by Kristel Carrington, Medical Director at Mantra Health
I did not consider myself someone with sleep issues. I never struggled with insomnia, and I enjoyed sleep more than most people. I could fall and stay asleep very easily, in both public and private settings. I was that person in lectures, conferences, and focus groups who was asleep before the hour was up. My classmates teased me for my particular talent of maintaining an alert sitting posture even while sleeping. I tried to cope with fatigue by fidgeting, biting the insides of my cheeks, and drinking more coffee, but often I just gave in and passed out. This was my MO from high school through medical school. I was used to it and never gave it serious thought. With no consistent routine, I often stayed up late and told myself that I functioned well on ~4-6 hours of sleep per night. Then something changed: I met my partner during residency, and he was committed to consistently getting eight hours of sleep. I quickly adopted his habit but only reflected on it when I started noticing how this change was improving my life.
I was no longer sleepy after sitting for more than 30 minutes. I no longer craved a nap (or coffee recharge) at 3pm. No more falling asleep in lecture, my attention and focus improved, and that constant tug of fatigue was gone. I drank less coffee, felt less irritable, and I literally felt lighter. What was the difference? I was reaping the benefits of sleeping eight hours every night. Not only was it a revelation, but it is now my broken-record anecdote used when trying to encourage clients to examine and/or change their sleep habits.
Neglecting sleep is common in adolescence and often continues into adulthood. In time, sleep becomes a victim of bodily self-neglect. With busy schedules and impending deadlines many adults tend to forego sleep because they hope it will give them back something they desperately need and feel deprived of - time. If you care about improving your overall health, start by examining your relationship with sleep.
As a psychiatrist, I spend a lot of time discussing sleep in the context of depression and anxiety. Most people agree that their sleep could be “better” and they could do more to optimize it, but sleep habits are some of the hardest to motivate people to address. I practice cognitive behavioral therapy (CBT), an evidence-based treatment that helps a person recognize and examine beliefs and attitudes they have about their lives, and how those beliefs drive their behavior. I have observed common themes in what clients express about their relationship with sleep. Here are a few typical examples:
- “I just can’t get to bed earlier. Period.”
- “I need to wind down.”
- “I can function just fine on less sleep”
- “I make it up on the weekends”
- “I need my phone/iPad/TV to fall asleep.”
- “I’m avoiding having to face the next day”
Do any of these resonate with you? Once identifying these beliefs, you can examine and challenge them, a process that is important in helping someone form new and healthier habits. Be honest with yourself about these ideas influence your behavior and what the actual consequences are. Consider the examples above. Feeling deprived by going to bed early is understandable. Still, unless you have a small child or have a job that expects you to be available 24/7, what is preventing you from physically getting to bed earlier? The later you go to bed, the less sleep you give yourself to function optimally the following day, which likely results in feeling too fatigued to carry out the goals you’ve set for the day. And contrary to popular opinion, you cannot make up for a week’s worth of poor sleep over the weekend. One or two days of increased sleep does not make up for the cumulative cognitive and physiological effects of chronic sleep deprivation, a term known as sleep debt. We all engage in these habits to some degree, but once you accept that the beliefs underlying your sleep habits are not helpful, you can start to make changes. I educate my clients on the concept of sleep hygiene, which refers to a set of behaviors that one can adapt in order to form better sleep habits and/or improve sleep quality. The list below cover the most important and commonly helpful tips to improve your sleep, and ultimately, help you bring your best self to everyday life.
- Consistency: This is crucial. Try to have a consistent bedtime and wake time. Maintain that consistency, even on the weekend. This is key to conditioning your body back to its natural sleep rhythms.
- Exercise: People sleep significantly better and feel more alert during the day if they get at least 150 minutes of exercise a week.[iii] Try not to exercise (within 3 hours of bedtime, as that can interfere with falling asleep.
- Turn off the screens: If electronics are part of your current sleep routine, be aware that light emitted from our screens suppresses production of an important sleep-promoting hormone in our brains.[iv] If background noise helps you fall asleep, there are meditation and white noise apps you can download and play while keeping your screen off.
- Stock up on sleep promoting items: Environmental factors like ambient noise, poor mattress quality, abundant light through windows all decrease sleep quality. Invest in earplugs, sleep masks, black out curtains, and/or a good mattress.
- Reduce/avoid caffeine and alcohol: Though people often use alcohol as a sleep aid, it actually worsens sleep quality. Avoid caffeine later in the day (after 1pm)
- Keep naps short: Long naps during the day can disturb sleep quality at night. Think of it like a snack. A large snack before dinner time will reduce your appetite and how much you eat. Between 20 to 30 minutes is an ideal nap duration and less likely to disrupt sleep rhythms at night.
- See your doctor: If your sleep issues are ongoing despite behavior changes, or if you are considering a medication, I strongly recommend checking in with your doctor to rule out medical causes of your sleep issues, discuss medications, or getting a sleep study.
- Change your attitude about sleep: Studies show that people who placed high importance on adequate bedtimes report better sleep quality, mood, and perception of their health.[v]
- Have some self-compassion: Self-criticism does not work. If you fall short of your goals intermittently, remind yourself that you are really making efforts towards change and that it is okay to be patient with yourself.
There is a plethora of research correlating sleep disturbance with mood, anxiety, cognitive, and physical conditions. Despite my medical knowledge, I was oblivious about my poor sleep habits for a long time, and that recognition made me question what other habits I needed to examine. Embrace this self-inquiry and ask yourself where you can start making small changes. Those small changes will have lasting positive benefits.