Director of Administrative Services, Harold C. Schott Foundation Eating Disorders Program
University of Cincinnati, Department of Psychiatry, Research Assistant Professor
We spend about one third of our lives sleeping, yet more than one third of Americans do not get enough sleep. Adults, ages 18-60, are recommended to get between seven to nine hours of sleep each night. The need for sleep varies in children and teenagers, with 13-17 years olds needing eight to ten hours per night for optimal wellness. Getting adequate sleep each night is mandatory for maintaining one’s overall mental and physical health and insufficient sleep is associated with a number of chronic diseases and conditions including diabetes, cardiovascular disease, decreased sex drive, obesity, depression and even increased thoughts of suicide and death. While its exact biological purpose remains unclear, sleep is found to be crucial for proper nerve cell communication and possibly plays a housekeeping role in removing toxins that build up in the brain when awake.
Insomnia is a sleep disorder that can make it hard to fall or to stay asleep, or causes early awakenings and inability to get back to sleep. Insomnia is common (6-10% of population struggles regularly with at least a few insomnia symptoms) but it remains under recognized and under treated. According to recently published guidelines from the American Academy of Sleep Medicine (1), psychological and behavioral interventions are effective and recommended in the treatment of chronic primary and comorbid (secondary) insomnia and should be utilized as an initial intervention when appropriate and when conditions permit. Cognitive behavioral therapy for insomnia (CBT-I), for example, is a structured program and an effective, non-medication treatment for chronic sleep problems. CBT-I teaches identification of thoughts and behaviors that cause or worsen sleep problems and encourages habits that promote healthy sleep. Some basic techniques used in CBT-I reinforce good sleep hygiene that can be easily implemented if one struggles with poor sleep are described below:
- “Yes” to fixed bedtime and an awakening time through the week- establishing a consistent sleep routine and allowing for no more than 30min variation, including on weekends, will reteach the body to “get used” to falling asleep at a certain time.
- “Yes” to sleep rituals -from relaxing stretches or breathing exercises, reading something light, meditating, or taking a hot bath to sitting calmly with a cup of caffeine-free tea, pre-sleep rituals can vary, but are needed to break the connection between all the intensive daily activities and bedtime. The sleep rituals might be equally important for enhancing healthy sleeping in both children and adults.
- “Yes” to using a sleep diary. Tracking amount and quality of sleep can be a very helpful tool in establishing realistic goals and following progress when working on improving sleep.
- “Yes” to comfortable bedding, moderate room temperature, limited excess noise and a well ventilated room.
- “No” to naps: avoiding activities/ taking naps because of tiredness or poor sleep the previous night perpetuates the insomnia issues. If a nap is needed, limiting it to no longer than 30 minutes, before 3pm, is recommended.
- “No” to caffeine 4-6 hours before bedtime, including caffeinated beverages like tea, many sodas and chocolate. Avoid heavy, spicy, or sugary foods 4-6 hours before bedtime.
- “No” to exercise before bed. Regular exercise no less than 3h before bedtime promotes better sleep, but exercising shortly before going to bed can increase insomnia issues.
- “No” to clock-watching and no electronics in the bedroom. Using a cell phone at night can increase depression and lower self-esteem, especially in teenagers.
On note, various smart phone apps that promote sleep hygiene via calming music (ex. Pzizz app), enhance circadian rhythm regulation (ex. Sleep Cycle app), teach meditation (ex. Long deep breathing” app), help with tracking sleep and can be used as a sleep diary (Sleep diary pro app) or even deliver mobile CBT-I support (ex. CBT-i Coach App.) can be helpful in insomnia management.
It takes up to one month before the body will naturally respond to some of the behavioral changes consistent with healthy sleep, thus patience and persistence while “relearning” sound sleep related habits are the key factors in psychological management of insomnia. Occasional restlessness at night can be normal, however if you have tried and failed to improve your sleep using some of the above mentioned strategies, you may like to consider professional help. Besides psychological interventions, an armamentarium of medications approved for insomnia is available and timely diagnosis and proper management of insomnia can significantly improve everyday wellness. Overall quality of life and life satisfaction should not be postponed, especially if symptoms are affecting daily functioning.