Hello, friends! There are several episodes of the podcast that I refer back to constantly. Episode 26, where I talk all about sleep is one of those. I talk about it in other podcast episodes, I talk about it with my patients, and I talk about it with people in my daily life. It turns out that at 180 episodes of the podcast so far, episode 26 is kind of hard to find. A lot of podcast players only keep the most recent 100 episodes. So, I’m re-doing it. This is not a re-release of that episode, but a re-recording of it with some new thoughts added in.
Before we dive in, I wanted to point you to another great resource. Dr. Matthew Walker, a professor of neuroscience at UC Berkeley who specializes in sleep, did a series of interviews on The Peter Attia Drive. Peter Attia is a Doctor who hosts his own podcast and talks about all sorts of things related to health, longevity, and wellbeing. It’s a really interesting show and often goes very deep into the details of the topics he discusses. In an interview series across three episodes, Matthew Walker and Peter Attia go way deeper into sleep than we will here and so if you’re in the field in some way or are just super interested in delving deeper into sleep, I highly recommend listening to these episodes – the first of which is episode 47!
All about sleep
Sleep is massively important for a variety of issues but for one reason or another, people kind of suck at sleep these days! It’s not necessarily a new thing but it’s one of the most common complaints I see in my clinical work and in my daily life – it’s a big deal. We’ll get into the whys shortly, but sleep is very important and you’re not alone if you struggle with it. I used to be really bad at sleep – in college and grad school I would get by with only a few hours of sleep…it would even be common for me to be online doing a live stream at 2 or 3 in the morning and then get up at 6am to drive to school. Not a great idea! But now I am actually pretty great at sleep. I don’t suffer with insomnia, I rarely struggle with sleep maintenance (staying asleep through the night) and I don’t dread going to sleep like I used to – it’s become a normal thing and I enjoy it!
One thing that I have found is the amount of intervention that you need to do is going to differ depending on how much you struggle and what exactly you struggle with, and there is often a barrier that you have to overcome. The thing is, your body gets used to being in a particular rhythm and if you’re not sleeping well then your body gets used to not sleeping well, and that becomes the ‘comfortable’ zone to be in. If you can break through that barrier and get into a good rhythm of sleeping well, it is possible to teach your body that you have the capability of sleeping well. When this happens you can often back off on the rules and some of the strict things that I’m going to talk about here. That’s where I’m at right now…I’ve proven to my body that I am able to sleep well and so I don’t need to do all of the things I’m suggesting. However, sometimes I might go through a period where I struggle again and in these instances, I would start putting some of the rules back in place and be a bit stricter with them. So it’s a case of addressing the issues as they occur.
Why is sleep important?
It’s important for a number of reasons…
Memory: The hippocampus is a part of your brain that’s involved with memory consolidation, meaning you learn things throughout the day and it helps you to transfer those memories into your actual storage. In some instances, this process can be inhibited. Alzheimer’s Disease, for example, is a degenerative brain condition that interferes with the function of the hippocampus meaning when somebody with this disease tries to learn something, it never makes it into their storage as they don’t have the ability to process memories like they used to. This process of consolidating your memories primarily happens during sleep. Therefore, if you’re not getting good or adequate sleep it can negatively impact your memory. In my practice as a neuropsychologist, I see a lot of people with memory problems who have them simply because they do not get good sleep. When your sleep is negatively impacted, whether it be through sleep apnea, narcolepsy or any other factors, it can actually appear as though you have dementia. In reality, it’s a temporary issue that’s caused because you’re not allowing your brain to consolidate those memories and put them into storage. Therefore, sleep is really important for learning and skill-building, consolidating everything you learn and do during the day.
Mental Health: Battling mental health problems is tiering in itself. Adding a lack of sleep into the mix can make it even harder to deal with. Take depression, for example, where you are trying to implement things to be more productive in increasing your wellbeing such as going for walks, being more active or picking up new hobbies. If you’re suffering from lack of sleep it’s going to make it even harder for you to do, especially when you add it to the lack of motivation that often comes with depression. So sleep is super important to help you continue with that fight and recover after each day.
Physical Health: There are a variety of physical issues that are associated with poor sleep that I’m sure you are familiar with, but one thing I was unaware of until I listened to the interview podcasts with Matthew Walker is that there is a really interesting process that happens in your brain while you sleep. There are cells in your brain called glial cells – research has found that during sleep these cells slightly shrink to create channels that allow your cerebral spinal fluid to flow through and wash away plaques and tangles (debris, bi-products of cells dying off). A build-up of these plaques and tangles is associated with diseases such as Alzheimer’s and so, in a way, this is a natural process that removes these from building up and therefore reduces your risk of developing something like a dementia condition. Therefore, if you’re not getting any sleep, not only does it impact your memory, but you continue to build up these unwanted bi-products which increases your risk of developing a degenerative condition such as Alzheimer’s.
Quality not Quantity: A final word before we look at what you can do to get better sleep – it isn’t necessarily the amount of sleep you get that matters, it’s the quality. If you’re not able to get down into those deeper levels of sleep where all these important processes take place then you’re not going to benefit as you should.
Improving your sleep hygiene – Tips for better sleep
Sleep hygiene is the term that we use to describe the behaviors that tend to promote good sleep. Therefore, if you hear somebody saying they have good sleep hygiene, it normally means they have good behaviors associated with getting better sleep. There are a few things you can do to improve your sleep hygiene and if you stick to them, they’re going to work…but you need to follow the advice!
When getting good sleep, the name of the game is association. Association is the term that we use to describe the process by which your brain basically pairs two things together. With sleep we want you to have a strong association in your body between certain behaviors and the process of going to sleep. Therefore, a lot of these tips are really going to focus on consistency – keeping things consistent and building that association over time. So the first tip…
Keep a consistent pre-sleep routine: It’s important to keep a very consistent routine prior to going to bed. Being consistent with this routine is important as the more you do it, the more you will begin to associate that routine with going to sleep. By doing so your body will start to recognize the signals that mean it’s time to start preparing for sleep. Everybody’s sleep routine will likely differ slightly, but it’s important to stick with. For example, the final part of my sleep routine is washing the dishes and then brushing my teeth/taking out my contacts and then getting into bed. By the time I get into bed, my bedtime routine has prepared my body for sleep. If you can make most of this routine portable (i.e. you can do aspects no matter where you are) then this will also help when your not home or sleeping in your own room. Along these lines, keeping a consistent sleep and wake time is also important as this will help keep your body in a set rhythm which will improve the more you do it – It might suck when you are not getting great sleep, but it will help to force your body into a regular rhythm.
It can also be possible to incorporate some ‘bad’ sleep routine habits if you keep them consistent every night. For example, in the past I have used an iPad in bed as part of my pre-sleep routine where I would do puzzle games or crosswords. Keeping this consistent each night and only using the iPad in bed to play these games meant my body associated this process with preparing for sleep. The same applies to mobile gaming, reading, anything that may not necessarily be thought of the best thing to do right before bed – if you’re doing the same thing every night you can train your body to expect sleep to follow. Again, I stress the importance of being as strict as you need to be. If you’re sleeping fine you can be a bit more lapse on this, but if it’s not working then tighten up as much as you can and follow the rules more strictly to try and promote good sleep. And if somethings not working for you, then don’t do it! Try a different option. For example, if you find using an iPad agitates you more, then obviously that isn’t working for you. Whatever you do, try to keep it as consistent as possible in terms of the activities you’re doing and even the order you do them in, as that consistency is going to help train your body to expect sleep once that sequence finishes.
Beds are for sleeping: Keeping on the theme of association, your body doesn’t naturally associate a bed with sleep, so you need to train it to. To do this successfully, you need to try and avoid non-sleep activities in bed, such as working on your laptop or checking social media. Your bed should be about sleep, and perhaps sexual activities, but definitely not work. If you’re having trouble sleeping this is the first thing you should look at – are you spending a lot of time on your laptop in bed? The more you do things that aren’t relaxing or related to bedtime, the more you are weakening that association between sleep and bed and so we want to try and avoid that. It doesn’t mean you can’t watch tv or read before bed but do it somewhere else, such as in a comfy chair, and then go to bed to sleep, as that’s what beds are for! It’s a balancing act and you have to explore what works for you, but if you’re struggling with sleep then you need to strengthen this association as much as possible.
Switch off and disconnect from the world: Your bedroom is exactly that…yours. The world has no place there, especially at night when you are preparing for sleep in order to recover from the day. You want this to be your time. The world will be there tomorrow. So, try to enforce a ‘no phones in the bedroom’ rule. Generally, there is just no purpose in taking your phone to bed other than to increase the risk of ruining your night. The last thing you need to hear lying in bed is the buzz of notifications or the opportunity to glance at social media. If you use it for wake-up alarms or in case of emergency, there are other options. You could get a regular digital clock, or keep an old flip phone as an emergency point of contact. Unless you’re an emergency technician of some kind, such as an emergency plumber or a doctor on call, there isn’t really a place for phones in the bedroom. If your phone is there you can almost never relax as you are always on notice for something to happen – so do your best to avoid taking your phone in the bedroom unless you are being very responsible with it. But if you have no self-control and just can’t help looking at the news or checking your email one last time, then it’s best to take it out completely. After all, unless there is an immediate emergency that impacts you right now, there is nothing that can’t wait until tomorrow.
Create a wind-down period: Ultimately, you need to keep your nighttime sacred and stick to routine, and what I find helps with this is having a wind-down period before bed – 30 minutes to an hour is ideal, but however much you can set aside. So even before the immediate sleep routine of brushing your teeth and stuff like that, it can be helpful to unplug from the world up to an hour before going to bed and start to calm down, shed the stress of the day and disconnect from the world, starting that transition into sleep and rest mode. Check your phone one last time and then leave it alone. Do some things that are related to resting that you find relaxing. This can include carrying out breathing exercises, doing guided relaxations, stretching while listening to some calming music, or even something like playing with your dog, arts and crafts, working on a puzzle, reading or watching a bit of tv (not the news!). Just anything that helps keep you calm and unwind from the day.
I think journaling is something that fits into this time very well. If you’re the type of person who has just too many thoughts in your head when you lie down to try to sleep, thinking about things you have to do the next day or anything you have to keep track of…that can impact your sleep. If you haven’t resolved things from the day, your brain will hold on to them and try to work them out while you sleep, which makes it hard to stay asleep at night. So if you give yourself a chance to write it down on paper before bed, it provides an opportunity to acknowledge your concerns, worries, plans, to-dos, and anything else that is swirling around in your head, so that you don’t take it to bed. This can be as structured or as unstructured as you like, the important part is just getting it down. One thing I would say though is to do this as early as possible in your bedtime routine. It can be a little agitating to bring all this stuff up, so I don’t want you to go from writing straight into bed. Doing it at the beginning of your routine allows you to give yourself permission to leave it on the paper, relax and prepare for rest.
So creating the perfect bedtime routine, you start by journaling and then you spend the rest of that hour doing relaxing things and before you transition into that very consistent sleep routine that I have talked about, and then get into bed and go to sleep.
Don’t battle with sleep
Sometimes people have a fine time falling asleep and the issue is they wake up, or they lay in bed and sleep just doesn’t come at all. If you’re having trouble like this, you have to try and not have a battle with sleep. When you try harder to sleep, you often find it even harder to actually sleep and become even more stressed. Then the more you worry about not sleeping, the more you transition back out of that restful mode for sleep. So if you find that you are fighting a battle with sleep, what I would say is try and do it over again. Rather than staying in bed and trying harder to sleep…get out of bed, stay disconnected and do something relaxing – grab some water, do some deep breathing, and engage in a relaxing activity like a crossword puzzle, doodling, reading, star gazing, etc. Take 10 minutes out and then try to go back to bed again. At this point it isn’t a continuation of trying to get to sleep, it’s you starting over – you’ve reset and you’re going to try and go to sleep again. Even if you have to take multiple breaks like this, it will likely still equate to more sleep and less frustration in the long run. When you just try to push harder to get to sleep, you end up staying awake for hours and you get more and more frustrated, which doesn’t help the situation.
Exercise: For many people, exercise right before sleep isn’t a good idea because it gets your body elevated and perks you up rather than calming you down. But getting more exercise during the day is definitely something that is associated with getting better sleep.
Get outdoors: If you’re somebody who doesn’t get a lot of sunshine or spends a lot of time indoors, it may help to get outside, especially during the evening when you can watch the sunset. Through the day the hormone melatonin builds up in your body. Once this reaches a particular threshold it signals to your body that it’s time to sleep. There are a lot of things that can naturally help this happen, one of which is being outside. Seeing the sun go down actually helps your body kick start that melatonin cascade that’s going to eventually make you sleepy. So if you can encourage this process and get your body trying to produce melatonin, when you start to do all of these other things that we’ve talked about your body’s actually ready to start getting sleepy.
Caffeine: Even if you feel caffeine doesn’t make a difference to you – it does. Physiologically it changes the way your body is working and ultimately is a stimulant. Therefore, we want to avoid caffeine in the afternoon and evening as we head towards bedtime as it can certainly interfere with your sleep. It also mimics the effect of anxiety and so this should be taken into consideration.
Discussions: Try to avoid big, lifechanging discussions with your family and loved ones in the evening or before bed. It’s always better to do this earlier in the day, or if you need to, journal about them first and then try to put them aside for the following day.
Substances: It’s always best to talk to your doctor about this before incorporating any new supplements diet. But there are substances you can take like melatonin supplements which can help aid the sleep process and have been shown to be very effective. Also, you can try CBD products – CBD being the compound in marijuana that is not psychoactive and so doesn’t make you high. The research is young but these have shown very promising, low-risk results in helping with sleep. Again – always discuss with your doctor. I would tend to avoid the use of alcohol or sleep medication as a sleeping aid as these can be very good at getting you to sleep, but you often don’t get the quality sleep you need through the night.
That pretty much wraps up my tips for sleep – I’ve talked about a lot and so hopefully there will be some aspects that you find helpful. I will just reiterate that sometimes if you’re struggling with sleep, what it takes is getting really strict with this to prove to yourself that you’re not somebody that sucks at sleeping. Once you break through that barrier you can ease off on a few things and can get away with some aspects that are considered bad sleep behaviors if you do them consistently and in a way that is intentionally restful.
That’s it! If you have any questions at all, feel free to hit me up – I’m happy to answer any other questions you may have on sleep and you can email me or find me @duffthepsych on Facebook, Twitter, and Instagram. And if you found this helpful, please do share it and help get the information out there – Thanks!
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