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How to improve your sleep

HOW CAN I IMRPOVE MY SLEEP?

In today's world, we are constantly bombarded with reasons NOT to sleep. Work, family, children's activities, television, email, social lives - all can present obstacles to sleep. If you feel like you are not getting adequate sleep, you should consult your Doctor, as you may have a sleep disorder that requires treatment. However, there are also things you can do TONIGHT to help improve your sleep hygiene. The tips below, practiced consistently, can help you fall asleep faster and sleep deeper. Try them this month and you may just have the best sleep you've had in a long time!

 

  1. Avoid caffeine, alcohol, and nicotine 4 hours before bedtime

Caffeine and tobacco are stimulants that can keep you awake, or increase your awakenings throughout the night. Many people believe alcohol helps to bring on sleep; however, after a few hours it acts a stimulant and can increase awakenings. This causes fragmented and lower quality sleep. Limiting these substances to at least 4 hours before bedtime will improve your sleep quality.

 

  1. Turn your bedroom into a Sleep Zone

Your brain should associate your bedroom as a place for two things: sleep and sex. Avoid bringing work or electronics such as television or laptops into the bedroom. Eliminate outside noise through the use of earplugs or white noise machines. Consider black out curtains or an eye mask to create darkness, which cues your brain that it’s bedtime. And ensure the room is comfortably cool (between 16-23 degrees Celsius). Your body temperature naturally drops during sleep, and by keeping a cooler bedroom you can promote this naturally occurring phenomenon (this is why it often feels good to dangle one leg outside of the covers!).

 

  1. Establish a pre-sleep routine

Our brains are usually racing from one thing to another throughout the day. Like a racecar or freight train, you can’t expect your brain to go from 100mph to 0mph immediately! Prepare your body for sleep by establishing a routine of relaxing activity ~1 hour prior to bed. This could include watching television, reading a book, taking a bath (the rise then fall in body temperature promotes sleepiness), or mindfulness meditation. If you find you take problems to bed with you, write down a To-Do list prior to bed to get them off your brain.

 

  1. Remove the clock from your bedside table

Staring at the clock when you can’t sleep only creates stress, making it harder to fall asleep. Turn the clock away from you or remove it from the room altogether.

 

  1. Catch some rays

Natural light helps keep your body’s natural sleep-wake cycle in order. Getting outside for a 30 minute walk during the day will help keep your body on track.

 

  1. Set a consistent wake up time

Waking up at the same time every day is the best way to set your body’s internal clock. This will help ensure you’re tired at the end of the day and ready for sleep. A recent UK study showed 60% of people have the hardest time falling asleep on Sunday night, and find it easiest to fall asleep on Thursday. Why? Likely due to “social jetlag”, whereby people go to bed later and wake up later on the weekend – effectively shifting their biological clock as if they’d traversed time zones. By Thursday their internal clock is back on track, only to be thrown off again on Friday! Stick to the same schedule as much as possible, even on weekends.

 

  1. Avoid napping during the day

Napping, as good as it feels at the time, will decrease sleep drive and make it more difficult to fall asleep at night. Avoid napping as much as possible, especially later in the day.

 

  1. Exercise early

Exercise helps promote deep, restful sleep if done at least 2-3 hours prior to bedtime. Exercising intensely too close to bedtime will stimulate the mind and body and release a stress hormone called cortisol, which can delay sleep.

 

  1. Lighten up on evening meals

Eating a heavy meal right before bed is likely to keep you awake and uncomfortable. Finish dinner several hours before bed, and try to avoid foods that can cause you indigestion.

 

  1. Avoid late night screen time

Your phone and laptop emit blue light, which has been shown to stimulate the brain and disrupt your internal clock. Avoid reading on your phone or laptop in the hour before bedtime. If you must be on your phone, take advantage of your phone’s night mode (on iPhone, go to Settings>Display & Brightness>Nightshift) to reduce the amount of bluelight after 9 or 10pm.

 

Sleep is critical for our lives. Taking steps to give yourself the best chance of having a good night’s rest will go a long way to improving both your mental and physical health.

March 17, 2023 by Michael Sharp

How does sleep change over the lifespan?

HOW DOES SLEEP CHANGE OVER THE LIFESPAN?

“She sleeps like a baby”; “my teenager is lazy, he sleeps till noon”; “now that I’m 65 I’m up 2 or 3 times a night and can’t fall back asleep!”. These are all common commentary around sleep, and each holds some truth to it. But what happens to our sleep, and how do our sleep needs change, over our life?

BABIES

Prior to birth (in utero), and in our early life, we spend most of our time in REM (Rapid Eye Movement) sleep. In fact, over the first two years of our lives, we spend over 50% of our sleep time in REM (vs. ~20% for adults). As anyone with a newborn knows, depriving a baby of just a few hours of sleep is not a good recipe for a happy baby! In fact, babies spend most of their day (ideally 14-17 hours) sleeping, and this amount of rest seems to be critical for brain and bodily growth, learning, and emotional regulation.

ADOLESCENTS

It’s our teenagers today where sleep (or lack thereof) is perhaps of most concern. Teenagers require more sleep than adults (8-10 hours per night, according to the CDC); however, due to several factors, approximately 95% of North American males and females in the 12th grade DO NOT get at least 8 hours of sleep. For teens, there are several factors at play:

  1. Circadian Rhythm shifts. After puberty, adolescents experience a biological shift in their body’s internal clock of approximately 2 hours. This means if they’d been going to bed naturally at 9pm, they’ll shift to 11pm. It also means waking up 2 hours later the next morning.
  2. Early School start times. Primarily due to the biological shift in Circadian Rhythm, the American Academy of Pediatrics has recommended that Middle and High Schools start at 8:30am or later, to give students the opportunity to get the proper amount of sleep. However, 93% of US High Schools and 83% of US Middle Schools start BEFORE 8:30am.
  3. Social Media. Our teenagers are connected like never before, and this comes with a huge cost for their sleep. Approximately 92% of US teens have a smartphone, and 33% of them bring their phones into their bedroom and use them before sleep. These devices stimulate the mind and emit harsh blue light, making sleep onset more difficult. Furthermore, even once they do put the phone down, 28% of teens leave their phones on while sleeping, only to awaken to texts, calls, or email alerts throughout the night.
  4. Educational Demands. Teenagers are under a lot of pressure, especially as they approach grades 11 and 12 and post-secondary applications are looming. Many can feel overwhelmed by school and extracurricular activities, and cut out sleep as a way to fit it all in. Ironically, reducing sleep in favour of more studying has the opposite effect on learning. According to sleep research Dr. Matt Walker, if you haven’t slept, your ability to learn new things drops by up to 40%. For learning and retention, a student is far better putting away the books and getting a good night’s sleep than pulling an all-nighter.

What can you do to help your teen’s sleep habits? Model good sleep habits yourself! Set a regular bed and wake time; dim the lighting in your house after 8pm; remove electronics from your room; and avoid cell phone or tablet use after a certain time (ideally one hour before bedtime).

Older Adults

Most people experience a decline in the quantity and quality of their sleep, starting in their forties. There is a myth that older adults need less sleep, but that does not seem to be true. What is true is that older adults report lower quality and quantity of sleep, due a number of factors.

  1. Reduction in Deep Sleep. There seems to be a palpable reduction in Deep Non-REM sleep as we age, making sleep feel less restorative.
  2. Increased fragmentation of sleep. Older adults wake up more frequently during the night, which fragments sleep and reduces sleep efficiency. Sleep Efficiency is defined as the % of time asleep while lying in bed. As healthy teenagers, we see ~95% sleep efficiency, while sleep doctors consider 90% sleep efficiency a healthy level for adults 40+
  3. Circadian Rhythm changes. In contrast to adolescents (who experience later Circadian sleep cues), the internal sleep clock as we age seems to advance earlier and earlier, leading to earlier bedtimes

Recommended Sleep per 24 hour period (per CDC Guidelines)

Newborn 0 to 3 months 14 - 17 hours
Infant 4 to 12 months 12 - 16 hours (including naps)
Toddler 1 to 2 years 11 - 14 hours (including naps)
Preschool 3 to 5 years  10 - 13 hours (including naps)
School Age 6 to 12 years 9 - 12 hours
Teen 13 to 18 years 8 - 10 hours
Adult 18 to 60 years 7 or more hours
61 to 64 years 7 - 9 hours
65+ 7 - 8 hours

If you’ve noticed your sleep as regressed with age, you are not alone. Also, there ARE things you can do to improve it! Proper sleep hygiene, which we’ll focus on in our next article in our Sleep Week series, is critical for all ages but becomes even more important as we age and sleep becomes more elusive.

March 16, 2023 by Michael Sharp

What Happens During Sleep?

WHAT HAPPENS DURING SLEEP?

Sleep is the single most effective thing we can do each and every day to reset the health of our mind and body. But what is happening to our bodies during sleep? The answer depends on the STAGE of sleep you are in. Sleep in humans can be subdivided into two main types of sleep: Rapid Eye Movement (REM) and Non-REM. Non-REM, in turn, can be further subdivided into Stage 1 (awake/light), Stage 2 (light sleep), and stage 3/4 (deep sleep).

We cycle through these sleep stages roughly every 90 minutes, what we call a “sleep cycle”.

NON-REM Sleep.

As we go into the light stages of Non-REM sleep, a few things happen:

  1. Heart Rate decreases
  2. Body temperature drops
  3. Electrical brain wave activity slows down

But then, as we move into deeper non-REM sleep (stage 3 and 4), the brain erupts with larger brain waves. It is in Deep Sleep that we see memory consolidation, massive boosts to our immune system, and an overhaul of our cardiovascular system. Even more impressive (yet for reasons we still don’t quite understand), during deep sleep, hundreds of thousands of brain cells in your cortex all of a sudden will fire together, and then go silent together…something that doesn’t happen at any other point during the day.

REM Sleep.

It’s during REM sleep when we typically have the most vivid and memorable dreams. It’s also during REM sleep when our Amygdala is soothed (reducing emotional stress), and our deepest learning integration happens, whereby our brain stitches new information processed that day into our longer term memory and storage, yielding creative solutions to previously unsolvable problems.

HOW SLEEP WORKS

Ultimately, two factors will determine your ability to transition into these sleep stages, and your alertness during the day.

  1. Sleep Pressure. From the moment you woke up this morning, a chemical called adenosine has been building up in your brain. The more adenosine, the sleepier you feel. When you sleep, your brain actually removes the adenosine, allowing you to wake up refreshed and alert for the day.
  2. Circadian Rhythm. Our bodies have evolved to have an internal 24 hour clock which we call our Circadian Rhythm. Your circadian rhythm is controlled by a center in your brain called the suprachiasmatic nucleus, which communicates to the rest of our body via a hormone called melatonin. The suprachiasmatic nucleus uses a number of inputs, chiefly sunlight and darkness, to regulate the amount of melatonin to release thereby telling your body it’s time to go to sleep or time to wake up.

 

As a brief aside, in recent years there has been an increase in people taking melatonin supplements to “kickstart” their sleep. BE CAREFUL HERE and consult your doctor before doing so. The long-term impacts of melatonin are still unclear. Additionally, while melatonin may help with sleep onset, it may have detrimental impacts on sleep quality over prolonged usage.

The Bottom Line: our bodies are AMAZING machines. Millions of years of evolution have created this thing called “sleep” which is critical for our minds and bodies. Next up in our Sleep Week series, we’ll look at how sleep changes over the course of our lives.

March 15, 2023 by Michael Sharp

Why do we Sleep?

WHY IS SLEEP IMPORTANT?

Although scientists are still learning exactly what is happening in our bodies when we sleep, the evidence is clear: Adequate Sleep is CRITICAL for short and long term physical and mental health.

In the short term, Sleep improves:

Our Learning and Memory.

Sleep performs three critical functions for learning and memory:

  1. INFORMATION TRANSFER: Information you’ve just learned is stored in the hippocampus (your brain’s short term “filing cabinet”). During sleep, information transfers from the hippocampus to the brain’s Cortex (your long term “hard drive” for memory storage), locking in learning for future accessibility.
  2. REPLAY: during sleep, information processed during the day actually replays over and over again in your brain, strengthening the neural networks and engraining these memories into your brain’s circuitry.
  3. INTEGRATION: during sleep, your brain integrates new information with information already stored in your brain, which can lead to novel and creative solutions to previously unsolved problems. This is why we say “sleep on it”!

Our Mood and Emotions.

Our emotional responses are largely controlled by the Amygdala, a deep emotional center of the brain. Sleep Research Brain Scanning conducted by Dr. Matthew Walker has shown that in those suffering from lack of sleep, the amygdala is hyperactive, negatively affecting mood, anxiety, stress and mental exhaustion. Sleep appears to improve the brain’s regulation of the amygdala, leading to improved emotional states. One study from the University of Pennsylvania found that subject who were limited to 4.5 hours of sleep a night for one week reported feeling stressed, angry, sad, and mentally exhausted. When the subjects returned to normal sleep, they reported a dramatic improvement in mood!

In the long term, Sleep impacts:

Our Weight

Several studies have linked insufficient sleep and weight gain. For example, studies have shown that people who habitually sleep less than six hours per night are much more likely to have a higher than average body mass index (BMI). Sleep is now being seen as a potential risk factor for obesity along with the two most commonly identified risk factors: lack of exercise and overeating.

During sleep, our bodies secrete hormones that help to control appetite, energy metabolism, and glucose processing. Obtaining too little sleep upsets the balance of these and other hormones. For example, poor sleep leads to an increase in the production of cortisol, often referred to as the "stress hormone." Poor sleep is also associated with increases in the secretion of insulin following a meal. Insulin is a hormone that regulates glucose processing and promotes fat storage; higher levels of insulin are associated with weight gain, a risk factor for diabetes.

Insufficient sleep is also associated with lower levels of leptin, a hormone that alerts the brain that it has enough food, as well as higher levels of ghrelin, a biochemical that stimulates appetite. As a result, poor sleep may result in food cravings even after we have eaten an adequate number of calories. We may also be more likely to eat foods such as sweets that satisfy the craving for a quick energy boost. In addition, insufficient sleep may leave us too tired to burn off these extra calories with exercise.

Our Cardiovascular Health

Studies have found that a single night of inadequate sleep in people who have existing hypertension can cause elevated blood pressure throughout the following day. This effect may begin to explain the correlation between poor sleep and cardiovascular disease and stroke. For example, one study found that sleeping too little (less than six hours) or too much (more than nine hours) increased the risk of coronary heart disease in women.

There is also growing evidence of a connection between obstructive sleep apnea and heart disease. People who have apnea typically experience multiple awakenings each night as a result of the closing of their airway when they fall asleep. In addition to these sleep disturbances, apnea sufferers also experience brief surges in blood pressure each time they wake up. Over time, this can lead to the chronic elevation of blood pressure known as hypertension, which is a major risk factor for cardiovascular disease. Fortunately, when sleep apnea is treated, blood pressure may go down.

Our Lifespan

Considering the many adverse health effects of insufficient sleep, it is not surprising that poor sleep is associated with lower life expectancy. Data from three large cross-sectional epidemiological studies reveal that sleeping five hours or less per night increased mortality risk from all causes by roughly 15%.

Adults 45+ who sleep less than 6 hours are:

  • 200% more likely to have a heart attack
  • 3.7x as likely to suffer a stroke
  • Significantly more at risk for type 2 diabetes
  • 3x as likely to develop cancer

The Bottom Line:

Sleep is IMPORTANT! Next up in our Sleep Week series, we’ll learn about sleep stages and what’s happening as we sleep.

March 14, 2023 by Michael Sharp
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