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March is National Sleep Awareness Month. It’s when we “spring forward” for Daylight Savings Time. Read this to find out how to get more sleep!

What we’ll cover;

• What happens during sleep
  • Sleep stages, sleep cycles, circadian rhythm, sleep drive
• How much sleep we need
  • Factors affecting our sleep
• Why we need sleep
  • Sleep at different life stages
• How to get better sleep
  • Exercise
  • Food and drink to consume and to avoid
  • Caffeine
  • Technology
• Best tips for sleep hygiene
• Help and treatment for sleep
  • CBTi
  • Medications and supplements
• Resources

Spoiler alert: I struggle with sleep

Admittedly, I am not the best role model when it comes to sleep.  As a high school student, I decided that there were so many things I wanted to do, I would just sleep less.  I went to school, worked in the afternoons, did homework until late at night, fell asleep “talking” to my boyfriend (on the rotary phone) and then woke up at 6 am to go running.  If I knew then what I know now (how important sleep is to every component of our health, wellbeing and longevity), I would have prioritized sleep more and established life habits early on to keep my sleep hours and sleep practices sacred. We know that sleep is one of the most important determinants of all aspects of health throughout our entire lifespan.

In my early 20’s I started my hospital nursing career, working both night shift and rotating shifts, completely confusing my “circadian” clock.  That coincided with getting married, and then having three babies in less than six years. Luckily, for almost 25 years, my School Nurse work hours have been stable at 7:30 am – 4:00 pm during the Monday – Friday work week. I continue with that schedule (plus my “new” slant2plants business), even as my husband and I (both in our early-mid 60’s) have been empty-nesting for a while. We aging adults have our own set of sleep challenges, but it’s just as important for our health to get a good night’s sleep.

Even with all my knowledge about the importance of sleep, I still aspire to obtain the “recommended” amount of sleep for my age range. The last several years I have actually been under the treatment of the sleep specialists at UCSF. After extensive evaluation, my doctor finally concluded that I am in the small percentage of people that is healthy and functions well at the lower end of the number of hours of recommended sleep per night.  Even so, I feel much better (emotionally AND physically) if I’ve had a good 6 to 7 hours of sleep per night (I rarely get more).  With less, I know I can still function just fine.  But no one likes feeling tired, especially me!

So, based on my professional expertise and my personal experience, I have a lot of resourceful information to share about sleep.

What happens during sleep

When we sleep and all of our senses are at rest, is we temporarily eliminate the normal sources of stimulation that use up our energy and attention. Our brains and body systems get a biological “reset”, from the biochemical processes that refresh, restore and renew. Sleep fuels us for another day full of all the physical, mental and emotional challenges of life!

The truth is, we’re not really sure about WHY we need sleep, but research helps us understand what happens WHEN we sleep and when we DON’T sleep.

• Sleep stages: HERE is a great site that explains the science of sleep, including the four stages of sleep, and the difference between REM and non-REM sleep.
• Sleep cycles: During our night of sleep, we progress through several sleep cycles, which last an average of 60-90 minutes. The percentage of REM sleep in each cycle progressively increases.
• Circadian rhythm – our “body clock” is a homeostasis mechanism that balances wakefulness and sleep(iness)
• Sleep “drive” – The “pressure” to sleep builds up throughout the evening correlating with a rise in the brain neurotransmitter Adenosine. This brain chemical promotes “deep” or restorative sleep. Caffeine actually works because it blocks adenosine receptors.

Watch this youtube on How does sleep work?

How much sleep do we need?

The CDC references this universal chart which indicates how much sleep one needs according to their age range. The American Academy of Sleep Medicine and the Sleep Research Society recommend:

Age Group	Age	Recommended Hours of Sleep1,2
Infant	4-12 months	12-16 hours per 24 hours (including naps)
Toddler	1-2 years	11-14 hours per 24 hours (including naps)
Pre-School	3-5 years	10-13 hours per 24 hours (including naps)
School Age	6-12 years	9-12 hours per 24 hours
Teen	13-18 years	8-10 hours per 24 hours
Adult	18-60 years	7 or more hours per night

External and internal factors that affect our sleep

Why we need sleep (or what happens if we don’t get enough)

The American College of Lifestyle Medicine identifies “restorative sleep” as one of the six pillars of Lifestyle Medicine. Sleep debt is the amount of sleep we haven’t gotten per night because of sleep deprivation. Accumulated sleep debt (or chronic sleep debt and/or insomnia) leads to serious health issues. What happens if you don’t sleep?

• Obesity: this goes in both directions–decreased sleep contributes to increased weight gain, and obesity is a risk factor for sleep disorders (ex: sleep apnea)
• Heart Disease
• Diabetes
• Immunity/Inflammation:
• Safety: insomnia and poor sleep contribute significantly to both fatal and non-fatal accidents, and motor vehicle accidents and deaths.

New Babies, Parenthood and Sleep (and Insomnia)

Why are new parents so sleep deprived if their babies are sleeping 12-16 hours per day? Because newborns have not yet established a circadian rhythm, so they sleep more during the day and keep their parents awake a lot at night. Additionally, they need to be fed (and changed!) every 1 ½ to 3 hours around the clock, preventing continuous sleep for parents/caregivers. The parenting practices of babies and young children are completely different today than they were when we raised our children in the 80’s and 90’s. Nurseries must have darkout shades or blinds. No more crib bumpers or blankets in cribs. Sleep sacks are the new PJ’s. Some new parents (my own adult kids included) even use sleep consultants, and they have services for adults too! Noise machines are popular gifts for new parents to use with sleeping babies. Here are some tips for new parents. Please let me know if I can send you a hand out on Sleep in Children from the American College of Lifestyle Medicine.

Teens Are Sleep-Deprived

As a School Nurse, I regularly do health screenings with adolescents. When we discuss sleep, I ask them what time they usually go to bed and what time they wake up. Many get the recommended 8-10 hours of sleep. But often, high school students will stay up late for a variety of reasons, including: late sports practices, doing homework and studying, and playing video games and/or using their phones (for no compelling reason). Besides infancy, there is no more demanding period of growth and development than adolescence. I’ve been working in a high school district for almost 25. years and I know there is a lot of competition for the hours in the day of a teen. Parents can support their kids by helping them prioritize and even make their sleep hours and environment “sacred”. That includes: working backwards to set sleep hours (if they have to wake up by 7 am to get to school on time, they should target bedtime to be around 10 pm), keeping phones and laptops away from their bed or even out of their room, eating dinner at least 3 hours before bedtime, and creating a winding down ritual before bed time,

Adolescents who get optimal (8-10 hours/night):

• Excel in the classroom by maximizing attention, memory and learning abilities
• Perform better in sports by being faster, stronger and more accurate
• Feel positive and have a more optimistic attitude toward life
• Look their best and maintain a healthy weight
• Have fun and enjoy life by making better decisions and staying safe

Sleep and Longevity: Don’t have FOMO

Don’t worry about what you are missing when you’re asleep (like I did when I was a teenager and young adult). Not only does sleep make you healthier and smarter (you learn and remember better), but getting enough sleep will add years to your life.

Exercise and Sleep

Getting regular exercise each day helps improve both insomnia and sleep quality. Avoiding strenuous exercise before bedtime is often recommended, as it increases your body temperature and level of stimulation. But some studies show that evening exercise can improve sleep. Regular exercise can also indirectly improve sleep by helping with weight control and stress management. Conversely, getting a good night’s sleep optimizes your exercise!

Food and Sleep

A plant-predominant diet can improve sleep duration and quality. Some science recommends we eat dinner at least three hours before bedtime for optimal digestion and sleep, and especially advises to avoid foods that are spicy, acidic and high in fat, as well as food and beverages with caffeine and alcohol. Not only have these substances been shown to interfere with sleep, they can contribute to GER symptoms, especially if we go to sleep soon after we’ve eaten. Adversely, some foods high in tryptophan, serotonin and melotonin can help certain people fall asleep easier. Additionally, some people with blood sugar issues find it important to have a healthy snack before bedtime to stabilize blood sugar.

Sleep and Caffeine

Coffee: Does it impair sleep? This Sleep Foundation video recommends waiting 60-90 minutes after waking before you start drinking coffee, and starting with water first. Avoid caffeine after 2 pm.

Technology and sleep

Exposure to blue light from digital devices and other light sources has been shown to depress melatonin levels, subsequently decreasing our sense of sleepiness at bedtime.

Sleep Technology

I use an app called AutoSleep. It requires me to wear my Apple Watch throughout the night while I sleep. I also use Sleep Health on the Apple Watch/iPhone. HERE is how you set it up.

Best Tips for Sleep Hygiene

• Be consistent in the time you go to bed and the time you wake up, even on weekends
• DFZ – make your bedroom a “digital-free zone”
• Don’t spend more than an extra hour in bed beyond the recommended amount of sleep for your age
• No naps if you have insomnia or insufficient sleep issues, otherwise keep “power” naps to 20 minutes
• Avoid alcohol within a few hours of bed time
• Avoid caffeine beyond lunch time
• Light: avoid bright lights at night but exposure yourself to morning light (if no available sunlight, use a light box)
• Dark: keep room dark-use black out shades and/or sleep masks as needed
• Noise: keep room quiet or use ear plugs
• Mattress, pillows and bedding: invest in quality sleep equipment!
• Temperature: Think Goldilocks–not too hot, not too cold, about 65-68 degrees F.
• Exercise: regular exercise promotes sleep quality and length, but avoid strenuous exercise close to bedtime
• Sleep and Sex*: our mind associates our bed and bedroom with what activites occur there. Keep your bed for those two – *though you can have sex in more places than just bed 😉
• Wind-down time: set an alarm on your clock (there’s even a setting on the iPhone) to disengage from stimulating activities and calm down between 30-60 minutes before going to sleep.

Seeking help for chronic sleep issues

See your primary care physician to discuss ongoing problems with sleep. If pain and discomfort is impairing your sleep, it is important to address the source of that pain. You may need a referral to a specialist for associated issues, including having a sleep study done to determine if you have sleep apnea. Most issues can be treated with the expectation of at least improvement if not full resolution.

Sleep treatment: CBTi

CBT is a formalized program of Cognitive Behavioral Therapy designed specifically for Insomnia. CBT is meant to be short-term vs. ongoing and focuses on interrupting ineffective patterns and subsequently developing skills that support optimal functioning and well-being. The main components of CBTi include: Sleep Restriction Therapy, Stimulus Control Therapy, Sleep Hygiene and Cognitive Therapy. The two primary goals in CBTi is to increase sleep drive and maximize consolidated sleep. CBTi therapists are licensed healthcare practitioners that are specially trained in this area.

I have done CBTi and I found that it I did experience improvement in my sleep and my attitude towards sleep. Typically it is not covered by medical insurance so you would need to pay out of pocket for the typical 6-8 sessions of this type of program. My therapist had me get this book Quiet Your Mind and Get to Sleep to use during my treatment.

Health Coaching

Improved sleep quality and duration will support your health goals. Consider Health and Well-being Coaching to integrate that on your journey to optimal wellness.

Medications and Supplements

Not being a medical doctor or pharmacist, I will not address sleep medications, other than to say that there are many things to try before and in conjunction with using medications to address sleep issues. There are several purported supplements that may support improved sleep, including magnesium and melatonin to name just two. I also believe that those should be used in consultation with your medical specialist, as they may have side effects and/or interactions with other medications you are currently taking.

Resources

Please note: As an Amazon Associate, I earn from qualifying purchases. I am sharing items with which I have direct experience and that I find useful in my pursuit of healthy living, self-care, and healthy travel. I hope that you find these helpful, and I would appreciate your feedback. 

• Why We Sleep by Matthew Walker, PhD
• Quiet Your Mind and Get to Sleep
• Sleep Mask Eye covers
• Ear plugs
• Blackout window cover
• Organic Lavender Oil Roll-on
• Light Therapy Lamp
• Noise machine

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