The Do’s and Don’ts of Restful Sleep
How much did you enjoy that “extra hour” of sleep we received with the recent fall back to standard time? Science has a lot to teach those of us who enjoyed it too much.
I frequently tell my patients and their care partners that sleep is one of the most important things we can do for ourselves. Of course, ‘life’ may get in the way of that—work, parenting, home responsibilities, social engagements.
Thanks to scientists hard at work in their labs, and the individuals willing to sacrifice sleep to be a part of research, we’re learning just how crucially important sleep is. In the past decade, we’ve come to learn that sleep is critical for:
· allowing us to think clearly:
· laying experiences down into long-term memory
· helping our bodies fight off illnesses
· making our moods more positive
· helping us to recover from neurological injury
· reducing seizure risk and slowing the progression (advancement) of some dementias
Sleep and Brain Power:
During sleep, our brains restore chemicals important for cognition (thinking skills). Currently, there is no ‘magic pill’ you can take to replenish these chemicals if you don’t get enough shut-eye. Our brains use this chemical during sleep while they also practice memories repeatedly. The repetitive practice allows our brain cells to convert experiences and conversations into long-term memory storage. These are primary reasons that new moms, students burning the midnight oil to finish homework or projects, and others staying up late feel more distracted for one or more days after lost sleep. Getting the right amount of sleep will make us solve problems faster, recall information better, and be able to handle more information.
Sleep and Emotions:
It’s easy to see young children becoming cranky or wound-up when they’re tired. However, fatigue and sleep deprivation affect adults just as much. Research has shown that depriving people of sleep leads them to interpret cues in their environment as being negative when they are not, making these individuals more sensitive, reactive or easily triggered, irritable, or angry. It’s important to recognize that we trust our emotional response to things as realistic and appropriate, so if we are the sleep-deprived individual, we are unlikely to recognize that we are misinterpreting things or being irrational, reactive, or overly negative.
Another consequence of chronic inadequate sleep for some individuals is the experience of anxiety, depression, and other mental health illnesses. Unfortunately, this will only compound our reactivity as well as our ability to sleep, if our minds are too busy with worried or negative thoughts.
Sleep and Neurobiology:
Many people who have epilepsy experience sleep deprivation as a trigger for their seizures. Then, after a seizure, you may find that you need more sleep. You are not alone.
Individuals who have suffered brain injuries, infections to the brain, and both small and large strokes are especially reliant on sleep to help the physical aspect of brain recovery. What’s frightening is that millions of Americans will have a silent stroke in their lifetime—that is, a stroke that they’re not overtly aware of, but that does impact either movement, thinking skills, emotions or behavior. Factors such as diabetes, hypertension, obesity, sleep apnea, and dehydration are frequent causes of these silent strokes. That means that we should all be focusing on getting good sleep.
More recently, we have come to learn that good sleep also clearly helps protect against dementias such as Alzheimer’s disease (AD), and that it slows the progression of movement disorders such as Parkinson’s disease. This applies both to the sleep we obtain during our adulthood as well as the sleep we get once we’ve begun to show signs of neurological decline. That means that being a too-busy-to-sleep adult can increase your risk of dementia later. For individuals at-risk or clinically experiencing any neurological syndrome, sleep is one of the best—and cheapest—gifts we can give ourselves!
How Much Sleep Is Ideal?
It is difficult to answer how much sleep each person should obtain because everyone is different. Some rules of thumb can help you determine if you’re getting enough sleep, though these are not ‘hard and fast rules.’ Ideally, if you’re getting enough sleep, you should:
· Awaken naturally at about the same time each day
· Not have trouble getting out of bed in the morning
· Not be cranky in the morning
· Feel rested when you wake up
· Not need to ‘sleep in’ on your day off. This is an important predictor!
· Not doze off at inappropriate times, such as during conversations, interesting television programs, or meals
· Not need naps or feel as if you run out of “brain power” later in the day
The need for a nap is less reliable of a rule, because as we get older, if we’re falling ill, if we’ve had an unusually demanding day, or if we have certain neurological conditions, we are likely to need an afternoon rest break. Read below, though, to learn more about napping.
The amount of sleep that one needs in hours varies by age, medical condition, and genetics. Believe it or not, as we get older we typically need less sleep. There are helpful charts available on the internet to describe these averages. You should not assume you’re getting insufficient sleep because you’re sleeping hours less than you did years ago. On the other hand, it’s important to be aware that those of us getting a couple of hours too little sleep every night will lose awareness that our cognitive performance drops, usually about 1 ½ weeks into this chronic sleep deprivation. This is in contrast to blatantly sleep-deprived individuals, who experience that cognitive performance drop very soon.
Abrupt or unusual changes to our sleep quantity can give us information about our physical or emotional health. Many with epilepsy know that if they have seizures at night, they may awaken and then have trouble sleeping for one or more nights afterwards. Also, when individuals with Major Depression slip into an active episode of depression, they may begin to awaken unusually early in the morning, such as 3 or 4 am when they typically sleep until 7. Similarly, individuals who are becoming hypomanic or manic (as experienced with bipolar disorder and similar illnesses), may begin to need less and less sleep over the period of days or weeks. This is typically a dramatic shift, with a change measured in hours less sleep. Using a sleep tracking device such as a watch can help you or your loved ones monitor sleep patterns.
How can we get better sleep?
Individuals often think of taking a pill to help with sleep, but research is showing that “tranquilized sleep” does not necessarily lead to better cognition. Additionally, most sleep aides—including those with happy sheep, clouds, moons, and stars on the box—are not safe for the brain. Most sleep aides work by depleting the “cognition chemicals,” which you read earlier need to be present at nighttime. Melatonin is a safe exception. It is no surprise that research is showing a highly increased risk of memory-loss dementia in individuals who use sleep aides at any point in life for a period of 4 months or longer. Toss the Benadryl and any medication with its active ingredient, diphenhydramine, from your sleep routine. Stay away from doxepin. Talk to your doctor about coming off of Ambien. Avoid medications such as Valium or Xanax for sleep if you can. Also, avoid alcohol prior to sleep, as this also disrupts the sleep cycles and can lead to early awakening.
Training your brain to fall asleep, to stay asleep, and to get better quality sleep can take time and practice, but it is possible for nearly everyone. Believe it or not, we can train our brain to know how and when to sleep; this instinct is so strong that some will eventually fall asleep instantly! The first step is to recognize that you need to commit to prioritizing sleep, even if it means making sacrifices or brining in extra help. Talk to those you live with to let them know you’re going to work on your sleep, so that they know not to interrupt you. If you’re a parent or caregiver, you may need to put a sign on your door to remind others.
Follow these additional tips to help your sleep:
1. Avoid caffeine after noon
2. Turn a bluelight filter on for all of your electronic devices after sundown
3. Have a set time to start your bedtime routine and to go to sleep, and a set time to wake up. It will take trial and error to figure out how much sleep you do need in order to set the sleep and weak times. (Add in 15 minutes a night until you find the good amount)
4. Try melatonin in 3, 5 or up to 10 mg to help you in your bedtime routine. You can take this up to 90 minutes before sleep, but some people respond very quickly.
5. Create a wind-down routine that you perform in about the same order every night. It might include stretches, washing your face with the same scented soap, reading a favorite passage, or meditating or praying. Some people prefer a 30-minute wind-down; others with stressful days or active minds tend to need more. During your wind-down, make sure others know not to disturb you.
6. Avoid having difficult or emotionally-charged conversations during your wind-down. Also avoid watching upsetting programming close to bedtime if you are affected by this.
7. Use the bed only for bed-related activities. Likewise, if you find yourself planning the next day, thinking about today, or worrying about tomorrow, stop yourself and remind yourself of the rule—the bed is not the place for that.
8. If you find that you cannot sleep, don’t just lay there, but rather get up and do something meditative, boring or fatiguing, such as reading, coloring, or completing a sudoku puzzle. Do not, however, reach for devices that emit blue light. These tell the brain to wake up.
9. If you wake up with worries, things you forgot, or solutions to your problems, write them on a notepad next to your bed and commit to tackling them tomorrow.
10. If this does not work for your, try training your brain through a method called classical conditioning. What I teach my patients is to create a playlist of music 60-120 minutes in length. This should be music you can sing along to—nothing repetitive or white noise—and music that you will not encounter on the radio while driving. Do not let this music be very emotional (happy or sad), as that will charge you up instead. Play the music in the same exact order every night. Follow along in your mind, singing to yourself in your head. When your mind wanders, just get back on track. It is natural for the mind to wander, especially when we’re stressed; don’t criticize yourself or think this means the task will not work for you. Get back to the music. It can take a couple of months of listening to the same music, but eventually you will fall asleep sooner and sooner, to the point that when you press play, you should fall asleep within minutes. When you no longer have trouble falling asleep, try stopping this part of the routine. If a big stressor happens and have trouble falling asleep, you should have the same success by turning the music on again—always the same songs, in the same order.
11. There are a number of sleep hypnosis tracks available on YouTube as well.
Lastly, if you have sleep apnea, always use your treatment, even when napping, to protect your brain.
If you have any questions, talk to your trusted doctor.
Dr. Myriam Sollman, PhD, ABPP
Board Certified Clinical Neuropsychologist