is for many of us - use a screen management app, like Brick or Opal.
Gotta go? If you wake in the night to use the restroom, push hydration (ideally water) in the day and limit drinking beverages in the evening.
Caffeine. depending on your genetics and other features of metabolism, caffeine has a half-life of 4-8 hours. That means that half of the 154 mg of caffeine in your 3 pm latte will be coursing through your system at 9 pm. If you’re having a hard time sleeping, especially falling asleep, I recommend a caffeine cut-off time of 12 PM - noon- or before. Remember that dark chocolate, pre-workout blends, Yerba Mate, decaf teas and coffees all have caffeine.
Alcohol. Alcohol may help you fall asleep, but it disrupts the quality of your sleep. It fragments sleep, suppresses REM, increases awakenings, worsens breathing, and activates stress hormones in the night. Even one drink can cause measurable sleep disruption in most individuals. This worsens for most of us as we age.
Be consistent. Set a pattern of going to sleep at approximately the same time every night and waking up at roughly the same time every morning.
Unwind before bedtime. An hour before you would like to be asleep, do a relaxing activity like reading, meditating, journaling, or taking a bath.
Medications. Ask about the recommended time to take prescription medications, as some can help you sleep or may keep you awake. Over-the-counter sleep aids like melatonin, 0.5-3 mg at bedtime, or Benadryl, 25 mg one to two tablets at bedtime, are low risk and may be helpful for occasional problems. We recommend that you start with melatonin, as the side effects from Benadryl include dry mouth, constipation, and feeling groggy the next day. Keep in mind that melatonin is not a sedative and that doses above 3 mg are not more likely to help you sleep.
Resources:
The National Sleep Foundation has a lot of good information, including a sleep journal that we can use to help better understand what is getting in the way of blissful sleep.
Shawn Stevenson’s Sleep Smart book.
The U.S. Veterans Affairs Department created the CBT-I Coach app, which is a simple and evidence-based cognitive behavioral therapy for sleep (CBT-I)