Three Keys to Good Sleep

So to sleep well at night, you need three things. You need to be emotionally, mentally, and physically tired. Emotionally tired means I was engaged today. I care about somebody, some things, some idea. It doesn't matter, but you put out some energy, you have a passion for something you're involved with life. Mentally tired means that you use your brain today. It may be that you worked hard or you're in school and you're learning something. Maybe you're doing crossword puzzles or some other endeavor where you construct yourself a little bit. Finally need to be physically tired in a way. This is the easiest one to understand. But unfortunately for most of America, it's not. When we do too easily, physically tired literally means that we got some exercise. We did some exertion. Maybe we built up a bit of a sweat and now the restlessness in the body is less and we're more likely to fall asleep at night.

Alcohol and Sleep

Other things that may help our sleep - not just same time to bed and same time to wake, but that will definitely be helpful - are substances that may affect our sleep such as alcohol. I love a good glass of wine and I have nothing against drinking, but it does have an effect on sleep. We all know initially if we have a glass of wine, we might feel a little more relaxed, a second one and we're maybe a little more sleepy. The third one might even promote sleep and also disinhibit us enough that we think we're a good dancer if we're not, but enough alcohol (if you drink it fast enough) will really bring us down. It's a central nervous system depressant. So unfortunately every year, kids on college campuses may actually drink too much, have alcohol poisoning, go into a coma and die. So that's the actual effect of alcohol if they can't clean it up fast enough. But the initial effect is that down. But what happens pretty quickly, (because alcohol has a pretty short half life - we clean it up relatively quickly) is that the body wants to be here in the middle. Alcohol brings us down and then the body brings us up too high. So if your me and you have a glass of wine, I probably won't feel it. A second glass - I know it's there. The third would be too much. I'm just not used to it. So even though I enjoy that third glass of a heavy red cab, it's going to affect me. And I know two sleep cycles in, three hours into my night, I'll wake up in the middle of the night having a hot sweat, feeling thirsty, looking at the digital clock being flushed and awake for 20-30-40 minutes. For me, I've a very exaggerated response to too much alcohol. But for most people that alcohol withdrawal (which is exactly what it is) simply makes for a restless night. It also suppresses dreaming. So the first half of the night, the dreams are suppressed. The second half, they're rebound, so they're much more. So not only is the night restless, but it may be filled with vivid dreams into the morning. So my rules of thumb for alcohol are: less is more, earlier is better (it gives you more time to detoxify that alcohol) and of course with food is better because it'll absorb more slowly and it won't hit you as hard.

Bed Characteristics

The bed should be comfortable. The sheet should be comfortable. The pillow should be comfortable. The whole surrounding of your bedroom should be comfortable to promote sleep. Sometimes that means calming colors, such as natural tones, browns and blues, and beiges as opposed to bright red or bright orange colors, those are stimulating and you want to avoid that. So you want a calm surrounding. You want to be free of clutter, like they talk about in the Far East and fung shuei can have an effect on our mind. We want things to be like a Zen peaceful environment. The bed should be comfortable. The average life of a bed will be seven to 10 years. If your bed is much older than that, it probably does need to be replaced. Some mattresses need to be flipped and switched around because we tend to sleep in our same patterns and we want the life of the mattress to be extended, but you don't want to be sleeping in a groove in your bed at night. It won't be comfortable ultimately.

Caffeine and Sleep

Another common thing that people do in their lifestyles is drink coffee or tea or soda. All of these things contain caffeine and caffeine is a very common drug and it keeps us alert and awake. The trouble with it is it lasts for a really long time. It has a very long half life - how long it takes to get rid of half of it. And so as we grow older, we may detoxify any drug (including caffeine) less well. So what happens is, we may drink a cup of coffee (two, maybe three, maybe four) in the morning and think that we're fine. But what happens is seven hours after you've taken those four cups of coffee by 8:00 AM, it's three o'clock in the afternoon. You still have two cups of coffee in you. Seven hours after that (the half life of caffeine) it's 10 o'clock at night and you still have a full cup of coffee in you. Caffeine takes a long time to clear through the liver system - again, it's half life is long. So even though people may say "but Dr. Sahni, I have been having a pot of coffee since I was 20 - how could that possibly be giving me insomnia now?" It may be that they're 70 and their liver is 50 years older and it just simply doesn't detoxify as well. After all, again, caffeine is a long acting stimulant and irritant and it may absolutely affect our sleep. Sometimes not falling asleep but staying asleep - because again, at the beginning of the night, sleepiness is high and you've been up all day. Sleepiness is high, noise is low. Noise literally could be a dog barking outside. It could be caffeine buzzing, it could be anxiety, it could be pain in your hip. But as the night goes on, you've gotten a little bit of sleep - you're less tired - and the noise that you ignored before (because you were so tired that you slept through the dog barking) begins to bother you. And so even though caffeine may not stop you from falling asleep, it may stop you from staying asleep. Now we already know everybody wakes up during the night, but with more caffeine on board, we may be more aware of it and we may stay awake for longer. So again, rules of thumb for caffeine would be simply: less is more and earlier is better. We have to find the place that works for us. It's rare that somebody has to have a zero tolerance policy to caffeine, but if you're having trouble sleeping, that's certainly one thing to look at and to gradually withdraw. If you've ever gone cold turkey on caffeine, you know it's terrible. There is a very big withdrawal, it could precipitate a headache or even a migraine in people who are prone, but it also can just make us feel sick or constipated and very fatigued. The withdrawal is the opposite effect of the drug itself.

TV in Bed

Sleeping Habits

The bed should be reserved for sleep. That means there shouldn't be reading, watching TV, playing video games, eating, or really doing much else than sleeping in our beds. We want to make a conditioned response that when we see our bed, we say, ah, that's the place where I sleep well tonight, the exception may be sex. In today's 24 hour society we often have our smartphones, cell phones, computers right next to us while we're sleeping. Some people actually sleep with their phone right on their pillow next to their head. And when it buzzes or rings, they of course have to take a look and see who's contacted them, or what's new in the world on Facebook or anywhere else. The trouble with that is that it interrupts your sleep and interrupts your concentration. You're always on. So you can't actually turn off, relax and surrender. Flip is very unique. In other parts of our lives, we can work really hard, force ourselves through it and let our will win. With sleep It's actually the opposite. All we can do is say sleep. I'm here in a horizontal position, in a dark room with my eyes closed, please come visit me. And it will eventually, but having phones and computers and other electronic gadgets, buzzing, clicking whistling, ringing will interrupt that natural flow.

Sleep Environment

"The environment is very important when kids are small, it makes no difference. I remember Thanksgiving with the family together and my little nephew, five years old, missing his nap time because they didn't want to go to bed with everybody celebrating. And so the game was on, it was a lot of noise and people were in the kitchen making a lot of noise and he laid down on the hard tile floor in the kitchen and fell asleep. Children are great at this, but as we get older, we're more sensitive to our surroundings. And so if we have difficulty sleeping, what we need to do is control those things. The bedroom should be dark. Any light that gets in is a signal to the brain that it may actually be daytime. After all electric light bulbs were only invented a little over a hundred years ago. And so it was either sunshine or it was firelight from the hearth or from a candle, much less bright than our bright fluorescent or led bulbs today. So keeping the bedroom dark with blackout blinds. So the sun doesn't creep in and all the digital apparatus, whether it's the digital clock or a TV lights or other things going on, make sense. But what happens if you have to get up and use the restroom at night, you don't want to trip and fall, but if you turn the bathroom light on, it actually turns off the melatonin that light goes through your eyes, tells your brain in the pineal gland to stop producing melatonin. A very important hormone that controls circadian rhythm. It tells you is it day? Is it night? If the lights on at three o'clock in the morning, your brain thinks, Oh, it must be morning. And to shut off the melatonin ordinarily once morning occurs 14 hours or so later melatonin gets turned on 16 hours or so we're sleepy. We sleep for eight hours and then the process begins again."

Napping

Often people ask me about naps - are they good? Are they bad? Can they help your sleep deprivation? Well, the truth is - it depends on you. If you can get away with a 10 or 20 minute nap and you feel refreshed and you're able to wake up easily and get to work and get back to work but then you can still sleep well at night, there's no reason not to have a nap. The problem with napping comes with somebody who suffers from insomnia. If they say that they can't sleep at night and then they're sleeping for an hour in the afternoon, I wouldn't be that surprised. It's kind of like having a snack an hour before dinner - how hungry are you for dinner if you've just eaten recently? For insomniacs who have difficulty falling asleep or staying asleep - I discourage them from taking naps. On the other hand, if you enjoy a nap and it makes you feel refreshed - as long as it doesn't go for too long and get in the way of your night sleep - there's no problem.

Good Habits

We should make sleep a priority. One of the important things to do around sleep is to pick a good bedtime and awake time and keep it totally consistent. While it might be boring, It's very important. All the body's circadian rhythm with its various hormones like estrogen, progesterone, testosterone, thyroid hormone, and the others are all around having the same bedtime, the same wake time. Another thing that's important is having a sleep ritual, a time to unwind and calm down so you can fall asleep in a reasonable amount of time. It's important to have the bedroom cool, dark, quiet, and have a comfortable bed. This is an important investment. It's where you're going to spend one third of your life. If you do awaken in the middle of the night, it's important not to stay in bed and flip and flop and worry and think about it, but actually remove yourself from the bed and do something boring, quiet, useless, for a little while, until you feel sleepy and then return to bed. When we want to have a strong conditioned response, that bed is where we sleep, not get frustrated. It's also important to keep our caffeine levels low and be emotionally, mentally, and physically tired to sleep well at night, mostly tired means that we're engaged in life. We care about people, places, things, ideas, mentally tired means we're using our brains stretching and growing and physically tired means for getting some exercise to get the restlessness out of our bodies.

Exercise and Sleep

What about exercise and sleep? Well, certainly I want you to get exercise - it's good for your health. But what time of day to do it? Well, oftentimes people who exercise in the morning get it out of the way, and actually studies have shown they're more consistent exercisers if they can do it in the morning. For those people who are very sensitive to the stimulating effects of exercise, that makes good sense. So some people find themselves awake and alert and more energized with exercise. They should avoid exercising too close to bedtime. That makes sense. But everybody's a little bit different. Typically, more exercise is better regardless, even if it's closer to bedtime, you get the restless inside of your body. And people who are regular exercisers have actually been shown to be more efficient at sleeping. They may be able to get away with shorter amounts of sleep because their quality of sleep is better.

Lights and Temperature

So bright lights, whether they're in the bedroom already or interrupting our sleep because the phone rings and the digital display wakes you up, or you're turning on the bathroom light, not a good idea. Some people are very sensitive to blue light, which tends to be more common among electronic gadgetry. So it may make sense to turn down the screen on the iPad or the TV or the computer. It does make sense to kind of mimic nature. One common thing I see is that people are active all day and then it's time for bed and they turn off the lights and expect to fall asleep. We didn't have a transition in nature. We go from daytime to sunset, to dusk, to Twilight tonight fall. It's a gradual process and the same should be true about the light in your own home. So if you go to bed at 10 o'clock, it might make sense around eight 30 or nine to go around the house and turn off extraneous lights. You want to mimic nature and come down gradually. We also want the bedroom temperature to be nice and cool, too hot and too cold either way would not be comfortable, but typically we relax better in a cooler environment. If that means a fan, if that means air conditioning, if that means the window open, or even just lighter sheets or blankets, we may need to do that. Sometimes it's hard with bed partners, not everybody's internal thermostat is the same, but it does make sense to try to make yourself comfortable. Cool tends to promote sleep.

Pain and Sleep

Some people will come to me and say they can't sleep throughout the night. And when I asked the simple question "why," they tell me something hurts, it may be a shoulder. It may be a hip. It may be their back. And I would really encourage you to go find out what it is and treat it appropriately. Treating pain to help you sleep at night is actually a very good reason to treat pain. Almost all pains are actually worsened at night. And so some things interrupting you such as pain in your hip, It's worth treating it because sleep is so important. And a lot of times people tell me, well, it's just pain. I can just make it through it's all right. If I took a Tylenol would just be treating the pain and that's not really necessary. I'm tough. But in fact, if you can't sleep well, the rest of your functioning doesn't work well either. And that actually would interrupt and prevent the healing process. So there's no point in being a tough guy here. It's not that the pain is such a terrible thing and not treating it as such a terrible thing, but it would be if you wouldn't allow you to function in other ways, so you actually get in the way of your own healing. So treating pain is important.

Food and Sleep

Another thing people ask about is food. Can food affect sleep? Well, definitely if you're hungry, it's going to be harder to fall asleep. If you're over full and your digestive system is working really hard to digest, that's going to be uncomfortable too. For those of us who have reflux, you certainly want to keep four hours between the last meal and bedtime and lying flat. So food can make a difference. Also, the foods we eat may make a difference. A big carbohydrate load (like a big plate of pasta) as a snack late at night will precipitate a rise in insulin and blood sugar and things will come crashing back down and we'll feel pretty wiped out. Not the best way to fall asleep, but certainly may have an effect on our falling asleep. Spicy foods can precipitate reflux in those people who are prone and they tend to be stimulating, so probably not the best thing before bed.