Note to Health Series: Sleep Hygiene

By NAACP Evansville Branch Health Committee

We spend about one-third of our lives in slumber.  Sleep is essential to sustain our physical and mental well-being. But many of us suffer from inadequate sleep. This may be sleep that is poor in quantity (too little) or quality. Poor quality sleep would not be restorative.  There can be underlying causes for low sleep quality (for those who sleep 7-8 hours and still feel exhausted.)  One of these major causes is sleep apnea (or “obstructive sleep apnea,” OSA.).  OSA affects an estimated 30 million Americans although only about 6 million are diagnosed. That means 80% of those with OSA don’t know they have it.  Untreated sleep apnea leads to greater fatigue and daytime sleepiness but also increases strain on the heart and risk for high blood pressure.  Restless Legs Syndrome (RLS) and other sleep-related movement disorders can also disrupt sleep onset AND affect sleep for anyone sharing the bed.  RLS is associated with some medical conditions, like iron-deficiency and kidney disease but can also occur in otherwise healthy people.  

Medications can also affect sleep.  If you’ve taken Benadryl (diphenhydramine) and felt very drowsy, you’ll know that even over the counter medications can profoundly affect sleep. Several prescription medications can make people sleepy. This may include some medications for blood pressure, depression, and mood stabilizing medications.  Likewise, pain medications and anti-anxiety medications often cause drowsiness.  If you are having difficulty getting to sleep, staying asleep, or if you wake up feeling groggy, medications, supplements, or herbs that you are ingesting may be the culprit.

Americans spend about $65 billion each year on sleep aids.  For those with insomnia, one of the most important measures, before any prescription medication or supplement is considered, is adopting sleep hygiene.  Good sleep hygiene means having a bedroom environment and daily routines that promote consistent, uninterrupted sleep. Each sleeper can tailor these practices as needed.

Sleep hygiene measures you might consider:

1.  Lights Out and that includes electronics!  Just as exposure to light (like the sunrise) early in your waking cycle promotes wakefulness, turning off the lights and being in a darkened room for sleep promotes and maintains sleep.  Stop pre-sleep electronic use (cellphones, videogames, etc.) 30 minutes before bed.  Electronics stimulate the mind and can trigger emotions (e.g., stress from an email, excitement from a story) that make it harder to wind down. The bright light from electronics also disrupts the natural daily light-dark cycle.

2.  Use the bed only for sleep, sex, and sickness. Spending less time in bed can promote more continuous and deeper sleep, as your body begins to associate the bed with rest. Don’t eat, work, do homework, or watch TV in bed. 

3.  Remove or limit naps. While naps can help after sleep deprivation, regular naps may deter sleep readiness. Sleeping continuously at a regular bedtime is best, so skip the nap and sleep longer at bedtime. If you really feel the need to nap, take it at least six hours before your bedtime and keep it under an hour.

4.  Keep a sleep routine. Maintain a fixed sleep schedule. Awakening around the same time every day promotes a regular sleep schedule. This also helps train the body to recognize when it is time to fall sleep. Even if it means waking up earlier on days off work or getting less sleep one night, your sleep will be better in the long term.

5. Avoid caffeine and alcohol (4-6 hours) before sleep. Caffeine and other stimulants (e.g., medications, drinks) activate neurobiological systems that maintain wakefulness. And while alcohol may make you sleepy initially, as your body metabolizes it, the effects cause fragmented sleep or early awakening.  

6.  Do relaxing or boring activities pre-sleep. Relaxing activities can promote sleepiness by reducing physiological arousal and minimizing thinking. On the other hand, work or planning activities at bedtime activates the brain and delays sleep.  Avoid these around bedtime.

7.  Put your worries to bed, too!  Falling asleep is harder if you are worrying or thinking about emotional things. So set aside a few minutes before bed and list everything that you want to remember for tomorrow, including worries themselves – you can worry about them tomorrow, just not right now.

8.  Improve your sleeping environment. Noises, light, and uncomfortable temperatures disrupt continuous sleep. Sleep is generally promoted in a cooler room.  Select comfortable pillows & mattresses, remove distractions, use a sound (white noise) machine – like a fan or a radio softly playing static. Darken the room (use a sleep mask if it helps or room-darkening shades especially for day sleepers.) 

9. Exercise at the right time. Exercise can facilitate or inhibit sleep. Do exercise earlier rather than before bedtime.  Exercise within 2 hours of your bedtime increases physiological arousal and will likely delay sleep.

10.  Get up and try again. If you can’t sleep after 20+ minutes, get up and do something relaxing or boring. Actively trying to fall asleep just frustrates you, preventing sleep.

11.  Learn about sleep. Obsessing over sleep difficulties or not understanding the science of sleep can perpetuate sleep difficulties. Read scientific articles to learn more about sleep, and thus correct misconceptions or expectations that may be exacerbating sleep-related frustration or anxiety. Avoid consulting “Dr. Google!”  See References for examples.

If sleep difficulties persist despite your sleep hygiene measures, seek additional help.  Please consult your doctor or a sleep specialist. The time you take for the appointment could save you invaluable time in the future.

Reference: 

Mastering Sleep Hygiene: Your Path to Quality Sleep

https://sdlab.fas.harvard.edu/files/sdlab/files/sleephygienecheckliststriveweekly.pdf

Stepanski, E.J. & Wyatt, J.K. (2003). Use of sleep hygiene in the treatment of insomnia. Sleep Medicine Reviews, 7, 215-25. 

Hauri, P. (2011). Sleep/wake lifestyle modifications: Sleep hygiene. In Barkoukis TR, Matheson JK, Ferber R, Doghramji K, eds. Therapy in Sleep Medicine. Elsevier Saunders, Philadelphia, PA. pp. 151–60. 

Czeisler, C.A. & Gooley, J.J. (2007). “Sleep and Circadian Rhythms in Humans”. Cold Spring Harbor Symposia on Quantitative Biology 72, 579–97. 

Xie, H., Kang, J., & Mills, G.H. (2009). “Clinical review: The impact of noise on patients’ sleep and the effectiveness of noise reduction strategies in intensive care units”. Crit Care 13 (2): 208. 

Irish, L.A., Kline, C.E., Gunn, H.E., Buysse, D.J., & Hall, M.H. (2014). The role of sleep hygiene in promoting public health: A review of empirical evidence. Sleep Medicine Reviews. 

Boutrel, B. & Koob, G.F. (2004). What keeps us awake: the neuropharmacology of stimulants and wakefulness-promoting medications. Sleep, 27, 1181–94. Driver, H.S. & Taylor, S.R. (2000). Exercise and sleep. Sleep Medicine Reviews, 4, 387–402.

The NAACP‘s policy recommendation to the federal government clearly states:  “Guarantee that all people in the US can obtain physical, mental, and oral health care when they need it regardless of their coverage, employment, financial, or immigration status.”  We at the Evansville Branch NAACP take this statement at face value. We recognize healthcare as a human right.  We see that we fall short of that aspiration, and we will continue to promote awareness of health disparities and insist on sustained systemic change to eliminate those disparities.  

Please submit any feedback or questions you’d like to have addressed in future columns to tlstratton2009@yahoo.com.