Every health practitioner worth their cup of warm milk these days seems to be talking about sleep or more correctly the lack of it. This is definitely worth discussing as insomnia affects up to 50% of the population. The true figure might actually be far higher as often treatment is not sought until it has progressed into a more chronic or debilitating condition 1.

 

The Importance of Sleep

• Learning & Memory: Sleep helps memory consolidation, the process of retaining new information 2. New research is exploring the links between Alzheimer’s disease and sleep disturbance 3.

• Metabolism and Weight: Sleep deprivation disrupts the hormones that control appetite and can contribute to weight gain, metabolic syndrome and diabetes mellitus. Sleep releases growth hormone and suppresses cortisol, which impact on carbohydrate metabolism. Lack of sleep leads to decreases in the appetite hormone leptin and increases in ghrelin which leads to subjective feelings of hunger and may cause overeating 4.

• Safety: According to the Sleep Health Foundation of Australia, driving after 17 hours of no sleep is equivalent to driving with a blood alcohol level of 0.05. It is estimated “drowsy driving” contributes to 20% of road accidents every year 5.

• Mood: Lack of sleep leads to irritability, impatience and can exacerbate depression and anxiety 6.

• Cardiovascular Disease: Sleep is a “cardiovascular holiday” lowering blood pressure by dilating blood vessels and resetting baroreceptors, the nerve sensors that help to regulate the “set point” of blood pressure 7.

• Immune Function: Lack of sleep results in decreased numbers of white blood cells and increases inflammatory molecules 8.

 

So, what is sleep hygiene?

It is a term introduced by Peter Hauri in 1977 based on the understanding of sleep psychology and pharmacology. It is a variety of daily habits to assist in obtaining quality nighttime sleep and promote full alertness during the day 9.

Five signs that you may have poor sleep hygiene

• Taking longer than 30 minutes to fall asleep;
• Waking up multiple times during the night;
• Waking up during the night and not being able to fall asleep again;
• Waking up feeling tired and un-refreshed
• Relying on caffeine and other stimulants to keep you awake during the day 10.

 

Your sleep hygiene checklist

1. Your schedule
Be regular: Try to go to bed and wake up at approximately the same time each day. An hour extra sleep in on the weekend is fine but if you spend four extra hours in bed you risk disrupting your sleeping pattern 10.

2. Create the right environment:
Use the bedroom only for sleeping (and sex). Avoid watching television, reading or studying in bed. You want your brain to associate your bedroom with sleeping.

Mattress and Pillows: You spend up to 10 hours a day in bed so ensure you have a comfortable and supportive mattress and pillow and appropriate bed linen for the climate and season 11.

3. Temperature
Just before sleep onset the core body temperature drops. To assist this a warm bath 30 minutes before bed increases the blood flow to the surface of the skin and reduces the core temperature. Ideally the bedroom should be cool (19-21°C) and well ventilated 12.

4. Noise & Music
Try to reduce external noise as much as possible. If this is not possible some studies have shown that constant white noise from fans or noise generators can be beneficial 13.

 

Establish a consistent routine that gets your body ready for sleep.

Before bed

• Reduce the lighting 30-60 minutes prior to bed. Strong light inhibits the release of the hormone melatonin, which is required for sleep.

• Shut down the screens. Avoid watching television or using the computer 60 minutes prior to bed. The blue light from the computer screen also suppresses melatonin 14.

• Do 10-15 minutes of meditation or breathing exercises

• Sit calmly with a cup of herbal tea or a glass of warm milk. Herbs that promote relaxation include Chamomile, Passionflower, Valerian, Hops or Lavender. Milk contains tryptophan which helps to induce sleep 6.

During the day

Avoid naps: This means you will be tired at night and ready for sleep. If you must nap do so for no more than 1 hour and not after 3:00pm 15.

Get outdoors: Exposure to natural sunlight (especially in the early morning) is important in regulating the circadian rhythm and provides stimulus for the production of sleep hormones 8.

Get moving: Regular exercise that raises your core body temperature has many health benefits including the promotion of sleep. Exercise should be done at least four hours prior to bed otherwise it may delay sleep onset 16.

Food: A healthy balanced diet provides nutrients that help with sleep. The last meal of the day should be eaten at least two hours prior to sleep and ideally should not be too large. Conversely, not eating an evening meal can cause problems with staying asleep. Nutrients that are particularly important are magnesium, calcium, potassium and B group vitamins 9.

Stimulants

Alcohol: Many people believe alcohol will help them get to sleep and while it can decrease the time to fall asleep research has shown that it interrupts sleep later in the night and can also increase sleep apnoea and snoring 17.

Caffeine: Avoid caffeine containing drinks and foods in the evening (coffee, green and black tea, cola and chocolate).

Cigarette Smoking: Nicotine is stimulating and will increase brain arousal. Avoid smoking just prior to bed and ideally aim to quit smoking for a whole range of other benefits to your health 6,10.

Underlying Causes

Address any underlying causes of insomnia using the appropriate therapies 15.

Sweet dreams…..

How do YOU get a good night’s sleep? I’d love to hear your tips so please comment below.

If you enjoyed this article you might also like:

Does alcohol help you to sleep?

Why do I wake up early in the morning?

 

References:
 1. Cain N. Ready, willing, and able? Sleep hygiene education, motivational interviewing and cognitive behaviour therapy for insomnia in an Australian high school setting. Educ Heal. 2012;30(3):60–64. Available at: www.ebsco.com. Accessed October 11, 2013.
 2. Cairney S a, Durrant SJ, Musgrove H, Lewis P a. Sleep and environmental context: interactive effects for memory. Exp Brain Res. 2011;214(1):83–92. doi:10.1007/s00221-011-2808-7.
 3. Lucey BP, Bateman RJ. Amyloid-β diurnal pattern: Possible role of sleep in Alzheimer’s disease pathogenesis. Neurobiol Aging. 2014;35(SUPPL.2):S29–S34. doi:10.1016/j.neurobiolaging.2014.03.035.
 4. Spiegel K, Leproult R, L’hermite-Balériaux M, Copinschi G, Penev PD, Van Cauter E. Leptin levels are dependent on sleep duration: relationships with sympathovagal balance, carbohydrate regulation, cortisol, and thyrotropin. J Clin Endocrinol Metab. 2004;89(11):5762–71. doi:10.1210/jc.2004-1003.
 5. Schwarz JFA, Geisler P, Hajak G, et al. The effect of partial sleep deprivation on computer-based measures of fitness to drive. Sleep Breath. 2015. doi:10.1007/s11325-015-1220-0.
 6. Abe Y, Mishima K, Kaneita Y, et al. Stress coping behaviors and sleep hygiene practices in a sample of Japanese adults with insomnia. Sleep Biol Rhythms. 2011;9(1):35–45. doi:10.1111/j.1479-8425.2010.00483.x.
 7. Trinder J, Waloszek J, Woods MJ, Jordan AS. Sleep and cardiovascular regulation. Eur J Physiol. 2012;463(1):161–8. doi:10.1007/s00424-011-1041-3.
 8. Bollinger T, Bollinger A, Oster H, Solbach W. Sleep, immunity, and circadian clocks: a mechanistic model. Gerontology. 2010;56(6):574–80. doi:10.1159/000281827.
 9. Gallasch J, Gradisar M. Relationships between sleep knowledge, sleep practice and sleep quality. Sleep Biol Rhythms. 2007;5(1):63–73. doi:10.1111/j.1479-8425.2006.00248.x.
 10. Brick C a, Seely DL, Palermo TM. Association between sleep hygiene and sleep quality in medical students. Behav Sleep Med. 2010;8(2):113–21. doi:10.1080/15402001003622925.
 11. Jefferson CD, Drake CL, Scofield HM, et al. Sleep hygiene practices in a population-based sample of insomniacs. Sleep. 2005;28(5):611–5. Available at: http://www.ncbi.nlm.nih.gov/pubmed/16171275.
 12. Kr�uchi K. How is the circadian rhythm of core body temperature regulated? Clin Auton Res. 2002;12(3):147–149. doi:10.1007/s10286-002-0043-9.
 13. Leanne M, Merle C. Continuous White Noise to Reduce Sleep Latency and Night Wakings in College Students. Sleep Hypn. 2007;9(2):60–66. Available at: www.proquest.com. Accessed October 11, 2013.
 14. Cain N, Gradisar M. Electronic media use and sleep in school-aged children and adolescents: A review. Sleep Med. 2010;11(8):735–42. doi:10.1016/j.sleep.2010.02.006.
 15. Zisapel N. Sleep and sleep disturbances: biological basis and clinical implications. Cell Mol Life Sci. 2007;64(10):1174–86. doi:10.1007/s00018-007-6529-9.
 16. Wells ME, Vaughn B V. Poor sleep challenging the health of a Nation. Neurodiagn J. 2012;52(3):233–49. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23019761. Accessed October 11, 2013.
 17. Roehrs T, Roth T. Sleep, sleepiness, sleep disorders and alcohol use and abuse. Sleep Med Rev. 2001;5(4):287–297. doi:10.1053/smrv.2001.0162.