What can we do to improve sleep?
- Simple but scientifically sound ways to improve sleep
After the movements for diet and exercise, our society is finally directing its attention to the third pillar of health: sleep. March 15th is the World’s Sleep Day, which is a perfect occasion to talk about sleep beyond the scope of circadian rhythm. Let’s see what are some simple but scientifically sound ways to improve sleep, and most importantly, what are the rationales behind them.
Sleep quality is the product of many different factors in your life. These factors can be categories into five buckets: genetics, circadian rhythm, sleep environment, behaviors, other health conditions.
Genetics
Sleep remains one of the least understood phenomena in biology. What scientists do know is that sleep is highly regulated genetically [2]. Not only that whether or not you are naturally a morning person or a night owl is influenced by your genes [3], recently scientist also discovered that insomnia is linked to genetics [4]. While there’s a genetic component in sleep, lifestyle also plays a big part in determining our sleep quality. There are still things we can do to understand and thus improve sleep.
Circadian rhythm
What’s circadian rhythm?
We have been talking about sleep and circadian rhythm all this time, not only because it’s the area of focus for the company, but also it’s the foundation of good sleep. Circadian rhythm is the rhythm that dictates the 24-hour cycle of our lives. Circadian rhythm not only takes place at the individual level that regulates your sleep-wake cycles, but also affects the function of your organs such as lung, liver, ovary, and so on. Many studies have correlated circadian rhythm dysregulation with negative health consequences such as altered metabolism and increased risk for cardiovascular diseases and even cancer [5].
Circadian rhythm misalignment and sleep
Ideally, you want (and have time) to sleep when your body wants you to, but that’s not always the case. Circadian rhythm misalignment happens when your body clock keeps you up when you are trying to sleep, or makes you drowsy when you need to stay up. It is one of the primary causes of poor sleep. Think about how painful it is trying to sleep at night or remain awake during the day time when you have jet lag, or to sleep during the day after pulling an all-nighter. These are extreme cases of circadian rhythm misalignment. Milder cases of circadian rhythm could result in difficulties falling asleep and waking up, as well as fragmented sleep.
How to maintain a healthy circadian rhythm?
Circadian rhythm is the foundation of sleep. Trying to get good sleep when your circadian rhythm is misaligned is like trying to build the Empire State Building on the sand. To maintain a healthy circadian rhythm, having consistency in your sleep schedule will help you in the long run. Something as simple as going to bed and getting up at the same time each day will help your body make the most the hours you actually sleep. Counterintuitively, this also means that sleeping in on the weekend is actually a bad idea, as it will likely throw off your body’s schedule at bedtime.
What if I don’t have the luxury of having a consistent sleep?
If you know your schedule will be disrupted, either due to travel, working the night shift, or going through puberty, light therapies can help realign your circadian rhythm with your desired schedule. This has traditionally meant using bright light-boxes for hours a week, but research at Stanford has shown that short light pulses, like those used in the Lumos sleep mask, applied to human subjects during the night can effectively shift circadian rhythms. This breakthrough technology quickly adjusts your circadian rhythm according to your preferred schedules while you sleep at night, helping you set a solid foundation for good sleep. To find out more about this research, watch this video from Dr. Jamie Zeitzer at Stanford University.
Sleep environment
In addition to aligning your circadian rhythm with your sleep schedules, there are further steps you can take to improve the quality of your sleep. As anyone who has tried to doze on an airplane knows, the environment around you can make a huge difference in how deeply you’ll sleep when you try to get some shut-eye.
Ambient light
Darkness helps our bodies commit to sleeping more deeply than they could with some form of ambient light on all night. Luckily, total darkness can be easily achieved with thick blackout curtains, wearing an eye mask, or even putting a piece of cloth over your eyes. Most sleep improvement practices are long-term battles with various levels of efficacy, but creating total darkness in your bedroom is probably the simplest investment with the fastest return. Just be sure to let the light back in when you get up in the morning.
Temperature
While nobody wants to shiver in bed, our bodies don’t want to be too hot at night either. Lower temperatures in the evening generally act as a cue to our circadian rhythm that it’s nearly time for bed. As such, it’s recommended that hot baths or showers are taken at least an hour before bed, rather than right before you turn out the lights.
The ideal temperature for sleep is what sleep doctors called “not too cold, not too hot”. Research suggests that temperatures too far from 72° Fahrenheit seem to interfere with both slow wave and REM sleep cycles. However, the ideal bedroom temperature is also influenced by bedding and clothing, as well as the amount of heat someone generates through blood flow to the skin. Even if you set a certain bedroom temperature, sleeping by yourself or with a partner makes a huge difference in your skin temperature. It requires experimenting for a few times to get to the optimal setting.
Noise
When it comes to noise, again, different people have different preferences. Some people like their bedroom to be completely quiet, while others prefer to have background noise. Research has shown that constant low-level noise can improve sleep [6]. This may even be connected to babies’ affinity for sleeping to the sound of a vacuum cleaner or air fan, which is thought to roughly remind them of the surprisingly noisy environment of their mother’s womb. Even if you’re not at an age where you want to be swaddled, white noise can be an effective way to mask smaller sounds that would otherwise be disruptive.
Fans are well known for creating white noise, which is a random signal having equal intensity at all frequencies. Recently, sleep studies have shown that another kind of noise, named pink noise, also improves sleep in elderly [7]. Pink noise is similar to white noise, but with equal intensity sound across the five main octave frequencies. It’s not easy to tell white noise from pink noise by ear, and not much study was done to compare the efficacy of white noise and pink noise in improving sleep, so it may be worth exploring with experimentation if you’re looking for the perfect sound to sleep to.
Behaviors
The term sleep hygiene refers to a variety of different practices and habits to help us sleep well and be energetic during the day. What we do in the evening and during the day have various impact on sleep. This article would be too long if we discuss each one of them, because most of them are like noise — there’s a fair degree of personal preference involved, requiring some exploration and experimentation. When deciding what works for you, keep in mind that you want to direct your behaviors to achieve two goals: 1) to increase sleep drive, and 2) to wind down before bed.
Increasing sleep drive
Sleep drive is used by sleep scientists to describe the hunger for sleep. The longer you stay awake, the more sleep drive that you build up. If you take a nap, your sleep drive is temporarily relieved. However, just like snacking takes away hunger but also affects appetite, taking a nap may have a negative impact on your sleep drive and ultimately your sleep quality. If you take a nap during the day, make sure that you keep it under 30 mins, and don’t take it too late during the day.
Winding down before bed
In modern society we are always busy running around to meet work and family demands, which can cause our mind and body to be very tense and alert, even if we’re not aware of it. Making an effort to slow our body and mind down before bed is critical for good sleep. Some simple things we can do:
- Avoid working too close to the bedtime;
- Avoid intense exercise too close to the bedtime;
- Avoid any activities that stir emotions, like watching horror movies or engaging a fight, or sometimes even texting or calling a friend;
- Avoid caffeine later in the day;
- Take actions to calm your brain: meditation, reading, time with family, and so on. Try avoid relaxing by staring at backlit phones, tablets or televisions, as the bright, blue-frequency light can confuse your circadian rhythmand keep you awake later into the night.
Different people will be more or less sensitive to some of these behaviors, so you should experiment to find the ones that work the best for you. As long as you’re reducing your body’s cortisol production, which helps keep us alert, you should be on the right track.
Other health conditions
Sleep apnea
Sleep apnea is a common and serious sleep disorder that causes you to stop breathing during sleep. Many people with sleep apnea have not been diagnosed or received treatment. To get diagnosed, you may participate in a sleep study where a doctor monitors a variety of functions during sleep including sleep state, airflow, and blood oxygen levels while you stay overnight in a sleep lab. The typical treatment for sleep apnea is using a CPAP device to keep the airway open during sleep. Philips and ResMed are the two leading suppliers for CPAP devices.
Snoring
Chronic snoring is a strong indicator of sleep apnea, but only about half of the people who snore loudly have obstructive sleep apnea. However, even if snoring is not a problem for the person snoring, it could be a cause of bad sleep for his/her bed partner. Philips just announced a novel solution to stop snoring at CES 2019. Instead of giving them a pair of earplugs, this solution may not only show how much you care about your partner but also potentially improve sleep by stopping you from snoring.
Other conditions
Poor sleep can be a primary condition on its own, or it can be the secondary symptom of other diseases and conditions, for example, chronic pain, depression, or cancer treatment. In any of these cases, you should consult your doctor on how to get better sleep.
Even if you have poor sleep due to other conditions, there are supportive resources available to help you. If you are going through some difficult time, there are therapists available to untie your mental and emotional knot. If you are can’t sleep due to acute conditions, you can try the medicine prescribed by psychiatrists to at least get yourself temporarily out of the physiological stress of having no sleep. If you are having chronic insomnia, there are sleep doctors available who may guide you with CBT-i treatment. There is also an online community called HealthUnlocked where you can discuss your condition with hundreds of people like you.
You are not alone
It is easy to feel frustrated when you don’t sleep well. There are 9 million people in this country share your pain, including me. You might wonder why I know all these things about sleep. Everything that I talked about here stems from my personal life. Several years ago I was going through a rough patch. I was up all day and all night. Fortunately, help was there when I needed it. I went through the process of seeing a psychiatrist for sleep medication, seeing a therapist (in fact, therapists) for emotional support, and then seeing a sleep doctor for CBT-i treatment. Even after getting over that insomnia hurdle, I still use blackout curtains for my bedroom and the Lumos Smart Sleep Mask to adjust my circadian rhythm when traveling to different time zones. I can’t say that I’ve been through your pain because everyone is different, but what I can say is that there might be a way to solve, or at least improve, your sleep. Everyone’s sleep needs are somewhat unique, and so the best approach to improving sleep is by creating a supportive and personalized sleep-ecosystem for yourself.
If I can get over my dark, sleepless days and sit here to write my story, chances are you can, too.
