Are You Getting Enough Rest?

The Four Ingredients for a Good Night's Sleep 💤

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Do you ever start dreaming about getting back under the covers from the moment you get up in the morning? Do you ever stare at your sleeping pets and envy their ability to effortlessly nod off?

I do. 

So, today I am going to talk about sleep and sleep habits. Why? Because none of us gets enough sleep, and everyone struggles with insomnia and sleep-related distress at some point in their life.

Sleep is the glue that holds our bodies and minds together. From preventing dementia and depression to mitigating high blood pressure and heart disease, there’s no lack of evidence that catching adequate zzz’s is nature’s best medicine.

During sleep, the fluid that bathes our brain (called cerebrospinal fluid) carries away toxins and metabolic waste that are produced during the day. The enzymes in this fluid are like little sanitation workers that only come out when you’re asleep. It’s during deep sleep—the kind of drool-on-your-pillow, near catatonic slumber—when these workers take the proverbial trash out. 

For insomniacs reading this, reminding you about the importance of sleep might create more anxiety about it, but, at the end of the day, dealing with sleep anxiety itself is an important part of getting needed rest.

So let’s have at it.

The ingredients for a good night’s sleep fall into four categories: Environmental, Behavioral, Psychological, and Biomedical. Each is important, and getting all four elements working together is a recipe for success.

Environmental factors

A good sleep environment is dark (think: blackout curtains and shades and no glowing lights from devices etc.) It’s also quiet and cool (i.e., below 65 degrees). So try turning down the heat or opening some windows. In the heat of summer, consider a floor or ceiling fan, which has a bonus feature of white noise.

Many of my patients don’t sleep well because they co-sleep with pets, and I gently remind them to (re)train their furry friends like they did their infants in order to get a decent rest. They will be okay!

If you have a pesky (i.e. snoring, up-late-reading, or sheet-thrashing) bed partner, have a frank but gentle conversation with them about getting your needs met. I have patients who extol the virtues of having separate beds in the same bedroom. One said her side-by-side twin beds are “cheaper than a divorce.” Or try two different bedrooms, at least some of the time. (Fun fact: actress Cameron Diaz is a huge fan of this approach.) If a bed change isn’t feasible, try earplugs and/or eyeshades. 

Got teenage kids who stay up late making noise? Try a sound machine. On Saturday night I fell asleep to the sound of an electronic rainforest on the Calm app in order to drown out the sounds of teen voices in our basement. (My husband was awake and on duty.) Whatever it takes to get your needs met!

Behavioral factors

Many sleep issues can be helped by changing pre-bedtime behaviors. We tend to get into bed with our minds still humming from the day, worrying about work, kids, parents, everything and nothing at the same time. Some of us subconsciously run through our to-do list at the exact moment our head hits the pillow.

When we’re wired and tired and facing the night ahead, it’s tempting to “just take something”—like Nyquil, an Ambien-type medication, or even a glass of wine to quiet the noisy brain. The problem is that prescription sleep aids produce a state that is closer to sedation and is not actually restorative sleep. They can also be addictive and can cause unpleasant side effects like nighttime eating and fuzzy-headedness upon awakening. Ambien, Clonazepam, and even antihistamines like Benadryl, especially when used regularly, can negatively affect cognition over time, so I’m super cautious about their use, particularly in my older patients.

Alcohol, while it makes us sleepy in the short-term, has other downsides and is actually disruptive to the circadian rhythm required for longer blocks of sleep. Even if alcohol causes us to fall asleep, once it is processed by our bodies, it can promote rebound wakefulness in the middle of the night. Alcohol can also accentuate menopausal hot flashes for an unpleasant sweaty 4 am awakening that no one is happy about.

I do, however, commonly recommend Melatonin, the over-the-counter version of the hormone that our brain naturally makes—but always in conjunction with other behavioral, psychological, and environmental measures. 

However, better than any pharmacology is starting with these behavioral rules of thumb:

• Try to get some sort of physical activity every day. A run or a walk discharges adrenaline, quells anxiety, and healthfully fatigues the body. Just try not to exercise in the night hours before bedtime.

• Don’t eat a large meal during the three to four hours before bedtime. (If you go to bed at 11, try to finish dinner by 7-7:30.) 

• Avoid daytime napping. The more we spend time in bed, the less your body associates it with sleepiness.

• Avoid caffeine intake after noon. Beware hidden caffeine in drinks that have black tea, like some HonestTeas, and even chocolate or some decaf coffees. Our sensitivity to caffeine tends to go up with age.

• Have an “electronics” curfew, ideally shutting off all screens an hour before bedtime—studies have shown that using a mobile phone before bed reduces sleep quality.

• Try not to work right up to the second you turn off the light, and if you must, try not to work IN bed.

• Do something relaxing right before bed if you can—like taking a shower, engaging in a pampering skin care routine, or reading something TRULY boring!

• Stick to a regular schedule, keeping your lights-out and wake-up times the same every day. Our body functions best when we’re on a routine—even on weekends.

Psychological factors

Bouts of sleeplessness can be part of the normal human experience, however persistent sleeplessness and insomnia that interfere with your quality of life and health also can be a symptom of underlying emotional and mental health issues. So it’s important to identify and manage issues like stress, anxiety, burnout, and depression head-on—by talking with your doctor and asking for support where needed. 

That said, there are general things you can do:

• Set better boundaries at work. The line between work and life can be blurry, especially for those of you who work from home. Which is all the more reason to establish healthy limits on your time and your work by talking honestly with clients, your boss, AND your workaholic self.

• Keep a journal. Decluttering your brain right before sleep is a lot better than wrestling with your to-do list during the night. Try jotting down your worries before bedtime so your restless brain can rest assured they’ll be there for you in the morning. 

• Reserve your bed for activities that are pleasant: sleeping, cuddling, and intimacy.

• If you read in bed, limit what you read to nonviolent or not terribly upsetting books. While I highly recommend reading In Cold Blood by Truman Capote, save it for a long plane ride.

• If you have to have an argument or non-boring discussion with your partner at night (realistically, this is often the time that relationship issues get sorted out), get out of bed to do it.

• Download a meditation app like Calm, Headspace, or Insight Timer. The “bedtime stories” on the Calm app are great.

• If you’ve been lying in bed for more than 30 minutes and can’t fall asleep, get up and do something else: Make a cup of herbal tea, read in the other room, listen to a relaxing audio story. Try to stay off your phone or other screens, and then try again in another 30 minutes.

Biomedical factors

Don’t assume your insomnia is all your fault! Insomnia can be caused or exacerbated by various medical conditions. Some common examples are chronic pain; neurological disorders such as Parkinson's disease, Alzheimer's disease, or restless legs syndrome; digestive problems like acid reflux (GERD) and irritable bowel syndrome (IBS); respiratory disorders such as asthma or sleep apnea; and hormonal issues like hyperthyroidism, perimenopause, and menopause. 

In addition, certain medications are known to be stimulating, such as ADHD medications (Vyvanse, Adderall, Concerta); Decongestants (Sudafed/pseudoephedrine or phenylephrine); Antidepressants (Wellbutrin and, less commonly, SNRIs like Effexor or Cymbalta); Thyroid medications (Levothyroxine, Synthroid); Corticosteroids (Prednisone, Medrol, Dexamethasone); and Bronchodilators/Inhalers (Albuterol, Salmeterol).

Of course not everyone will experience insomnia as a part of the above medical issues, and not everyone develops sleeplessness as a side effect from the above medications. However, it's essential to raise these issues with your doctor and to problem-solve your insomnia with an open-minded, whole-person approach. 

The upshot?

Some of these suggestions—like adjusting your thermostat or taking your Wellbutrin tablet before noon—are quick and easy. Others—like setting an electronic curfew—are easier said than done. And others—like reforming a snoring bed partner—may be close to impossible.

So just do the best you can. Don’t let “perfect” sleep be the enemy of “good enough” sleep. And remember that this is a process. For example, even if you can only manage a 15-minute window of screen-free time before bed, it’s well worth trying. If you notice it helping just a wee bit, you might try taking it further. You might even delete an over-stimulating app or two—and find yourself less agitated and more relaxed on awakening.

In the meantime, I (for one) will remain envious of my blissfully sleeping cat, who doesn't scroll Twitter or have an inbox full of unread emails.

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Disclaimer: The views expressed here are entirely my own. They do not reflect those of my employer, nor are they a substitute for advice from your personal physician.