Optimizing your sleep hygiene is a great measure to take and can lead to a plethora of health benefits. The information on sleep health is abundant, yet somehow many of us are still sleeping poorly. Numerous sleep tips and toolkits abound and for some that may be all you need to start sleeping soundly. However, it is vital to remember that sleep is not linear. It can’t be perfected and there will be times in all of our lives when sleep feels insufficient.
The CDC sleep recommendations for adults are 7+ hours per night yet 1/3 of the adult population does not meet these requirements. For teenagers, The American Academy of Sleep Medicine recommends 8–10 h of sleep per night. However, the percentage of high school students getting adequate sleep is only 25.4% (in 2017).
The main factors for sleep health are light, body temperature, food, exercise and social support/connection. It is no surprise to learn that what you do when you are awake determines when and how you fall asleep, and how well you stay asleep. Consistency of your daily meals, your exercise schedule, and your wake/sleep times all factor in to falling and staying asleep. Likewise pay equal attention to the mindset/ beliefs/ attitudes around sleep which has the potential to be disruptive to your sleep health.
I am writing this article to give a broader, interconnected picture of sleep health and to offer remedies for a good nights sleep. This is not meant for medical advice. If you have clinical insomnia or obstructive sleep apnea you will need further medical evaluation beyond the scope of this article.
Everything is Connected
Sleep, physical activity, and obesity are important biomarkers of one’s mental health. A recent study found that daytime sleepiness is a predictor of depressive symptoms in middle-aged and older adults. Daytime sleepiness can occur for many reasons, but is also considered as a symptom in medical disorders.
There is a multifaceted relationship with sleep, mental health, and one’s physical health. As a physical therapist, I am fascinated by the bi-directional relationship between sleep and pain and believe that a biopsychosocial approach to both sleep and pain is crucial for real change. It is a whole person approach.
The biopsychosocial model was first coined in 1977 by George Engel as a way to conceptualize a dynamic interaction between psychological, social, and biological variables for one’s mental and physical health and/or illness. It is understanding of how “suffering, disease, and illness are affected by multiple levels of organization, from the societal to the molecular.”
The Journal of Pediatric Nursing defines sleep as, ” a vital biopsychosocial state, a naturally occurring process necessary for brain activity and body functions, psychological health and behavior, and individual, family and sociocultural norms.”
When we sleep, brain cells communicate with each other in surprisingly active ways. A good nights sleep is critical for allowing the body to grow, repair, and recover. Sleep is vital for memory, immune function, and healing after injury or disease. Sleep also plays a housekeeping role in the brain to removes toxins that form when we are awake.
Good sleep remedies will not only allow you to sleep better, but can impact your physical and mental health in profound ways.
Do you have a daily rhythm? Let me guess, it includes groggily getting out of bed and stumbling to find the button for the coffee maker then splashing cold water on your face and grumbling till you’ve finished your cup of Joe.
Sleep is a rhythm. It can vary and shift. You can be consistent with your schedule and it may not be perfect at times. That’s ok, learn to adapt. Ideally you should wake at the same time every morning and get to bed at a consistent time each night.
One of the tools I have tried to implement was from a podcast with Dr Huberman about the importance of getting morning sunlight. Exposure to sunlight adjusts the circadian rhythm. This is preferably done first thing in the morning and without sunglasses or through a window. It can even help on cloudy days. See more light exposure tips below.
Another rhythm is meal time. Whether you eat breakfast or intermittent fast, the key is a consistent schedule. Meal times should occur during the most active parts of the day and not late at night before bed. You are likely to make better meal choices when you have a set eating schedule. Try planning out your meal times and do not eat about 3 hours before bedtime.
Caffeine is a rhythm for many people. It is also a stimulant with around a 5 hour half life. It’s best to avoid caffeine use in the afternoon as it can disrupt your sleep.
One last thing is to consider your sleeping environment. Is it cluttered and messy or peaceful and relaxing? How much light comes in during the night? Does it make you anxious or do you feel restful? It is noisy? Is your bed comfortable? What is the temperature like? Your environment matters. Your sleeping position on the other hand doesn’t matter so much. There is no perfect sleeping position for all, but is unique to each individual.
Mindset Around Sleep
I heard a sleep coach once say, “Good sleepers can’t tell you how they sleep they just go to bed and sleep well.” It’s so true. Sleep hygiene can become an obsessive act especially with all the gadgets and apps at our disposal now. Lose a night or two of sleep and we relentlessly pursue how to catch up on lost sleep.
Sleep loss is without a doubt uncomfortable but it is not something to fear. Life circumstances, physical health, menopause, parenthood, pregnancy, stressful events, and illness can all affect loss of sleep. Accepting your lack of sleep during these times can actually help to fuel better sleep.
All the information out now about the importance of sleep is helpful but can also be paralyzing and fear inducing. If you are hyper aware around sleep loss your beliefs around sleep. They too can act as common sleep disruptors.
- Worrying about getting a specific amount of sleep
- Feeling anxiety around sleep loss
- Obsessing over apps and trackers
- Clock watching in the middle of the night
- Decreasing social support and meaningful activity
- Worrying about a perfect sleep position
If you have excess anxiety around sleep health or insomnia seek out professional help relating to CBTi. CBTi has been shown to significantly reduce dysfunctional sleep beliefs, improve sleep outcomes as well as improve daytime functioning.
Our body temperature cycles along with the sleep-wake rhythm. It decreases during sleep and increases during wakefulness repeating every 24 hours with the circadian rhythm. This is one reason why a set schedule of waking the same time every morning and going to bed the same time in the evening is so important. Being groggy in the morning and wired at night is a disruption in the normal rhythm which can be improved upon with some of these actionable items.
- Exercise- movement trains the body’s temperature system to work effectively for sleep. So move your body daily and often. Exercise heats up body’s core temperature and then recovers by cooling it back down, thus mimicking what happens in the sleep-wake cycle.
- Bedroom temperature – ideally be between 65- 68 degrees to optimize sleep. If you can’t regulate the room temp then look into cooling pads for your mattress.
- Shower/Bath – Besides the relaxing effect there is a temperature effect. Cold showers in the morning – to heat up the internal temp. Warm/Hot showers before bed to cool the body down.
The cycle of exercise followed by recovery is the same nervous system response as awake time followed by sleep. Moderate aerobic exercise increases the amount of time you spend in deep sleep thus allowing your body to restore replenish, adapt, and learn. Just 30 min of exercise helps the body get into restorative sleep.
- When exercise hurts- When you hurt with exercise, you may not need to stop exercising but rather doing something different can make all the difference. You can also gradually expose yourself to new movement to restore the novelty in exercise. Get help from a physical therapist who can guide you into feeling more capable with exercise.
- When you have no time- Prioritize. Physical Activity guidelines for American Adults are 150 minutes of moderate-intensity physical activity and 2 days of muscle strengthening activity. Exercise doesn’t need to be as time consuming as you think. This could be broken up into smaller bits of movement more often in the day to fit your schedule. How can you add more movement into your day?
- When you are too tired to exercise- Choose movement you enjoy over movement that’s exhausting. Move your body during the times of day when you have the most energy. Avoid intense exercise at least 4 hours before bedtime as this can keep you awake and wired. Consider all the other factors in sleep health to balance your energy.
- When you exercise and still have poor sleep-This may be a sign of potentially overtraining or not getting adequate nutrition with your training load. Both are an example of added stress on the body as a whole. Take note of the stress of your daily routine and/or your mental stressors to give you an idea of where you can ask for help from your support system.
Light exposure is a powerful regulator of the rhythm between wakefulness and sleep. For a more in depth understand of light exposure and sleep, read here. Below are some actionable items to optimize light both daytime and nighttime.
- Morning light – get natural sunlight hitting your eyes within the first hour of waking preferably outside and not through a window. The sun hitting the eyes regulates the sleep wake cycle in the brain. Exposure to daylight in the morning and early afternoon supports consistent healthy sleep. Raise the blinds to let in daylight or try to take a quick break outside. Even on cloudy days, natural light has a much stronger effect than indoor lighting.
- Evening light – The recommendation is not to view bright lights between the hours of 10 pm and 4 am. In the evening keep your house lights dim.
- Blue light – Electronics stimulate the mind and make it more difficult to fall asleep. They also emit blue light which disrupts the melatonin clock at night. Blue light blockers during the day is not necessary, but night time is a different story. Using blue light blocker glasses can benefit in the evening if screens are an absolute necessity. It is important to shut off screens 2 hours before bed.
Stay connected to the good things in life. Our daily life rhythm of external factors like food, exercise, and light are important, but equally so are the ways we connect with others, with nature, and with our own self. Do not neglect joy in order to control your sleep patterns. The following ways to stay connected can optimize sleep health.
- Get outside in sunlight
- Exercise with a friend
- Engage in meaningful conversations
- Make eye to eye contact
- Pause for reflective moments throughout your day
- Be present
- Grounding practice: What do you see? What do you hear? What do you feel?
- Bed-time writing. Take 5 minutes to write out tomorrow’s to do list. Studies show that expressing future tasks in writing (rather than journaling about completed tasks) can help people fall asleep.