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Adequate sleep promotes cardiac health and regulates blood sugar. Adults who get less than 7 hours are at risk of developing type ll diabetes. 

Sleep also allows the body to produce growth hormones which helps repair tissues and growth of muscle. Growth hormone is released in the early part of the night during slow wave sleep. This is why it’s important to put down the phone and go to sleep around the same time each night! 

During sleep, your body increases the production of the appetite suppressing hormone, leptin, and reduces the production of the appetite stimulating hormone, ghrelin. Ever heard the phrase “rest and digest?”

However, if you get a poor night's sleep then the opposite can happen! This means poor sleep can lead to greater feelings of hunger. Feeling hungry can lead to overeating and poor diet choices. If you want to read more about the importance of diet on mental health then look here.

Wanna read more? Check out this article from the Sleep Foundation. 

Summary

There’s so many benefits to getting good quality sleep! Adequate sleep can improve attention/focus, energy, mood and weight.

With all these benefits, why not focus on your sleep? 

I dare you to really make sleep a priority the next few weeks and see how your mental health skyrockets! 

Stage 1

Stage 1 is part of your light sleep. It’s the shortest phase of sleep! It only lasts a handful of minutes. 

This is where your brain activity and your body start to slow and relax. It’s easy to wake someone from this stage of sleep. 

Stage 2

Stage 2 is also part of your light sleep. The body continues to relax by lowering body temperature and slowing breathing and heart rate.

This stage gets longer throughout the night. People on average spend about half their sleep in this stage. 

Stage 3

Stage 3 is also called slow wave sleep or deep sleep. This stage of sleep has specific brain waves associated with it called delta waves. 

Most of your sleep early on in the night is spent in this stage and the stage shortens throughout the night. 

This stage is hard to wake someone up from and is associated with restorative sleep.

Stage 4

Stage 4 is also called rapid eye movement (REM) sleep. This stage of sleep gets longer throughout the night, especially in the second half of the night.

During this stage the brain is alert like when you’re awake, but your muscles are paralyzed except for your breathing muscles and your eyes. Your eyes are rapidly moving back and forth which is how the stage got the name REM. 

This is the stage of sleep where dreaming is most common and is incredibly important for learning and memory.

Sleep Hygiene Techniques

-Avoid substances (alcohol/caffeine/cigarettes/marijuana) in the evening 

-Avoid eating 2-3 hours before bed 

-Bedroom is an optimal sleeping environment (cold, dark, diet)

-Dim lights 1-2 hours prior to bedtime

-Get morning sunlight/bright light therapy 

-Get out of bed if you can’t fall back asleep after 20 mins, do something restful, then return to your bed when actively sleepy

-Going to bed and waking up at the same time every day 

-Movement during the day 

-No napping (if you struggle with insomnia)

-Only consume caffeine in the morning 

-Only use your bed for sleep and sex (no reading, TV watching, phone scrolling)

-Limit your time in bed to 8 hours

-Limiting screens 1-2 hours before bedtime 

Keep reading to understand how to start implementing these sleep hygiene techniques! I’ll break down these concepts more below. 

You want to put your screens (phone, Ipad, TV) about 1-2 hours before bedtime because they emit blue light. Blue light is activating to the brain and suppresses melatonin production.

You DO want to get morning sunlight and/or bright light therapy! Morning light causes melatonin to be released earlier and in greater amounts at night.

The 3-2-1 method for better sleep refers to not eating 3 hours before bed, no fluids 2 hours before bed, and no screens 1 hour before bed.

What Substances to Avoid Before Bed

What substances do you want to avoid before bed? 

You want to avoid:

-Alcohol

-Caffeine

-Cigarettes

-Food

-Marijuana 

Only consume caffeine in the morning - aka - before 12 PM. It can take over 8 hours to metabolize one cup of coffee! One cup (8 fluid oz) of coffee is about 95 mg of caffeine.

Are you an avid coffee drinker and annoyed that I’m mentioning limiting your use? You can read from the Sleep Foundation about how coffee impacts your sleep here. Don’t blame the messenger!  

Additionally, delaying your morning coffee 1-2 hours after waking allows your morning spike in cortisol clear out adenosine which aids in better energy levels throughout the day.

Try to avoid alcohol, cigarettes, and marijuana in the evening. These substances disrupt your sleep architecture by shortening your REM phase,the restorative phase, of sleep.

Most people turn to these substances to help with sleep, but in fact they do the opposite and reduce the overall quality of sleep. Don’t let the substance use marketing strategies trick you! 

Ideally, you don’t want to eat 2-3 hours before bed. This gives your body time to digest your dinner. You don’t want an upset stomach, reflux, or indigestion when you’re trying to fall asleep!

If you have sleep apnea then avoid alcohol and medications that lower the respiratory drive (Benzodiazepines, Z-drugs/Hypnotics, Opioids). If you have obstructive sleep apnea, then keep reading because we’ll discuss it soon!

Supplements

Keep in mind that most of the evidence for supplements for sleep is minimal or mixed. I encourage you to implement behavioral changes mentioned in the sleep hygiene section prior to considering supplementation. The most common supplements for sleep are magnesium and melatonin. 

If you are considering any form of supplementation to help you sleep then please speak to your medical provider. 

An important note - dietary supplements, such as melatonin, aren't monitored by the U.S. Food and Drug Administration (FDA) the same way prescribed medications are. You can't always be 100% certain of what you're getting and whether it's safe. 

A good rule of thumb is to make sure your product has the “USP” label, which means the contents of the product have been tested by the non-profit research group United States Pharmacopeia. 

Magnesium

Overall, the data on magnesium for sleep is mixed. I say somewhat because there’s conflicting data - some studies showing improvement and some showing no benefit. 

Most of the positive data for using magnesium supplementation for sleep was with those who were deficient in magnesium such as older adults or elderly. Here is a study representing these findings. 

There’s also many different forms of magnesium. Some forms of magnesium that have been used in sleep research are:

Magnesium

-Bisglycinate/glycinate

-Citrate

-Threonate

Magnesium supplementation has been shown to be somewhat helpful in those suffering from restless leg syndrome, also called Willis Ekbom disease.

The uncomfortable sensations from restless leg syndrome occur most commonly when one is inactive such as laying down so symptoms can be disruptful to sleep. 

Speak to your provider if you’re concerned about restless leg syndrome!

Melatonin

Remember when melatonin was mentioned earlier? Let's discuss it more here! 

One of the most popular over the counter sleep aids is a dietary supplement called melatonin. Melatonin is the hormone that is secreted after the sun goes down and signals us that it’s time to “wind down.”

If using melatonin as a sleep aid, the Sleep Foundation and the Cleveland Clinic recommend taking 1-5 mg of melatonin a night with a max dose of 10 mg.

Melatonin is marketed as a “natural” sleep aid. However, the research on taking supplemental melatonin for sleep is really not that great. 

The research that has shown positive results of melatonin supplementation for sleep, just like for magnesium, showed better efficacy in older adults or elderly. The thought behind this is that the pineal gland which is responsible for secreting melatonin can calcify as you age leading to less natural melatonin secretion. 

It’s always important to have the supplement conversation with your healthcare provider. Taking too much supplemental melatonin can disrupt your body’s natural melatonin production along with altering the other functions melatonin serves. 

Melatonin helps your body prepare for sleep as opposed to improving your sleep quality or architecture. Many people take melatonin as they get in bed, but it is less effective this way. If you do want to try taking melatonin, take it 1-3 hours prior to your desired bedtime. 

Common treatments for sleep apnea include:

-Continuous positive airway pressure (CPAP)

-Medications (central type only)

-Nerve stimulators 

-Non-medical (weight loss)

-Oral appliances (mouth pieces)

-Oral surgery

Here are articles about sleep apnea from the Cleveland Clinic and the Mayo Clinic. You can read about the benefits of getting treatment with CPAP (continuous positive airway pressure) are discussed by the Sleep Foundation here.  

Additionally, it’s possible a sleep study could be helpful at identifying another potential cause for your trouble sleeping! Here is a John Hopkins Medicine article about sleep studies. There are NO risks of obtaining a sleep study!

CBT-I, Breathing & Grounding Techniques, and Apps

CBT-I

The GOLD standard of treatment for insomnia is cognitive behavioral therapy for insomnia (CBT-I). CBT-I is the first line treatment recommendation by the American College of Physicians. 

Indeed, there have even been studies that CBT-I is more effective than sleep medications. Check it out here. 

Here’s the Sleep Foundation’s article about CBT-I. Here is an unpaid phone application for CBT-I and here is a paid one. 

Keep in mind CBT-I typically involves implementing the sleep hygiene techniques discussed above and much more. 

Changing your habits is difficult! This will take time and effort. 

Personally, I completed CBT-I while in graduate school when I was going through insomnia. I can tell you from experience I thought it was well worth it!

5-4-3-2-1 Grounding Technique

There’s a 5-4-3-2-1 grounding technique you can do if you’re feeling anxious before bedtime. 

If you’re an audio or visual learner then watch this video about how to use the 5-4-3-2-1 grounding technique. You  can also read this article from the Mayo Clinic. 

Trackers

It’s important to note that the data from a common, standard sleep tracker needs to be taken with a grain of salt. Typically, a sleep tracker uses heart rate and movement to track sleep which isn’t very accurate.

To properly track sleep, you need to utilize electroencephalography (EEG) to measure your brain waves. Other tools commonly used during a sleep study include: electrooculogram (EOG - this measures eye movement) or electromyography (EMG - this measures muscle movement).

So just remember unless you’re looking at sleep data from a sleep study it’s simply the “best guess.”