Conquering Insomnia: Mastering the Essentials of Sleep Hygiene

What is insomnia?

Insomnia can be defined as persistent difficulty in falling or staying asleep. It is the most common sleep disorder. A lot of people believe that they suffer from insomnia when in fact they do not. There is a difference between being sleep deprived and suffering from insomnia.

Sleep deprivation refers to having inadequate ability to sleep and giving oneself an inadequate opportunity to sleep. Therefore a sleep deprived person can sleep if only they took the appropriate time to do so. And this is the category most of us fall into.

On the other hand a person suffering from insomnia has inadequate ability to generate sleep despite allowing oneself the adequate opportunity to get sleep. These individuals cannot get sufficient sleep despite giving themselves enough time to sleep.

There are two types of insomnia;

• Sleep onset insomnia – this refers to difficulty falling asleep
• Sleep maintenance insomnia – this refers to difficulty staying asleep

I sleep like a baby. I wake up every hour

Bill Crystal

Insomnia is not only a nighttime disorder but also a daytime disorder. This is because it also affects one’s productivity during the day.

What is sleep hygiene?

Sleep hygiene refers to the habits and practices that can help you improve your sleep quality and make sure you wake up refreshed and well rested in the morning. Practicing sleep hygiene can help people struggling with sleep get better sleep quality and quantity. While practicing good sleep hygiene works for people who are sleep deprived and those with insomnia sometimes depending on the causes and factors involved, the latter may need more intervention and assistance medically.

Why is it important to practice sleep hygiene?

As we have discussed in the two previous articles, sleep deprivation has been strongly linked to a wide range of physical and mental health problems. Sleep deprivation and psychiatric illnesses are strongly related. No replacement has been found for sleep. No drug or activity can replace all the benefits that sleep has to offer to the human brain and body. It is widespread knowledge now that insomnia and hypersomnia (excessive sleepiness) can be an indication of an underlying or yet to be discovered mental illness. The vice versa is also true. Therefore anyone who values their health should value their sleep. Sleep should be at the top of the list when we list the things that prevent diseases and improve the quality of our lives.

Can lack of sleep cause death?

Jiang Xiaoshan was a 26 year old Chinese man who died after going for 11 nights without sleep. He stayed awake at night watching football and went to work the following day. On his last day, he came home from work, had a shower and never woke up.

Moritz Erhardt was a 21 year old Banker intern who faced the same fate as the Chinese football fan. He was found dead at home after working until 6 am for three days in a row.

These two very sad stories and all the research work that has now been published about the detrimental effects that sleep deprivation has on the human body should be motivation enough for everyone to rethink their sleep routine and hygiene.

Good sleep hygiene

• Don’t fight your biological clock

It would be difficult to maintain a healthy sleep schedule if you don’t understand your chronotype. I think understanding this would be a great place to start for everyone.

• Deal with the triggers

There are a lot of things that can keep us awake at night. These include physical/biologiocal, psychological, medical, environmental or external factors etc.

Physical or biological factors can be a symptom of a disease or a side effect of a particular drug. Certain medications can cause insomnia.

Psychological factors can be emotional distress or anxiety. When we worry about the things we said or did during the day, the things we forgot to do or the things we have to face tomorrow we negatively affect our sleep schedules. Unfortunately because most of us are very busy and in extremely noisy environments during the day that when we finally get to bed that is the only time we have to reflect on all the happenings and experiences we had.

External factors include exposure to too much bright light at night, caffeine, alcohol and having the wrong ambient temperature in the room .

Identifying the trigger or cause of your sleep deprivation and dealing with it is therefore very important.

• Avoid too much bright light during the night

The internal clock uses the loss of natural light as an alarm that it is now nighttime. The loss of natural daylight alerts the suprachiasmatic nucleus that it is now dusk and this further informs the pineal gland that it is time to release melatonin, the sleep hormone. Melatonin then signals the brain and body that it is time to sleep.

Unfortunately the presence of electric lights in our modern day has reversed this natural order. The artificial light fools the suprachiasmatic nucleus into believing that it is still day time. What this does is that it causes sleep onset insomnia.

Having dim lights in your bedroom will therefore help. Life in the city sometimes also means that even with your lights off in the house you still get a well-lit room from the street lights. You should therefore invest in some black curtains for your bedroom to block the artificial light.

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• Avoid sleep procrastination

This means that you should go to sleep when you feel sleepy. This is important because the pineal gland releases the hormone melatonin which communicates to the body that it is time to sleep. Thus the time you begin to doze off or feel sleepy should be the best time for you to go to bed. In a perfect and ideal world this would let you know what your chronotype is. Do not postpone sleep to watch late night movies and television. Respect that endogenous melatonin.

• Keep your screens away

The suprachiasmatic nucleus is more sensitive to short wavelength light within the blue spectrum. That said, screen time before bed time has significant impact on the release of melatonin which in turn affects sleep onset. Make it a routine to stay away from your screens a few hours before bed time. You can also invest in certain software that gradually reduce the harmful effects of blue LED light as evening approaches. Some phones and gadgets have night shields which reduce the blue light or change it to a warmer yellow light. Utilize these functions if it is not possible to completely stay away from your computer, phone, tablet or iPad screens.

• Avoid stimulants

Contrary to popular belief, alcohol does not improve the quality of sleep. Alcohol induced sleep is neither continuous nor restorative. It suppresses the REM stage of sleep.

Caffeine is also a stimulant that affects the quality and quantity of sleep. The half life of caffeine is about 5 hours. Therefore you should avoid having caffeine after the afternoon hours.

• The alarm clock

One of the most consistent and effective ways of helping people with insomnia is having them wake up at the same time everyday including the weekends. This is a good recommendation but there is just one problem. This often requires the use of an alarm clock for most people. The alarm clock is one of the painful ways we have invented to make us wake up on time. The snooze function even makes the situation worse. The alarms unfortunately inflict cardiovascular assault which can have detrimental effects over time. Therefore if you have to use an alarm do away with the snooze function and adopt the habit of waking up only once to spare your heart the repeated shock.

• No sleeping pills

The risks of using sleeping pills outweigh the benefits. They have also not been scientifically proven to help with sleep quality. The negative effects include rebound insomnia, waking grogginess, drug tolerance etc

• Diet and Exercise

Exercise has positive impact on sleep quality but not when it is done right before going to bed. You should work out at least 2-3 hours before bedtime.

Always avoid going to bed too full or too hungry. Stay way from foods that have high content of carbohydrates (more than 70% of all energy intake) especially sugar.

• Do not toss and turn

If you go to bed and after 20 minutes you haven’t fallen asleep, get up and fins yourself something calming to do in low light. You can stretch or read.

• Make your bedroom conducive

Make sure that your beddings and pillows are comfortable. Keep your bedroom quiet and dimly lit. Also use your bedroom only for sleep and intimacy. This will help your brain associate your bedroom with sleep more easily.

If you repeatedly have trouble sleeping and you can’t seem to get enough sleep no matter how hard you try, you should definitely seek professional help.

It is important to note that the relationship between sleep and mortality is not entirely linear. In other words, it is not necessarily true that the more you sleep the lower the risk of death. Once the average sleep time goes beyond 9 hours there is no proven reduction in the risk of mortality. There is an acceptable adaptive balance between wakefulness and sleep in human beings which is 16 hours of wakefulness and 8 hours of sleep in an average adult.

If you repeatedly have trouble sleeping and you can’t seem to get enough sleep no matter how hard you try, you should definitely seek professional help. There are better remedies for insomnia like cognitive behavioral therapy that can be offered by medical professionals.

References:

1. Why we sleep (Unlocking the power of sleep and dreams) by Matthew Walker PhD
2. National Sleep Foundation website