There was a day and age before the Industrial Revolution (early 19th century) where there was no artificial light or heavy use of caffeine and people would go to sleep around dusk and wake up with the chickens; our internal circadian clock was in synch with the 24 hour day and melatonin was released one hour before we would go to sleep—and there was no need for alarm clocks.
Fast forward 200 years and as a society we are all sleeping two hours less a night than we did before electricity and that applies to all age groups including young children. The key issue is the artificial light we are exposed to between dusk and bedtime that suppresses melatonin release and has wreaked havoc on our internal circadian clock.
Contrary to popular wishful thinking, most of us still need about 8 hours of sleep a night but we are often up close to midnight to unwind and watch our favorite shows (more bright light exposure) but still planning to get up quite early the next morning. Hence, 90% of Americans consume caffeine including children who have caffeinated soft drinks. We live in an increasingly 24/7 society where sleep is not a priority and can be regarded as an unnecessary diversion of time that could be better spent elsewhere. Of course, some of us feel we’ve lost the ability to sleep well even though our intentions are good to get more sleep but we just don’t know how anymore with all the stress in our lives. I encourage patients not to compromise sleep away but to pay attention to their daily routines and become aware that healthy sleep is shaped by what we do: what you eat and drink, how you schedule your days, and how you spend the hours before you go to sleep can all impact your quality of sleep.
When I mention the term “sleep hygiene,” some patients wonder if that means having clean sheets. That’s not exactly it although having comfortable sheets is a part of it. “Sleep hygiene” refers to a series of healthy sleep habits that can improve your ability to fall asleep and stay asleep. Healthy sleep habits are a combination of evidence-based interventions and good advice that work best when personalized as everyone is different.
I like to break down healthy sleep habit tips into 6 categories: Daytime, Evening, Bedroom, Behaviors, Schedule, and Substances (or the mnemonic, DEBBSS).
Daytime:
Get plenty of light exposure, for most people beginning at the scheduled out-of-bed time
Be active throughout the day and plan specific exercise time
If you nap, make it early afternoon and short duration (up to 20-30 minutes)
Evening:
Have early supper but if you are hungry at night, eat a light, healthy snack
Moderate evening fluids, but not to the point of thirst
Developing a relaxing routine such as listening to soothing music or reading
Consider a warm Epsom salt bath
Avoid bright light exposure as bedtime approaches (and use blue frequency blocking apps and bulbs)
Make the bedroom a technology free zone and turn off electronic devices at least 30 minutes before bedtime
Plan worry/idle time before getting into bed—take notes
Avoid important discussions at bedtime
Bedroom:
Temperature should be on the cool side
Light should be safely dark
Consider shades to block out external light (or eyeshades)
But consider value of external light exposure at dawn
Regulate sound
Avoid disturbing noises (consider a good pair of earplugs)
Consider “white noise” device which can block out outside noises like trucks and dogs and can also give a sense of comfort like a cocoon
Consider Earthing sheets and EMF protection for the home
Consider ventilation (fan for air movement and sound)
Comfortable mattress, pillows, and sheets (possibly socks or gloves)
Reserve the room for sleep and sex only
Pets in the room or not depending on if they are problematic
Behaviors:
Don’t spend excessive wakeful time in bed
Consider a boring activity that can be stopped at any time like reading a book with dim lighting
Avoid excessive light
Return to bed when sleepy
Don’t watch the clock throughout the night
Confirm the alarm is set at bedtime and don’t check it again
Avoid a lighted clock facing the bed
Schedule:
Try to maintain a regular bedtime that’s before midnight; the hours of sleep before midnight are the most rejuvenating of the night so the earlier the better. If you need to be up by 6 am then your bedtime should be around 10 pm. In the winter, you might want to consider going to bed even earlier.
Try to maintain a regular out-of-bed time—every day
Allot sufficient time for sleep (approximately 8 hours)
If you have a poor night of sleep, it’s okay to take a brief nap but don’t sleep in during the next day.
Substances:
Avoid caffeine in the afternoon and evening
Avoid alcohol in the evening
Avoid nicotine (cigarettes, e-cigarettes, gum, and patches) in the evening and throughout the night
Consider a calming tea such as valerian or chamomile
Studies confirm that healthy sleep is important to repair and reorganize the brain that helps us resist infection, and improve concentration, insight, and creativity. The consequences of not getting enough sleep are depression, weakened immune system, diabetes, cardiovascular disease, weight gain, ADHD, and hormone dysregulation. If you want to be the best version of yourself, decide to make sleep a priority and that starts with becoming aware of the choices you make in your everyday life.
Here are a couple good resources on sleep hygiene habits: