by Valerie Cacho MD
Certified Sleep Medicine Physician
Sleep is essential for health, wellness, and longevity. Simply put, sleep occurs when our brain waves slow down, our muscles relax, and we lose consciousness. The brain itself doesn’t turn completely off, rather it controls a multitude of biological processes that recharge our bodies while we sleep. These processes allow our brains to function properly during the day, maintain our normal heart rhythms and blood pressures, support our immune system to stave off infections, and curb our appetite to reduce the risk of overeating.
It comes as a surprise to many that sleep is one of the pillars to healthy living – just as important as eating a healthy diet and engaging in regular exercise.
A good night’s rest can give you the mental clarity and energy to make healthy food choices and provides the stamina and motivation to keep your body moving. Planning a nourishing meal, choosing healthy foods at the grocery store, cooking, and cleaning afterwards is the last thing we want to do when we feel exhausted.
Getting adequate rest is a must, so keep reading to learn more about how to optimize your sleep.
Some consider sleep a waste of time believing the hours spent sleeping could have been used on more productive endeavors. However, sleep is necessary to stay alive. In addition, healthy sleep improves our brain health, stabilizes the hormones involved in metabolism, strengthens our immune system, and helps the heart rest and recharge. People who get adequate sleep have less chronic medical and mental health issues.1
Adults need between 7-9 hours of sleep every night. Sleeping outside of the recommended 7-9 hours has been shown to be associated with a higher risk for chronic medical conditions and overall poor health.
Sleeping longer than nine hours a night may indicate poor sleep quality from an underlying medical sleep disorder.
A CDC report on sleep duration found rates of adults sleeping 6 hours or less a night have been increasing. There are several warning signs that you may not be getting enough sleep. They include falling asleep when driving, forgetfulness, feeling like your brain is sluggish, making simple errors at work, fatigue, lack of energy, wanting to take a nap, being moody, irritable, grouchy or angry, and needing to drink more caffeine throughout the day. If you have any or all these signs, keep reading to discover what you can do to improve your sleep quality. 2, 3
To get better sleep at night, you must give it the focus by making it a top priority. Truly understanding how sleep works can help you adopt the habits that will improve your sleep experience. So let’s delve into exactly how sleep works by using the illustration below as a reference.
As noted in the image, sleep and wakefulness are controlled by two inborn biorhythms. The first process, the homeostasis sleep drive, urges you to sleep based on how long you’ve been awake. This is illustrated by the top half of the graph. When we first wake up in the morning, our need to sleep is typically very low. As evening time approaches, we start to long for our bed. The longer we stay awake, the more likely we are to get sleepy. Going to bed and waking up at consistent times, along with avoiding naps, helps to strengthen our homeostatic drive which results in better sleep.
The second biorhythm that controls sleep is our circadian rhythm which is based on light, darkness, and melatonin. This is illustrated by the bottom half of the graph. In my practice, I’ve noticed that people who spend much of their time indoors with low lighting can have disrupted sleep patterns. So I focus on teaching how to leverage light and darkness to improve sleep. For example, exposure to light at night can delay the release of melatonin, the hormone of sleep and darkness that helps regulate the timing of our sleep. I recommend my patients dim their lights and stay away from screens the hour prior to going to bed. Morning light is another phenomenon that helps wakefulness and signals our brain when to go to bed the following night. I recommend my patients go outside first thing in the morning for 10-30 minutes.
Daytime and nighttime habits that improve sleep quality are known as sleep hygiene. Here is a list of habits you can start incorporating to help you have a better sleep.
For sleep to occur, our brain waves need to wind down. Too much stress prevents this natural slow down and keeps us from sleeping. Stress activates our sympathetic drive (aka the fight, flight, or freeze system) which then releases our stress hormone - cortisol. Every morning we experience a normal rise in cortisol levels, as this is the signal causing us to wake up. When cortisol does its normal job, it keeps us alert. However, excessive levels of cortisol in our system in the evening, or the wrong times during sleep can lead us to wake up more often and have fragmented sleep.
Wind Down Routine: Some suggestions to incorporate in your nighttime routine in addition to brushing your teeth or taking a shower may include journaling moments from the day that brought you joy, perform gentle stretching, take a few minutes for mindful meditation or prayer, listening to a sleep story, or enjoy some herbal tea while reading to wind down before going to bed.4
Understanding why your mind can’t slowdown will provide the answer on how to fall asleep for you. Many struggle going to sleep due to emotional stresses, while others might not be sleepy enough to fall asleep yet. Sometimes the brain “just doesn’t shut off” due to ruminating thoughts or feelings of anxiety or depression. If you are unable to fall asleep within 15-20 minutes, it is best to get out of bed and only return when you feel physical sleeping cues: heavy eyelids, yawning or muscles starting to feel more relaxed.
Our brain is a wonderfully complex organ. Without our awareness, it creates associations to places or experiences that either help us relax more or become increasingly anxious. Put this knowledge to good use whenever you find yourself waking up in the middle of the night. Try to find a comfortable sleep position and relax your breathing. If this isn’t working for you and you find yourself feeling frustrated and annoyed at your lack of sleep, get out of bed. Sit in a comfortable chair and calm yourself down. When you return to bed, use mind-body practices such as visualizing a relaxing vacation, your dream relaxing place, or think through positive mantras about sleep to help you revisit slumberland (“I’m grateful for this time to rest” or “The world is sleeping and all is well”).
Not getting enough sleep can be harmful for multiple systems within our body.
One of the main reasons to talk to a doctor about your sleep is to rule out an underlying sleep disorder. Most common sleep disorders are insomnia, obstructive sleep apnea, circadian rhythm issues, and restless leg syndrome.
If your sleep condition is debilitating and you are having a hard time at work, if your relationships have been impacted, or if you have medical issues that are made worse by your sleep, seek out care from a healthcare professional.
If you think you may have an underlying sleep disorder such as obstructive sleep apnea, insomnia, or restless leg syndrome, let your provider know.
Kilduff, T. S., & Kushida, C. A. (1999). Circadian regulation of sleep. Sleep Disorders Medicine: Basic Science, Technical Considerations, and Clinical Aspects. 2nd ed. Oxford, England: Butterworth Heinemann, 135-147.