What one step can you take that will benefit your physical wellbeing and immune system functioning, improve memory and attention, support emotion regulation and processing, and improve mental wellness? You might be surprised to learn that sleep has a beneficial impact in all of these areas, and then some. Adults spend roughly one-third of their lives asleep. But when sleep becomes disrupted, it can be hard to get back on course. This article will provide an overview of sleep and sleep stages, define insomnia and disrupted sleep, and review helpful sleep strategies.
What is Sleep Anyway?
In the most simple of terms, sleep is a period of time when the conscious mind is mostly quiet, but the body’s systems are active in a variety of restorative processes. Sleep occurs in stages that correlate with typical brain wave (EEG) activity as well as physical states.
When we first fall asleep, we enter stage 1 sleep. This is light sleep, lasting approximately seven minutes, during which time we are easy to rouse. If you notice that you jerk your arm or a leg, don’t be surprised or alarmed: these “hypnic jerks” are common as we fall into stage 1 sleep.
Next, we enter stage 2 sleep, during which our brain waves continue to slow. Stage 2 sleep occurs for approximately 50% of our total sleep time.
In stage 3 sleep, we enter a state of deep, slow-wave sleep from which it is hard to rouse a person. Restorative stage 3 sleep accounts for approximately 20% of our sleep. After moving through these three stages, known as Non-Rapid Eye Movement or NREM sleep, we move into Rapid Eye Movement or REM sleep: the part of the night when we dream.
During REM sleep, our mind is active but the body is still due to muscle inhibition controlled by the central nervous system. Across the span of the night, we cycle down into deep sleep, then back up into lighter sleep and dreams. As our time asleep increases, we spend progressively less time in deep sleep and more time in light sleep and REM sleep. Occasional awakenings during the night are not uncommon, typically brief, and frequently not remembered if the sleeper is able to rapidly return to sleep.
When sleep is elusive and a person either struggles to fall asleep, stay asleep, or feel refreshed upon awakening in the morning, they may be struggling with insomnia. Insomnia is defined as insufficient sleep quality or quantity for at least three nights a week, lasting for three months. Insomnia impacts one in ten adults, with about 30% of adults experiencing short term (less than three month duration) insomnia. The recommended sleep need for adults is seven to nine hours; however, 35.3% of US adults report typically receiving less than seven hours of sleep per day. Source
Insomnia often starts as a reaction to a triggering event. In these acute or transient insomnia situations, a stressful time or transition triggers a disruption in a person’s sleep and/or sleep schedule. Triggering events could be both joyful and upsetting, but have in common a significant change to a person’s life. Such situations might include grief and loss, a move, a new job, a wedding or graduation, or the birth of a child. Acute insomnia can also result from short term illnesses, disruptions in sleep schedule due to jet lag or shift work, environmental factors like noise, light, room temperature, medications that impact sleep, and physical or emotional pain.
While acute insomnia usually resolves in a few days to a week as the stressful situation resolves, it can turn into conditioned insomnia, also referred to as psychophysiological insomnia. Conditioned insomnia occurs when the conditions that led to the sleep disturbance are gone, but the sleep issues continue. When this pattern lasts 3 nights a week for three months or more, an individual meets the criteria for chronic insomnia. Chronic Insomnia is characterized by a lot of time thinking or worrying about sleep, which then interferes with sleep by leading to increased arousal at bedtime. In other words, the psychological aspects (worry) impact the physiological aspects (arousal interfering with sleep). Over time, chronic insomnia can lead to difficulties with work performance, quality of life, avoidance of social activities that may interfere with sleep, and physical symptoms such as headaches, muscle tension or pain, and gastrointestinal problems.
The first step to optimizing sleep–whether you are experiencing insomnia or just want to improve your sleep quality and fall asleep faster–is referred to as sleep hygiene. Sleep hygiene includes all the steps you can take and daytime behaviors you can engage in to help get a good night’s sleep. Our body is ready to sleep when our circadian rhythm and our sleep drive line up. Circadian rhythm is the body’s tendency towards alertness when the sun rises and sleepiness when the sunsets. Sleep drive signifies our sleep need, based on a build-up of a chemical called adenosine in the brain that accumulates while we are awake and is metabolized while we sleep. Accumulation of sleep drive leads to a person “feeling sleepy.” Combine the two factors and we are primed to fall asleep from both an environmental standpoint in which cues in the world around us signal it is nighttime, and from a physiological standpoint when we feel tired after being awake for the day.
Sleep hygiene strategies seek to make the most of both of these factors so that we are ready to go to bed at nighttime. Environmental strategies that mimic the evening help send signals to the brain that the day is ending. Limiting exposure to light and decreasing the temperature in the house in the evening are two ways to cue your body towards the end of the day. Blackout curtains, minimizing blue light with glasses or electronic screen settings, and limiting the indoor lights to the bare minimum needed for evening tasks are some ways to help reduce light. Limiting exposure to electronics before bed is helpful both due to the light from screens as well as due to the stimulating nature of reading news, social media, or other material before bed.
Other environmental strategies include reducing noise in the bedroom to the extent possible, keeping the bedroom uncluttered and restful, and keeping the bedroom, and the bed in particular, for use only for sleeping and intimacy. We want our bodies and brains to associate the bedroom with restful sleep and calm emotions, something that is difficult if we are also, for instance, working, schooling, or completing household management responsibilities while sitting in bed using electronics.
Additionally, if you are struggling to fall asleep or wake up during the night and can’t fall back asleep in a reasonable time period, the recommendation is to get out of bed, do something in another part of the house until you feel sleepy, and then return to bed. Laying in bed without sleeping can lead to frustration and builds up an association of being frustrated while being in bed.
Physiologically, we can help our body to be ready for sleep by matching our activity levels and sunlight exposure in such a way that flows in sync with our natural circadian rhythm. Daily exercise is beneficial for a number of physical and emotional reasons, and timing exercise early in the day can help to reset our internal clock. Exposure to sunlight early in the day is also helpful to orient ourselves to daytime. Combine the two when the weather is cooperative with outdoor exercise early in the day and you may find yourself sleeping better at night. Acid reflux/GERD can impair a person’s ability to sleep, so avoiding heavy meals right before bed and seeking treatment for acid reflux and any other medical issues impacting sleep is important.
Substances can also impact sleep onset, sleep maintenance, and sleep quality. Many prescribed and over the counter medications can lead to sleep problems, so discuss these with your doctor or pharmacist.
Caffeine in coffee, tea, energy drinks, and soft drinks, has a significant impact on sleep by blocking the adenosine receptors in the brain–the chemical discussed above that leads to sleepiness and sleep drive. Avoiding caffeine either all together or cutting off caffeine after a certain point in the day can be helpful so that our bodies feel sleepy when we want to go to bed. Similarly, avoiding daytime napping also helps us to be most ready for sleep in the evening as we have allowed sleep drive to build all day.
Finally, behavioral sleep hygiene strategies refer to actions that we can take to help us sleep well. A consistent and calm bedtime routine is a key behavioral strategy to ensure a good night’s sleep. Everything a person does prior to going to bed can become a cue for the brain and body to begin relaxing and getting ready for sleep. When this becomes a routine practiced with consistency, it is similar to building up a chain of events that culminate in going to sleep. For instance, a person might have rituals around getting ready for bed–showering, dental hygiene, etc, as well as steps to emotionally decompress from the day–relaxation exercises, quiet music, meditation, gentle stretching, and other non-stimulating, quiet activities. You can download a pdf of sleep strategies from my website.
Tracking sleep using a sleep log is another behavioral strategy that might help you identify patterns in sleep quality, as well as serve as a tool to share should you seek out support for insomnia. There are a number of free sleep log or sleep diary forms available, such as the National Sleep Foundation’s sleep diary. These tools help you to record total time in bed, total time asleep, and the impact of sleep hygiene and lifestyle on sleep.
If you have implemented solid sleep hygiene strategies and logged sleep without improvement, or if your current sleep issues are significantly impacting your social, emotional, or occupational functioning, you might want to consult with a professional. Ruling out the impact of any medical or medication/substance issues on sleep is an important first step. Cognitive Behavioral Therapy for Insomnia (CBT-I) is the recommended first line of treatment for insomnia and, unlike sedative medications, it results in lasting changes without side effects or tolerance to medications. CBT-I challenges negative thoughts and attributions about sleep, retrains the body to associate the bed with sleep, and works to improve sleep efficiency.