A Whole9 guest post by Emily Deans M.D., a board certified psychiatrist with a practice in Massachusetts and she teaches psychiatry at Harvard Medical School.
Sleep is incredibly important for good mental health. In my view it comes ahead of exercise and a good diet…if you aren’t sleeping reasonably well, no matter how great your workout habits and how clean your diet, you are shoveling sand against the tide. It’s no coincidence that pretty much every major mental health condition you can tick off on your fingers can have derangements of sleep as a major symptom: major depression, anxiety disorders, bipolar disorder, PTSD, and ADHD all make the list.
The problem is that insomnia is often either a chicken and egg issue or a lifestyle issue. Stress leads to poor sleep which leads to poor functioning which leads to more stress which leads to more poor sleep. Or perhaps you are a night shift worker or busy working mother of three taking evening college classes who simply does not have enough hours in the day. In any event, regulating and prioritizing good sleep as much as possible is vital for a healthy brain. Sleep is the time when the metabolic toxins that build up in the brain from all the energy-hungry thinking we do gets washed away. Complete lack of sleep will eventually lead to inflammation, neuron damage, dementia, possibly psychosis, and death. Sleep deprivation, even a few hours a night, leads to decreased cognitive function, increased irritability, and increased susceptibility to mental health problems.
So if your sleep is a problem, then how do you make it better? As a practical matter, there are folks who have trouble getting to sleep, then others who have trouble staying asleep, some who have trouble with both, and some who have a wacky sleep schedule that doesn’t match the normal day/night cycle. There are acute or temporary cases of insomnia caused by a sudden stress (death in the family, for example) that can become chronic, and then there are folks who sleep horribly for years. We’ll start with some tips about good sleep hygiene to get you started, and in part II of this article we’ll go on to some more complex strategies for tougher cases of insomnia.
Tips for Good Sleep Hygiene
1) Routine, routine, routine.
Circadian rhythms in the body are a dance of hormones, clock proteins, and neurotransmitters. Temperature, particular wavelengths of light, darkness, cortisol, stimulants, hypnotic agents, and a host of other factors all play a role in getting the brain from wakefulness to sleep. All these disparate systems can come together to play a nice lullaby, or you can get one out of rhythm leading to a cacophony.
Routine will help all the systems stay in sync with one another. Get up and go to sleep at about the same time, even on the weekends. Doing the same thing before bed every night, whether it is a meditative evening yoga or reading will help. However, watching TV right before bed can be problematic (too stimulating and the wavelengths of light from screens can interfere with sleep). Keep the bedroom cool and the pajamas loose. Tight clothing can interfere with sleep.
2) Use the sun/light in the morning to help establish a good sleep pattern.
If your schedule allows, get up with the sun and preferably get some real outside bright morning sunlight each day. Sleeping late is associated with depression. If you live in a permanently cloudy region, a dark hole in the ground, or the extreme north or south, using a 10,000 lux lamp in the dark winter morning can help entrain normal circadian rhythms, improving insomnia and consolidating sleep better. Night shift workers can also use the lamp at the beginning of the evening to entrain “daytime” in the brain and then use dark or blue-blocking glasses in the early morning along with black-out curtains to help improve sleep.
3) Don’t sleep late.
I know I’m repeating myself, but I really can’t stress this point enough. Sleeping late wrecks body rhythms. If you have a late night, you are much better off getting up with the sun then catching an afternoon nap if possible than sleeping past about eight in the morning. Ever wake up early, fall back to sleep, wake up at 11am and feel like death warmed over? A morning nap tends to result in non-restorative sleep, whereas an afternoon nap can be energizing and feel great.
4) Manage evening light.
We obviously didn’t evolve with electric lights, and the newest generation of brilliant, cheap LED lights and the LED screens on the iPads and Kindles and phones are precisely designed to wreck sleep. Why is that? We have special cells in our eyes called intrinsically photosensitive retinal ganglion cells, and they have a direct line of communication to the master clock of our bodies in the brain. Beautiful glorious 480nm blue light which makes our iPads look so awesome streaming Game of Thrones is a precision-tuned GOOD MORNING signal to the brain.
In the lullaby of hormones, clock proteins, and environmental signals that help us to sleep, bright lights at night is like someone nearby crashing cymbals. The best strategy is to either avoid electronics after sunset or, if you must indulge, wear blue-blocking glasses. They are cheap, have no side effects other than making you look super cool (ahem), and are effective if you wear them.
5) Watch those bad habits.
Alcohol and short-acting sleeping medicines tend to make you sleep hard at first, then wake up in the middle of the night in a bit of withdrawal and wide awake. Longer acting sleeping medicines are still in the system when you wake up, leading to a dangerous drive into work or school. All of them can be habit forming, which means you won’t be able to get to sleep without them. Caffeine has a half-life of approximately 6 hours or much longer if you are a slow metabolizer. If you have insomnia, avoid it after noon, or get rid of it altogether.
Trouble sleeping? Try the strategies above first, then read part 2 if these basic tips aren’t enough.