Rest


Philosophy on Sleep

Sleep makes almost everything better. Taking time for adequate rest is one of the best things you can do for your body, as it’s the time our bodies use to heal and recharge our systems.

How much sleep do we need? This is an individual answer based on your homeostatic sleep drive and circadian rhythm. Your homeostatic sleep drive is the amount of sleep you naturally need to feel rested. Most of us need 7-8 hours per night, but there are certainly some who only need 5 hours or some who need a whopping 11 hours. The best way to know your homeostatic sleep drive is to remember back to your younger years (when fewer of us had sleeping issues) and think about how much sleep you needed to feel great. There’s your answer.

Sleep changes as we age, and my elder patients often have unrealistic expectations that they will sleep through the night uninterrupted like most teenagers do. When we’re older, our sleep pattern can become more like that of a small baby or child, where we sleep a few hours and then are up for a little while, and then fall asleep again. If napping is necessary during the day, I recommend limiting nap time to 20 minutes or less.

 
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Insomnia

What if you can’t sleep? As one who has struggled with insomnia, which started during my stressful Intensive Care Unit rotation in residency and was refueled after a stressful home renovation, I understand how it feels to not sleep.

Insomnia is characterized as difficulty falling or maintaining sleep and associated with daytime fatigue, poor memory, or concentration difficulties. Insomnia affects 15% of us during our lifetimes and is often in conjunction with chronic pain or mood disorders like anxiety and depression.

Insomnia is typically initiated by stressful life events and then becomes a cycle where we start to worry about our performance the day following a sleepless night, which just furthers the cycle.

When asked, most people who struggle with insomnia don’t actually find themselves sleepy. They say they are fatigued or tired. If you’re not sleepy, you could be hyper-aroused or excessively wakeful. We call this the “tired-but-wired” feeling.

My own savior for insomnia didn’t come from sleep botanicals, but from a combination of meditation and Cognitive Behavioral Therapy for Insomnia (CBT-I), a form of psychotherapy that identifies thoughts and behaviors and addresses the underlying causes of sleep problems. It includes:

  • Stimulus control therapy

  • Sleep restriction

  • Sleep hygiene

  • Sleep environment improvement

  • Relaxation training

  • Work on paradoxical intention (the idea that worrying about falling asleep can actually keep us awake)

  • Biofeedback

I worked with a great sleep therapist who is writing a book about CBT-I for women, and I am writing a guest chapter on what to do if you need more than CBT-I to help with sleep. Stay tuned for our book when it’s released!

 
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Recommendations

Tips for good sleep (which can take 2 weeks or more of regular practice to work):

  • Comfortable room: 67 degrees, quiet, white noise if needed, high-quality linens (this is the time to spend your hard-earned money!)

  • Avoid caffeine after mid-afternoon

  • Avoid exercise within 2-3 hours of sleep

  • Same schedule 7 days per week with the same awake time each day

  • Limit to one alcoholic beverage

  • Bedroom used only for sleep and sex

  • Chamomile tea before bed (two tea bags steeped for 20 minutes)

  • Enjoy comedies on TV early in the evening

  • Avoid stimulating topics before bed, like work or finances

  • Avoid screen time within 1 hour of bed and “cyber-loafing”

  • Developing a bedtime routine, starting with a hot bath or shower

  • Go to bed only when feeling sleepy

  • If feeling frustrated in bed: get out of bed and do something quiet like reading a boring book or meditating, going back to bed only when you nod off or feel sleepy

 
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