“Sleep is an essential part of life — but more important, sleep is a gift.”
— William C. Dement
Your sleep is the key to a long and happy life.
Sleep is foundational to good health. There is not an aspect of the way your brain or body functions that isn’t impacted by sleep. It’s not a question of whether something is impacted by sleep but the degree to which it is impacted.
Lots of activities are going on in the brain and body during sleep, including rewiring of neurons (consolidating memories, forgetting things that are not essential), transport of toxins out of the brain, movement of energy and nutrients, optimizing healing, etc. In the short term, not getting enough sleep leads to reduced physical and mental performance, worse immune function, and improper energy utilization.
Health and performance
Getting inadequate sleep for years can lead to increased likelihood of getting depression, diabetes, dementia, and cardiovascular disease. It is important to note that losing a single night of sleep doesn’t make you get any of these diseases. Each time you get bad sleep, you are increasing the probability that you could develop one of these problems. Think of each night of bad sleep as a lottery ticket. Very low odds that you are going to win, but if you get enough tickets, eventually, you will unfortunately win that lottery.
Sleep isn’t just about avoiding diseases, it’s also about optimizing your physical and mental health. It can improve your metabolism, your mental acuity, your emotional health, and your athletic ability. It’s not going to change you from a weekend warrior to a Golden State Warrior, but it will help you be your best self and enable you to optimize all of the pillars of lifestyle medicine!
Many studies have shown that people who don’t get enough sleep also tend to have other mental and physical health issues. It’s true — sleep is a crucial part of maintaining good physical and mental health; however, not all inadequate sleep is created equally. If you aren’t sleeping, you are by definition doing something else. What that “something else” is matters. If you are spending time with friends and family late into the night, maybe that will help offset some of the negative impacts of sleep loss on depression, but not on the negative impacts on physical health. If you are streaming videos into the wee hours, make sure you are getting something positive from this and not just mindlessly clicking forward (Don’t believe us? Check out the 24:15 mark here.
Sleep Quality
Many people focus on how long they sleep at night and use this as a measure of “sleep quality.” While getting enough sleep at night is an important part of sleep health, it’s not the only part. Dr. Daniel Buysse at the University of Pittsburgh has formulated a useful model that encompasses the many parts of sleep health: Ru-SATED. This acronym stands for Regularity-Satisfaction-Alertness-Timing-Efficiency-Duration. Regularity encompasses going to sleep and awakening at the same time every day, including weekends (yes, weekends!). Satisfaction represents how you feel when you wake up — did it feel like a good, refreshing night of sleep? Alertness is how you feel during the daytime (without the extra caffeine). Timing is the easiest to accomplish – are you sleeping at night when your body is prepared for sleep (the ‘biological nighttime’). Efficiency refers to how much wake time interferes with your sleep – either taking a long time to fall asleep or waking up a bunch during the night. Duration is just that, how long you have slept. While it’s great to have perfect sleep in each dimension of Ru-SATED, if you don’t, no need to worry. Focus on the parts of sleep that you can change.
Sleep myths and concerns.
Wearables: Most wearable devices have sleep trackers and, if you are a good sleeper, these are reasonable at telling you how much you slept. However, if it takes you a while to fall asleep, if you wake up frequently, or spend lots of time in bed and not asleep, these devices are universally poor at revealing how much you have slept. Basically, these devices cannot tell the difference between being quietly awake in bed and being asleep. The same holds true for the sleep stage data that these trackers provide – it is reasonably accurate in good sleepers and highly inaccurate in poor sleepers. The true hope for wearables lies in the future — improving the algorithms for sleep detection and integrating this information into all of the other devices you have (the Internet of Things) could give you actionable insight into your sleep. Until then, take the information from these devices with a grain of salt.
Melatonin: Melatonin is a hormone that is naturally produced by the pineal gland, a small structure deep in the head, with high levels being present during the biological night (when your brain thinks it is time to sleep) and low levels during the biological daytime (when your brain thinks it is time to be awake). Many people take melatonin to help themselves sleep. Contrary to what you might think, taking melatonin during the biological daytime, when it’s not normally being produced, can help people sleep longer – up to an extra hour of sleep. In adults, taking melatonin at night, when it is normally made, however, has very little biological impact. Meta-analyses of double-blind placebo-controlled trials indicate that taking melatonin at night at best gives you an extra couple of minutes of sleep. Open label trials (when you know you are getting melatonin) indicate that melatonin is much more effective. This means that if you take melatonin and think you are going to sleep better, you probably will. Be careful though, physiologic replacement levels of melatonin are one-half (0.5) of a milligram. Anything higher will cause melatonin levels to be elevated when you wake up in the morning, which will make you tired and groggy. So, doses lower than 0.5 milligrams are better at avoiding this morning “hangover.” Also, melatonin is the only hormone that is not regulated by the FDA in the United States, so quality and concentration varies widely. Always select from a trusted manufacturer.
Napping: There is nothing wrong with napping, until it becomes a problem. Napping is not identical to nighttime sleep but is still useful in relieving some of your sleep needs. So, if you aren’t getting enough sleep at night and have the opportunity to take a little snooze, nap away; however, if you do not, realize that you have a finite amount of sleep that you can get. So, if napping makes it more difficult for you to fall or stay asleep at night, think about avoiding naps.
Tips & Practices
How to get better sleep tonight:
If you want to make it easier to fall asleep, follow a consistent sleep schedule. Going to bed and waking up at the same time each day helps to regulate our body’s internal clock. Ensuring adequate light exposure during the day while minimizing bright lights at nighttime also helps to maintain a healthy sleep-wake cycle.
Establish a relaxing bedtime routine. Allow yourself sufficient time to unwind and shift into sleep mode. This could include taking a warm shower or bath, light stretching, or enjoying a warm bedtime drink such as chamomile tea. Meditation and deep breathing techniques can also help balance the autonomic nervous system and promote a state of calmness.
Maintain an optimal sleep environment. Mattress and pillows should be comfortable and the bedroom should be cool (60-67 degrees). Minimize exposure to bright lights, disruptive noises, and electronic distractions at least 30 minutes (preferably 1 hour) before bedtime. Avoid stimulating or stressful activities before bedtime.
If you struggle with awakening at 3 a.m.:
- Get regular exercise and minimize sitting throughout the day. While vigorous exercise is optimal, even light exercise and increased movement can improve sleep quality. If you can perform moderate to high intensity exercise, the American College of Physicians recommends 150 minutes of moderate to high intensity exercise every week to improve sleep. Evening exercise within a few hours of bedtime may impact sleep for some individuals, however this can vary from person to person so find the time of day to exercise that works for you.
- Avoid stimulants such as caffeine and cigarettes in the afternoon. Caffeine and nicotine can both disrupt sleep. Caffeine is particularly pernicious as it can have a half-life that is anywhere between two and twelve hours. So, for some people, even one cup of coffee can impact their nighttime sleep.
- Be mindful of alcohol use close to bedtime. Alcohol can disrupt sleep quality fragmenting sleep throughout the night and particularly in the morning hours when you get more of your REM sleep.
- If you are having difficulty falling asleep, get out of bed. After about 30 minutes, get out of bed and go to another room and try doing something relaxing in dim light (e.g. reading a book, breathing exercises, and journaling). Once you feel tired and ready to sleep, you can try getting back into bed.
If you are a night owl who wants to shift to an earlier schedule:
- Follow a consistent sleep schedule. Going to bed and waking up at the same time each day helps to regulate our body’s internal clock. Ensuring adequate light exposure during the day while minimizing bright lights at nighttime also helps to maintain a healthy sleep-wake cycle.
- Avoid naps. If necessary, limit naps to less than 30 minutes and before 3 p.m. While a short power nap (20-30 minutes) can help improve performance during the day, it does not make up for inadequate nighttime sleep and can make it more difficult to fall asleep at your desired bedtime.
- Aim for at least seven hours of sleep. Most adults aged 18 and older need at least seven hours of sleep every night. Some people may require eight or nine hours to feel their best. To figure out if you are getting enough sleep ask yourself if you sleep in when you are given the opportunity (e.g., weekend, vacation). If you don’t, you are probably getting the right amount of sleep.
- If sleep problems persist, consider keeping a Sleep Diary or speak with your doctor about your sleep concerns. This can help identify problems with common sleeping patterns and would be beneficial if you speak with a doctor about your concerns.
How do Stanford Lifestyle Medicine team members get restorative sleep?
Further Reading
