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Week 4 - Sleep Part 2: How to sleep well

Updated: Jan 5

(If you’ve arrived here and want to know a little more about me, Margaret, and the background to this project this 3-minute introductory read is for you. You can also see my other Posts in the Wellness Project series here. These are my personal views. I'm just an interested lay person with no medical qualifications. I’m very open to learn and rethink things).

If you read my Week 3 Post - Sleep Part 1: The Science Bits- (thank you!) I hope you'll have been persuaded, as I have been, that good sleep is a fundamental wellness element and you've been encouraged to optimise your own sleep. If so, fantastic. This Sleep Part 2 looks at how we can do this in very practical, natural ways. Here I'm talking about simple lifestyle changes which can support good sleep. Personally I don't have any sleep problems caused by a medical condition such as insomnia or sleep apnoea . If you think that you may have such a condition you may want to speak with your doctor about this, its definitely worth investigating.

Please don't worry, sleep patterns do change and a short period of disrupted sleep due to an identifiable lifestyle or environment change is something many of us experience, I know I do. Also, there are lots of accessible, gentle things we can do to improve our sleep.

How well do I sleep?

Perhaps the first step is to think carefully about how I am currently sleeping. You may already be consistently getting great nights of quality sleep in which case you can tick the sleep box and move on. It may be something you come back to later if your circumstances change. I used to be a great sleeper but as I've got older, and particularly through the phases of the menopause, I find a solid night of quality sleep something I need to work harder to achieve.

Because I do have trouble consistently getting a good night's sleep, recently I kept a sleep diary for a typical week i.e. a week that was representative of my regular routine. It took less than 10 minutes a day and I simply noted down for each night:

  • What time I got into bed.

  • Roughly how long after getting into bed I fell asleep.

  • How many times I woke before finally awaking in the morning.

  • What time I finally awoke in the morning and whether that was natural or because of an alarm or Jack waking me.

  • How I rated the quality of my sleep - from very poor to very good.

  • If I dreamt and, if so, the nature of my dream(s).

  • Any events during my day that may have affected my sleep including exercise, the time of my last meal, any unusual stress/emotion, alcohol, caffeine after midday etc.

The results of this exercise were pretty interesting (to me) and at the same time pretty obvious. Overall I had 5 nights which I rated as good and 2 of poor sleep. Alcohol really has a huge effect on my sleep. I had 2 or 3 glasses of wine on both "poor" nights and no alcohol on any of the "good" nights.

There are several on-line tests designed to help you subjectively analyse the quality of your sleep. There also several commercial wearable devises which track sleep. The devices are different of course but typically seem to offer data on overall sleep duration, time spent awake or asleep and, when asleep, in the different REM and NREM phases. I've never tried one but plan to invest in a wearable health tracker which includes sleep data so I can get a longer-term insight into my sleep trends and, ideally, regularly get 7 "goods". I'm doing some research on best buys but am leaning towards a Samsung Galaxy watch that syncs with my Samsung phone. If anyone has any recommendations I'd love to hear them.

How much sleep do I need and when do I need it?

The simple answer is that multiple studies have concluded that an adult needs between 7 and 8 or 9 hours of quality sleep a night. Infants through to 18 year olds need considerably more sleep and older adults may need slightly less to wake feeling refreshed.

Some of us are morning people, larks, and some evening people, owls. In fact this isn't something we are entirely free to choose as our genes dictate which chronotype we are. Ideally we would sleep in a pattern which fits our lark or owl chronotype. You can try a simple free on-line Morningness-Eveningness Questionnaire developed by researchers in the 1970s and still used today to explore whether you are a morning or evening gene person. I am a moderate morning person according to this which actually feels about right.

My Week 4 Sleep Part 2 Take Aways

Simple things that can support good sleep

There are many good sources of advice on what is sometimes called "sleep hygiene". Happily there is a high degree of consistency on the key factors that influence sleep either positively or negatively. I've done my best to summarise these here.

A consistent sleep schedule- our bodies like consistency (as do all the microbes we host, of which more in a later Post). Having regular times to go to sleep and wake up helps us to prepare for and optimise sleep quality. In his book Why We Sleep, Matthew Walker includes Twelve Tips for Healthy Sleep from the US National Institutes of Health website. The first tip is "Stick to a sleep schedule." and Matt says '"if you can only adhere to one of these (tips), make it: going to bed and waking up at the same time of day no matter what. It is perhaps the single most effective way of improving your sleep". I am very fortunate to be able to follow this advice and I do as far as possible. However, I understand that others such as shift workers, long haul aircrew and parents of young children aren't so fortunate.

Eating earlier in the evening - on one level an easy and useful tip to give is to eat your last meal several hours before you go to bed to allow your digestive system to work within its effective "waking hours" - all organs, cells and even gut bacteria have a circadian rhythm. There also seems to be an overall health benefit in giving our bodies a significant period of time when we're not burdened by trying to process food/calories of any kind. This is part of the logic used to promote eating each day exclusively within a set window of time, time restricted eating. Delve deeper and you learn how complex the relationship is between eating and sleep. For example the same meal eaten in the evening results in higher blood glucose levels than when eaten in the morning because at night there is a lower circadian driven insulin release from the pancreas. Also there are fascinating and important links between sleep and our hormones which govern our feelings of satiety and hunger, leptin and grelin. Inadequate sleep reduces the amount of leptin released and increases grelin levels. There is a link between poor sleep, increased weight and poor metabolic health. Professor Russell Foster in his book Life Time has 2 chapters (12 & 13) on meal timing and "chrononutrition". To me, a non-medical person, this is all terrifying and fascinating at the same time. I wish I had known about it decades ago but this is an area where the science is developing at speed so much of the current knowledge is relatively recent.

Daylight Exposure - daylight is key to regulating sleep patterns. Getting outside in daylight soon after we wake up helps to support our internal circadian rhythms and in particular the inverse cortisol/melatonin rhythms (see the diagrams below). This is true even on an overcast day in winter. Dr. Will Bulsiewicz ("Dr B") is a US gastroenterologist who we will hear more from when we look at gut health. In January 2024 I joined Dr B's 21 Day microbiome challenge. One new habit he asked us challenge participants to adopt was to get 20 minutes outside every morning soon after waking (with no dark glasses). Exposure to bright light detected by our eyes stops our body's production and release of melatonin, the sleep hormone. Levels of cortisol, our stress hormone, also rise and fall triggered by light throughout each 24 hour period.

Darkness in the bedroom - our bodies natural rhythm is to release the sleep hormone melatonin in the evening with a sharp rise in the amount in circulation from 10pm to midnight and the highest levels between 1am and 5am. As exposure to light blocks or impedes melatonin's rhythm it is very important that we limit exposure to bright light before bedtime and that our bedrooms are dark. This includes not using electronic devices in the bedroom and ideally not in the hour before you go to bed (hands up, I struggle with this but I'm trying and have stopped scrolling). I live in the countryside and am lucky to have no man-made light pollution at home (as we used to when we lived in a permanently lit city centre). However, during the long light evenings in the summer and with clear skies during a full moon phase natural light can be an issue. Relatively recently we started closing our bedroom shutters at night which gives complete darkness and this has noticeably improved our sleep. Backout blinds were our solution when we lived in central London. Eye masks are also an option especially when you have less control over your physical environment such as when not in your own home.

Calm - a very obvious tip - you'll sleep better if you go to bed calm and relaxed. Calmness can be as a result of leaving plenty of time at the end of the day to rest and decompress rather than working late or having stressful interactions in the evening. The body's stress hormone, cortisol, has a natural circadian rhythm which is roughly the inverse of melatonin's sleep inducing rhythm. Levels of cortisol drop to the lowest point at around 10pm at night and rise to the highest levels around 7am to kick start our day. Elevated levels of cortisol at night time inhibit and/or disrupt sleep. Some people meditate or do breath work before bed to relax and there are apps to help induce calmness and quiet busy minds/hormones. We've tried a couple of sleep apps including HeadSpace Sleepcasts but I'm not yet convinced it's for me. You can try a Headspace Sleepcast, "Rainday Antiques", for free here. Calm is another popular subscription-based sleep and meditation app. We have a HeadSpace subscription which we just use for morning mediation at the moment (which we'll discuss in another Post). Another evening calming routine is journalling. This is recommended by several experts including UK doctor and podcaster, Dr Rangan Chatterjee, who I have a lot of time for. I don't journal myself although I do live by lists which is a way for me to get things that might otherwise swirl in my mind onto paper and into an ordered, calm state. Whatever works best for each of us!

Stimulants - there's no debate about the fact that for many people drinking or smoking stimulants such as caffeine (coffee, tea, chocolate) and nicotine (cigarettes, drugs) can make it hard to fall asleep (heavy smokers can also wake early due to nicotine withrawl). The way we each metabolise stimulants is different based, at least in part, on our genes. So its true that some people can have a late night expresso without being wide awake all night whilst others still have impactful levels of caffeine left in their systems many hours after their last coffee. I have always been very sensitive to caffeine and have limited how much I have for over 20 years. I'm currently at 2 caffeinated coffees before 10am.

Alcohol - an evening glass or 2 of scotch or wine may feel relaxing, and in larger volumes can cause people to fall asleep, but multiple scientific studies show that alcohol disrupts restorative deep sleep, significantly. Also, as the effects of alcohol wear off during the night, this can cause people to wake up before their natural body clock waking time. Alcohol and good sleep just don't mix for me any more. I fought this for quite a while but have given in now, sleep is just too important to me.

Temperature - even our core body temperature has its natural circadian rhythm. It has its lowest temperature at around 2am, 1.5°C lower than its daytime peak in the afternoon. Keeping the bedroom cool supports this rhythm and aids sleep especially deep NREM sleep (Part 1 Sleep gives more information on the phases of our sleep cycle). Having a hot bath before bed can help encourage this natural rythmn. After the bath the blood vessels near the body's surface are dilated drawing heat from the core of the body and helping the natural drop in core body temperature. You can buy temperature controlled mattresses and even thermal assistance body suits to aid sleep. This winter we have not used the radiator in our bedroom (other than on the coldest nights) and it does seem to help our sleep although every night we moan about getting into a cold bed!

Medicines - just a word to say that many prescription medicines are known to have an impact on sleep. So its a very good discipline to check the listed side effects and, if you notice a detrimental effect on your sleep, perhaps check with your doctor if any alternative treatments could be effective. Don't suffer poor sleep in silence!

Thanks for reading, Margaret

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