Get Your Rest
"Because why do anything...if it doesn't lead you to happiness and fulfillment and stronger relationships."
This week on Beyond the Prescription I’m so excited to share a conversation with one of the most influential women in media today: Mika Brzezinski.
Mika and I discuss how she overcame adversity in her life and how she advocates for women—especially in the workplace. She also shares some advice for overcoming our own challenges with grace and humor.
Be on the lookout tomorrow for Episode 3. Please be sure to subscribe—and rate and review—on iTunes, Spotify, and wherever else you get your podcasts.This really helps a new podcast like mine get found by others.
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This morning I started dreaming about getting back into my cozy bed from the moment I made my way out of it!
How’s your Monday?
As more and more people head back into the office—and as social events increasingly populate our calendars—sleep is more essential than ever. Yet sleep is often the first thing to go out the window when we cram too many things into the day.
So today I am going to talk about sleep and sleep habits. This topic may pop up in more than one newsletter because it’s so important. None of us gets enough sleep, and everyone struggles at times with insomnia and stress about our sleep.
Sleep is the glue that holds our bodies and minds together. It’s not just a pillar of health; it’s the platform on which practically all health rests. From preventing dementia and depression to high blood pressure and heart disease, there’s no lack of hard evidence that catching adequate zzz’s is nature’s best medicine. Sleep is critical for mood, cognition, stress management, focus, attention, metabolic function, weight control—all of it.
During sleep, our brain is bathed in a special fluid that carries away toxins produced during wakefulness by enzymes that are like little sanitation workers that only come out when you are asleep. Every animal sleeps—even worms and sea snails. As anyone with a cat knows, other animals do a better job at sleeping than humans do, because they don’t scroll Twitter or have inboxes full of unread emails and unpaid bills.
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 just have at it.
The ingredients for a good night’s sleep fall into three categories: environmental, behavioral, and psychological. Each is important, and getting all three elements down pat is a recipe for success.
Environmental factors
A good sleep environment is dark, quiet, and cool (i.e. below 65 degrees). These elements are fairly easily achieved by turning down the heat or having a cooling system.
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.
If you have a pesky (i.e. snoring, up-late-reading, or sheet-thrashing) bed partner, have a frank but gentle conversation with that person about getting your needs met. And if change isn’t on the table, try earplugs and/or eyeshades!
On Saturday night I fell asleep to the “Rainforest” sound machine on the Calm app to drown out the sounds of teen voices in our basement. (My husband was 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. Others of us have brains that start buzzing with guilt, shame, or anxiety at the very time we’re supposed to chill the heck out.
Maybe we’ve been on screens right up until lights out. Maybe we engaged in a heated phone conversation just before we expected to turn in for the night. Maybe we thought we could read about the war in Ukraine and gently drift off to sleep immediately thereafter.
Nope.
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 turn the brain volume down a few points. The problem with these stop-gap measures is that prescription sleep aids produce a state that is closer to sedation and not actually restorative sleep. They can also be addictive and can cause unpleasant side effects like nighttime eating and fuzzy-headedness upon awakening. Ambien, when used regularly, can negatively affect cognition over time, so I’m super cautious about its 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 wakefullness 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. As a recent New York Times article about Melatonin explained, “Melatonin may make you feel a little drowsier when you take it, but it has a bigger impact on regulating the timing of your overall sleep-wake cycle and helping to set the circadian clock, the roughly 24-hour internal timekeeper that tells your body what time of day it is and syncs it with the outside world.”
Better than any pharmacology, though, 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 at least an hour before bedtime.
Don’t eat a big meal at least three hours before bedtime.
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.
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 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
Managing issues like stress (about things like BA.2, boosters and managing COVID risks), anxiety, burnout, depressed moods, or the fear of not sleeping itself—among other psychological issues—is the hardest element to control. (In fact, one of the reasons I’ve been writing this very newsletter for 26 months is to help people with these very issues!)
In other words, sleeplessness and insomnia are common symptoms of underlying emotional and mental health issues—for which there’s no one-size-fits-all recommendation and about which you should talk with your doctor.
That said, there are things you can do:
Set better boundaries at work. For many of us over the last 26 months, there’s no longer a hyphen—or even the word “balance”—in the concept of work-life balance. (It’s simply worklife.) Which is all the more reason to establish healthy limits on your time and your work—by talking honestly with clients, your boss, or your workaholic self.
Keep a journal. Decluttering your brain in the daytime—or even right before sleep—is a lot better than wrestling with it at night.
Reserve your bed for activities that are pleasant: sleeping, cuddling, and intimacy.
If you must read in bed (I do), limit what you read to nonviolent or not terribly upsetting books. While I highly recommend that book about the Golden Gate killer, 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.
Some of these items—like ordering black-out shades—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. 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 experimenting with it further. You might even delete an over-stimulating app or two—and find yourself less outraged and more relaxed on awakening.
I will see you next week. Until then, be well.