Do you struggle with sleep problems? If so, you are not alone.
Many people struggle with sleep problems from time to time. You don’t need an expert to tell you that sleep and mood are interconnected. After all, it is not uncommon to feel irritable after just one night of poor sleep! When sleep problems become chronic, however, it can increase your risk of developing mental health conditions, such as depression or anxiety. Sleep and mood actually have a bidirectional relationship. Poor sleep can lead to depression or anxiety, and both disorders also cause poor sleep. I find that helping patients regulate their sleep patterns will often lead to quicker symptom reduction for many mental health complaints.
So why is sleep so important for mental wellbeing?
Sleep is a highly complex process that affects both physical and mental health. Sleep impacts memory and emotional processing, as well as cellular and immune function. Normal sleep involves cycling through various sleep stages, including light sleep, deep sleep, and REM sleep. Each sleep phase plays a role in restoring the brain at night. Good sleep has indeed been shown to improve memory, regulate metabolism, and reduce mental fatigue. The brain consolidates memories and forms new connections during sleep. Additionally, sleep is a time when the brain “cleans house.” The clearance of neurotoxins (also known as brain waste metabolites) literally occurs at a much faster rate during sleep. In fact, one animal study demonstrated an expansion in the space between brain cells during sleep, so that neurotoxins and cell-damaging proteins can be more easily removed. Scientists have termed this process “the glymphatic system” of the brain. It has been hypothesized that this is the reason why sleep is so restorative. Who doesn’t feel better after a night of good sleep?
What factors can improve sleep?
So now that you know why sleep is so important, how can you improve your sleep? There are various practices that fall within the category of sleep hygiene. Sleep hygiene involves lifestyle modifications to support sleep. It consists of various guidelines, such as regular sleep schedules, improvements in sleep environment, and changes in bedtime behavior. Sleep hygiene is an effective treatment for insomnia, and is typically the first line recommendation to improve sleep. See below for an exhaustive list of sleep hygiene practices.
Please keep in mind that although sleep hygiene fosters good sleep, it does involve many rules. For those who tend towards the anxious side, I recommend practicing sleep hygiene, but not getting too rigid with your bedtime routine. Also, keep in mind that worrying about sleep often perpetuates insomnia. It can be helpful to remember at times that you can definitely survive one or two nights of poor sleep. You may feel grumpy or foggy the next day, but most likely, you will function.
If you struggle with excessive worrying about sleep, then Cognitive Behavioral Therapy for Insomnia may be right for you. Cognitive Behavioral Therapy for Insomnia involves challenging maladaptive beliefs about sleep and exploring specific behaviors to improve sleep. Research demonstrates that it is highly effective. Ask your therapist about cognitive behavioral therapy for insomnia, or check out a work book such as CBT for Insomnia by Dr. Gregg Jacobs. You can also use a free app called CBT-I.
Lastly, sleep aids or natural supplements are treatment options, particularly when the cycle of insomnia needs to be “broken.” If you are considering a sleep aid, talk to your doctor about the risks and benefits of both short-term and long-term use. Most sleep medications are not approved for long-term use and have been associated with health consequences with extended use.
Sleep Hygiene Guidelines
Routine
· Keep Regular Sleep/Wake cycles.
This means waking up at the same time daily and going to bed at the same time nightly. Also, sleep should happen at night, with a bedtime preferably before 10:30pm. For most people, sleep duration should be about 7-8.5 hours. Research shows that at least 7 hours is necessary for optimal cognitive function. Too much sleep can also be a problem. Set an alarm if you have the tendency to sleep more. Consistency is key. Keep in mind that variable sleep schedules can interrupt sleep architecture. This can impact the quality of sleep. It does not work well to have poor sleep habits during the week, and extra sleep on the weekends. Consistency is much better. For some people, especially those prone to mood swings, it can even be helpful to have a fairly consistent routine of eating, exercising, working, socializing, and sleeping. These habits create your biorhythms. Consistent biorhythms are crucial for those with bipolar disorder.
· Get plenty of natural daylight in the morning. This can improve your mood in the day and help regulate your circadian rhythm.
· Avoid naps, but if a nap is needed, keep it to 20-60mins. A short nap can be restorative after a bad night of sleep, but too much daytime sleep will negatively impact your sleep quantity/quality at night.
· Exercise regularly, preferably in the morning. Avoid intense exercise 2-4 hours prior to bedtime.
Avoid
· Cut down on screen time and avoid it altogether at least one hour prior to bedtime, but preferably 2-3 hours. Phone screens, computer screens, and TVs emit blue light, which tricks the brain into thinking it is daylight. This stops the natural production of melatonin, thus resulting in problems falling asleep, and staying asleep. If refraining for screen time is too difficult, you can use blue light filters for your phone or wear blue light blocking glasses in the evenings.
· Avoid artificial lighting- such as LED lights, 1-3 hours prior to bedtime. These lights also mimic natural daylight and therefore inhibit your production of melatonin.
· Limit caffeine to no more than one cup of coffee in the morning. Some people are even sensitive to one cup of coffee per day, and benefit from eliminating caffeine products altogether. Keep in mind that caffeine has a half life of about 5-6 hours. If you drink a caffeinated beverage at noon, then it will be approximately half the dose around 6pm, and not completely eliminated until a few hours after.
· Limit alcohol. Although alcohol can cause you to feel drowsy and fall asleep quickly, it actually disrupts sleep quality and is known to disturb natural sleep architecture. Furthermore, it decreases the natural production of melatonin. Even though you may feel sleepy after drinking alcohol, you are more prone to waking up more often during the night, even if you don’t remember it. Not to mention, you may wake up to use the bathroom more often.
· Minimize wakeful time in bed. Go to bed only when sleepy. If waking at night occurs for more than 20 minutes, engage in a relaxing activity with low lighting or no light, and return to bed once you are sleepy again. Staying in bed for too long when you are awake creates an association with wakefulness and the bed.
Environment
· Limit the bed to sleep and sexual intimacy. The bed should be associated with sleep, and can serve as a cue to your body that it is time to fall asleep. If you spend too much time reading or watching moves in bed, then the bed becomes associated with these other activities, and not necessarily sleep.
· Create a comfortable sleep environment. This means having a comfortable bed, a comfortable room temperature (68- 72), silence, and complete darkness. A white noise/pink noise machine may be helpful if you live in loud neighborhood. Black out curtains can help decrease light from your window. You may consider diffusing calming scents such as lavender.
· Dedicate your evening to relaxation. Use this time to read the old fashioned way (without a screen, or using blue light blocking glasses), take a bath (Epsom salts are great), sip an herbal tea (chamomile+lavender is great), meditate, or practice a restorative yoga class.
· Avoid upsetting conversations, anxious people, or media in the evening. This can lead to the release of stress hormones at nighttime, which is stimulating. Difficult conversations with a loved one, reading work email, or engaging with other stressors should wait for the morning.
· Avoid foods that are high in sugars or harder to digest prior to bedtime. As an alternative, consider complex carbohydrates that may help transport tryptophan, a precursor to melatonin, across the blood-brain barrier.
· Manage anxiety. You can do this by engaging in mind-body practices regularly. Meditation, guided imagery, progressive muscle relaxation, restorative yoga, regular massage, and tai chi are all practices that engage the parasympathetic nervous system, known as the “rest and digest” part of our nervous system. Boosting parasympathetic activity can counteract stress and lead to better sleep.
Works Cited
1. Eugene, A; Masiak J. The Neuroprotective Aspects of Sleep. MEDtube Sci. 2015 Mar; 3(1): 35–40.
2. Xie, L; Kang, H; Xu, Q; Chen, MJ; Liao, Y; Thiyagarajan, M; O'Donnell, J; Christensen, DJ; Nicholson, C; Iliff, JJ; Takano, T; Deane, R; Nedergaard, M. Sleep drives metabolite clearance from the adult brain. Science. 2013 Oct 18;342(6156):373-7.
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