Getting To Sleep

by Suzanne Manser, PhD

Most people over the age of teenagerhood need between 7-9 hours of sleep per night. Do you get 7-9 hours each night? Do you wake each morning feeling refreshed? Most of the people I work with don’t. The trend in our society is to get less sleep as we try to fit in more hours of waking activity. And all of that waking activity tends to stress us out to the point of disrupting our sleep when we finally do get in bed.

Not sleeping enough and not sleeping well is a problem. This is not news to you if you have trouble sleeping. Beyond just feeling tired, lack of sleep impacts important systems in the body. Lack of regular sleep compromises mood regulation, immune functioning, muscle restoration, and cognitive functioning. Basically, it impacts your life.

If you’ve done any research on help getting to sleep, you’ve learned the common elements of good “sleep hygiene.” Good sleep hygiene includes the steps you can take to put yourself in the best physical and mental space for a full night of restful sleep:

• Stay active during the day to tire the body, but do not exercise in the several hours prior to bedtime.
• Do not drink caffeine or alcohol past mid-afternoon.
• Use the bed only for sleeping and sex, so your brain associates it with sleep (i.e., do not read, work, scan social media, play on your phone, watch TV, etc. in bed).
• Go to sleep at the same time each night.
• Have a nightly ritual that cues your brain that it is time to sleep. It could be as simple as brushing your teeth. Some people drink tea, have a bath, listen to soothing music, and/or read something light.
• Stay away from screens at bedtime (i.e., TV, phone, tablets, and computer off). The blue light and frequently the content of what you are seeing are stimulating to your brain and therefore counterproductive to sleep.
• A cool room temperature, as well as a dark and quiet environment, are ideal.
• Do not have a clock that you can see from your bed. Checking the time as you are not sleeping  increases anxiety and is counterproductive.

There are three additional pieces of sleep hygiene that are not always highlighted but should be. The first is recognizing the value of sleep. Those who don’t value sleep are prone to poorer sleep. These are folks who see sleep as a nuisance – a useless interruption of their day. They are often focused on being as productive as possible, and sleep does not, in their minds, contribute to the agenda. Clearly, this attitude is at odds with good sleep hygiene.

If you fall into this category, learn more about how sleep significantly improves your day-to-day brain functioning. The things that happen in the brain while we sleep are fascinating. And necessary for optimal remembering, learning, focusing, and decision-making. Did you know: while we sleep, the brain has the energy to do things like transfer information from one brain structure to another, shrink cells up to 60% to make room for the cleaning crew, clean toxic build up, and prune neurons to make room for new learning to take place? The less sleep you get, the less of this wonderful stuff is happening.

If sleep were truly useless, it doesn’t makes sense that we would need so much of it. Neuroscientists have been searching for what happens in the brain while we sleep that makes it worth all of the perceived downtime. Some really interesting things have been uncovered. For example, the “glymphatic” system has been recently discovered. The glymphatic system, which becomes much more active when we sleep, is the brain’s cleaning crew. It’s responsible for restoring the brain each night by removing the by-products of neural activity that build up throughout the day. Some of the by-products that get carted out are toxins that, if allowed to build up, can lead to Alzheimer’s or other neurological diseases. Other bits are synaptic connections (the connection between neurons) that the brain deems not very relevant. Removing synaptic connections makes room for new neural pathways to grow. In other words, space is made in the brain for new learning to happen.

It is also during sleep that new memories get moved from short-term to long-term memory. This is important if you are actually trying to retain the information you took in that day and learn it at a deeper level. The brain changes during different phases of sleep. During Stages 1 and 2 of sleep, the brain is plastic enough to allow memories to be integrated and consolidated, which creates deeper learning. The majority of Stage 1 and 2 sleep typically happen in the second half of the night. So, if you don’t get a full night’s sleep, you are limiting your ability to learn at an optimal level. However, even a 90-minute nap has been found to help with information consolidation (and in fact, naps are best if you are trying to learn a physical sequence).

The research is clear: sleep is not a waste of time. The brain simply doesn’t have enough energy to do all of these tasks and do all of the awake tasks at the same time. You will remember more, learn better, make better judgments, and generally think better if you get regular, good sleep. So if you tend to regard sleep as a nuisance, try shifting your perspective. Start by giving yourself 7-9 hours to sleep. Then, when you approach bedtime, think about all of the useful activity that will take place while you sleep. Appreciate that room will be made for new learning and toxins will be carted out. Look forward to the fact that the things you learned will be locked in.

The second piece of sleep hygiene to highlight is waking at the same time every morning. This is actually more important than going to bed at the same time each night. If the body can anticipate when it will wake, it creates a consistency in the circadian rhythm that translates to feeling sleepy at the same time each night. This is especially helpful for people who have come to dread bedtime because they don’t feel tired. Because this strategy engages the circadian rhythm so directly, it is a major player in cultivating regular sleep.

If you want to establish a consistent, 7-days-a-week wake time, you will need to choose a wake time that is realistic for you and your schedule. Generally, whatever time you wake up on work days (or your earliest school day) is the time you should wake every day. Set the alarm 7 days a week and do not hit snooze. Consistency is essential to shifting a biological cycle. Expect some resistance to waking early when you don’t “have to,” and make room for that. Remind yourself that improved sleep and all of its benefits are worth the discomfort. Give it a month or 40 days and see how it changes your experiences, both at night and during the day.

The third piece of sleep hygiene is most relevant for those who are held awake by their thoughts and worries. This piece involves realizing that you have a choice about what you are thinking about and that you can choose to prioritize sleep over anything else your brain wants you to think about. This was a radical concept to me. I used to lay awake for hours going on all sorts of long, unnecessary mental road trips. I would think very intently about an interpersonal or work situation from that day that had, in my mind, not gone well. I would stew about mistakes made. I would worry intensely about some far-off possibility that I had no current control over. I would run lists: home to-do’s, work to-do’s, grocery lists. At some point in this process, I might notice that my brow was literally furrowed and the muscles throughout my body were tense. As you may have guessed, none of this intensity is conducive to sleep.

Once I realized that I didn’t have to focus on those topics at night (see Don’t Believe Everything You Think), my sleep world changed. Over time, I learned to notice my thoughts, notice my furrowed brow, and change my focus when it is counterproductive to sleep. I have made a clear decision that sleep is the priority at bedtime: if I catch myself having activating thoughts, my strategy is immediately to shift focus.

“Shifting focus” is not easy and requires its own strategies. It is essential to know ahead of time what you are going to shift your focus to. The general goal is to find something neutral or positive that is interesting enough to hold your attention (so it doesn’t wander back to the intense thoughts too often) but not activating enough to keep you awake. You can play around with what works for you. Here are three strategies to start with:
The alphabet game. Pick a theme that comes somewhat easily to you (movies, actors, books, authors, songs, bands, painters, etc.). Start with A and identify a movie (or whatever your theme is) that starts with A. Then B, then C, and so on.
Focusing on your breath. Slow your breath and breath diaphragmatically if you can. Focusing on each slow breath, count 1 on the inhale, 2 on the exhale, 3 on the next inhale, and so on up to 10. Once you reach 10, count back down to 1. If you lose track of where you are, start over – with no self-scolding. If this particular way of focusing on your breath does not work for you, try another.
Count gratitudes. Identify 5-10 things you are grateful for, trying not to choose the same ones each night. As you identify each one, connect to the feeling it gives you for half a minute.

If you “finish” one of these and are still awake (as is to be expected), either do the same exercise over (and over) or move on to a different one. The goal is to keep your brain on this even keel of non-focus-on-stressful-thoughts and to bring it back to that even keel every time it wanders. For as long as possible. That is a much more useful goal to focus on, by the way, than trying to fall asleep (but that is for another article).

I say that I shift focus whenever I notice activating thoughts after bedtime. Much more easily said than done. Some thoughts (like the lists and some of the worries) indeed do need to be paid attention to at some point. There are much better times than late at night to entertain these thoughts, so create a designated day time that works for you. Decide when during each day you will sit down and make your daily to-do list, and put that task into your daily schedule. Literally schedule a time once or twice a week to worry or think about things that need attention, and keep that appointment with yourself (none of this works if you don’t actually make time for these things). The appointment shouldn’t be longer than 30 minutes and should begin with an agenda. Then, when these types of thoughts scream for your attention at night, remind yourself that you will (or have already) attend to them at the designated time, and shift your focus.

Clearly, getting a good night’s sleep can take a lot of effort. The strategies suggested here need to be tried consistently over time to have a long-term effect, and you have to decide that it’s worth the effort. Aim for a marathon, not sprint, attitude.

Not all sleep difficulties can be resolved with good sleep hygiene. There are sleep disorders including narcolepsy, restless leg syndrome, and sleep apnea that require the attention of a sleep specialist. If you have tried these strategies and you are still not waking up feeling refreshed most days, make an appointment with a sleep specialist to explore other possibilities and treatment.

References (and articles with additional suggestions to help with sleep):
https://www.eurekalert.org/pub_releases/2013-10/uorm-tsp100913.php
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2824214/
http://healthysleep.med.harvard.edu/healthy/matters/benefits-of-sleep/learning-memory
https://www.tuck.com/sleep-and-learning/
http://www.markfriesen.net/blog/sleep
https://www.verywellhealth.com/30-days-to-better-sleep-3973920
https://www.wexnermedical.osu.edu/blog/why-do-i-wake-up-at-the-same-time-every-night