Sleep is supposed to be easy. We literally have to do nothing but lie down and close our eyes and yet 20-40% of people will experience insomnia this year. Lack of sleep increases the likelihood of chronic diseases including hypertension, diabetes, depression, cancer and obesity, as well as increasing mortality, and reducing quality of life and productivity. For athletes and those who exercise, sleep is vital for recovery. Without enough quality sleep, all the effort in the gym, money spent on supplements and time spent weighing chicken breasts is wasted. Sleep is something we’ve been doing our whole lives, it comes naturally to us and, therefore, most have never been taught “how” to sleep. Sleep hygiene is a term used to describe habits and practices that are conducive to sleeping well on a regular basis. I’ve organized a plethora of sleep hygiene topics into 9 general categories you can incorporate into your daily routines to foster a good night’s sleep. To give you a chance to incorporate them slowly, I’ve broken this article into three parts to be released throughout February. Sweet Dreams.
9 Steps to a Restful and Restorative Sleep
- Make it a Routine
We are creatures of habit. Inconsistency can wreak havoc on our health when it comes to how and when we prepare for sleep. Our circadian rhythm, an internal clock that determines our sleeping pattern, is governed by a number of different hormones that can be influenced by our actions during the day. By hitting the sack and waking up at a consistent time each day, our body is able to regulate these hormones and prepare our body more efficiently for a good night’s sleep. Had a late night? It’s better long-term to wake up at your regular time and make up for it the following night.
In addition to sleep and wake times, our circadian rhythm and its associated hormones are also sensitive to our activities leading up to sleep. Simple routines like brushing our teeth or having a bath can tell our bodies to start preparing for sleep when consistently done before bed. As well, the rise and fall of temperature with bathing encourages the natural temperature drop we experience when sleeping. To take further advantage of our body’s affinity for habits and ease the transition from wake time to sleeping, we can start practising a regular relaxing bedtime ritual such as breathing exercising, mindfulness or meditation. These can help bring down our sympathic tone(the “fight or flight” excitatory division of our autonomic nervous system) and limit the secretion of the stress hormone cortisol, which increases alertness. If you tend to have an active mind and take your problems to bed, try writing them down and leaving them in another room before you start your nightly winding down routine.
- Use Light to Your Advantage
Our circadian rhythm and the hormones that govern it are extremely sensitive to light exposure in ways that can affect our sleep both positively and negatively. Increasing light exposure during the day helps our body regulate the natural balance of hormones like melatonin, cortisol and adenosine. By taking breaks from life indoors to venture out into the sun, we encourage the natural rise and fall of these hormones to promote peaks at the most opportune times.
Inversely, too much artificial light in the evenings and bright phone and computer use before bed can negatively affect the same delicate hormone ratios. This tricks our body’s into thinking it’s still time to be awake and ready for action. Studies have found that the bright blue tones in our phones and computers have the most negative effect on our melatonin and cortisol levels by stimulating our pituitary gland (the connection between our nervous and endocrine systems that governs many of our hormones) into a more excited state. Avoiding screen use 30 minutes before bed is your best option to boost natural melatonin(a sleep promoting hormone) levels. If you have no other choice than to set your phone alarm or check your e-mail immediately before your head hits the pillow, then try an app like “Twilight” that significantly dims the screen and also shifts the screen color to the red end of the spectrum to limit the impact on the pituitary gland.
FUN FACT: An Ohio State University study using hamsters found that four weeks of exposure to artificial light—the kind that stems from smartphones, laptops, tablets, and television screens—left the critters more lethargic and depressed than those that slept in total darkness.
- Get Out of Bed
Bear with me. We can foster our sleep routine by avoiding spending time on the bed or in the bedroom for reasons other than sleep and intimate activities. Netflix binges and last minute work proposals should all be done outside of the bedroom. Keeping TV’s, computers and work materials out of the room will help strengthen the mental association between your bedroom and sleep and not other activities. By developing the bedroom into a fortress of solitude for sleep we can program our bodies to start preparing for bed just by walking into the bedroom.
Another time to avoid the bed is when you’ve woken up in the middle of the night with a racing mind and are having trouble falling back to sleep. It may sound counterintuitive, but the pressure and concentration we use to force ourselves back to sleep may actually be keeping us awake. If after 20 minutes you’re not asleep, get out of bed, go to another room, and do something relaxing until you are tired enough to sleep. Make sure not to turn on any bright lights, the TV or computers during these times Read by candlelight, grab a glass of water, listen to relaxing music or just sit in a chair in the middle of a dark room like a horror movie villain. Whatever you choose to do, just get out of bed so your body doesn’t associate worrying and being stressed out with being in bed. Do your mind racing elsewhere until you are sleepy, then return to bed. It’s ok for this to happen multiple times during the night, don’t stress about it and try to maintain your regular wake time.
No napping either. Sorry. Many people struggling with sleep quality take naps in an attempt to make up for lost sleep. Although short naps have been shown to boost awareness throughout the day, prolonged afternoon naps may be one of the culprits for those having difficulty falling asleep or staying asleep at night. Because late-day naps decrease sleep drive, it’s better to keep them shorter than 45 minutes and before 5 p.m.
4. Environment is Key
Your bedroom should be as cool, dark and quiet as possible. A well ventilated room between 60 and 75°F is ideal to encourage the natural fall in body temperature we experience each night. Too hot or too cold and our bodies will take action to get more comfortable, which will probably involve waking you up.
Silence is best, but when it comes to sleeping, “quiet” can be relative. An ideal auditory environment isn’t so much perfectly quiet as it is consistent without loud spikes of noise to wake us up during the night. If you live in a busy city or close to potential noise generators it can be difficult to limit the outside noise completely. But, we can decrease the relative volume of outside noise by creating constant low-level noise with a fan or a “white noise” appliance.
5. Embrace the Darkness Within You(r Bedroom)
As soothing as a nightlight may be if you’re 4 years old, all light sources can act as a powerful signal telling our brain that it’s time to wake up. Melatonin(our sleep hormone) levels can be significantly decreased by any artificial light sources throughout the night. Using heavy curtains, blackout shades, or, as a last resort, an eye mask to block light ensures our sensitive nervous and hormonal systems aren’t getting confused as we slumber. Additionally, turn the clock face away and do not check the time or your phone if woken up at night.
ASIDE: Pets – studies have shown benefits of sleeping with pets, however, an active pet chasing squirrels in their sleep can interrupt your sleep cycle. Try sleeping without Fluffy for a couple nights and you both may get a better sleep.
There are many lifestyle factors that can affect the quantity and quality of our sleep but we’ll keep it simple:
- Exercise – minimum 30 minutes a day to build up adenosine(another sleepy hormone) but not too close to bedtime to control cortisol levels, keep body temperature low and avoid putting ourselves into an excited state. Try to finish exercising at least three hours before bed or work out earlier in the day.
- Avoid alcohol – although it has the ability to make you pass out(not a recommended sleep aid), the metabolism of alcohol actually decreases the efficiency of our sleep and interrupts our circadian rhythm
- Avoid nicotine, heavy meals and excessive fluid intake after dinner – too much metabolic activity can rattle our cages and actually limit how restorative our sleep is
- Avoid caffeine after lunch – although helpful during the day to boost your metabolic rate and improve alertness, consuming it too late in the day can keep you revved up well past bedtime. Don’t forget tea, chocolate, cola, and some pain relievers can all be significant sources of caffeine, it’s not just the coffee keeping you wired!
7. Pillow talk
Choosing a pillow involves the consideration of a combination of factors including slеер posture (ѕіdе, ѕtоmасh, back etc.), age аnd body composition, hеаlth оf your musculoskeletal system, personal рrеfеrеnсеѕ (mаtеrіаl, comfort and style), and budget. Selecting the right pillow should be a trial and error process, testing variations of different factors in store or on lease from family or friends until you find the perfect fit.
In general, softer more malleable pillows or memory foams tend to be better for healthy adults. While a gооd соntоur ріllоw , ѕhареd tо еnѕurе neutral ѕріnаl аlіgnmеnt and hеlр relax muѕсlеѕ, may provide relief for those with neck or back pain. No two people are the same and the best way to find your perfect fit is to get out there and try as many different types as you can. The goal is to have your head and neck in a neutral position with weight еvеnlу dіѕtrіbutеd thrоughоut thе еntіrе ѕurfаce area avoiding pressure points or unsupported segments. Also consider using pillows in positions other than under the head and neck. A soft pillow between the knees in a side posture can help support the hips and pelvis, while a more firm pillow placed under the knees in a supine position can help take pressure off of the lower back.
8. You Sleep in the bed You’ve Made
Buying a new mattress can be compared to buying a new car. There are many different options with hundreds of factors to consider, you will be using it everyday and you will be spending a significant amount of your hard-earned money on it. Most people shop around for their vehicles and yet many don’t put the same effort into choosing their new mattress and often base their decision on price alone. Considering you will be spending one third of your life in it, I’d suggest giving your next purchase some serious thought. So when is it time to get a new mattress?
Experts suggest investing in a new mattress every 8-10 years. But a change may be needed sooner if signs of wear appear such as sagging in the middle, changes in density, musty odours that won’t wash out, or excessive noise production. After making the decision to buy a new mattress, its then time to find the perfect one. There are no stead-fast rules when it comes to selecting a mattress. General concepts can be applied such as even distribution of weight, appropriate spinal support and vibration and noise reduction, but inevitably it comes down to personal comfort preference. Similar to purchasing a pillow, there are hundreds of options and you’ll want to test out as many beds as possible. Don’t just test the firm ones or the soft ones because that’s what you’ve always gone with. As we age our body’s change and may require a different type of support as the years go by.
Attempt to test out the beds you are seriously considering for at least 15 minutes. Yes, lie on the bed, in the store, in front of strangers for 15 minutes. The sales-person will be very understanding and you’d be surprised how different a mattress can feel after a quarter of a hour. Finally, try not to mix and match mattress and boxsprings from different sets. Box springs are designed to support a specific mattress type and weight. Having an overwhelmed boxspring can result in a sagging or contorted mattress, resulting in a sagging or contorted you.
9. Last resort
If all other sleep hygiene modifications haven’t made a significant difference, consider using a natural sleep enhancing supplement like melatonin, California Poppy extract, Lemonbalm or 5HTP before resorting tomore powerful prescribed medication. Ambien, Lunesta, and other doctor-prescribed medications are highly effective sleep inducers, but they can also be habit-forming and come with a number of potentially dangerous side effects. Others, like Unisom, containing the sedating antihistamine doxylamine can help short-term, but can also cause fogginess during the day. Taking a more natural and less harmful option such as melatonin has been shown to help induce sleep and regulate circadian rhythm if the conditions are optimal, meaning, if all other factors of sleep hygiene are accounted for.
So there you have it! Thanks for investing in your health by reading and hopefully taking some steps to getting a more restorative sleep. Some of these practices and tips will be easier to include in your daily and nightly routine than others, but, if you give them a chance, the odds of achieving restful sleep will improve. Remember the most important factor or sleep is routine, so stick to it and reap the benefits.
When applying these tips it may also be helpful to consider recent studies showing that, individually, each specific component of sleep hygiene is related to sleep, however, addressing multiple individual components at once does not seem to make the same kind of significant difference. Therefore, it may be more beneficial to make changes one by one, incorporating a new component each week instead of all of them at once. Sleep is all about routine and by changing too much too quickly, we may be hindering the very thing we are trying to promote.
Finally, as much as these tips have the potential to help, remember, not all sleep dysfunctions can be improved with sleep hygiene alone. Significant sleep disorders such as sleep apnea, restless leg syndrome, clinical insomnia or narcolepsy are always a possibility and if sleep doesn’t improve through good sleep hygiene alone, you may want to consult your physician.
Dr. Nicholas Lendvoy is a DC practising in
West Vancouver, B.C. offering neuro-musculoskeletal
clinical services and performance therapy.
For more information visit: Impulse Sport Therapeutics