#Gbites: Reframing Your Relationship With Sleep

by Dan Goldstein and Natalie Gentile, MD

“But [Pooh] couldn't sleep. The more he tried to sleep the more he couldn't. He tried counting Sheep, which is sometimes a good way of getting to sleep, and, as that was no good, he tried counting Heffalumps. And that was worse. Because every Heffalump that he counted was making straight for a pot of Pooh's honey, and eating it all.”
― A.A. Milne, Winnie-the-Pooh

Yes, sleep. Everyone is sick of hearing about it. But there is a reason this topic keeps coming up in the lifestyle medicine discussion. Because when it comes to sleep, many of us feel like Pooh Bear. Most peoples’ relationship with sleep is very love-hate. We know we need it, but man, can it really get in the way of our plans. With a long list of responsibilities in a given day, getting a good night’s sleep often just becomes another thing on the list—the very last thing on that list, getting pushed back and pushed back further into the night. And like Pooh, intention is not always enough in cultivating restful sleep. For those who experience difficulty with falling asleep or staying asleep, nights of tossing and turning and praying for sleep are commonplace and a sense of helplessness pervades. 

It is easy to get caught in a vicious cycle of not sleeping enough. We have a couple of nights of poor sleep and we can no longer operate as our best selves, forcing us to stay up late to get everything done. We are even more sleep deprived the next day and use caffeine in order to help us to fulfil our responsibilities, making it harder to fall asleep at night and keeping the cycle going. Sounds stressful and it is. It is no wonder that people even find sleep itself to be a point of anxiety. Another thing to do and another thing to fall short on, and subsequently judge ourselves. 

Sleep seems like the most pointless biological necessity there is. All animals sleep, and when they do so, they are not eating, not mating, and they are more-or-less sitting ducks for predators! Seems unimportant. However, in experiments on rats where they are kept from  sleeping for multiple weeks, they die.1 Not many people are attempting to stay awake for days on end (and certainly not weeks), but we have all had the experience of being sleep deprived. 

Apparently sleep is important, and while it is not overtly “productive,” it is absolutely integral to life; it’s a necessity, a basic condition of being alive. 

As stated by the National Institutes of Health, “sleeping is a vital part of the foundation for good health and well-being throughout your lifetime.”2 When we do not get enough sleep, we are more susceptible to illnesses like heart disease, diabetes, and hypertension.2 But these things are longer-term consequences and do not serve as the most tangible source of motivation for some people. It may be easier to latch onto the way we feel in our everyday lives and assess the way that sleep may affect mood and productivity. People who do not sleep well are more likely to be depressed.2 Poor sleep is correlated with poor performance at school in adolescence.3 Students with later weekday bedtimes tend to perform more poorly, as well as those with large discrepancies between the weekday and weekend bedtimes. A study of medical students had a similar conclusion, also drawing connections between poor sleep and depression and substance abuse,4 which can further impact performance at work, school, and life in general. 

Now is anyone out there getting even more stressed out by reading this? Thinking about how you really ought to be sleeping more? Well considering you are reading this article, you are obviously taking steps to improve your sleep and are well on your way to doing so. Relax a little bit and let us begin the process of reframing your relationship to sleep. You may have heard these things a thousand times, but you will not begin to actually care until you internalize these truths. See sleep as the restorative and powerful act that it is. It is not something extraneous that you just have to check off of your list, but something that is valuable and productive in itself—even something to look forward to. Sleep is a pleasure and a privilege, not just another task.

When you are chronically tired, you simply are not your best self. Get some sleep for the sake of your work, your relationships, and your sanity. You owe it to yourself. Below are some tips to help you achieve better sleep.

How to get a better night’s sleep

There are those sleep strategies that everyone has heard before: exercise every day, limit screen time during the evening hours, engage in calming activities in the hour or two leading up to hopping into bed. These strategies may be overplayed, but they are not overrated. There is substantial science behind the very real benefits of making each of these a part of your routine.5 Here are a few others that you may not have heard of:

• Carbs before bed: Eating carbohydrate-packed foods before going to bed may help to put you to sleep.6 A humble slice of bread or a banana may do the trick. This strategy seems to help when a person is having trouble falling asleep or if they wake up in the middle of the night.6 
• Keeping a regular sleep schedule: Having a regular sleep schedule is associated with longer sleep duration, at least in older adults.7 Try to wake up and go to bed at the same time on weekdays and weekends alike. Daytime napping is more common in people with insomnia,8 therefore, eliminating napping may be something to consider.
• Integrative Medicine Techniques: Mindfulness meditation, breathing techniques, and light, calming yoga poses have demonstrated positive impacts on sleep and are not to be overlooked.9 For those looking to pursue a more formalized route, CBT-I is a form of Cognitive Behavioral Therapy focused on cultivating a positive relationship with sleep and developing skills to prepare your mind for the act of sleep. 
• Botanicals: There are a number of botanical products available that have been demonstrated in their ability to enhance sleep quality. Valerian root, lemon balm, l-theanine (an amino acid found in tea leaves), kava, and jasmine have all been studied in their role in promoting sleep.10 When looking for dietary supplements, take caution, be skeptical, and do your research. Not all supplements on the supermarket shelves are effective or even safe. While particular botanicals may indeed have benefits, it is difficult to be sure that a dietary supplement actually contains what it advertises. Refer to our article on dietary supplements to help inform your decision on whether or not to pursue this route. With dietary supplements, the safest bet is to simply buy the plant in its whole or minimally processed form.
• Respect the role of the bedroom: When counseling about sleep hygiene, I always remind my patients that the bedroom is strictly for sleeping and sex, not laying awake checking facebook, watching TV, or doing work in bed. Respect the space where you sleep as the energy you build in your bedroom greatly affects sleep quality.

Employ any of these tips that resonate with you. Enjoy your sleep and know that when you do so, you are nourishing yourself on many levels. Drugs also have their role, especially in those suffering from clinical sleep disorders. If you are currently prescribed a medication to address issues with sleep, some of these strategies may be used in tandem with conventional medicine practices in order to reinforce your approach and augment your ability to get a good night’s sleep. Additionally, these strategies may be useful for those who wish to reduce their use of sleeping pills or for anyone who just wants to achieve more restful sleep.

“Each night, when I go to sleep, I die. And the next morning, when I wake up, I am reborn.”
― Mahatma Gandhi

1. Miyazaki S, Liu C-Y, Hayashi Y. Sleep in vertebrate and invertebrate animals, and insights into the function and evolution of sleep. Neurosci Res. 2017;118:3-12. doi:10.1016/j.neures.2017.04.017

2. Sleep Deprivation and Deficiency | National Heart, Lung, and Blood Institute (NHLBI). https://www.nhlbi.nih.gov/health-topics/sleep-deprivation-and-deficiency. Accessed February 3, 2020.

3. Hysing M, Harvey AG, Linton SJ, Askeland KG, Sivertsen B. Sleep and academic performance in later adolescence: results from a large population-based study. J Sleep Res. 2016;25(3):318-324. doi:10.1111/jsr.12373

4. Barahona-Correa JE, Aristizabal-Mayor JD, Lasalvia P, Ruiz ÁJ, Hidalgo-Martínez P. Sleep disturbances, academic performance, depressive symptoms and substance use among medical students in Bogota, Colombia. Sleep Sci. 2018;11(4):260-268. doi:10.5935/1984-0063.20180041

5. Houlden RL, Yen HH, Mirrahimi A. The Lifestyle History: A Neglected But Essential Component of the Medical History. Am J Lifestyle Med. 2017;12(5):404-411. doi:10.1177/1559827617703045

6. Neal D. Barnard. Your Body in Balance: The New Science of Food, Hormones, and Health. New York: Grand Central Publishing; 2020.

7. Paterson JL, Reynolds AC, Dawson D. Sleep Schedule Regularity Is Associated with Sleep Duration in Older Australian Adults: Implications for Improving the Sleep Health and Wellbeing of Our Aging Population. Clin Gerontol. 2018;41(2):113-122. doi:10.1080/07317115.2017.1358790

8. Chung K-F, Lee C-T, Yeung W-F, Chan M-S, Chung EW-Y, Lin W-L. Sleep hygiene education as a treatment of insomnia: a systematic review and meta-analysis. Fam Pract. 2018;35(4):365-375. doi:10.1093/fampra/cmx122

9. Naiman R. Integrative Medicine Approaches to Insomnia. Sleep Review. http://www.sleepreviewmag.com/2015/08/integrative-medicine-approaches-insomnia/. Accessed February 7, 2020.

10. R. Naiman. An Integrative Medicine Approach to Insomnia. Integr Med 3rd Ed Rakel David. 2012.