LAURA LEWIS MANTELL MD

Sleep Hygiene

The overall goal is to feel rested upon awakening; generally most of us require 7-8 hours of sleep every 24 hours in order to feel that way. It’s not necessary for our daily sleep to be continuous, but given our lifestyle, packing sleep hours into one period works best for most.

Core sleep

Core sleep, the sleep required to maintain normal abilities to problem solve and remain alert requires 5.5 hours of sleep. Core sleep contains 100% of our deep sleep, which is the most important stage. It does not mean that people feel their best with this amount of sleep; most people prefer an extra two or three hours of sleep, but there are no significant physiological or cognitive ill effects if you only sleep 5.5 hours. Remember this the next time you feel you are anxious about falling asleep.

• If your insomnia is caused by worrying about not sleeping enough, you may have boxed yourself into a vicious cycle. Practice the healthy sleep habits listed here and let your body get into its own natural rhythm.

• Sleep is necessary for your body to rebuild the resources it used during the day.

• The best treatment for insomnia is exhaustion, so missing sleep is not necessarily bad, because it will work to lower your sleep threshold allowing for a deeper and more replenishing sleep.

• Get out of bed in the morning at the time you wish to awaken, even if you’re tired. Your tiredness will serve you later in the day when you want to fall asleep at a time you feel is reasonable.

• When we miss sleep, our bodies automatically adjust our sleep when we next sleep, by spending less time in the earlier stages of sleep in order to spend more time in the deep stages that replenish us most.

• It’s best to go to bed when you’re tired. Notice what time you usually become tired and make that time your bedtime. That way, you will go to bed close to when you typically fall asleep. Build the habit of going to bed and going to sleep.

• The ability to fall asleep within ~ 20 minutes is considered a normal sleep onset. If you awaken in between the 2-3 sleep cycles of your nighttime sleep, the same rule holds, i.e., if you resume your sleep within ~ 20 minutes, it’s normal.

• If it takes you longer than 20-30 minutes to fall asleep, get out of bed and do something that won’t be overly stimulating, but will be tiring, i.e., reading. This can be challenging. Avoid watching television or using your computer.

• Sleep is a body habit that when healthy operates through a set rhythm. It requires discipline to have healthy sleep, at least initially.

• We can change our sleep patterns in 15 minute increments. For example, if you want to sleep from 10pm-6am and now go to sleep at midnight, try going go to bed at 11:45pm until you are falling asleep sooner. Once you have established that pattern, start going to sleep at 11:30pm until that becomes habit. Continue until you have established the sleep pattern you wish for.

• Early morning awakening can be helped with room darkening shades and practicing the relaxation response. (See Stress section).

• 15-30 minutes of bedtime rituals help to ready your body for sleep. Soothing music, warm bath or shower, grooming, clothing preparation for next day, writing in a journal about things you appreciated that day can all be helpful.

• Exercise ~3-6 hours before bedtime can help decrease cortisol. Cortisol is a stress-related hormone that keeps our minds vigilant and unable to quiet.

• Build a discipline of not engaging in worries after dinner.

Positive Sleep Thoughts

• My performance will not suffer if I get my core sleep.

• I’m probably getting more sleep than I think I am.

• My daytime functioning is not just affected by my sleep.

• Since I have survived nights of insomnia before, I can do it again.

• If I didn’t sleep well last night, I am more likely to sleep well tonight due to biological pressure to recover my core sleep.

• My daytime functioning is due in part to my negative, stress-related thoughts.

• Sleep requirements vary from person to person.

• In most cases, the worst thing that may happen if I don’t’ sleep well is that my mood will be impaired during the day.

• Sleeping 6-7 hours per night is associated with the longest life expectance.

• If I awaken after about 5 ½ hours of sleep, I have gotten my core sleep.

• I’m more likely to fall asleep as my body temperature falls throughout the night.

• It is normal to initially feel alert if I awaken at the beginning or end of dream; drowsiness will soon follow.

• My functioning will improve during the day as my body temperature rises.

• My sleep will be improving as I learn these behavioral techniques.

• These techniques have worked for others, they will work for me.

THE EPWORTH SLEEPINESS SCALE

How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired? This refers to your usual way of life in recent times. Even if you have not done some of these things recently try to work out how they would have affected you. Use the following scale to choose the most appropriate number for each situation:

Scale
0 = no chance of dozing
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing

1 - 6 Congratulations, you are getting enough sleep!
7 - 8 Your score is average
9 and up Seek the advice of a sleep specialist