Healthy Sleep

There’s almost nothing more important for your health than good sleep. You have probably heard it before, and if you are someone who struggles with getting enough shut-eye, it probably makes you cringe every time you hear it. Sleep provides us with absolutely necessary brain-cleansing that prevents dementia, helps us think clearly during the day, and boosts our immune systems. Chronic sleep deprivation is very bad for your health, both in the short and long-term. Even though for the chronically sleep-deprived it is maddening, it is true.

There are many different reasons why people don’t get enough sleep. The first is just not prioritizing sleep. It can be hard when there are not enough hours in the day. Often parents put their kids to bed, and then need some “me time”, which often results in staying up too late so that it is impossible to get adequate sleep. Other people have chronic sleep disruptions, either from their own issues with sleep apnea, or a partner who snores or stirs often, or children who wake up frequently in the night. Another reason is anxiety or depression, which makes normal sleep difficult because of disruptive thought patterns. Sometimes it is a combination of all of these things.

Luckily you are not alone. Many people struggle with getting good sleep, and I have some personal experience and professional guidance to offer you on the topic. As a general Ob-Gyn in the US, I have had years of experience with disrupted sleep. Between 24 hour calls where sometimes I would get zero hours of sleep, my 3 small kids who pop up in the night with nightmares/fevers/bed wetting accidents, and a partner who (sorry honey) occasionally snores… it’s a recipe for sleeping poorly. In fact I did have major issues with sleep for about ten years. I would be so, so tired, but when I finally laid down to get some rest my mind would spin and I couldn’t sleep. Then I would stress about not sleeping “while I could” and it would get me even more worked up. I would try all the usual hacks (dark, quiet room, sleep aids in the form of Benadryl or Valerian root) and could usually eek out a few hours, but I would always feel groggy afterwards. Eventually, even these tricks no longer worked and I got into a patterns of not sleeping for 3 or 4 nights in a row, and then on the brink of absolute collapse I would sleep for 6 or 7 hours and then start the cycle all over again. If this story sounds familiar to you, you have my utmost sympathy. So, what can you do about it?

The first thing to do is to keep track of how much sleep you are actually getting. You don’t need to obsess, and some folks actually get more stressed about those “sleep trackers” than they are worth, but it is good to get an idea of where you are starting out. Keep a journal of when you go to sleep and when you wake up for 2-3 weeks, and then take the average of the nights. Most adults need about 7-9 hours a night to feel well rested. Napping during the day to make it up doesn’t really count. You may think you are a person who can function on 4 hours of sleep, but trust me, that is really uncommon and you are probably not getting enough brain rest to reap the benefits of a good night’s sleep. Try sleeping more by going to bed earlier, and getting up later, and see if that doesn’t help. Whatever show you are watching at night, or book you are reading, or game you are playing, set an absolute hard stop around 9:30 or 10PM so that you remind yourself that sleep is a priority and it is time to get to bed.

If you get woken up frequently in the night by someone else, keep track of that in your sleep journal as well, if nothing else by making a simple hash line on a piece of paper to track the number of wake ups. If it is your partner who is waking you up, try optimizing their sleep if they snore or have sleep apnea, and try minimizing the disturbance for you by using a white noise machine, earplugs or headphones, and see if that doesn’t help. If the problem is your kids waking you up, then you need to work on a better sleep routine for them. For older kids, a lot of times you can discuss it in a calm moment and come up with a plan. If they are having nightmares, try to come up with some solutions to minimize the chance that they will have a nightmare, and make a plan that doesn’t involve waking you up. If it is bed-wetting or night terrors, that is a bit more complicated. You can always talk with your pediatrician about methods to address these issues and see if they help. If the problem is environmental noise, try a sound-cancelling or white noise machine. It may take some getting used to but a constant background noise can make the street sounds of car horns and sirens less distinct and help you sleep through them.

Ok, so say the problem is that you are too wound up to go to sleep. This happens to a lot of people. We are so tired, and then the moment our heads hit the pillow our minds start to race. This is maddening, and often results in a vicious cycle of increased anxiety which then makes it harder to get to sleep. What do you do about that?

First, lets talk about the evidence. The craziest thing I ever heard, but that is absolutely true, is that even though sleep is super important, if you can tell yourself that if you don’t get a good night’s rest, it is not the end of the world, that can take a lot of the fear out of the situation. Sure, you want to sleep better, but think of how many nights you have not slept, and that you have somehow managed to stay alive, and it will take some of the catastrophizing out of the equation. Less catastrophizing = less anxiety = a sense of control over your life and the situation. Next, let’s talk about sleep aids. There are medications available that can make you drowsy, or even flat out knock you out (I’m looking at you Ambien) but these sleep aids don’t actually provide people with restful sleep. Sleep scientists pretty much agree, you need normal sleep cycles to provide your brain with the inflammation-soothing, toxin-removing processes that occur during a normal restful night. Sleep aids disrupt these sleep cycles and prevent your brain from really recovering. That is why many people complain of feeling drowsy or tired, even after 8-10 hours of being asleep after they have used a sleeping aid. The mind is a tricky place though, and sometimes in order to break the cycle of insomnia you may need to rely on chemically-induced rest for a night or two, but it is not a good long-term solution. It’s not that you can’t ever use sleep aids, they can be useful to break the cycle of insomnia, but they will not help you be healthier in the long run. So what to do? The answer is relatively simple, and it depends on what works for you, but there are a few tried and true solutions that work for most people.

It’s called “sleep hygiene” people. If you haven’t heard of it before, it’s a thing. Like dental hygiene, but for optimizing your sleep health. Number one, there is a general rule to limit chemicals that can affect your sleep around bedtime. These are caffeine (most people with sleep trouble should stop drinking caffeinated beverages around 2-3 PM), and alcohol. Just don’t drink heavily before bedtime. Alcohol can make you sleepy, but it’s kind of like sleep aids in that once it wears off, sometimes it causes a rebound awareness that will wake you up in the early morning hours and disrupt your sleep. These are the basic changes that help most folks. If they help some, but you still feel like you are wired from your afternoon coffee or tea, try eliminating the stimulants even earlier in the day and see if it doesn’t help. If you aren’t getting “drunk” at night but still partake in nightly alcohol consumption, give it a rest for one or two nights and see how you feel. Ok, on to the second thing: optimize your sleep environment. In general, people sleep best in cool, dark rooms that are quiet and with warm feet. I’m not kidding. Try throwing on a pair of light socks to keep your toes warm, see if it doesn’t help. There are many ways to achieve your optimal sleep-cave, and the degree of dark and quiet is up to you. I generally recommend someway to block external light (black-out curtains or sun shades). These can also help muffle outside sounds that might be waking you up. A fan is usually sufficient if your room is too hot, and make sure you are sleeping in comfortable, breathable sleepwear. White noise machines also help by blocking out disruptive noise from the environment, but some folks find them annoying. You can try out many of the available “white noise making” apps on your smartphone too, to see if you can find something that helps. While we are on the topic of smartphones that is another agreed-upon source of poor sleep. The blue-light from electronics is really bad for prepping your brain to sleep. So, try to limit exposure to screens right before bed. No TV in bed, no CandyCrush in bed, and limit your exposure in the last hour prior to when you plan on going to sleep. If you read books on your phone, try using a setting to limit blue light exposure and see if it doesn’t help. If you are binge-watching a show before bed, build in some time for your brain to relax, free of blue light before you actually plan on sleeping. Finally, if you feel like your brain is spinning and you suffer from anxiety about sleep, or about not sleeping, try journaling right before sleeping. You can journal about your day, write down that list that is running through your mind, or try a gratitude entry, write down all the things in your life you feel grateful for. All of these exercises will help decompress your stress and help you sleep.

There is also evidence that creating a “ritual” around sleep will help you to sleep better. A ritual is any pattern of behavior that is done around the same time of day, in the same sequence, and will help send your mind signals that it is time to sleep. People swear by lavender room spray, and this can be a part of your nightly ritual. I would start with the following: Get your space ready for sleep, change into your sleep clothes, do your evening hygiene (tooth brushing, use the toilet, wash your face etc), use a calming lavender spray in your room, take a few minutes to journal about your day, and then turn of the lights and try to get to sleep.

It’s also important to remember that nothing is perfect. Sometimes it takes doing these things over and over to get yourself into a healthy sleep pattern. Don’t stress about perfection. If you find that you cannot sleep, after about ten to fifteen minutes, get up out of bed, go to another room, read a paper book or journal about the fears that are keeping you awake. Do something calm, quiet and relaxing for about thirty minutes, and then try repeating your sleep ritual and going to sleep again. Be kind to yourself, know that you are not alone, and keep trying.

Good luck and sweet dreams!