Are you part of the 1/3 of the population who don’t sleep well? Rather than jumping to sleeping pills or supplements, you can start with the basics – sleep hygiene.
Hygiene is a somewhat odd word to describe sleep, but it made sense when it was first used by Italian anthropologist Paolo Mantegazza in 1864. At that time it literally referred to how clean and hygienic one’s sleeping space was. During this century people often put their bedposts in pots of oil to prevent insects from climbing up!
Over 100 years later, in 1977, the “father of sleep medicine” Peter Hauri adopted the term “sleep hygiene” to describe a set of rules and behaviors to get better sleep.
The term stuck around, and nowadays in 2017, “inadequate sleep hygiene” is considered a medical diagnosis, one of many sleep disorders. Sleep doctors use the Sleep Hygiene Index for diagnosis. The higher your score, the more likely you have inadequate sleep hygiene. Check out your score:
DOWNLOAD SLEEP HYGIENE INDEX
How much sleep do you need?
The National Sleep Foundation updated sleep guidelines in 2015:
- Newborns (0-3 months): 14-17 hours
- Infants (4-11 months): 12-15 hours
- Toddlers (1-2 years): 11-14 hours
- Preschoolers (3-5): 10-13 hours
- Elementary school age (6-13): 9-11 hours
- Teens (14-17): 8-10 hours
- Adults (18-64): 7-9 hours
- Older adults (65+): 7-8 hours
Let’s get to the rules of sleep hygiene
When you really think about it, these make good sense. I could easily tell every woman who sees me for sleep issues (many!) to first get clean up their sleep hygiene:
1. DO keep a consistent sleep schedule
Get up at the same time every day, even on weekends or during vacations. This trains your brain to develop a regular circadian rhythm (24-hour body clock). It is fine to vary it by 20 minutes.
2. DO set an appropriate bedtime
We all need a certain amount of sleep. Set your bedtime to get at least seven hours sleep.
3. DON’T lie in bed awake. If you don’t fall asleep after 20 minutes, get out of bed.
If this happens during the night, do the same, even if it is more than one time per night. Sit in a chair in the dark until you feel sleepy. No screens (TV, phone, computer, etc.) or lights. A guided relaxation recording can work well.
4. DO establish a relaxing bedtime routine.
This can include a warm bath or shower. Meditate or have quiet time to wind down from the day. Get your mental clutter out by reflecting, journaling, or writing lists. Often events of the day spin around in your mind, or things to do tomorrow. You can write these down on a list, and tell yourself that you don’t need to look at the list or think about it until the following day.
5. DO use your bed only for sleep and sex.
When you read, look at your phone, or watch TV in bed, you associate it with wakefulness. When you go to bed, it should be when you are ready to sleep or “get it on.”
6. DO make your bedroom quiet, cool, comfortable and relaxing.
Sleep is better when your room is cool rather than warm. You can keep a door or window cracked for circulation and to avoid stuffiness. Keep all lights off, including night lights, and lights from electronic devices. Sleep on a comfortable mattress. Turn off the extraneous noise. A white noise machine is fine. If your pets wake you up, keep them in another part of the house.
7. DO turn off electronic devices at least 30 minutes before bedtime.
Electronic devices emit blue light, and blue light stimulates the waking hormone cortisol while blocking the sleep hormone melatonin. Some people need to turn off electronic devices 1 to 2 hours before bedtime.
8. DON’T eat a large meal before bedtime.
If you find that you are hungry at bedtime or during the night, you may need more food with dinner. Some people need more carbohydrates, which help make sleepy neurotransmitters like serotonin. Others need more protein and/or fat, to keep blood sugar regulated throughout the night. Some people do need a light snack before bed.
9. DO exercise regularly, during the day.
Exercise promotes continuous sleep. Avoid rigorous exercise in the evening. Rigorous exercise circulates neurotransmitters that can interfere with sleep.
10. DO exercise caution with caffeine
The effects of caffeine may last for several hours after ingestion. Some people report that even a cup of green tea during the day will interfere with their sleep. Caffeine can fragment sleep, and cause difficulty initiating sleep. If you drink caffeine, do it before noon, as caffeine stimulates waking hormones and neurotransmitters. It’s pretty much a no-brainer to avoid caffeine if you have insomnia. Yet, many people with insomnia are addicted to caffeine to get through the day, and this is a vicious cycle. With insomnia, you may not recover if you don’t lose the caffeine. Seriously.
11. DON’T drink your fluids before bed. Instead, reduce fluids before bedtime.
The last thing you want is your bladder waking you up continuously throughout the night!
12. DON’T nap if possible
When we take naps, it decreases the amount of sleep that we need at night – which may cause sleep fragmentation and difficulty initiating sleep and may lead to insomnia. Naps under 30 minutes may be fine. Set an alarm for daytime naps.
13. DON’T take substances that interfere with sleep
Cigarettes, alcohol, and some over-the-counter medications may disrupt your sleep. Women with menopausal insomnia can really notice the difference with these!
14. DO hide the clock, if you are a clock watcher at night
If you have insomnia, it is not helpful to constantly look at the clock. This can exacerbate stress about not sleeping!
DOWNLOAD Sleep Hygiene Handout
Additions to regulate circadian hormones
It’s easy to focus on what to take or what to do right before bed in order to get better sleep. However, your sleep is part of your 24-hour circadian rhythm. You can influence this clock at any time, and for most people, the morning is the neglected time.
Cortisol Awakening Response
With a healthy circadian rhythm, 50% of your cortisol is secreted during the first 30 minutes you are awake. This is called the Cortisol Awakening Response (CAR). With the Precision Analytical Dutch hormone test, you can measure your 24-hour cortisol levels, including your CAR. You can also find out your melatonin levels.
Cortisol and melatonin work harmoniously, yet when one is high the other needs to be low. Daylight stimulates cortisol release, and darkness stimulates melatonin. When you first wake up in the morning, it’s likely that you are experiencing your CAR. This can even happen before sunrise. This is the best time to set your circadian rhythm for the day, no matter how your night went.
The best thing to do is get up and expose yourself to full-spectrum light and movement. Ideally, go outside and exercise. For people with HPA-D (hypothalamus-pituitary-adrenal dysfunction), it may mean going outside and walking around the block. Another idea is to go into your backyard and jump rope or bounce lightly on a mini trampoline. If those activities are too strenuous for you due to HPA-D, you can simply step outside and soak in the light.
If there isn’t enough light, or going outside is too difficult, you can purchase a portable blue light box and turn it on in your vicinity while you move or exercise indoors, or simply sit and wake up. Research shows that blue light boxes help to restore circadian rhythms, and improve sleep and depression.
Try not to ignore your Cortisol Awakening Response and push yourself to sleep through it, because of a bad night or just because you can. If you have a circadian rhythm disruption, you may not restore it if you do not get up with your CAR. Just like a healthy protein-centric breakfast sets your blood sugar regulation for the day, so does a healthy wake up when your cortisol is peaking.
Making your own melatonin works far better than taking melatonin as a supplement. You don’t need a lot of your own melatonin! If your circadian rhythm is disrupted, you may fall into a pattern of high cortisol at night, which can manifest as nighttime insomnia, excessive thinking or worry, heart palpitations, or the classic second wind/ night owl energy. Many people with this pattern are tired throughout the day and then have a burst of energy late at night and stay up with it.
You are not going to produce melatonin if cortisol is high. They work in a yin/yang relationship with each other, as cortisol declines, melatonin comes out. Melatonin is secreted by your pineal gland (right between your eyebrows), which is extremely light-sensitive. Even street lights filtering in, or little lights from electronic devices can interfere with melatonin secretion.
If artificial street lights stream into your bedroom, use blackout curtains. They are affordable and easy to find. Natural light from the stars and the moon do not interfere with melatonin production. Have you ever gone camping and noticed how well you sleep? One way to restore circadian rhythms is to take a camping trip! Sleep outside in nature, with the natural light/dark cycle.
Restore your yin/yang cycle of cortisol and melatonin
In the morning encourage the yang, waking nature of cortisol:
Get up with your first waking, expose yourself to outdoor light, full-spectrum light, or a blue light box. Move vigorously (for you) if possible.
In the evening discourage cortisol, and invite the calm yin nature of melatonin:
Shutdown blue light from electronics. Say goodnight to drama, stress, and your busy thoughts. Avoid reading dramatic novels or news. Use low lights. Do something calm – listen to something relaxing, inspiring, or funny. Meditate. Do movements such as Feldenkrais or restorative/yin yoga.
DOWNLOAD Sleep Hygiene Handout