HOW TO GET MORE SLEEP

This week’s practice, in short

• Sleep is a cornerstone of health and well-being

• Improving sleep can require:

  • Focused attention over a period of time;

  • A strategy;

  • Some know-how.

• There are definitely some easy tricks to sleeping more and better:

  • Expose your eyes to bright light in the 30 minutes after you wake up;

  • Don’t sit for long uninterrupted periods in the evening;

  • Explore different exercise options: regular exercise improves sleep, but timing, intensity, and nature matter. Exercising late in the day does not necessarily disrupt sleep.

Favorite finds

• Sleep Cycle is a free app on the cellphone that keeps track of your sleep. the paid version keeps track of your statistics.

• The Whoop probably is the most accurate at estimating REM sleep and deep sleep. The Oura also provides some information, and could be useful for tracking trends over time.

• When worn overnight, Garmin watches monitor both your sleep patterns and stress levels. This tracking feature helps encourage healthier bedtime habits by prompting you to unwind before sleep, making it more likely you'll begin your night in a relaxed state.

• The Wellue O2 is a ring that can be used to figure out if your oxygen levels drop significantly at night, which would prompt a doctor visit for a sleep study.

• I have no affiliations with these companies. I have, however, developed a Sleep Workbook to guide people systematically through the steps to optimzing sleep.

Deep Dive

I learned most of what I know about sleep from Matthew Walker‘s book Why We Sleep. Most of us know that we should be sleeping enough hours for our health, but there is so more to optimal or even good sleep!

Many people have insomnia. By this they mean that they do not feel refreshed by their sleep. They may have trouble falling asleep, staying asleep, or they may be tossing and turning and wake up feeling unrefreshed. There are ways to address all of these problems. First of all, there is cognitive behavioral therapy for insomnia (CBT– I), which may be covered by insurance. There are also a number of tips and tricks, diet changes, stress reduction techniques, etc.

Chronotypes

Different people have different “chronotypes“. Some of us are genetically wired to be night owls, and others are early risers. The majority of people fall in the category in between, but the early risers really need “midnight” to be near the middle of their night. Night owls really need not to have a job that forces them to wake up at 6 or 7 AM. Teenagers usually become night owls for several years and adults are somewhere in between as the ability to fall asleep earlier improves as you get older.

The importance of chronotypes relates to the three major sleep phases. Every night, we cycle through 3 phases several times. One important phase is called “deep sleep.” We have the opportunity to get deep sleep mostly at the beginning of the night. The functions of deep sleep include improving short-term memory and preventing Alzheimer’s disease, cardiovascular disease, and more. In the second part of the night, we have the opportunity to get more REM (“rapid eye movement”) sleep. The functions of REM sleep again include memory, but importantly also involve stabilizing mood and preventing psychological trauma.

Your natural chronotype (whether you're an early bird or night owl) interacts with your bedtime to influence your sleep cycles. This timing is crucial: early birds who stay up until midnight or 1 AM might miss their prime window for deep sleep. Similarly, night owls, even if they fall asleep at 10 PM may not get enough REM sleep unless they can sleep in late the next morning.

What one would predict is that people whose chronotype is mismatched to their schedule will have one of the following symptoms:

• a night owl who wakes up early has an increased risk of suffering from anxiety and depression

• an early riser who goes to bed too late may increase their likelihood of developing cognitive problems

•  a night owl who has to wake up early may be especially attached to their coffee

Creativity, safety while driving, optimal cognitive performance, general happiness – these are all connected to getting proper sleep at the right time.

Pay Attention to These Four

Sleep should be of sufficient:

1. Quantity – we should give ourselves a nonnegotiable 8 hour sleep opportunity each night

2. Quality (enough deep sleep and REM sleep)

3. Consistency, similar start and end times night after night

4. Continuity – which means that fewer nighttime interruptions are bette

I see people struggle with many of these aspects:

1. People don’t always give themselves a nonnegotiable 8 hour sleep opportunity

2. If they do, they may not fall asleep easily. There’s a number of steps that people should go through to see if they can improve how they fall asleep:

• room temperature

• avoiding naps

• winding down before bed

• not exposing themselves to bright light in the evening

• not exercising too late at night

• not eating in the last 3 hours before bed

• limiting alcohol: some report that they can tolerate a single drink, but need at least 4 hours before bedtime, and others say that any alcohol past 5 pm disrupts their sleep phases.

• THC likely disrupts REM sleep and causes rebound insomnia; CBD may help some people fall asleep by reducing anxiety

If you still can't fall asleep easily after trying all these different things, consider that you’re trying to fall asleep at the wrong time for your chronotype. People who are stuck in jobs that require getting up early and who are not matched to that schedule can never optimize their health from that point of view in that job. Enlightened employers should provide a mix of starting times to accommodate employees with different chronotypes: at the very least they will improve productivity.

Falling Asleep and Staying Asleep

While persistent sleep problems can signal underlying conditions like depression or anxiety that require medical attention, not every sleep issue is serious. Sometimes our sleep patterns are simply irregular, and small adjustments may be all we need to get back on track.

I will not cover in this newsletter all the different options for improving sleep, but instead I will focus on three particular areas.

Exposure to light in the morning

The hormonal and neurotransmitter mechanisms that help us fall asleep are part of a cascade that begins when we wake up in the morning. For people who have difficulty falling asleep, a 20 minutes exposure to direct outdoor light, in the first 30 minutes after waking up, can help reset the clock and allow proper melatonin secretion at the right time in the evening. One experiment where college students were told to get morning light exposure showed faster sleep onset and increased sleep efficiency after just a few days (He).

Sleeping longer in the early hours

A common problem is waking up at 5 or 6 AM without having had nearly the 8 hours one would ideally hope for, but being unable to go back to sleep. One interesting intervention helped study subject gain 30 minutes of sleep time. This involved engaging in 3 minutes of bodyweight exercise every 30 minutes from 5 PM to bedtime (Gale). Each break involved three exercises (chair squats, calf raises and standing knee raises with straight leg hip extensions) for 20 seconds each, over three rounds.

Exercise improves sleep

The studies I reviewed for this section are randomized studies: participants were assigned to different types of exercise, and resulting changes in their sleep were recorded. Studies lasted a few weeks to a few months. Sleep quality, quantity, and timing improved, but sleep efficiency (the percentage of time asleep divided by time in bed) did not improve (Ishihara).

• A study of menopausal women showed that walking in increasing amounts over the course of 12 weeks improved sleep quality (Tadayon)

• Inactive study subjects with insomnia assigned to moderate to intense exercise 150 minutes per week improved their mood, and reduced fatigue and daytime sleepiness (Hartescu)

• In a study of older adults with insomnia, participants followed a six-week exercise program that gradually increased in both duration and intensity. The results showed broad improvements in their sleep patterns, including better sleep quality, longer sleep duration, shorter time to fall asleep, and reduced daytime fatigue (Reid).

• Although individuals who exercised intensely reported higher levels of depression and stress, they still experienced fewer sleep disturbances than those who exercised lightly (Golshani).

CONCLUSION

Don't let poor sleep hold you back. With so many simple, affordable tools to track and troubleshoot your sleep, you can start making meaningful improvements right away.

The path to better rest begins with your next night's sleep.

REFERENCES

Banno M, Harada Y, Taniguchi M, Tobita R, Tsujimoto H, Tsujimoto Y, Kataoka Y, Noda A. Exercise can improve sleep quality: a systematic review and meta-analysis. PeerJ. 2018.

Gale JT, Haszard JJ, Wei DL, Taylor RW, Peddie MC. Evening regular activity breaks extend subsequent free-living sleep time in healthy adults: a randomised crossover trial. BMJ Open Sport Exerc Med. 2024.

Golshani S, Najafpour A, Hashemian SS, Goudarzi N, Shahmari F, Golshani S, Babaei M, Firoozabadi K, Dürsteler KM, Brühl AB, Shakeri J, Brand S, Sadeghi-Bahmani D. When Much Is Too Much-Compared to Light Exercisers, Heavy Exercisers Report More Mental Health Issues and Stress, but Less Sleep Complaints. Healthcare (Basel). 2021

Hartescu I, Morgan K, Stevinson CD. Increased physical activity improves sleep and mood outcomes in inactive people with insomnia: a randomized controlled trial. J Sleep Res. 2015 Oct;24(5):526-34.

He M, Ru T, Li S, Li Y, Zhou G. Shine light on sleep: Morning bright light improves nocturnal sleep and next morning alertness among college students. J Sleep Res. 2023

Ishihara A, Courville AB, Chen KY. The Complex Effects of Light on Metabolism in Humans. Nutrients. 2023.Reid KJ, Baron KG, Lu B,

Naylor E, Wolfe L, Zee PC. Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia. Sleep Med. 2010 Oct;11(9):934-40. doi: 10.1016/j.sleep.2010.04.014. Epub 2010.

Tadayon M, Abedi P, Farshadbakht F. Impact of pedometer-based walking on menopausal women's sleep quality: a randomized controlled trial. Climacteric. 2016. Epub 2016 Jan 12. Erratum in: Climacteric. 2016 Aug;19(4):i.