​Sleep
The American Academy of Sleep Medicine recommends at least 7 hours of sleep for adults each night but 1 in 3 Americans are not getting enough sleep and over 60 millions Americans have difficulty with sleep (1,2).
It is recommended that children and teenagers get more than adults and the exact amount varies with age and activity level.
Several factors influence our ability to fall asleep and stay asleep. These include light intensity and timing of light exposure, timing of food consumption (mainly carbohydrates), caffeine exposure, temperature, fluid status, body mass index (BMI), stress, and some common medical problems including mood disorders, obstructive sleep apnea, and restless leg syndrome. Rest assured, you don't need to understand the complex biologic process of sleep to improve your own sleep. Read below for some practical tips on how to get better sleep.
Tips for Better Sleep:
1. Routine. Create a bedtime routine. Same bed. Same sleep and wake time. Every night and every day. Only use your bed for sleep and sex. It's possible that a consistent wake time may even be more important than the time you go to bed every night. If you are a shift worker, this may be near impossible but you are not entirely helpless. Some biohacks for improving your sleep are listed here.
2. Environment. Create an environment that is effective for sleep. Experts recommend a dark, quiet and cool environment. Minimize factors that may interrupt sleep. To those of you with young kids, I feel your pain! Don't worry, your sleep will improve some day.
3. Exercise. Engage in physical activity every single day but avoid vigorous exercise 2-3 hours prior to bedtime. If you have difficulty falling asleep 2-3 hours after vigorous exercise, some would recommend avoiding it for even up to 6 hours before bed.
4. Light. Avoid electronics (computers, smartphones, tablets, video games) and turn off any blue-light in your home at least 60 minutes before bed. Blue light increases sympathetic tone which increases body temperature, wakefulness, heart rate, and blood pressure. If you consistently avoid electronics 60 minutes before bed but are still having a hard time falling asleep and staying sleep, I would increase this time to 3 hours before bed. If you are a shift worker in bright lit environment or your job requires you to work with electronics close to bedtime, I recommend blue-light blocking glasses 60 minutes before anticipated sleep.
5. Napping. Avoid naps at least 6 hours before bedtime and be cautious of napping during the daytime. Power naps can be helpful if you are feeling sluggish but these should be limited to <30 minutes.
6. Eating. Avoid large meals, especially salty foods and carbohydrates, within 3 hours of bedtime. Salty foods can cause a shift blood flow causing higher body temperatures overnight which is not ideal for sleep. Carbohydrate intake can alter your melatonin spike which is important for sleep. Avoid caffeine within 3 hours of bedtime. Some people are more sensitive and may notice difficulty falling asleep with caffeine after noon so get to you know your body and stop when you think it's right for you.
7. Drinking. Alcohol in the evening is largely disruptive to sleep. Stop all alcohol at least 3 hours before bed. If you are someone who chronically suffers from sleep disruption and you are drinking more than the recommended amount, you may benefit from stopping alcohol altogether for a period of time. Avoid caffeine within 3 hours of bedtime. Some people are more sensitive and may notice difficulty falling asleep with caffeine after noon so get to you know your body and stop when you think it's right for you.
8. Nighttime voiding. If frequent urination keeps you awake at night, you should try to front load water intake and decrease this as the night approaches. If slowing water intake before bed doesn't work, try avoiding it altogether 3 hours before bed.
9. Meditation. Begin to wind down from the days activities between 1 and 2 hours before your anticipated bedtime. Put the computer away, stop doing work, turn the lights down and RELAX. The practice of meditation and breath work can relieve worrying and is helpful for sleep induction.
10. Difficulty falling asleep or staying asleep. If you are having difficulty falling asleep, staying asleep, have frequent nighttime waking, or are excessively drowsy during the day this can represent a medical problem and you should meet with a healthcare professional. If you are having PAIN that is waking you from sleep it is very important that you speak with your healthcare provider about this as sleep is absolutely essential to improving your pain (yes, it's a catch 22). It is also well-known that those with mood disorders can suffer from poor sleep. If you think your mood could be affecting your sleep, please talk with someone.
References:
1. https://www.cdc.gov/media/releases/2016/p0215-enough-sleep.html
2. Foundation, N.S. 2002 Adult Sleep Habits. 2002; Available from https://sleepfoundation.org/sleep-polls-data/sleep-in-america-poll/2002/adult-sleep-habits​