A ReLACSing Blog #7: 5 Tips That Can Improve Sleep for Everyone
Photo by Sarah Halliday on Unsplash
The rooster has perfected Tip #1.
One of the cool things about being a sleep specialist, particularly at cocktail parties, is that everyone can relate to this aspect of health, because everyone sleeps! Here are five tips that every human who sleeps can adopt to improve their sleep quality.
Wake up at the same time every day, with an alarm if needed. Because sleep and circadian rhythms (the biological clock) have been preserved throughout evolution from the tiniest microscopic organisms, human history has provided a lot of advice in this arena. A common recommendation currently is that you should go to bed at the same time every night. This is only somewhat true. Rather, the most important recommendation for sleep, if you were to follow only one recommendation at all, would be to wake up at the same time every day. The Rooster understands this. If you ever lived with grade school-age children whose sleep is at its peak, you would recall this as well. The best sleepers wake up naturally at the same time every day. Of course, sleep can be disrupted in so many ways that many of you will want to set an alarm to compete with the rooster for consistency, but this is essential to good sleep quality and stabilization of circadian rhythm. The circadian rhythm is such an important part of human function that research in this area recently won the Nobel prize. Digging out my high school Latin for rare utility (as there is a dearth of Roman consuls around these days with which to converse), circa means around and dies means day. Circadian means around the day, or the cycling of bodily functions directly related to the 24-hour light-dark cycle due to the sun’s orbiting of the errr…earth’s orbiting of the sun. Most animals and the most perfect animal, human beings, have evolved to perform functions on a regular sleep-wake cycle based on the 24-hour day. Human circadian rhythms are not quite 24 hours, but obtaining natural sunlight in the morning and darkness at the end of the day helps to adjust the schedule nearly perfectly to match the day-night cycle of the earth. When you wake up is the most important factor for setting the day’s rhythm, not when you go to bed. If you need a specific amount of sleep and wake up at the same time every day, your bedtime will inevitably become about the same, but this will vary a lot more than your wakeup time should. For example, if you are sleep deprived or had a poor night of sleep, you may need to go to bed a little earlier the next night. The wake up time also sets the bedtime and not vice versa. If you wake up at 10 am every morning, your bedtime should NOT be 10 pm. Depending on how much sleep you need, your bedtime should be about 7-8 hours before your wake up time; let your body inform you when it is time for bed. The inconsistency of the wake time is a cause of many of the most common sleep disorders we see in sleep medicine including insomnia, excessive daytime sleepiness, jet lag, and shift work disorder to name a few. At first, you may have to set an alarm to develop consistency, but if sleeping well, you may just wake up naturally at the same time every day once you get into a rhythm.
Get 30 minutes of moderate to vigorous activity daily. Along with nutrition, social relationships, spiritual/emotional health, and sleep, exercise is one of my not-so-original five pillars to healthspan and longevity. There is little debate that exercise is beneficial for health, but the timing of such activity is not clear. I recommend the following two timings of exercise that are ideal for sleep. The first time may be about 4-6 hours before bedtime. This tends to be the peak time for athletic performance. A hockey player who is lights out at midnight probably will be doing well for a 7 pm puck drop to start the game. For sleep, the core body temperature ramps up during vigorous activity and then will cool over 4-6 hours coinciding with the correlation of lowering of core body temperature and sleep onset and quality. Exercising close to bedtime can have a negative effect in the same way as it over-stimulates the body (see #3) and raises core body temperature too close to bedtime. The second best time to work out for sleep and circadian rhythm may be first thing in the morning. In terms of ancestral health, that antelope did not come into the cave to be sacrificed for breakfast at dawn like you can open up the refrigerator for that orange juice. Rather, our ancestors had to wake up and hunt or gather before obtaining the first meal for the day. Exerting yourself early in the day can get the body moving, and particularly if done outside where you can obtain natural light, this can be fantastic for sleep by getting the circadian rhythm going. This is aside from the fact that this may be the only time in your schedule where you may be able to fit the exercise in. Even if not 4-6 hours before bed, this may be a close second. Some football teams do “two-a-days” where they have morning and afternoon practice. Though dreaded by the players, it is thumbs up from this sleep doctor.
Create a buffer zone of relaxation prior to bedtime. The body was not built to go from 60 to zero in 70 feet like a sports car. Back to our ancestors, once the sun set there was not a lot of activity after dusk, in part due to lack of touchscreens and LED lighting in caves of the time. They had ample time to wind down the day, particularly in dim or no lighting. There must be at least some buffer zone between work or other stressful or mind-activating activities before bedtime. Try to incorporate at least one hour of a relaxing activity of your choice prior to bedtime, preferably in darkness or dim light. The activity itself will be unique to you. Some find prayer or meditation relaxing, others podcasts, still others a warm bath. I talked to a priest once who found it a little stressful to pray at bedtime, so I told him to stop working at least one hour before bed! TV for most people is not the greatest as the lights, movements, and the content, in particular, tend to be quite stimulating. Sleep is a physiological process that requires the deactivation of mind. Anything–whether prayer or TV–that causes increased processing of the brain may interfere with falling asleep. Find that activity that relaxes you the most. Start at least one hour before your target bedtime (based on your newly consistent wake time!) and let your mind start to relax and drift off. Then go to bed. Let your body tell you when to go to bed but you need to give it that chance.
Turn off media and entertainment during your sleep zone. Social engagement is one of the five pillars of health, but not when you should be sleeping. Particularly with technology well beyond radio and television now, email, text messaging, social media, streaming, etc., have multiple negative effects on sleep beyond just the exposure to artificial light. Social media is designed to entertain and draw in the audience, not put you to sleep. TV is filled with anything from news channels depicting acts of war to fighting over politics, and other entertainment should in fact be quite entertaining, whether sports or drama. Our ancestors did not have the ability to relive scenes of that cheetah devouring an antelope in the savannah from earlier in the day, and if they did, they would probably not be sleeping well either. Again, the idea is to de-activate the mind prior to bedtime and the business intentions of the above run counter this goal by definition. If possible, get that phone, tablet, laptop, and TV out of the bedroom. Turn off notifications, and disengage with the rest of the world to protect your sacred sleep period.
Unless you are depriving yourself of sleep, don’t worry so much about sleep and the negative effects of poor sleep. OK, so I was going to write about something more common like, don’t eat for 3 hours before bed, but this is more helpful. The eating thing can be #6 but I’m out of room in the sleep tip jar. I guess if you’re reading about 5 sleep tips here, you might be worrying about sleep too much. However, there are different audiences of people. Some of you are good sleepers and may be sleep deprived by not allowing enough time to sleep. Others of you may have underlying conditions like obstructive sleep apnea that can interfere with sleep no matter how well you follow these five tips. You do need to get enough sleep and you do need to address any condition disrupting sleep. However, those of you who struggle with insomnia disorder, or chronic difficulty falling asleep and staying asleep, worrying too much about sleep may actually be causing a lot of the problem! As stated above, and to be addressed in future blogs, sleep is a physical process of the brain that can be blocked by overactivity of the mind. That means you can indeed keep yourself awake counting sheep too hard! Those who are significantly troubled with insomnia should talk to their primary care provider about treatment, and ReLACS Health will be offering cognitive and behavioral therapy (CBT-I) for those with chronic insomnia. For everyone else, you should consider sharpening some of the four tips above, but also focusing less on perfecting your sleep, or if you do have a bad night of sleep, know that there will be a new night of sleep in another 16-17 hours or less. Even our ancestors, who probably slept like rocks (or on a rock or inside a rock), occasionally would have had that bear show up at the cave leading to nights with poor sleep as well, and we are all still here as a species to talk about it!
-Andy Berkowski, MD, sleep specialist (the most relatable medical subspecialty for cocktail parties)
ReLACS Health
