Patients must pay attention to how they spend their day
The things you do in the day while you are awake and pursuing the activities of daily living are the things that are going to let you get a good night’s sleep — or not.
“Sleep is a powerful biological drive like any other you can imagine, but it is affected by behavior and how you feel about it,” says Steven Feinsilver, MD, director of the Center for Sleep Medicine at Lenox Hill Hospital and professor of medicine at Hofstra Northwell School of Medicine in New York City. “How you feel about your kidneys doesn’t affect the way they work, but how you feel about sleep does — but only to a certain point.
“Sleep is still a powerful biological drive, and if you don’t mess it up, it tends to work,” he says. “But we tend to mess it up in all sorts of ways.”
The key to getting to sleep right away, and staying asleep — that is, the opposite of having insomnia — is to develop and maintain good sleep hygiene, researchers suggest.
“Behavior that you do in the daytime influences how you fall asleep and stay asleep at night,” says Russell Rosenberg, PhD, chief science officer and chief executive officer of NeuroTrials Research of Atlanta. “There are several things can be done to improve sleep hygiene,” he says, “such as not eating too close to bedtime. Even if a patient doesn’t have a reflux problem, eating close to bedtime is a bad idea.
“Drinking alcohol often helps people get to sleep,” Dr. Rosenberg says, “and there are reports that during the Covid-19 pandemic people are drinking more alcoholic beverages. If someone is drinking more and having more sleep problems, one thing to think about is cutting back on is alcohol, especially three hours before bedtime.
“A nightcap may help someone get to sleep, but it can fragment sleep, so I don’t think it is a good idea,” he says.
He also suggests that before you go to bed, don’t watch the late news. “This is a time of heightened anxiety for everyone. I don’t know anyone who is nonchalant about this,” Dr. Rosenberg says. “Try to avoid, in general, anything that is emotionally charged, including emotionally charged movies or reading an emotionally charged book. Watch some fluff or comedy but not some kind of high drama.”
“These things can make it more difficult not only to fall asleep but to stay asleep. There is nothing you need to know right before going to bed that is going to make you feel any better,” he says. “People do wake up for a minute or 2 during the night, but usually they go right back to sleep. But there are those times where it is problematic, when it takes 30 minutes or an hour or 2 hours to get back to sleep. That’s the issue. Things we experience and do in the daytime can affect us at night.”
“You need a cold, dark, quiet place to sleep,” says Dr. Feinsilver, “and habit is everything for getting good sleep. The biggest thing you can do if you want to be a decent sleeper is to stick to a really strict schedule — particularly the wake-up time. We all have a built-in body clock, or circadian rhythm, and that rhythm is pretty much set by wake-up.”
Irregular habits breed irregular sleep patterns, says Jennifer Martin, PhD, a clinical psychologist, professor of medicine at the David Geffen School of Medicine at the University of California at Los Angeles. “Some people become classically conditioned to be anxious and alert when they are in bed,” she says.
“You might remember Pavlov’s dog experiment,” she says. “You ring the bell and the dog salivates as a conditioned response. Well, if you have trouble sleeping over and over and over again, night after night after night, and you feel terrible when you are in bed, well then you start to feel terrible in anticipation of getting into bed.
“So, one of the strategies that we use is to try to eliminate struggling with sleep in bed,” Dr. Martin says. “That might mean doing things to make sure you are getting into bed when you are already sleepy so that you fall asleep right away. If you are getting frustrated in the middle of the night, sometimes it is better to give up for a while and get out of bed and do something until you feel sleepy again.”
Dr. Feinsilver says there may be a role for sleep medications in some patients. “Clearly it is a lot more expedient to write a prescription for a pill. But the pills, combined with improving habits, helps a lot,” he says.
Getting patients’ circadian rhythm aligned may require what Dr. Feinsilver describes as sleep restriction therapy. “When I ask people how much sleep they need,” he explains, “there are people who will say ‘I just got 4 hours sleep and I feel great.’ For most people, I don’t believe that. Then there are people who think they need 8 or 9 hours of sleep and I’m not sure I believe that either for a lot of them. We usually settle on something. The average human needs 7 and a quarter hours of sleep.
“So, this process is known as sleep restriction therapy, and it is limited to about 7 hours of sleep,” Dr. Feinsilver says. “I tell the patients, ‘From now on, set an alarm. Bad sleepers need alarms clocks more than good sleepers because if the body clock is working, it doesn’t matter if you have an alarm clock or not. If the alarm clock is set, when you wake up at night – and everybody does – you can ignore it and go back to sleep’.”
That’s because the alarm is set so the patients will be awakened at the proper time – but, Dr. Feinsilver says, don’t hit the snooze button. “Get out of bed. No matter how rotten your night is, when the alarm goes off, get out of bed.”
Disclosure: Rosenberg disclosed that he and his research organization consult for all the companies that work on insomnia issues. Martin and Feinsilver disclosed no relevant relationships with industry.
Source: Various telephone interviews.