Do Not Lose, Snooze

In a previous article, I introduced some of the ‘homework assignments’ that I prescribe to patients as I support their journey to health and happiness. These assignments usually begin with a focus on the following four areas: good sleep, good nutrition, sound exercise or physical activity, and good work-life balance. If asked which of these pillars of health is most fundamental, I will respond with good sleep without reservation.

Several adages regarding sleep help put its importance in context:

“A well-spent day brings happy sleep.” – Leonardo da Vinci

“We are such stuff as dreams are made on, and our little life is rounded with a sleep.” – William Shakespeare

“Many things – such as loving, going to sleep, or behaving unaffectedly – are done worst when we try hardest to do them.” – C.S. Lewis

So, what is good sleep? Why is sleep important? How can we experience good sleep?

Sleep requirements rely on both time and quality of sleep. Consensus recommendations of the American Academy of Sleep Medicine and Sleep Research Society specify that adults aged 18 – 60 years should sleep seven or more hours per night regularly¹.  The National Sleep Foundation recommends seven to nine hours for adults aged 18 – 64 and seven to eight hours for those 65 years of age and older². It is important to understand that these are general recommendations, and certain scenarios may require a patient to achieve longer amounts of sleep. Quality sleep should be refreshing with minimal awakenings during the sleep period and minimize inadequate sleep-induced fatigue, tiredness, irritability, and cognitive difficulties. Clues to different sleep disorders (i.e. chronic insomnia, sleep apnea, restless leg syndrome) can be understood through a thoughtful patient history and evaluation.

Sleep is essential for good mental health, cognition, physical health, and even immune function. However, inadequate sleep has been associated with several adverse health outcomes, including cardiovascular disease, immunosuppression, diabetes, obesity, and all-cause mortality.

While the former quotes above describe the importance of sleep, the latter may be most useful in helping understand how one can achieve restorative sleep. Namely, sleep should not be a chore or something we fixate on achieving, but rather a natural process that is derived from creating a subconscious routine and an environment that fosters this essential bodily function. While recommendations for achieving good sleep are tailored to the patient at that moment in time, the following advice can help improve sleep when practiced consistently and in a subconscious manner.

1. Set a regular sleep schedule with consistent bedtime and waking time, even on weekends.
2. Create a bedtime routine that begins a couple of hours before it is time to sleep and includes a wind-down routine, such as dimming the light and avoiding the blue light of electronics, to promote natural melatonin rise.
3. Avoid the use of stimulants such as caffeine after noon.
4. Modify your sleeping environment to minimize disturbances. This includes a comfortably cooler, dark room, with minimal exposure to external noise.
5. Minimize the amount of time spent in bed not sleeping. If you cannot sleep do not look at the clock. Get up and go to another room to do something relaxing until you feel sleepy enough to return to sleep.
6. Form a relaxing image that helps prevent intrusive thoughts.
7. Practice progressive relaxation of muscle groups from head to toe if needed to relieve muscle tension.

The approach to obtaining good sleep, like most aspects of health, relies on forming good habits. Despite one’s best efforts, there are times when medications can be prescribed to help with sleep duration and quality. However, these medications are not substitutes for the recommendations mentioned above, and it is important to acknowledge that some can have unwanted side effects. Moreover, certain conditions leading to sleep deprivation or chronic insomnia require the evaluation of a sleep medicine specialist to help support a physiologic process that is leading to inadequate sleep.

¹Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, Dinges DF, Gangwisch J, Grandner MA, Kushida C, Malhotra RK, Martin JL, Patel SR, Quan SF, Tasali E. 2015. “Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society.” J Clin Sleep Med 11 (6): 591.

²  Hirshkowitz M, Whiton K, Albert SM, Alessi C, Bruni O, DonCarlos L, Hazen N, Herman J, Adams Hillard PJ, Katz ES, Kheirandish-Gozal L, Neubauer DN, O’Donnell AE, Ohayon M, Peever J, Rawding R, Sachdeva RC, Setters B, Vitiello MV, Ware JC. 2015. “National Sleep Foundation’s updated sleep duration recommendations: final report.” Sleep Health 1 (4): 233.