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.

Have you ever wondered why we sleep in the first place? 

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

Are you getting enough sleep? How much sleep do we need?

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}

How to get better sleep 

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.

 

10 Habits for Better Sleep

1. Go to sleep and wake up at the same time every day; avoid naps
2. Dim lights and stay away from screens the hour prior to bed
3. Go outside first thing in the morning for 10-30 minutes for light exposure
4. Avoid excessive amounts of caffeine after lunch as it can make it difficult to fall asleep
5. Reduce your alcohol intake, since it prevents deep regenerative sleep
6. Create a relaxing bedroom environment - keep your bedroom for sleep and sex only
7. Keep your sleeping area cool, dark and quiet
8. Eat your dinner at latest 3 hours before going to bed
9. Avoid activities in bed such as watching TV, scrolling on your phone, eating, and reading
10. Create an evening wind down routine to help you transition from day stresses to sleep 

 

Why Controlling Your Stress Matters

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

What to do when you can’t fall asleep

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.

What to do when you wake up throughout the night

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”).

How sleep deprivation can affect your health ⁵

Not getting enough sleep can be harmful for multiple systems within our body. 

• Cognitive System – When we sleep our memories are consolidated, our ability to focus and hold attention is strengthened and our performance at work and school increases. During deep sleep our brain’s trash collectors (aka the glymphatic system) is active and cleans up waste and toxins that have built up over the day. Our risk for developing dementia increases if these toxins don’t get cleaned up on a regular basis.
• Cardiovascular System – Sleeping less than 6 hours is inflammatory to our body and our hearts have to work harder due to increased amounts of stress hormones. There are higher rates of high blood pressure, coronary artery disease, and heart attacks in people with an inadequate amount of sleep.
• Metabolic System – When we sleep the hormones that control our appetite and satiety are affected. The ghrelin hormone makes us want to eat more and the leptin hormone tells us we’ve had enough food. Lack of sleep leads to higher ghrelin levels and lower leptin levels. 
• Endocrine System – Short sleepers are twice as likely to develop diabetes compared to people who sleep a normal amount. Lack of sleep creates a decline in insulin working to bring sugar inside your cells and higher levels of cortisol raising the amount of sugar in your blood. 

When to see a doctor about your sleep  

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. 

• Insomnia: Insomnia is a condition where someone has a hard time falling asleep or staying asleep. It is associated with daytime consequences such as fatigue, difficulty concentrating, needing to drink more caffeine or take naps. Acute insomnia is characterized if the symptoms have been ongoing for at least 3 days a week for less than 3 months. If the symptoms have lasted longer than 3 months, it is now considered to be chronic insomnia. Oftentimes people self-medicate with over the counter sleeping pills, alcohol, or cannabis. While these substances may help in the short term, there are consequences to using them on a long-term basis. Check out this more in-depth article on insomnia to learn more. Best treatment for chronic insomnia is Cognitive Behavioral Therapy. Use the Society of Behavioral Sleep Medicine to find a licensed practitioner in your area. ⁶

• Obstructive Sleep Apnea: Obstructive sleep apnea is a very common condition in adults that happens when the muscles of our upper airway (generally the tongue) relax at night resulting in decreased air and oxygen flow into our bodies. When this occurs, we can snore, gasp, choke for air, or even stop breathing. After this relaxation of our upper airway, the brain is signaled to increase the muscle tone which can lead someone to wake up choking or gasping. Sometimes that airway can open unconsciously and since this pattern of relaxation and opening happens throughout the night, we can wake up tired and exhausted in the morning. If you are experiencing these symptoms, ask your doctor for a sleep study. 

• Circadian Rhythm Issues: Did you know that being a night owl is also known as delayed sleep phase syndrome and is a condition that affects your internal clock (circadian rhythm)? Typically, this is defined as someone who goes to sleep after midnight and it can be observed in multiple family members. Some people who have it are misdiagnosed with having insomnia and are given sleeping pills to help them fall asleep early. However, if you can align your work or school schedule around your internal clock (i.e. sign up for the graveyard shift or night classes) your later bedtime won’t be much of an issue. If your schedule cannot be adjusted to match your sleeping preference, try this science backed approach instead. Increase your exposure to bright light in the morning to turn your clock back to be able to fall asleep earlier.

• Restless Leg Syndrome: Restless leg syndrome is characterized by a creepy crawling, electric, energy sensation in your legs prior to bedtime that gets better with movement. It is typically worse at the end of the day. Because it can keep you from falling asleep, it is associated with insomnia. This syndrome also runs in the family and is associated with low iron levels. Ask your doctor to have a blood test to check your ferritin level, which is the iron storage protein.

 

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.  

 

Image Reference:

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.

References:

1. Division of Sleep Medicine at Harvard Medical School. (2021, December 16). Healthy Sleep. https://sleep.hms.harvard.edu/education-training/public-education/sleep-and-health-education-program/sleep-health-education-40
2. CDC publishes new estimates of U.S. adult sleep duration. (2016, February 18). American Academy of Sleep Medicine – Association for Sleep Clinicians and Researchers. https://aasm.org/cdc-publishes-new-estimates-of-u-s-adult-sleep-duration/
3. Dautovich, N., Imel, J., & Dzierzewski, J. (2021). Sleep Duration, Timing, and Napping as Components of Health Sleep. In Integrative Sleep Medicine (1st ed., pp. 87–100). Oxford University Press.
4. Patel, S. (2021). Sleep Hygiene. In Integrative sleep medicine (pp. 113–125). Oxford University Press.
5. Tubbs, A. (2021) Sleep and Health. In Integrative Sleep Medicine (1st ed., pp. 17–32). Oxford University Press.
6. Dedhia, P. (2021). Insomnia and Integrative Therapies. In Integrative Sleep Medicine (1st ed., pp. 397–418). Oxford University Press.