Sleep Hygiene
As mentioned in my video yesterday, here are my recommendations in regards to sleep hygiene:
Sleep hygiene refers to behaviors or habits that help you get good quality sleep. I think habits is a better term, because really these behaviors need to be repeated and maintained for best outcomes. I remind patients that if you go home tonight and do every single thing we discuss, you still might not have a good night of sleep! It’s really the repeated behaviors over several weeks that lead to success.
When it comes to sleep, routines are very important. Going to bed at the same time and waking up at the same time is recommended, and it makes sense when you consider it. If you go to bed at 2am on Saturday night and sleep in until 10am, it’s going to be really hard to fall asleep at 10pm Sunday night. So a lot of people will get out of their Monday through Friday sleep schedule on the weekend, and struggle to get good quality sleep to start off the work week.
Extend the idea of keeping to a routine to the hour or so before your planned bedtime. Start winding down your body and your mind to ease the transition to sleep in a set, repeatable number of steps. An example could be each night at 9:30 taking a shower, brushing your teeth, dressing in your pajamas, writing down a few thoughts or a to-do list in a journal to help empty your mind, practice a 5 minute meditation or yoga stretch, and then get into bed.
This is vastly different then what I hear from most patients when we talk about bedtime routines. Many people are watching TV in the evenings, falling asleep on the couch, waking up a couple of hours later and going to their rooms, unable to fall asleep again (I know you’ve done this, I see you!). A few things are happening here. It’s essentially like taking a nap right before bed, which when said in that way doesn’t sound like a successful way to help you fall asleep. Also you are getting screen time in the evening, which is just shining a bright flashing light directly to your brain, counteracting the release of melatonin that is supposed to be happening as the sun sets. Melatonin levels are meant to gradually rise to signal to the brain that it is night and time for sleep. Lights from screens, which includes tablets and phones and TVs etc, reduce the brain’s natural production of melatonin and interfere with the ability to fall asleep and stay asleep.
I also think those who are falling asleep on the couch are missing their ‘sleep window.’ To be transparent, this is something that I have postulated, not something that I find in studies on sleep behavior, but rather something that I observe in patients and in myself. If you try and stay awake past your normal time for sleep, you are initially tired but then get a second wind, preventing you from falling asleep when you finally do lay down. Instead, listen to your body’s cues and go to bed when you feel tired, rather than allowing yourself to fall asleep on the couch. Even consider stopping screen time an hour before bed. This is when you can instead implement your sleep routine!
Sleep hygiene is not just for habits right before going to sleep. Things that you do throughout the day will also have an effect on your sleep quality. Exercise has been shown in many different studies to improve sleep duration, ability to fall asleep, and sleep quality. Diet plays a role as well - caffeine in the afternoon or eating a heavy meal in the evening could affect your sleep quality. Alcohol is interesting when it comes to sleep - it is a sedative, so it might be tempting to have a glass of wine or other drink in the evening to help you feel relaxed and fall asleep. However, alcohol has an overall negative effect on sleep quality, with more night time awakening, especially in the second half of the night.
The environment for sleep is also a part of sleep hygiene. Most people find a cool temperature better for sleep, ambient noise such as a sound machine or a fan beneficial for staying asleep, and of course dark or low lights. Consider investing in a good mattress and pillow - you spend (ideally anyway!) 8 hours of every day in your bed, so it’s worth paying for higher quality supplies.
Some of these behaviors might be fairly easy to implement, like turning down the temperature in your bedroom a few degrees, while others might take a much greater effort to change - I know, Netflix after the kids go to bed!! But perhaps start by picking a few that seem easy and just one that seems more challenging, and roll out these changes slowly. Ultimately it is worth it, because sleep is essential. Without sleep, we have low energy, sour mood, weakened immune system, concentration deficits, worse cardiovascular outcomes and so on. Even obesity has been linked to poor sleep, so if you are struggling to lose weight and feel you are doing everything you should be in terms of diet and exercise, take a look at your sleep habits next!
If you end up talking to your primary care about your sleep and you are first offered a medication, think about making a change to direct access primary care. In most primary care practices, there is not enough time to review these habits, let alone discuss which ones might be more of a challenge with your lifestyle and brainstorming how to make adjustments. The benefit of direct access primary care is that we do have the time to focus on this - writing a prescription for Ambien is way faster, but has significantly more side effects! And that’s not to say that sleep medications have no role, because I do prescribe them as well, but an assessment of sleep hygiene and implementation of these habits as best able should always be included!
