Diverse group of five women standing arm in arm as they hike a nature trail

5 Ways to Make Healthy Habits Stick—No Willpower Required 

By Sharon Brock, MS, MEd

If you’ve already given up on your New Year’s resolutions, you’re not alone. Studies show that 88 percent of resolutions are broken within the first two weeks of January, and 95 percent are abandoned by the end of the month. Many people start a protocol on January 1st, stick with it for a couple of weeks, but then drop off and feel like a failure.

Stanford behavior change expert BJ Fogg, PhD, shows us a different way. “Research shows that relying on willpower is not how behavior change works,” says Dr. Fogg, founder of the Stanford Behavior Design Lab. Rather than give up on your health goals after you (inevitably) get off track, Dr. Fogg recommends trying a few of the following strategies to help make your new healthy habits last.

1. Help Yourself Do What You Already Want to Do

Everyone has a part of them that wants to eat healthy and exercise and another part that wants to eat junk food and sit on the couch. We have conflicting motivations. So how can we help the part of ourselves that wants to eat healthy and exercise? Dr. Fogg recommends choosing a healthy habit that you already enjoy doing.

“If you don’t like running, don’t have ‘go for a run every morning’ as your new year’s resolution. There are a hundred other ways to be active, so pick something you already enjoy,” says Dr. Fogg.

It may be helpful to reflect on which healthy habits would work for you in a sustainable way and write down behaviors you already enjoy doing. For example, if walking on a treadmill doesn’t work for you, try walking in nature. Or if you’re not a morning person, don’t set your alarm for 5 a.m. to workout; instead plan to exercise at the end of your workday.

“Most protocols, such as strict diets, don’t work long term because they are too prescriptive,” says Dr. Fogg. “When it comes to behavior change, one size does not fit all. A new habit only sticks when it makes sense at the individual level.”

2. Set the Bar Low

The best way to create a lasting habit is to set the bar low so that you can be consistent with it every day. For example, if you want to start jogging, commit to putting on your running shoes and walking to the end of your driveway and back. If you feel overwhelmed about cleaning your house, commit to tidying up just one piece of furniture every night before bed. If you’re not motivated to floss your teeth, commit to flossing just one tooth. It might sound silly, but making the habit small lowers the amount of motivation required to complete the behavior. With consistency, the behavior becomes a habit that eventually becomes part of your automatic daily routine.

“The key is making the habit so small that you can do it even when you’re sick, busy, preoccupied, or just low motivation,” says Dr. Fogg, explaining the habit-forming technique from his bestselling book, Tiny Habits. “Let’s say the new habit is flossing. You don’t have to stop at one tooth; you can always do more if you feel like it, but it’s not necessary to feel successful. Simply put, you have a minimal habit that you do every day, and when you want to do more, then you do more.”

3. Positive Emotions Create the Habit

It’s important to recognize that habits are created when we feel successful, so the key is to make the feeling of success easier to attain (see Tip #2).  As we are on our habit-forming journey, Dr. Fogg encourages us to feel proud of ourselves even for the tiniest of successes because when we feel good about a new habit, we will become more motivated to keep doing it—and eventually, willpower is out of the picture entirely.

“Most people are so hard on themselves, and they use guilt and shame to establish new habits, but that doesn’t work,” says Dr. Fogg. “They think that identifying their short comings rather than their successes will help motivate them. What works better is finding every excuse to seeing you’re doing a good job so that you continue doing the new habit.”

Also, many of us have heard that it takes 28 days to establish a new habit, however, this theory has been debunked. Dr. Fogg says that if we feel successful at a deep and authentic level, even for the tiny version of the behavior, the habit can form at a much faster rate.

4. Anchor Your New Habit to an Existing Habit

If there’s a habit that you already do every day (I see you, coffee drinkers), you can anchor your new habit to the original one. Dr. Fogg calls this “anchoring” because you’re tying a new habit to something already stable in your life. This technique has also been referred to as “habit stacking”.

Regardless of what you call it, this is what you do. Identify something you already do automatically and then perform the new habit afterward. Here are some examples:

After I make my coffee, I meditate

After I turn on the faucet for my nightly bath, I floss my teeth

After I press “start” on the microwave to heat my lunch, I do 20 jumping jacks and 20 squats

After I turn on the television when I’m done with work, I hop on a stationary bike

Write down a few of the habits you already do automatically and see if you can anchor a new habit after them. The anchoring technique provides a great way to incorporate many new habits simultaneously into your daily routine.

5. Try to Change Together, Not Alone

We’ve all heard of the concept of “accountability buddies,” but Dr. Fogg says this strategy actually works. So, if you have a friend with the same health goals as you, it would be wise to sync up your efforts. For example, if you want to walk for 30 minutes daily, finding a friend to walk with can help you both become consistent. Also, since we now know that positive emotions help establish new habits, try and find a walking companion who adds laughter or interesting conversations to the experience so that you associate walking with feeling good.

Also, Dr. Fogg explains that changing together is especially important in certain domains, such as sleep (i.e., going to bed and waking up at the same time as your bed partner), nutrition (i.e., eating similar meals with other members of your household), and media use (i.e., how much television you and your family watches every night).

 “We can change alone, with a friend or partner, or even with a group,” says Dr. Fogg. “If you want to change as a household, I invite you to hold a family meeting to discuss one behavior change the entire family can agree on for the entire year. Changing with others can make establishing new habits easier and potentially even fun.”

 

 

 

 

 

 

 

 

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sleep

How Sleep Deprivation Affects Your Metabolic Health

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By Nicole Molumphy, BS and Sharon Brock, MEd, MS

Do you ever get those late-night cravings or feel like your hunger is never satiated? Research shows that consistent short sleep duration (less than 7 hours per night) can influence metabolic health, affect the function of appetite hormones, increase food cravings, and lead to a 38 percent increase in obesity in adults.

Consistent sleep deprivation can lead to altered functioning of the appetite hormones ghrelin and leptin. Ghrelin increases our appetite and is released by cells in the stomach lining. When your stomach is “growling,” that is the ghrelin hormone talking. Conversely, the hormone leptin, made by our fat cells, lowers our appetite. Studies have revealed that sleep deprivation can lead to increased ghrelin and decreased leptin, resulting in an overall experience of constantly being hungry.

“There are so many health conditions associated with poor sleep,” says Rob Oh, MD, Clinical Associate Professor (Affiliated) and family physician at the Veterans Affairs Health Care System in Palo Alto. “With chronic sleep deprivation, your metabolism becomes dysregulated, leading to cravings for processed foods. Also, you’re less likely to exercise, you feel more stressed, and you’re more likely to think poorly. The combination of these factors can lead to metabolic health problems like obesity and type 2 diabetes.”

Sleep Deprivation Increases Stress Hormones

Our cortisol levels are typically lowest near midnight and then increase towards waking hours, ultimately peaking around 9 a.m. Studies demonstrate that reoccurring poor sleep is associated with an altered cortisol secretion pattern.

For example, delaying your bedtime could lead to high cortisol levels in the middle of the day, rather than just in the morning. Sustained high levels of cortisol can lead to an increased amount of insulin in the blood, which promotes the accumulation of belly fat and has the potential to lead to prediabetes, type 2 diabetes, and other metabolic disorders.  An increase in cortisol levels during the day may induce prolonged feelings of stress, increased food cravings, and further insomnia—promoting a recurrent, cyclical pattern.

“Inadequate sleep disrupts hormone levels, which dysregulates one’s metabolism and makes individuals hungrier,” says Dr. Oh. ” When we are hungrier, we eat more, which leads to weight gain and potentially metabolic disease.”

If that’s not bad enough, cravings for ultra-processed foods, sugars, and alcohol become more of a tease with sleep deprivation. A possible mechanism for this added hunger is an increased activation of the endocannabinoid system, which is found throughout the body and controls several biological systems, including sleep, mood, and appetite.

Sleep Deprivation and Increased Risk of Diabetes

Research shows that a lack of sleep may also result in insulin resistance, a driving factor in prediabetes and type 2 diabetes. Insulin is a hormone made by the pancreas that regulates blood glucose levels. Insulin resistance occurs when cells in the liver, fat, and muscles do not respond well to insulin, and in turn, glucose is not taken up into the blood.

The exact mechanism behind the causal relationship between insufficient sleep and insulin resistance is still being studied, however, some studies note that increased inflammatory markers, like C-reactive protein and hormone dysregulation, such as cortisol may be involved.

Currently, prediabetes affects one in three adults in the US. While many mechanisms contribute to the development of prediabetes and type 2 diabetes, some of the more prominent ones include impaired cellular insulin sensitivity, modified gut microbiota, and overly-sensitive sympathetic nervous system (fight-or-flight) activation. When the sympathetic nervous system is activated, it signals the liver to release more glucose into the bloodstream, leading to higher blood sugar levels.

What Can We Do About It?

Unfortunately, research finds that “weekend recovery sleep” is not enough to bring your metabolism back into balance after a lack of sufficient sleep throughout the week. Instead, Dr. Oh recommends taking a holistic approach and examining not only your sleep habits but also your nutritional choices and workout routines to support the restoration of metabolic health.

For those with pre-diabetes and type 2 diabetes, a diet focused on whole foods and low refined carbohydrates is critical for weight loss and glucose control.

Specifically, Dr. Oh recommends a low carbohydrate diet, such as consuming 75 to 100 grams of carbohydrates per day, to control and balance blood sugar levels. He also recommends quick, 20-minute, high intensity workouts for time-efficient and effective exercises that promote metabolic health. Regarding supplements, Dr. Oh recommends magnesium to promote muscle recovery and relaxation before bedtime.

“Optimal sleep is so intertwined with athletic and exercise performance, brain health, and metabolic health,” says Dr. Oh. “Sleep really is a keystone area where many of us can do better and hence reducing our risk for metabolic diseases and lengthening our healthspan.”

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Don’t Hit Snooze! And Other Practical Tips for Optimal Sleep

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By Sharon Brock, MEd, MS

Millions of Americans share a similar experience every morning. The alarm goes off, but they’ve already been awake for hours in bed. They hit the snooze button to squeeze in a few more minutes of precious rest, not realizing they were making their sleep problems worse.

“Hitting the snooze button is one of the worst things you can do because it prolongs morning grogginess and associates the bed with being awake,” says Fiona Barwick, PhD, DBSM, Stanford Clinical Associate Professor, Psychiatry and Behavioral Sciences – Sleep Medicine. “Rather than hitting snooze, it’s important to get out of bed within 15 minutes of the alarm going off and get some natural light to stop melatonin production.”

You may not think that something you do first thing in the morning will affect your sleep that night; however, Dr. Barwick says that the behaviors we engage with throughout the day can impact the quality of our sleep at night.

“Getting a good night’s sleep is a 24-hour endeavor,” says Dr. Barwick.

How Does Sleep Work?

According to Dr. Barwick, we fall asleep when these three biological systems are in working order:

  • Circadian Rhythm (CR)
  • Sleep Drive (SD)
  • Stress Management (SM)

 

Here is a list of behaviors that can negatively affect the three systems (CR, SD, SM), as well as alternative behaviors that have a more positive impact:

Since it may be difficult to change all the behaviors in this table, Dr. Barwick shares the top two behaviors that are most important for each system:

  • Circadian Rhythm
  1. Sleeping in the right window for your body clock (e.g., 10pm – 6am, 11pm – 7am, or 12am – 8am, etc.) and staying consistent with those sleep and wake times.
  2. Appropriate exposure to light and darkness to sync the release of melatonin with wake and sleep times (e.g., getting morning sunlight, not looking at screens one hour before bed, and making sure the bedroom is dark).
  • Sleep Drive
  1. Increase sleep drive by tiring the body with regular physical exercise and outdoor light exposure.
  2. Getting out of bed promptly (no hitting the snooze button) and making sure you spend the appropriate amount of time in bed (anywhere from 6-10 hours depending on your individual genetics and age).
  • Stress Management
  1. Physical relaxation—Deep breathing throughout the day to relax the body.
  2. Mental/Emotional relaxation—mindfulness meditation or journaling to process emotions before going to bed.

Practice of the Month:

Avoid hitting snooze (i.e., get out of bed when the alarm goes off) and create morning, midday, and evening routines to optimize the three key systems for sleep.

From the table above, write two behaviors you can do in the morning, midday, and at night. Make sure that you’re addressing all three systems (CR, SD, and SM).

What to do in the morning for good sleep:

1)

2)

What to do during the day for good sleep:

1)

2)

What to do at night for good sleep:

1)

2)

Here is a sample:

What to do in the morning for good sleep:

1)  Put phone out of arm’s reach and get out of bed right after alarm goes off (CR, SD).

2)  Go for a walk around the block, then eat breakfast (CR, SD).

What to do during the day for good sleep:

1)  Stress reduction: do a 10-minute mindfulness meditation at lunch (SM).

2) Physical exercise: do a 45-minute workout right after work (SD, SM).

What to do at night for good sleep:

1) Turn off all screens one hour before bed and write in my journal while listening to relaxing music (CR, SM).

2) Take a luxurious candle-lit bubble bath while taking deep breaths and counting my blessings (CR, SM).

“These are behaviors we can do to increase the likelihood of getting better sleep, but there may be times when we do everything right and still not sleep well,” says Dr. Barwick. “The most important thing to remember is that we will be fine the next day. We are evolutionarily adapted to deal with insufficient sleep, and we can still do what we need to get done, even without the full amount of sleep that we normally get.”

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Screen Time and Sleep—It’s Different for Adults

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By Mary Grace Descourouez, MS, NBC-HWC and Sharon Brock, MEd, MS

Many of us have heard that looking at our phones or iPads at night can keep us awake due to light exposure, however, research shows this may be true for children, but there is not sufficient evidence to support this claim for adults.

“Young children have a greater sensitivity to light because more light gets to the retina of a child than an adult,” says Jamie Zeitzer, PhD, Co-Director of the Stanford Center for Sleep and Circadian Sciences. “Since adults have more opacities in their eyes and smaller pupils than children, less light passes through adult eyes, so there’s less of an effect on melatonin production.”

Melatonin is a hormone that makes us feel sleepy and is released when the eyes perceive darkness. Conversely, when we see natural light in the morning, we feel more awake because light hitting our eyes stops the production of melatonin.

Given this logic, it would seem reasonable that looking at our screens (smart phones, computers, iPads, etc.) at night could delay melatonin production and inhibit our ability to fall asleep, but Dr. Zeitzer says this is not the case.

While darkness enables melatonin production, suppressing melatonin production works by the brain comparing the amount of light we receive during at night with how much we received during the day. It’s the shift from light to dark that cues the release of melatonin, which is why we start to feel sleepy after the sun goes down.

Since natural sunlight emits 10,000-100,000 lux of light and phone screens emit 25-50 lux under usual conditions at night, Dr. Zeitzer says the light from our screens doesn’t have much of an impact on the melatonin cueing process.

“There just isn’t that much light coming from your phone,” says Dr. Zeitzer. “As long as you go outside during the day and get exposed to the intensity of natural light then the amount of light from a screen in the evening most likely won’t halt the production of melatonin.”

If it’s Not Light, What Keeps us Up at Night?

Rather than light exposure, Dr. Zeitzer believes that what is keeping us awake is what we are watching on our screens. Millions of Americans stay awake at night scrolling on social media looking at page after page of emotionally activating content and writing posts that lead to likes, comments, and followers. Others stay up to play games on their phones or computers, all of which stimulate the dopamine reward system in the brain, which is the basis of addictive behaviors.

“In the past, when a television show ended, you turned off the TV and went to sleep because there was nothing else to do,” says Dr. Zeitzer. “But now you could watch Netflix, look at apps or play computer games all night because this entertainment has been commodified to engaged with it for as long as possible; it’s optimized to never stop playing and this is causing sleep deprivation.”

When watching screens before bed, Dr. Zeitzer recommends that we not only avoid content that could be distressing, but also content that could stir excitement within us.

“In order to fall asleep, we need to reduce stimuli exposure and calm our mind and body,” says Dr. Zeitzer. “Even if you’re watching something positive, if it stirs excitement, the brain will release dopamine, and over time we can develop a dopamine addiction, making staying awake playing games or on social media much more fun that going to sleep.”

Lastly, Dr. Zeitzer says that he can’t make a general statement that nighttime screen use negatively affects everyone’s sleep. For some, their addiction to games or apps could make falling asleep a challenge, while others may watch soothing nature videos on their phones to help them relax and fall asleep. Therefore, Dr. Zeitzer suggests that you take note of how screens are impacting your sleep health by asking yourself these questions:

  • Is the content of your screen time making you feel distressed or excited? If yes, then you should not look at screens for about an hour before bedtime to calm the mind and body and prepare for sleep.
  • Also, do you engage with screens throughout the night when you could be sleeping? If so, you may have a dopamine addiction that is making screen time activities more enjoyable than sleep.
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insomnia

How to Cure Insomnia

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By Sharon Brock, MEd, MS

Not getting enough restorative sleep is a rampant health concern across the US. It’s estimated that 50 to 70 million Americans suffer from sleep disorders, and 1 in 3 adults do not get the recommended 7 to 8 hours of sleep regularly.

Many of us have tried sleep hygiene techniques, such as keeping our bedroom dark, cool, and quiet and having a one-hour-before-bed evening routine, but still have trouble sleeping soundly on a consistent basis.

Stanford sleep specialist Fiona Barwick, PhD, DBSM shares that sleep hygiene is only one piece of the puzzle.  “If you have good sleep and maintain good sleep hygiene, then you’ll continue to get good sleep,” says Dr. Barwick, Stanford Clinical Associate Professor, Psychiatry and Behavioral Sciences – Sleep Medicine. “But if you have poor sleep, all the sleep hygiene in the world will not help because it’s not targeting what we typically see in patients with insomnia, which is anxious thinking and not building enough sleep drive.”

What Causes Insomnia?

Insomnia is defined as difficulty falling asleep, staying asleep, or waking up too early (greater than 30 minutes before the alarm) three times per week for at least three months. Many factors can cause insomnia, such as stressors related to one’s job, finances, health, family and friends, new onset health conditions, or feeling unsafe in one’s environment.

Dr. Barwick says her patients with insomnia often spend hours lying awake, ruminating about relationships and events in their lives, or simply worrying about how their inability to sleep will impact their performance the next day (especially true for perfectionists). To address these factors, Dr. Barwick teaches classes on cognitive behavioral therapy for insomnia (CBT-I) at Stanford University.

“It’s a vicious cycle. The anxiety we feel about not sleeping can prevent us from falling and staying asleep,” says Dr. Barwick. “With CBT-I, we address not only the physical requirements of sleep but also how we think and feel about sleep. CBT-I helps to shift our mindset about sleep.”

 

This table shows the difference between sleep hygiene and CBT-I:

How to Cure Insomnia with CBT-I Training

CBT-I employs a classical conditioning technique of having patients get out of bed when not sleeping so that they associate their bed with sleep and nothing else. Just as Pavlovian dogs salivated when they heard a bell, Dr. Barwick says we can teach our brains to see our bed as a cue to feeling sleepy and falling asleep rather than a place where we lie awake feeling anxious.

Along with bed re-association, another technique for improving sleep is sleep consolidation, or shortening the time spent in bed. At the outset of treatment, students of the CBT-I course are instructed to reduce the amount of time they spend in bed (their “sleep opportunity”) and get out of bed promptly when the alarm goes off (no hitting snooze!), regardless of how they slept. As wakefulness at night decreases and sleep quality improves, time in bed, or sleep opportunity, is gradually extended.

This disciplined approach of spending a shorter amount of time in bed for two to three weeks increases sleep drive and thus sleepiness, or the desire to sleep. By the end of treatment, patients are falling asleep more easily, waking up less at night, and returning to sleep more easily. They have also ensured that their bed is re-associated with sleep, rather than lying awake worrying, thus breaking the pattern of insomnia.

Along with bed re-association, CBT-I also offers cognitive strategies to calm anxious thoughts about sleep, relaxation techniques to reduce tension in the body, as well as emotional relaxation practices like mindfulness.

How Do I Fix My Sleep Problems?

Ironically, anxiety about sleep is often the cause of our sleep problems, making stress management an important part of restorative sleep. Dr. Barwick says that “our mindset about sleep is critical. We are worrying about a system that is not broken.” Instead of anxiety about sleep, Dr. Barwick encourages us to learn about the biological systems involved in sleep and optimize them with our behaviors.

The three biological systems that need to be in working order for sleep to occur are:

  • Circadian rhythm
  • Sleep drive
  • Stress management

“The way sleep works is, when your sleep drive is high, you understand your own circadian sleep-wake timing, and you allow yourself to relax, you should fall asleep and return to sleep easily,” says Dr. Barwick. “These biological systems of sleep are not broken; they are intact, but our worry about sleep can override their ability to function properly.”

For practical tips on how to optimize these three systems, read our blog, “Don’t Hit Snooze! And Other Practical Tips for Optimal Sleep.” 

What to Do When Lying Awake in the Night

If you’re lying awake in bed during the night, the first step is not to check the time. This can lead to anxious thoughts about how your lack of sleep will affect you the next day. It’s best not to look at the clock and trust that you’ll wake up and get out of bed with your alarm.

Secondly, take deep breaths and engage in mindfulness practices, such as feeling the softness of your pillow and appreciating the comfort of your mattress. Listening to gentle music or a guided meditation can also help relax the mind and body.

If these relaxation practices do not lull you back to sleep and you’ve been wide awake for over 30 minutes, Dr. Barwick suggests getting out of bed and doing a relaxing activity in another room until you feel sleepy again.

“It’s best to keep your bed for sleep, so if you can’t fall back asleep, be awake outside your bed in an enjoyable and relaxing way, such as reading a book in the living room,” says Dr. Barwick. “While reading, you build sleep drive and calm anxiety, so you’re more likely to fall asleep when you go back to bed.”

Another thing to remember is that your middle-of-the-night thinking comes from your emotional brain. During sleep, the rational part of your brain is offline, leaving your emotions to run unchecked. This can lead to bizarre dreams and even nightmares that could wake you up, especially if you’re going through stressful circumstances.

To address this, Dr. Barwick recommends reducing stress throughout the day, not just right before bed.

“People with anxiety are more reactive to stress and need to address sleep as a 24-hour endeavor,” says Dr. Barwick. “They need to put more effort into managing their stress response with exercise, deep breaths, and mindfulness throughout the day–not just before bed.”

Dr. Barwick explains that when we first go to sleep, our sleep drive is high enough to counter our stress level. But if we wake up 3-4 hours later, when sleep drive has diminished, it is harder to fall back asleep, especially if our emotional brain begins to ruminate from stress built up throughout the day. And since the rational part of the brain is offline, these negative thoughts can take over our consciousness.

Therefore, Dr. Barwick recommends journaling before bed to reframe life challenges and process difficult emotions. This way, if you wake up at night, you’ll be able to fall back asleep easily.

Along with journaling before bed, Dr. Barwick has a second recommendation for those experiencing anger that often leads to the rehearsal of mental arguments during the night.

“If you have resentment, I recommend you do loving-kindness meditation before bed. You can offer loving-kindness toward those whom your ego believes has ‘wronged’ you,” says Dr. Barwick. “This meditation can shift your emotional mindset from anger to ease, which will help you fall asleep.”

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