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Sleep Hygiene

"You really need to sleep to keep a healthy brain because it links electrical activity to a practical housekeeping function.”

- Maiken Nedergaard Scientific American

Written by Dr.Craig Liebenson, Certified Pain Management, Rehabilitation & Sports Health Professional

CONTENTS

  • Introduction
  • How Big a Problem is Lack of Sleep?
  • How Does Lack of Sleep Effect Your Health and Performance?
  • What is Sleep Hygiene?
  • What about Blue Light Glasses Worn Near Bedtime?
  • Conclusion

Introduction

Sleep is as important.

Sleep is as important for health and performance as food or exercise. Yet while people don’t hesitate to blame their diet for energy lapses or lack of exercise for injury or performance issues sleep rarely gets the attention it deserves. Yet without proper sleep we become stressed, fatigued, moody, and more prone to injury or persistent pain. We lose focus, suffer cognitive lapses, and perform at our worst.

We spend 1/3 to 1/4 of our lives sleeping. It is one of the essential components of recovery yet there is an epidemic today of people not getting enough sleep, having difficulty falling asleep or even having insomnia.

Big Pharm has many ‘quick fix’ approaches for sleep disorders, but they all have major side effects. Natural products abound, but how can a consumer know what the actual science has demonstrated actually works, from the hype advertisements and wellness claims.

As an alternative to medications and the latest unproven remedies let’s look at the Sleep Science and what has been demonstrated to promote good ‘Sleep Hygiene.’ For our purposes Sleep Hygiene means approaches and methods designed to improve both the quality and quantity of sleep you get.

medication

In this article, we will first examine the impact of poor sleep and how it can affect your health. Then we will cover how much sleep you really need and what good sleep hygiene is all about. We will also recommend some practical measures, which you can implement into your lifestyle to try and improve the overall quality of your experience.

How big a problem is lack of sleep?

How big a problem is lack of sleep? We are in an age where there is a poverty of time. In a paper written in 2019 by Laura Giruge and Ashley Whillans from the Harvard Business School titled ‘Beyond Material Poverty: Why Time Poverty Matters for Individuals, Organisations, and Nations’ it writes -

Over the last two decades, global wealth has risen. Yet, material affluence has not translated into time affluence. Instead, most people today report feeling persistently “time poor”—like they have too many things to do and not enough time to do them. This is critical because time poverty is linked to lower well-being, physical health, and productivity.

Did you know that 35% of people sleep less than 6 hours a day. 1/3 of people have insomnia or have had it in their lifetime. Nearly 60% of athletes have mild-moderate sleep problems.

lack of sleep

How does lack of sleep effect your health and performance?

IT HAS BEEN PROVEN THAT SLEEPING LESS THAN 7-8 HOURS REDUCES COGNITIVE ABILITIES AND COULD LEAD OTHER PROBLEMS THAT ARE LISTED BELOW SUCH AS:

· Lower alertness and concentration/decreased focus.

· Pain (increased pain sensitivity/experience) (Chloe, 2023)
   42% of chronic neck and back pain patients experience sleep problems.

· Increases infection risk (increased inflammation) (Lasselin 2016) Those sleeping less than 6 h were at greater risk of developing a cold compared to those sleeping greater than 7 h per night (Prather 2015)

· Performance (increased neuromuscular fatigue)

· Increased sports injuries are associated with lack of sleep.
  Sleeping less than 8 hours/night is associated with 1.7x higher risk of injury (Milewski 2014)

· Increases the risk of heart disease (by 20%) even in non-smokers who exercise and have no genetic risk factors (Daghlas 2019).

· Metabolism (impaired glucose/carbohydrate metabolism) & Endocrine dysregulation (cortisol, anabolic – testosterone)
  It’s been estimated that adults who sleep less than 7 hours/night are 30% more likely to be obese (Ding 2018, Lasselin 2016)
  “A chronic pattern of sleep duration of ≤6 h a night has been associated with a higher body mass index (BMI)” (Papatriantafyllou 2022).

· In 1989, Ford and Kamerow’s study demonstrated that insomnia increased the likelihood of psychiatric disorders.

sleep hours

For most adults 8-10 hours is enough for maintaining good health. People in their teens (13-18 years old) need somewhat more and children between 6-12 years old need around 9-12 hours. These numbers vary from person to person and our genetics can affect how long we need to sleep each night (Fu & Ptacek 2022).

Sleep Trackers can measure both how long you sleep and the quality of your sleep (e.g. reaching REM sleep). However, in spite of their growing popularity none of the sleep measurement devices are very accurate yet. Questoinairres are often used in Sleep Clinics. But, there is no consensus yet. One widely used scale is the ‘Pittsburgh Sleep Quality Index (PSQI)’.

2 SIMPLE MEASUREMENTS I RECOMMED ARE:

1.What time do you get into bed and what time you get out of bed
2.How rested or fatigued do you feel when you awaken

What is Sleep Hygiene?

Now that you understand how important sleep hygiene is let’s go into practical detail about how you can improve your sleep quality today. Quality sleep is affected by not just your mattress, but also the way you live and the routine programmed into our daily lives. We call this day-to-day plan or habit ‘sleep hygiene.’ It is influenced by a combination of environmental, behavioral, and psychological factors in our lives. From what time you usually drink your last coffee, how much exercise you get through a week and to how long you sleep, all these factors that are apart of sleep hygiene can affect the level of restfulness you get each night.

SLEEP HYGIENE - THE BASICS

Here are my Top 4 Tips for Getting a Good Night Sleep

• Know when you get into bed at night and get up from bed in the morning
  •Sleep Trackers are inaccurate

Avoid food or alcohol within 3 hours of bedtime

Keep your room temperature a little cool

Ensure that there is minimal ambient light or sound in your bedroom

the basics of sleep hygiene

Here is a 7 Point Plan for Improving the quantity and quality of your sleep

a comfortable mattress
no ambient light

1. Find a Comfortable MattressFinding a comfortable mattress may be the easiest thing to change, since it is the physical object that we sleep on. There are quite the number of mattresses available market varying in design, materials and much more. If you are having difficulties finding the mattress that suits your needs, you can read my article on "How to Choose a Mattress" so that you can make an informed decision yourself. In general, a mattress of medium firmness is ideal for most sleep positions, but if you want to get into more detail, read that article first.

2. No Ambient Light – Ambient light can be a disturbance for sleepers, but the connection between light and sleep is greater than it may seem. Did you know that one night of moderate light exposure, which is basically having the light on during sleep increases nighttime heart rate, decreases heart rate variability, and increases next morning insulin resistance when compared to people sleeping in a dimly lit environment (Mason et al., 2022). Reducing the number of light sources in your bedroom can help facilitate better sleep hygiene. Blackout curtains may be an option. Remove alarm clocks. Finally, consider an eye mask or sleep mask.

keep your room at a cool temperature
all electronics off

3. Keep your bedroom at a Cool Temperature – Waking up from overheating is more frequent than people may think. It can be caused by a combination of reasons from seasonal, mattress design, body weight, bedding accessories and more. You could choose to use a fan or air-conditioning to regulate temperature. You may even consider mattress designs that have better airflow or have body heat transfer features such as gel-infused memory foam. Breathable sheets may help. It could even be as simple as wearing light clothing or using less covers during sleep. Evaluate temperature factors and change the ones that are practical to you to achieve an optimal sleep temperature.

4. All Electronics OffElectronics are a culprit to modern sleep problems. Whether you are playing games, reading the news or watching over stimulating content of varying genres the fact that you are in a state of focus and concentration does not help for you to be in a restful state. As mentioned previously, light sources affect sleep. Display screens that emit light of a blue wavelength such as your smart phone or tablet device disrupts your circadian rhythm and suppresses the production of melatonin a hormone that supports sleep (Shechter et al., 2017). If you want to reduce sleep latency before bed it would make sense to stop the use of electronic devices at least 30minutes to 1 hour before bed.

do not eat 2-3 hours before bed
avoid day time napping

5. Do Not Eat 2-3 Hours Before Bed Avoiding food before bedtime is a widely accepted sleep hygiene practice with research suggesting that targeting meal timing may help to improve sleep quality and potentially assist in preventing poor health outcomes (Chung et al.). Foods that can cause nocturnal awakenings such a spicy or high in saturated fats, and too much liquid before bed can cause sleep disturbances. Higher calorific intake before sleep leads to increases in body weight.

6. Avoid Day Time Napping if You Have Sleep Issues – Some people love to take a nap during the day. Research in a laboratory environment has shown that a short nap in the afternoon can increase cognitive performance (Dutheil et al.). However, you need to take into consideration the time you take the nap and the duration of the nap. If you take the nap late afternoon after 3pm or if the nap is greater than one hour it could make it harder to sleep at night. Usually when people nap during the day it is quite possible that the quality and quantity of sleep at night is insufficient, which could lead to diabetes, depression, and other issues. If you can avoid napping, but if need to make them short and around midday. Try to correct the problems of sleep that you are experiencing at night.

meditation

7. Meditation, Relaxation Routine, or Cognitive Behavioural Training Can Help – When you are anxious, tense and filled with negative thoughts it can have an adverse impact on sleep quality and increase sleep latency. This is easier said than done, considering the number of stressors that we must deal with daily from work, family and much more, but finding ways to manage an overactive mind before sleep is crucial to health and your overall well-being. There are several methods from meditation, relaxation routines or for more serious cases cognitive behavioural training to help deal with anxiety and other emotional factors that could affect sleep.

Other Additional Sleep Hygiene Tips

 Maintain a regular sleep schedule (bedtime), pre-bed routine, and regular sleep duration of 7-8 hours.

 Seek bright light during the day, especially in the early morning to reset your circadian rhythm.
  •It’s been recommended that early morning light exposure close to the horizon helps to re-set the circadian rhythm so it’s easier to fall asleep at night (Rivera 2020).
 •Let your eyes physically relax by looking at the morning horizon or a panoramic view. We call this ‘soft’ eyes. It is when you are not straining to focus on a single object but allowing the eyes to take in the expanse of your field of vision. 
  •Take in at least 30-60 minutes of direct sunlight/day.

Keep your bedroom quiet. If necessary, consider a pair of ear plugs.

• Avoid caffeine after 2 P.M. or 12 hours before bedtime (realize if you can sleep on caffeine, you’re not actually achieving deep REM sleep)

 
“To avoid reductions in total sleep time, coffee (107 mg per 250 mL) should be consumed at least 8.8 h prior to bedtime…Caffeine consumption reduced total sleep time by 45 min” (Gardiner 2023)

• Wake up at same time; even on weekends to maintain a regular sleep and wake pattern.

• Exercise during the day is the single best way to improve the quality of your sleep.

Deep sleep is often compromised by certain sleep aids such as alcohol or sleeping pills.

• A warm shower prior to bed can help you prepare for sleep by triggering the cooling process that naturally occurs during sleep.

What about blue light glasses worn near bedtime?

Although technology has solved many issues in our daily lives, it undoubtedly created other issues. Did you know “exposure to blue-wavelength light in particular from these devices may affect sleep by suppressing melatonin and causing neurophysiologic arousal…Wearing amber vs. clear lenses for 2-h preceding bedtime for 1-week improved sleep in individuals with insomnia symptoms.” (Shechter 2018).

If you’re going to be viewing electronics close to bedtime investing in anti-blue light glasses can help your sleep. You need to make sure that you have optimal levels of melatonin to sleep quickly and stay asleep throughout the night. If not, you can consider avoiding the use of electronic displays all together for at least one hour before sleep.

blue light glasses

Conclusion

There are many ways to improve sleep hygiene besides taking pills. These options include behavioral, lifestyle, diet, environmental or psychological strategies. Experiement until you find what works for you!

If you are still having issues trying to figure out where to start just make some easy changes first such as start exercising during the day and ensure that you have a comfortable mattress or sleep environment at night. If even after exploring the options suggested in this article you are still having significant sleep problems, then find a sleep professional for additional assessments and strategies.

start exercising
Dr. Craig

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