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SLEEP HYGIENE

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What is sleep hygiene?

This is the full range of conditions and behaviors related to sleep that you can generally control.

These include sleep habits, environmental factors, lifestyle choices, and bedtime rituals.

Why does sleep hygiene matter?

Sleep hygiene is the first place to look for ways to improve one’s sleep health. Many problems with sleep can be eradicated by tending to one’s own sleep hygiene.

Often, doctors will ask patients with sleep problems to account for their sleep hygiene first before moving forward with diagnostic testing or prescribing therapies for their sleep problems. This usually means the patient will keep a sleep diary which reports activities of daily living like eating, alcohol consumption, prescription use, current medical condition status, and exercise, as well as sleep habits.

Fixing poor habits can often take care of most patients’ sleep problems, or at least reduce their impact on overall health.

How do my electronic devices impact my ability to sleep?

Electronic devices emit blue spectrum light, which automatically disrupts the function of the pineal gland.

The pineal gland requires the natural dimming of daylight in order to function. Located in the center of the brain, the pineal gland is responsible for melatonin production.

Melatonin is the hormone most responsible for sleep. Even 10 minutes spent checking your email at night can have a major impact on your pineal gland’s ability to generate melatonin, as blue spectrum light is the brightest type of light.

It is recommended that you turn off handheld electronics with screens one hour before bedtime to allow your brain to properly generate these natural sleep hormones.

Electronics most commonly related to disrupted melatonin production include smartphones, tablets, handheld games, and laptops, which are typically backlit.

If you need to read at night to relax, try:

  • reading paper books or magazines
  • using an e-book reader with so-called “electronic paper,” which does not emit light
  • filtering your book light (many emit blue spectrum light!)
  • wearing “gamer’s glasses” or other eyewear with blue-blocking lenses
  • changing light settings on handheld devices; many now offer a blue light blocking feature

Sleep hygiene considerations

Consider the following habits and how they can impact the quality and quantity of your sleep.

Time of day when you go to bed or rise

Bedtime should correspond with how sleepy you are. This is because your body generates a “sleep drive” based on how much you have slept previously (including last night’s sleep and the day’s naps). This buildup of the need to sleep resolves by going to bed when sleepy.

Rise time, by contrast, should be consistent every morning. This is so that one’s circadian rhythms can reset by the light of the morning sun, an important circadian calibration the human body needs daily. 

Pre-sleep rituals

What you do before bed has a major impact on how you will sleep.

If you decide to watch an intense or scary movie before bedtime, use your electronic devices (see above), have an emotionally charged conversation with a loved one, or find the day’s events make it hard for you to “turn off” your brain, then you are more likely to have difficulty sleeping.

However, if you take some time to find ways to relax, the odds you will fall asleep easily improve dramatically. Relaxing shouldn’t be a complicated process. There are rituals and habits you choose and can practice with little or no investment.

Easy ways to practice relaxation include:

Diet and time of last meal

Eating a fat-laden, high-calorie meal at dinner time or right before bed can lead to regular problems with Gastroesophageal Reflux Disease (GERD). GERD is a well-known sleep disruptor.

Midnight snacks may seem comforting for some, but these can also be problematic for sleep as the digestive system and liver function differently during sleep and may not respond well to calories, protein, and fiber introduced at a time when the body should be asleep.

Try to eat at least two hours before going to bed at night to stave off these digestive issues, which can seriously disturb your sleep patterns and lead to other problems.

High-sugar snacks just before bedtime can also have a detrimental effect on your sleep, so avoid these as well.

If you are diabetic and require carbohydrates well past dinnertime, choose healthy options and consume the minimum necessary to reset your blood sugar.

Exercise habits

Daily exercise is great for sleeping better, especially if it’s done outside in natural daylight and fresh air.

However, you don’t want too rigorous exercise right before bed. Your body’s internal temperature follows a specific pattern during sleep and any exercise-related increase in your internal thermostat at bedtime could lead to undesirable changes in sleep architecture.

In addition, exercise can be highly arousing because it stimulates hormones like adrenaline, which generate alertness for as long as two hours after you have exercised.

Regularity of sleep schedule

Sleeping in on weekends always sounds good, and especially if you are up too late on weeknights tending to work or studies.

However, though you will want to sleep longer on weekend mornings to make up for lost sleep during the week, you can also inadvertently mess with your sleep schedule by doing so.

Why? More than a couple of extra hours of “sleep in” time can disrupt your circadian rhythms and even shift them too far in the wrong direction, making it harder to recover on Monday morning. This is why people experience something known as “social jet lag,” or more commonly, the “Monday morning hangover.”

Though the term relates to people who tend to keep very late hours on Friday and Saturday nights, it refers to anyone who spends the weekend off their normal schedule.

It is better to rise at your usual time on the weekends and then go to bed earlier to make up for that lost sleep and recover from sleep debt. Barring that, try to keep your hours as consistent as possible. An occasional night out is not going to set you up for sleep problems. It’s when you routinely shirk a normal sleep-wake schedule that you run the risk of long-term deprivation, which results in sleep debt.

Caffeine, alcohol, cigarette, marijuana use and sleep

Caffeine

It goes without saying that consuming caffeine products (coffee, tea, chocolate, cocoa, caffeinated sodas, energy drinks, caffeinated food products) will overstimulate your system and keep you awake. Put five hours between any consumption of caffeine and your bedtime for optimal results. If you are caffeine sensitive, keep in mind that even decaffeinated products still contain a tiny amount of caffeine.

Alcohol

It’s also true that alcohol before bedtime, known as “having a nightcap,” can mess with your sleep stages.

Alcohol may help us fall sleep, but once it’s metabolized, the body goes through a withdrawal period. This severely disrupts the sleep architecture in a way that can deny your brain and body enough deep sleep to maintain optimal health.

Besides that, it often means getting out of bed multiple times to use the bathroom. This is known as nocturia.

Nicotine

Nicotine may help some smokers to relax before bed, but cigarettes have a dual effect on the brain; they both stimulate and depress certain areas of the brain. It’s advised that smokers have their last cigarette at least 30 minutes before bedtime to avoid this problem.

It’s also well known that people who smoke also generally have more problems with respiratory health. Those with asthma, chronic bronchitis, emphysema, pulmonary hypertension, and chronic obstructive pulmonary disease are more likely to experience inflammation in the lungs and airways at night, which can significantly impair sleep health.

Marijuana

Results are not conclusive about the use of marijuana (medicinally or recreationally) as a sleep aid. Much remains unknown about how the cannabinoid compounds found in marijuana influence the brain and body during sleep. We know that marijuana is relaxing, but it can also have a stimulating quality (like nicotine). It has been shown to alter sleep architecture in ways that are similar to alcohol.

Nap habits

Naps are extremely useful for children as they transition from intensely different sleeping patterns at birth to the sleep-wake cycles of adults. This period references the time when sleep consolidation takes place, pushing sleep cycles to the nighttime hours and to a period in the mid-afternoon.

Naps are also useful for the elderly and for the chronically ill to combat fatigue. For these people, planned naps are often prescribed.

However, napping during the day for people who are otherwise healthy can interfere with their sleep drive. The more (and later) one naps during the day can influence one’s ability to fall asleep at night.

Planned “make up” naps meant to pay off some sleep debt recently acquired from an “all nighter” aren’t necessarily bad as long as they don’t become habitual. Nor are naps taken intentionally to prepare for anticipated sleep deprivation (the case for night shift workers who “sleep ahead”).

Also, if you are extremely fatigued, taking a quick “cat nap” of 10 to 20 minutes can keep you from risking dangerous judgments or behavior on the job, at home, or behind the wheel of a car. Just don’t make it a habit.

Note: Unplanned naps (meaning, someone has a full day planned, but still needs a nap) can be considered a symptom of an unidentified sleep disorder or other medical condition.

If this is your case, and you cannot identify another reason why you are so sleepy during the day (a medication or drug interaction, for instance, or another medical condition), you need to address this with your primary care physician.

Use of sleep aids

Nonprescription sleep aids

It’s always important to remember the following about using over-the-counter (OTC) medications to help with sleep:

  • Nutritional and “natural” OTC sleep aids are still drugs with potential side effects.
  • Nutritional and “natural” OTC sleep aids may interfere or interact negatively with your current prescribed or OTC medications. Please consult a pharmacist before using them to make sure you don’t do more harm than good.
  • Melatonin is generally recognized as safe (GRAS), but most sleep health professionals disagree on its most effective dosage. Also, because melatonin enhances circadian influences on sleep, its timing with the earth’s light-dark cycles, as well as your nighttime behaviors, will influence how effective it is. Taking melatonin, then sitting at your computer for an hour answering email right before you go to bed, is not going to work, for instance.

Prescription sleep aids

There are all kinds of pharmaceutical drug classes that physicians turn to in order to find the right aid for sleep (or alertness). These include:

  • anxiolytics
  • stimulants
  • antidepressants
  • antipsychotics
  • antihistamines
  • hypnotics
  • narcotics
  • sedatives
  • barbiturates
  • opiates
  • anticonvulsants
  • dopamine agonists

All of these medications may prove to be very powerful and dangerous when taken with other medications.

However, the medications prescribed for sleep have become much safer and less addictive than those prescribed in the past. Consult with your doctor and your pharmacist before taking any of these medications to ensure they are the best, safest option for improving your sleep.

For more detailed information about prescription drugs and their impact on sleep, click here.

Stress management

Often, the trouble with sleeping comes from daily stress that remains unresolved over time. Stress and anxiety is at the top of the list of reasons why people have “racing thoughts” or struggle to fall asleep.

Relaxation (see Pre-Sleep Rituals, above) is a skill that we all need to master in the 21st century. Whether it’s politics, natural disasters, war, economic stress, relationship problems, medical conditions, or any other long-term disruption to one’s life, knowing how to relax is absolutely essential to one’s physical, emotional, and psychic survival.

Seeking help from a therapist, who can give you tools for dealing with the stress of life can lead to improvements in better sleep overall. This can be achieved through cognitive behavior therapy, which has been shown to be an effective solution for insomnia.

Use of bedroom outside of sleeping/sex

If you have an office in your bedroom, or a TV, or a computer, you might find you live at odds with these distracting activities when it comes to getting quality sleep. Most care providers recommend that your sleeping space be used only for sleeping and intimacy as a way to avoid this problem.

Environmental impacts (comfort, light, noise, air quality)

Comfort

Obviously, you are not going to sleep well if your mattress is too hard or too soft, or if your pillow gives you allergies.

Keeping your room clear of clutter, painting it a relaxing color, and decorating it softly are all ways to make it a more comfortable sanctuary conducive to sleep.

It’s especially helpful to keep pets and children out of the bedroom if their presence is disruptive to your sleep.

Room temperature should also be even: too warm a room can prevent certain phases of sleep from occurring, as your body temperature normally decreases over the course of the night and should be allowed to do so.

Having multiple blankets to add and subtract for comfort is highly recommended, as are ceiling fans for summer sleeping.

A room that is too cold may make it impossible to fall asleep, so make sure you dress accordingly, if you find yourself in this situation.

Light

If there’s a lot of atmospheric light in your bedroom, try to find a way to change the situation by using window treatments, room darkening shades, or blinds, or an eye mask.

Turn your alarm clockwith its glowing numbersaway from you so that you can’t see it at night; you don’t need to know what time it is while you are sleeping anyway! If you use your smartphone as an alarm, charge it in your closet or bathroom: this forces you to get up to turn it off in the morning and prevents peeking at blue light and stimulating apps when you should be sleeping.

Exposure in your bedroom (the direction your window faces) can also dictate how easily you get up in the morning. If you have a bright eastern or southern window that’s not blocked by buildings and trees, you will want to find ways to darken it so the sun doesn’t wake you up too early. If you have a dark northern or western window, you may wish to go without window treatments at all.

Noise

If there’s ambient noise in your room, do what you can to shut it down. That might mean unplugging appliances that create a humming noise, removing pets to a different room, or repairing leaky faucets or rattling, squeaky doors or windows.

Outside noise from the street an also be a problem. Ask your neighbors to be quiet; teach your kids and train your pets to respect quiet time at night.

Don’t listen to talk radio or stimulating music at night; though it can be soothing for some, it can also be distracting or stimulating at a time when you should be relaxing.

White noise machines and the sounds emitted from a fan are helpful to block out noise you can’t control. If you find the sound of crickets or frogs outside your window relaxing, by all means, crack your windows. Some people also find car noise in the city relaxing.

If your partner snores, try wearing ear plugs. (Even better: record their snoring and prompt them to get a sleep health assessment, as they may have unidentified and untreated sleep apnea.)

Air quality

If you live in damp areas, molds and mildews can create congestion problems at night. Any kinds of allergens in your bedroom should be reduced, or removed entirely, whenever possible. Regular vacuuming is a useful practice for keeping carpets allergen free.

If you live with a smoker, please have them smoke outside and away from bedroom windows.

Those who live in areas where air quality can be an issue (summer wildfires, winter woodstove smoke) should invest in household air filters to prevent breathing problems during sleep.

After a hot summer (with air conditioning recycling the indoor air) or after the winter (too cold to crack windows), use the first best chance to air out your home by throwing open your windows. Letting fresh air into your home after long periods helps improve the oxygen content of your home, which will also improve your sleeping conditions and your overall health. Air quality can be significantly reduced if one’s home has been shut up tight for weeks.

Even dirty laundry can be problematic to air quality; remove it to another room if you can’t wash it right away. Odors are caused by compounds that can become airborne and congest your nasal passages or irritate your lungs and bronchial passages.

If fragrances from laundry soap, candles, aromatherapy products, decorations, or other items leave you with a stuffy nose, keep them out of your bedroom.

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2 Comments on SLEEP HYGIENE

  1. Side sleepers should attach a knee pillow between their knees, to align their hips preventing pain (back, hip, knee) from disturbing their sleep. Sleepy Kneez

  2. Good advice, Eileen, with so many good orthopedic pillow options out there, it should be easy to find the right pillow to match the right use!

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