This is the final instalment in a 3 part series on Sleep! Part 1 explores the vexing question of How Much Sleep Do I Need? Part 2 explores the health impacts of short and long term sleep deprivation. This final instalment sets out my bumper list of evidence-based tips and tweaks to help you improve your sleep!
When it comes to health and wellbeing, getting enough quality sleep is right up there with good nutrition and getting enough exercise. But it is way too easy to push sleep down our list of priorities, and fall into habits (like late-night internet shopping and netflix binge-watching) that eat into our sleep.
Studies show that we are getting less sleep than 20 years ago, and rates of insomnia and sleep disorders has risen over the last few decades. It’s no exaggeration to state that sleep deprivation is at pandemic levels. You, me and everyone we know are sleep deprived to some degree. And that’s NOT good news.
We all need to put sleep right up at the top of our health-and wellbeing list by making it a conscious priority. Part of this process is understanding the importance of sleep for our health, and the adverse impacts of sleep deprivation. Need a refresher on this? Check out Part 2 in this series for a whistle-stop tour of the health risks of not getting enough sleep. It makes for very sobering reading, but the great news is that a small but consistent and growing body of research indicates that there is significant scope to halt and even reverse a lot of the above harmful health impacts of sleep deprivation by simply committing to (and actually getting!) 7-8 consistent hours of sleep over the long term! And benefits can be seen in as little as 2-4 weeks.
When it comes to sleep impairment, a growing body of research indicates that “lifestyle” interventions like the ones listed in this post, can be just as effective as sleeping tablets, and without the risks of dependence.
When I work with a coaching clients to improve their sleep, we work through a simple two-step process:
First, make sure your schedule is set up so that you are actually spending enough hours in bed each night.
Next, trouble-shoot your “sleep robbers”.
STEP 1: MAKE SURE YOU ARE PUTTING IN THE HOURS
The first step is to look at how many hours you are actually spending in bed. If it is less than 7 hours per night, then you may be at risk of not getting enough sleep for your needs.
So start by organise your daily routine to create a sleep schedule that will give you at least 7 hours in bed (plus an hour of “buffer”)
Work out what time you need to wake up, and then set a bedtime that will give you at least 8 hours in bed. We all experience several periods of wakefulness throughout the night, so our hours of sleep will always be less than the hours we spend in bed. Sleep experts recommend we get at least 7 hours sleep per night, so if you are aiming for 7 hours, allow yourself at least an hour of “buffer” to account for those periods during the night when you are awake, as well as the amount of time it takes you to fall asleep.
Consistency is key - so stick to your sleep schedule!
People with consistent sleep schedules are less likely to experience problems with their sleep. Inconsistent sleep patterns will throw out our circadian rhythm. A consistent sleep schedule will anchor you to a set bedtime and wakeup time to synchronise your sleep-wake cycle. So you need to set up some triggers to help you embed a consistent sleep schedule.
My top tip? Set a bedtime alarm, as well as a morning alarm!
Seriously! Do it! If you regularly find yourself going to bed too late to get the hours of sleep you need, this will be a game-changer. Just set an alarm for 15-20 minutes before you want to be in bed. When your sleep alarm goes off, brush your teeth wash your face, shower, whatever and then get straight into bed.
Here are some more tips to help you get to bed on time
If time on your phone or computer or watching TV eats into your sleep, consider putting your wifi router and/or TV on a timer so that it shuts off at a set time, and if your phone is the problem, search around for an app or two to help you put your phone down at bedtime. If you are a Mac user there is an app called Self Control. This is how they describe it: "SelfControl is a free and open-source application for Mac OS X that lets you block your own access to distracting websites, your mail servers, or anything else on the Internet. Just set a period of time to block for, add sites to your blacklist, and click "Start." Until that timer expires, you will be unable to access those sites--even if you restart your computer or delete the application.” Here's the link if you would like to check it out! If you're on Google Chrome, here's a link to a similar app.
And once we have embedded a great, consistent sleep schedule, we can then focus on doing what we can to improve sleep quality too….
STEP 2: TROUBLE-SHOOT YOUR SLEEP ROBBERS (AKA “SLEEP RISK FACTORS”)
This is where you will spend most of your time and effort. It’s also likely that this step is likely to be a game-changer, once you find the tweak (or tweaks) that bust your sleep-robbers.
Sleep scientists categorise sleep risk-factors into the following five categories:
Lifestyle factors including excessive caffeine, alcohol, drug abuse, shift work, and jet lag.
Environmental factors including excessive noise in your sleep environment, and excessive light.
Psychosocial factors including anxiety, worry, rumination, having babies and young children in your household or being a caregiver to a family member with a chronic or terminal illness.
Medical issues including pain, lung disease, kidney disease. neurodegenerative disease, mental illness or diabetes.
Diagnosed Sleep disorders. There are actually more than 100 different classifications of sleep disorders, but problems with our sleep can be broadly classified into one of the following five broad areas:
Sleep delay: where it can take us longer than 15-20 minutes to fall asleep.
Early awakening: where you wake up in the early hours of the morning and can’t get back to sleep;
Sleep Disruption or Fragmentation: where we have difficulty maintaining our sleep throughout the night; and
Disruptive events during sleep such as restless leg syndrome or sleep apnoea
Sleep Deprivation: where we just don’t get the hours and/or quality of sleep that our body needs (which can wholly or in part be due to the first three issues).
So take a look at the Sleep Risk Factors above. Chances are that quite a few will make it onto your personal list of Sleep Trouble-Shooters. Pick the ones that are robbing you of good quality Sleep, and choose from the tips below to trouble-shoot.
Here is my “in-no-particular-order” list of evidence-based sleep trouble-shooting tips!
1.Be mindful of your evening light exposure
Our exposure to both light and darkness has a powerful influence on our circadian rhythm. Melatonin, a sleep-promoting hormone, rises when darkness falls, promoting sleep, and falls when it's light, promoting wakefulness. Light signals our brains to be alert and awake. Evening light exposure delays melatonin release.
Dim the lights in your home: Consider investing in one or more lamps to use in the evening, and purchase lightbulbs for them that emit a soft, “warm” light. If you want to get technical, look for lightbulbs with Kelvins under 3000 and lumens under 450. This will mean that the light has a more “yellow” hue, and is less starkly bright.
Dim your TV screen too. Most models enable you to do this in their settings.
Be especially wary of blue light and screen light before bed: The cells in our retina that influence our circadian rhythm have been found to be particularly sensitive to blue (short wave, 400-490 nm) light. TVs, computer screens, smartphones, tablets and energy-saving LED light bulbs have all been found to emit light in this short wave, “blue” spectrum. Exposure to this light in particular has been found to decrease sleepiness, increase alertness and reduces our production of melatonin, a hormone you body produces in the evening to induce sleep.
Minimise screen exposure: Sleep experts recommend avoiding exposure to blue light at least 2-3 hours before bed. Or for bonus sleep points put away or turn off all screens in the hour before bedtime. This is what the National Sleep Foundation recommends.
Try glasses that block blue light: You might have seen ads for expensive glasses that block blue light. Do they work? Yes they do, by helping to reduce the suppression in sleep hormone melatonin that happens when we are exposed to high levels of blue light in the evening. But there’s no need to spend a fortune. Studies have found that inexpensive, mass-produced plastic orange-tinted glasses often advertised “for shift workers” can be just as effective as the more expensive blue-block glasses.
Consider installing f.lux on your computer: F.lux adapts the the colour of your computer's display to the time of day, warm at night and like sunlight during the day. Check it out HERE.
2. Minimise fluid intake 2-3 hours before going to bed
When we sleep our bodies release anti-diuretic hormone, to reduce the urge to urinate through the night. But that isn’t always enough to prevent disruption to our sleep. So if you find your sleep is often disrupted by the need to get up to tinkle in the middle of the night, limit your fluid intake at least 2 hours before bed. But don’t take this advice to the other extreme. If you go to bed dehydrated you may wake up thirsty during the night.
3. Consume Caffeine Carefully
It can take up to 8 hours for your body to fully process and eliminate caffeine, so sleep experts recommend avoiding caffeine after 2pm. Caffeine is a stimulant, which has been shown to impair our body’s production of melatonin in the evening. It also antagonises the effects of adenosine, a hormone that regulates our sleep–wake cycles. Studies show that caffeine intake can increase the time it takes you to get to sleep, the time you spend asleep and the quality of your sleep, including reduced restorative deep (slow wave) sleep, and REM sleep. Women are more susceptible to caffeine-induced sleep disruption, and the effects on both sexes tend to increase as we age.
4. Alcohol is a sleep-disruptor
Alcohol has been described as one of the most popular “over the counter” sleep aids. You may think that alcohol will relax you, and while it certainly may help you fall asleep faster, it will also reduce the quality of your sleep and increase the likelihood of waking throughout the night, and particularly during the second half of the night as the alcohol is metabolised. It can also cause more vivid dreams and even nightmares. Alcohol also impacts our daytime alertness, and certain physiological processes that occur during sleep. If you snore, suffer breathing issues or sleep apnea, alcohol can make it worse. Sleep experts estimate that alcohol may be responsible for up to 10% of chronic insomnia cases.
5. Avoid over eating in the evening, especially close to bedtime
If you go to bed before your body has had adequate time to digest your dinner, you will place pressure on the little muscle in your oesophagus that keeps the contents of your stomach (and your stomach acids) where they belong, which can cause heartburn, particularly if you have eaten a large meal. So make an effort eat a reasonably-sized dinner, at least 2-3 hours before you go to bed.
6. Decompress and clear your mind as your day draws to a close
One of the most common sleep issues is sleep delay, where we toss and turn after getting into bed and can’t fall asleep. Taking steps to calm your sympathetic nervous system in the evening can help you fall asleep faster and improve your sleep quality.
Create an evening “wind down” routine: This is especially important if your mind races and either delays you getting to sleep, wakes you in the middle of the night or early morning.
Reading can be a great pre-bed activity, depending on what you read of course! Choose to read a real, paper book in preference to an iPad or e-reader - or follow my blue light reduction tips above. But be choosy about your evening reading matter. Exciting, emotional and intellectually demanding reading matter can delay or disrupt your sleep.
Try mindfulness meditation, Tai Chi, Yoga or even going for a walk: All have been found to improve sleep, likely due to a positive impact on anxiety levels.
Gratitude journaling has been found to be a great bedtime activity.
Make an effort not to work right up to bedtime: I work with lots of busy professionals who often pull out their laptops after dinner. Ap[art from the effect of your computer screen on your sleep-wake cycle, working too close to bedtime can be too stimulating and sabotage your sleep, so if you can, set a hard deadline for “pens down”.
What about taking a warm bath before sleep? This one tends to pop up in every magazine article and blog post on getting better sleep, but there is actually very little research to back it up, apart from one study published in 1985. In fact, if your bath is too warm it may elevate your body temperature to the extent that it interferes with your sleep. My suggestion: if you enjoy warm baths and they relax you, by all means take a bath, but make sure you don’t make it too hot, dim the lights, and consider adding a drop or two of lavender oil as inhaling the oil has been shown in some studies to improve sleep.
7. Try guided imagery visualisation to help you fall asleep
Ruminating on the day’s stressors or life’s problems is a great way to sabotage your sleep! Whilst clearing your mind-chatter with mindfulness meditation works a treat for some people, others find that they can’t always clear their mind, and the old demons come racing in once the lights go out, along with a generous helping of “I can’t meditate and now I’ll never get to sleep”. So if you are not a Jedi-level meditator, you may find that instead of trying to empty your mind, filling it with a guided imagery visualisation can help you fall asleep. Visualising a peaceful environment like a rainforest or beach has been found to reduce the time people can take to fall asleep, and is recommended by the National Sleep Foundation.
8. Audit your sleeping environment
Look at Light: Is light pollution in your bedroom impacting your sleep? Consider blackout blinds or a sleep eye-mask. If lots of light streams into your bedroom window, from street lamps for example, this can be a good option.
Consider banning screens: don’t shoot the messenger! This is what sleep experts recommend - keep phones, tablets, computers and televisions out of the bedroom, or use amber-coloured glasses if you like to watch a little TV in bed.
Check your clock: Is it too bright? Some bedside clocks are really bright, and also emit the blue, short-wave light that studies show can disrupt your circadian rhythm. Red displays are less disruptive than blue or white displays. Consider changing your clock, turning it away from you or wearing eye shades while you sleep.
Consider how noise impacts your sleep: When it comes to sleep, people tend to fall into two camps: they either need total silence to be able to sleep, or they need some soothing ambient noise. Are you being woken by noise? Consider ear plugs or even double glazing your bedroom window. Or…
Try white or pink noise: Both have been shown to improve sleep. There are lots of apps, and even bedside noise generators on the market. Or you can go “old school” and turn on a fan or airconditioner.
Room Temperature (aka Thermal Environment): Our thermoregulatory system and sleep regulating mechanisms are strongly linked. High or low air temperatures, can significantly decrease sleep quality. Sleep experts recommend that our bedrooms should be cool – 60-76 degrees Fahrenheit or 15-20 degrees Celsius.
In winter, don’t let your hands or feet get icy cold: we recognise this one as plain old common sense, but those very helpful scientists have confirmed that this is one of the best physiological predictors for the rapid onset of sleep. So if your hands or feet feel like ice blocks at bedtime, put on some clean socks or fill up a hot water bottle and put it at the foot of your bed.
Don’t let your pet sleep on the bed: I know this won’t be popular with some people. But check out this time lapse video of a couple who allows their dog to sleep on their bed. If you are waking exhausted, it might be worth trialling a pet-free sleeping environment.
9. Consider your sleeping position
Your choice of sleeping position can impact your breathing and your pain levels, two issues which can seriously impact your sleep quality. Sleeping on your back can increase your chances of snoring, or experiencing sleep-associated breathing difficulties including sleep apnea. If you sleep on your side, sleep experts recommend using the right pillow to ensure your neck rests in a straight line, and to prevent your pelvis from twisting and potentially causing lower back pain, consider sleeping with a pillow between your knees. If your bed is really old and saggy, consider getting a new one. But don’t fall for up-selling by salespeople. A session with a physiotherapist can help you find the most comfortable sleep position, and decide what level of firmness you need in a mattress.
10. If you wake in the middle of the night
Firstly, don’t panic. Even the best sleepers will wake one or (many) more times during the night. The key is to make sure you don’t rev up your nervous system or send your body signals that it is time to get up and start your day. So whatever you do, don’t look at your phone! Resist the urge to look at your clock, especially if it has a luminous blue display. If you need to get up, be wary of turning on the lights. My husband bought a few tiny floor-mounted battery powered motion-activated sensor lights and positioned them in our bedroom, hallway and bathroom, so we don’t need to switch on lights if we wake in the middle of the night. It has made such a positive difference to our ability to get back to sleep if we ever need to get up during the night.
11. Stay away from the snooze button
It might feel like you are going yourself a little favour each time you hit that snooze button in the morning, but you are actually having the opposite effect. Hitting the snooze button has been found to disrupt our REM sleep and result in us waking up groggier than if we simply bite the bullet and get up when our alarm goes off. Hitting the snooze button can also undermine the regularity of our sleep schedule and undermine our efforts to establish a consistent healthy sleep routine. It also increases the length of time we will experience “sleep inertia”, that groggy disoriented feeling we experience shortly after waking up. This is because we begin a new sleep cycle as soon as we doze off after hitting the snooze button, only to be woken again a few minutes later. This can lead to a vicious cycle of needing to hit the snooze button again and again, until your morning routine is derailed.
12. Use natural sunlight to help set your body clock and regulate your circadian rhythm
The normal functioning of circadian rhythm depends on, among other things, the duration and pattern of exposure to light and darkness. So in addition to minimising your light exposure in the evenings, make sure you get light exposure (especially natural sunlight) in the daytime. Morning sunlight exposure can be especially helpful in establishing a healthy sleep-wake cycle. Open your blinds as soon as you wake up in the morning, especially if you use blackout blinds in your home.
13. Get outside and walk (or any kind of exercise) in the morning sunlight
This will yield multiple benefits - exercise has been shown to improve sleep duration and quality, and the morning light exposure will help regulate your sleep-wake cycle, and you will get a dose of Vitamin D (scientists are starting to look at the links between Vitamin D deficiency and sleep quality). So make an effort to go outside for a 15-30 minute walk in the sunlight first thing in the morning.
14. Avoid Daytime Sleep
When you are exhausted due to impaired sleep, it can be really tempting to nap during the day. But sleep experts advise against this, as it can hamper our development of a healthy, consistent sleep-wake cycle and sabotage your efforts to fall asleep at bedtime, especially if you nap after 3pm. Daytime napping can leave you with a lingering groggy feeling (technically referred to as “sleep inertia”), and some studies indicate a link between daytime napping and increased inflammation and impaired glucose tolerance.
15. Exercise and Sleep
Exercise is something we all should be engaging in on a consistent basis. Not only can it help you sleep better, but it has LOTS of other health benefits - read more HERE! Exercise and evening light exposure are, in my book, the two big game-changers for sleep quality improvement, so if you really need to improve your sleep, make exercise a priority!
Here are some specific tips for exercise and sleep:
Avoid inactivity: Research consistently shows that people who are consistently sedentary are at a higher risk of sleep disturbance and insomnia.
Exercise regularly: Randomised controlled trials (RCTs) consistently show the beneficial effects of exercise - shortening the time it takes to fall asleep, increasing hours we spend asleep and the quality of that sleep. Moderate-intensity aerobic exercise seems to provide the greatest benefits. The effects are both immediate (you will sleep better after even a single exercise session) but the research also shows that people who have a consistent exercise habit enjoy consistently better sleep. Researchers who undertook a meta analysis in 2015 actually concluded “there is support for the use of exercise as a prescriptive to improve sleep quality, with expectations for immediate benefits that have the potential to grow over time”.*
If you are a high-intensity exerciser, don’t do it too close to bedtime: Vigorous exercise raises our heart rate, circulation and body temperature. So if we engage in vigorous exercise too close to bedtime it can delay or impair our sleep. So if you find your sleep is disrupted after a vigorous workout, try to schedule it so that you do it earlier in the day, or so that you finish up at least 2-3 hours before bed.
Be careful about robbing yourself of sleep to get in a workout: This can be a tricky one, especially for busy professionals who work long hours and need to make a choice between sleep and exercise. Sleep experts acknowledge that exercise can enhance sleep but caution against robbing yourself of sleep to work out. Both sleep and exercise are health-enhancers. If sleep and exercise are truly either/or propositions for you, I recommend taking a step back, taking stock, and taking the steps you need to create a healthier, more balanced lifestyle.
16. Diet and Sleep
I’m a food-loving nutritionist so of course I had fun digging into the studies on food and sleep. This section summarises most of what I found (apart from the info on caffeine, alcohol and fluids, which I summarised above):
Dietary patters and sleep: Population studies show a positive correlation between healthy Mediterranean-style diet and sleep quality, but these studies can’t tell us if people are sleeping well because they are eating well, or eating well because they are sleeping well (In Part 2 of this series I explored the impact of poor sleep on our appetite and food choices. Check it out HERE.) Having said that, a healthy Mediterranean style diet is linked with many other health benefits including improved mood, cardiovascular health, weight management and even our microbiome, all of which can support healthy sleep.
Carbs at dinner? Some studies suggest that a carb-rich dinner can help you sleep, but as a nutritionist I’m extremely wary of recommendations like these. Firstly, because the studies aren’t consistent (there are also studies which have found improved sleep due to low-energy, protein-rich meals too). But more importantly, not all carbs are created equal, and a dinner that is high in refined carbs is likely to spike your insulin, leading to a later drop which can in itself disturb your sleep. It is far better to eat a balanced meal, which includes a sensible amount of protein, healthy fats and whole unrefined carbs like veggies, whole grains or legumes.
Nutrient deficiencies and sleep: Scientists are starting to unpick the links between certain nutrient deficiencies (such as magnesium and Vitamin D) and sleep. Rather than popping pills, it is much better to ensure you are eating a healthy balanced diet to supply you with your nutrient needs (Need help with that? Contact me to book a consultation!)
Can specific foods help you sleep?
Milk: a glass of warm milk before bedtime has traditionally been touted as a sleep aid. But the evidence doesn’t actually back this up, unless the milk is rich in melatonin because the cows have been milked at night (yes, some clever scientists actually looked into this!).
Kiwifruit: studies have shown that consuming two kiwifruit one hour before bedtime can increasing duration and quality of sleep. If you love kiwifruit, consider eating a couple for dessert and see if it makes a difference for you.
Tart cherry juice: consumption of a glass of tart cherry juice has been shown to boost melatonin levels and improve sleep. This one I’m not so fond of. I’m not really a fan of any fruit juice as the healthy fibre has been removed, so your blood sugar and insulin levels will spike. Definitely not for anyone with insulin resistance!
17. Manage your overall stress levels
In addition to taking some proactive steps to decompress and clear your mind in the evening, sleep experts recommend we take a good look at our overall stress levels. Stress is one of our biggest sleep saboteurs. So check in with yourself: if you are having problems with your sleep and you are stressed, seriously consider what practicals steps you can take to address your overall day-to-day stress levels. This may take a bit of time and trouble-shooting to find what works for you. Consider meditation, a few sessions with a psychologist, increasing your activity levels, or taking proactive steps to minimise your exposure stressful situations or people.
18. Be mindful of your mood
There is a significant two-way relationship between our mood and our sleep. Of course it goes without saying that sleep deprivation can cause our mood to nosedive. But recent studies are exploring the link between “positive affect” and sleep. It’s still very early days, but if you do suffer from depression, there is a very good chance that improving your sleep may improve your mood. But there is also a possibility that addressing your depression (via lifestyle, psychological therapy or meds) may help to improve your sleep. Interested in the relationship between diet and mood (including depression)? Check out THIS POST!
19. Try Using a Sleep Diary
If the cause of your sleep issues aren’t glaringly obvious, Sleep Diary can help you identify the issues that are impacting your sleep. Sleep experts recommend using it for at least a week to help uncover any patterns. Click here to download the National Sleep Foundation’s Sleep Diary Template.
20. Or a sleep tracker
The gold standard for sleep measurement is polysomnography. However, polysomnography typically requires expensive equipment and technical expertise to set up, and is therefore not appropriate for regular use in a home environment. The technology for sleep trackers that you wear, place in your bed or on your bedside table is rapidly evolving, but the general consensus at this time is that they don’t provide anywhere near the accuracy of polysomnography. So if you use a tracker, take its readings as a rough indication of your sleep duration and quality rather than gospel. I personally choose to track my sleep via my Fitbit AltaHR. I’m aware that it may not be completely accurate, but I have been using it whilst I am working on improving my own sleep quality, to track the impacts on my sleep of variables like exercise, alcohol and evening screen exposure.
21. Avoid “insomnia phobia”
Try not to get too stressed out over your sleep. Becoming stressed or anxious about your impaired sleep is likely to further contribute to your sleep disruption. People with insomnia are at risk of developing a condition some sleep experts call “insomnia phobia”; a preoccupation with their sleep impairment and its consequences.
22. Believe it and achieve it
If you believe something will improve your sleep, it probably will. A 2014 Meta Analysis of 32 studies involving almost 4,000 test subjects found evidence of significant improvements under placebo conditions.
23. Speak to your doctor
I think it is always a good idea to check in with your doctor, and to seek their support in making lifestyle changes. Involving your doctor is essential if you are a heavy snorer, have trouble staying awake during the day or just have that feeling that “something’s not right”. They can investigate and deal with any medical issues that may be impacting your sleep such as chronic pain or sleep apnea, and even refer you for a sleep study.
24. Consider asking for a referral to have a sleep study done
If your sleep problems are more serious, or if you suspect you may have sleep apnea, consider asking your doctor for a referral to have a sleep study done. There are three types of sleep studies.
A Polysomnogram involves an overnight stay where you will have a number of sensors applies which will measure your breathing, movement, blood pressure, heart rate, oxygen levels, brain activity.
A Multiple Sleep Latency Test (aka the napping test) measures daytime sleepiness, and is conducted during the day.
The Maintenance of Wakefulness Test is another daytime study that measures your alertness and ability to stay awake.
These studies can give you detailed information on your sleep, and pave the way for improvements to your sleep and your health.
25. Consider CBT-I (Cognitive Behaviour Therapy for Insomnia)
If you are becoming stressed about your sleep issues, consider asking your doctor for a referral to a psychologist who is experienced in CBT-I, a type of cognitive behaviour therapy specifically adapted for insomnia sufferers. CBT-I is a combination of of psychoeducation/sleep hygiene, relaxation training, stimulus control therapy, sleep restriction therapy and cognitive therapy.
26. What about melatonin?
Melatonin is the most studied “sleep supplement”. It’s actually a hormone. Our bodies should naturally increase melatonin production in the evening in preparation for sleep. Studies show it can have a mild positive effect on your sleep-wake cycle, help you fall asleep faster and stay asleep for longer. But it’s not a “magic bullet” and it’s not without side-effects, contraindications and drug interactions. For example, melatonin is unsafe for use during pregnancy, can lower your seizure threshold, and can interact with a wide range of medications. In Australia, melatonin can only be obtained via doctors’ prescription. Given the potential risks, irrespective of where you live I recommend you don’t take melatonin unless prescribed and supervised by your doctor. Rather than popping a pill, take a few steps to enhance your evening melatonin production by minimising your evening light exposure and getting out into the sunlight in the morning.
27. What about herbal supplements?
Herbs such as chamomile, passionflower, kava, hops, valerian and even catnip have been listed in various articles and blog posts as helping sleep. When I dug into the research on each of these herbs I was struck by two things. Firstly, the lack of consistent, high quality studies and secondly the frightening list of potential drug interactions and side effects. If you want to put the occasional drop or two of lavender oil in your bath or on your pillow, or sip an evening cup of mild chamomile tea (not too close to bedtime!), go ahead. But the risks of taking large “therapeutic” or “pharmacological” doses of these supplements are too high for my liking, especially when there are so many carefully investigated, evidence-based, low-risk tips you can follow.
28. Be especially careful when it comes to sleep medications
I think this goes without saying, but I will say it anyway. Many sleep medications can be habit forming, impair daytime alertness or have side effects. They are generally only prescribed as a very short-term strategy. If your sleep issues are not severe, research indicates that lifestyle changes like the ones listed in this post, can be just as effective as sleep meds, even if they can be more challenging to implement than simply swallowing a pill.
29. Make small, simple changes
There are a LOT of tips here, and family and friends will no doubt have more. So where should you start?
You could start by changing your biggest sleep saboteur. Or you could go for the low-low-hanging fruit option and choose a small, relatively painless tweak.
For sustainable long term change, behaviour change experts recommend tiny changes. So if you want to make a change, go for the low hanging fruit, choose one easy change and practice it until it becomes and embedded habit, and then move on to the next one. Resist the urge to make lots of big changes at once, as you risk overwhelming yourself. Start by making one small change at a time, and move on to the next once it is embedded as a habit.
30. Make sleep improvement a team sport
If you share a bed with someone else, their sleep will impact yours and vice versa. So make sleep improvement a joint project! This is especially important if your partner snores, has breathing difficulties or is a poor sleeper, as their sleep disturbances will impact your sleep.
31. Can you “catch up” on lost sleep?
In the short-term, it seems you can. When we experience short-term sleep deprivation, our bodies naturally drive us to get extra sleep via the “rebound effect”. And while there aren’t a huge number of studies on the topic, it does appear that we don’t need to catch up on the exact number of hours we have lost. The best way to “catch up” on lost sleep is to go to bed earlier for several nights in a row rather than sleeping in. This is because sleeping in can disrupt our circadian rhythm, pushing it back and making us want to go to bed later. As discussed above, people with consistent sleep schedules enjoy better sleep, so while catch-up sleep may be a good short-term solution, the more sustainable long-term solution is to trouble-shoot your sleep deprivers and commit to consistent healthy sleep habits.
There are lots of great, evidence-based tips here for you to try!
Do drop me a note and let me know which tips you try, and which ones you found to be the most helpful!
Apologies - these references aren’t numbered, or even in the correct order. My blog isn’t compatible with referencing software so they fell out of order as I edited and added to this post!
Riemann D, Baglioni C, Bassetti C, Bjorvatn B, Dolenc Groselj L, Ellis JG, Espie CA, Garcia‐Borreguero D, Gjerstad M, Gonçalves M, Hertenstein E. European guideline for the diagnosis and treatment of insomnia. Journal of sleep research. 2017 Dec;26(6):675-700.
Dautovich ND, Shoji KD, McCrae CS. Variety is the spice of life: a microlongitudinal study examining age differences in intraindividual variability in daily activities in relation to sleep outcomes. Journals of Gerontology Series B: Psychological Sciences and Social Sciences. 2013 Dec 10;70(4):581-90.
Gooley JJ, Chamberlain K, Smith KA, Khalsa SB, Rajaratnam SM, Van Reen E, Zeitzer JM, Czeisler CA, Lockley SW. Exposure to room light before bedtime suppresses melatonin onset and shortens melatonin duration in humans. The Journal of Clinical Endocrinology & Metabolism. 2011 Mar 1;96(3):E463-72.
Smolensky MH, Sackett-Lundeen LL, Portaluppi F. Nocturnal light pollution and underexposure to daytime sunlight: Complementary mechanisms of circadian disruption and related diseases.
Cho Y, Ryu SH, Lee BR, Kim KH, Lee E, Choi J. Effects of artificial light at night on human health: A literature review of observational and experimental studies applied to exposure assessment. Chronobiology international. 2015 Oct 21;32(9):1294-310.
Gringras P, Middleton B, Skene DJ, Revell VL. Bigger, brighter, bluer-better? Current light-emitting devices–adverse sleep properties and preventative strategies. Frontiers in public health. 2015 Oct 13;3:233.
Van der Lely S, Frey S, Garbazza C, Wirz-Justice A, Jenni OG, Steiner R, Wolf S, Cajochen C, Bromundt V, Schmidt C. Blue blocker glasses as a countermeasure for alerting effects of evening light-emitting diode screen exposure in male teenagers. Journal of Adolescent Health. 2015 Jan 1;56(1):113-9.
Grønli J, Byrkjedal IK, Bjorvatn B, Nødtvedt Ø, Hamre B, Pallesen S. Reading from an iPad or from a book in bed: the impact on human sleep. A randomized controlled crossover trial. Sleep medicine. 2016 May 1;21:86-92.
Green A, Cohen-Zion M, Haim A, Dagan Y. Evening light exposure to computer screens disrupts human sleep, biological rhythms, and attention abilities. Chronobiology international. 2017 Aug 9;34(7):855-65.
Shilo L, Sabbah H, Hadari R, Kovatz S, Weinberg U, Dolev S, Dagan Y, Shenkman L. The effects of coffee consumption on sleep and melatonin secretion. Sleep medicine. 2002 May 1;3(3):271-3.
Clark I, Landolt HP. Coffee, caffeine, and sleep: A systematic review of epidemiological studies and randomized controlled trials. Sleep medicine reviews. 2017 Feb 1;31:70-8.
Drake C, Roehrs T, Shambroom J, Roth T. Caffeine effects on sleep taken 0, 3, or 6 hours before going to bed. Journal of Clinical Sleep Medicine. 2013 Nov 15;9(11):1195-200.
Roehrs T, Roth T. Sleep, sleepiness, and alcohol use. Alcohol research and Health. 2001 Jan 1;25(2):101-9.
Jackson CL, Gaston SA, Liu R, Mukamal K, Rimm EB. The relationship between alcohol drinking patterns and sleep duration among black and white men and women in the United States. International journal of environmental research and public health. 2018 Mar 20;15(3):557.
Thakkar MM, Sharma R, Sahota P. Alcohol disrupts sleep homeostasis. Alcohol. 2015 Jun 1;49(4):299-310.
Lan L, Qian XL, Lian ZW, Lin YB. Local body cooling to improve sleep quality and thermal comfort in a hot environment. Indoor air. 2018 Jan;28(1):135-45.
Kräuchi K, Cajochen C, Werth E, Wirz-Justice A. Physiology: warm feet promote the rapid onset of sleep. Nature. 1999 Sep;401(6748):36.
Raymann RJ, Swaab DF, Van Someren EJ. Skin deep: enhanced sleep depth by cutaneous temperature manipulation. Brain. 2008 Jan 11;131(2):500-13.
Lack LC, Gradisar M, Van Someren EJ, Wright HR, Lushington K. The relationship between insomnia and body temperatures. Sleep medicine reviews. 2008 Aug 1;12(4):307-17.
Horne JA, Reid AJ. Night-time sleep EEG changes following body heating in a warm bath. Electroencephalography and clinical neurophysiology. 1985 Feb 1;60(2):154-7.
Hirshkowitz M, Whiton K, Albert SM, Alessi C, Bruni O, DonCarlos L, Hazen N, Herman J, Hillard PJ, Katz ES, Kheirandish-Gozal L. National Sleep Foundation’s updated sleep duration recommendations. Sleep Health. 2015 Dec 1;1(4):233-43.
Jeon L, Finkelstein J. Consumer sleep tracking devices: a critical review. Digital Healthcare Empowering Europeans: Proceedings of MIE2015. 2015 May 8;210:458.
Baroni A, Bruzzese JM, Di Bartolo CA, Shatkin JP. Fitbit Flex: an unreliable device for longitudinal sleep measures in a non-clinical population. Sleep Breath. 2016 May 1;20(2):853-4.
Mantua J, Gravel N, Spencer R. Reliability of sleep measures from four personal health monitoring devices compared to research-based actigraphy and polysomnography. Sensors. 2016 May 5;16(5):646.
Baron KG, Duffecy J, Berendsen MA, Cheung IN, Lattie E, Manalo NC. Feeling validated yet? A scoping review of the use of consumer-targeted wearable and mobile technology to measure and improve sleep. Sleep medicine reviews. 2017 Dec 20.
de Zambotti M, Goldstone A, Claudatos S, Colrain IM, Baker FC. A validation study of Fitbit Charge 2™ compared with polysomnography in adults. Chronobiology international. 2018 Apr 3;35(4):465-76.
Peake J, Kerr GK, Sullivan JP. A critical review of consumer wearables, mobile applications and equipment for providing biofeedback, monitoring stress and sleep in physically active populations. Frontiers in Physiology. 2018 May 28.
Yang PY, Ho KH, Chen HC, Chien MY. Exercise training improves sleep quality in middle-aged and older adults with sleep problems: a systematic review. Journal of physiotherapy. 2012 Sep 1;58(3):157-63.
Kredlow MA, Capozzoli MC, Hearon BA, Calkins AW, Otto MW. The effects of physical activity on sleep: a meta-analytic review. Journal of behavioral medicine. 2015 Jun 1;38(3):427-49.
Chennaoui M, Arnal PJ, Sauvet F, Léger D. Sleep and exercise: a reciprocal issue?. Sleep medicine reviews. 2015 Apr 1;20:59-72.
Hartescu I, Morgan K, Stevinson CD. Increased physical activity improves sleep and mood outcomes in inactive people with insomnia: a randomized controlled trial. Journal of sleep research. 2015 Oct;24(5):526-34.
Baron KG, Reid KJ, Zee PC. Exercise to improve sleep in insomnia: exploration of the bidirectional effects. Journal of Clinical Sleep Medicine. 2013 Aug 15;9(08):819-24. Zhou J, Liu D, Li X, Ma J,
Zhang J, Fang J. Pink noise: effect on complexity synchronization of brain activity and sleep consolidation. Journal of theoretical biology. 2012 Aug 7;306:68-72.
Forquer LM, Johnson CM. Continuous white noise to reduce sleep latency and night wakings in college students. Sleep and Hypnosis. 2007;9(2):60.
Okajima I, Komada Y, Inoue Y. A meta‐analysis on the treatment effectiveness of cognitive behavioral therapy for primary insomnia. Sleep and Biological Rhythms. 2011 Jan;9(1):24-34.
Mitchell MD, Gehrman P, Perlis M, Umscheid CA. Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review. BMC family practice. 2012 Dec;13(1):40.
Trauer JM, Qian MY, Doyle JS, Rajaratnam SM, Cunnington D. Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-analysis. Annals of internal medicine. 2015 Aug 4;163(3):191-204.
Stothard ER et al. Circadian Entrainment to the Natural Light-Dark Cycle across Seasons and the Weekend. Current Biology 2017; 27: 508–513.
Roehrs T, Roth T. Sleep, sleepiness, and alcohol use. Alcohol research and Health. 2001 Jan 1;25(2):101-9.
Gooley JJ et al. Exposure to room light before bedtime suppresses melatonin onset and shortens melatonin duration in humans. Journal of Clinical Endocrinology and Metabolism. 2011; 96(3) :E463-72.
Black DS, O’reilly GA, Olmstead R, Breen EC, Irwin MR. Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances: a randomized clinical trial. JAMA internal medicine. 2015 Apr 1;175(4):494-501.
Gong H, Ni CX, Liu YZ, Zhang Y, Su WJ, Lian YJ, Peng W, Jiang CL. Mindfulness meditation for insomnia: A meta-analysis of randomized controlled trials. Journal of psychosomatic research. 2016 Oct 1;89:1-6.
Taylor A, Wright HR, Lack LC. Sleeping-in on the weekend delays circadian phase and increases sleepiness the following week. Sleep and Biological Rhythms. 2008 Jul 1;6(3):172-9.
Burgess HJ, Molina TA. Home lighting before usual bedtime impacts circadian timing: a field study. Photochemistry and photobiology. 2014 May;90(3):723-6.
Esaki Y, Kitajima T, Ito Y, Koike S, Nakao Y, Tsuchiya A, Hirose M, Iwata N. Wearing blue light-blocking glasses in the evening advances circadian rhythms in the patients with delayed sleep phase disorder: An open-label trial. Chronobiology international. 2016 Sep 13;33(8):1037-44.
Chang AM, Aeschbach D, Duffy JF, Czeisler CA. Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness. Proceedings of the National Academy of Sciences. 2015 Jan 27;112(4):1232-7.
Tosini G, Ferguson I, Tsubota K. Effects of blue light on the circadian system and eye physiology. Molecular vision. 2016;22:61.
Touitou Y, Reinberg A, Touitou D. Association between light at night, melatonin secretion, sleep deprivation, and the internal clock: Health impacts and mechanisms of circadian disruption. Life sciences. 2017 Mar 15;173:94-106.
Frank S, Gonzalez K, Lee-Ang L, Young MC, Tamez M, Mattei J. Diet and sleep physiology: Public health and clinical implications. Frontiers in neurology. 2017 Aug 11;8:393.
St-Onge MP, Mikic A, Pietrolungo CE. Effects of diet on sleep quality. Advances in Nutrition. 2016 Sep 7;7(5):938-49.
Richard W, Kox D, den Herder C, Laman M, van Tinteren H, de Vries N. The role of sleep position in obstructive sleep apnea syndrome. European Archives of Oto-Rhino-Laryngology and Head & Neck. 2006 Oct 1;263(10):946-50.
Ravesloot MJ, Van Maanen JP, Dun L, De Vries N. The undervalued potential of positional therapy in position-dependent snoring and obstructive sleep apnea—a review of the literature. Sleep and Breathing. 2013 Mar 1;17(1):39-49.
Joosten SA, O'Driscoll DM, Berger PJ, Hamilton GS. Supine position related obstructive sleep apnea in adults: pathogenesis and treatment. Sleep medicine reviews. 2014 Feb 1;18(1):7-17.
Zenian J. Sleep position and shoulder pain. Medical hypotheses. 2010 Apr 1;74(4):639-43.
Gordon SJ, Grimmer-Somers K, Trott P. Pillow use: the behaviour of cervical pain, sleep quality and pillow comfort in side sleepers. Manual therapy. 2009 Dec 1;14(6):671-8.
Lee WH, Ko MS. Effect of sleep posture on neck muscle activity. Journal of physical therapy science. 2017;29(6):1021-4.
Kim MR, Chung JY, Lee DY, Hong JH, Kim JS, Yu JH, Jung S. The Influence of Pillow Material and Shape on Cervical Curvature Stability. Indian Journal of Science and Technology. 2016 Dec 16;9(47).
Lack LC, Gradisar M, Van Someren EJ, Wright HR, Lushington K. The relationship between insomnia and body temperatures. Sleep medicine reviews. 2008 Aug 1;12(4):307-17.
Harvey AG, Payne S. The management of unwanted pre-sleep thoughts in insomnia: distraction with imagery versus general distraction. Behaviour research and therapy. 2002 Mar 1;40(3):267-77.
Nagendra RP, Maruthai N, Kutty BM. Meditation and its regulatory role on sleep. Frontiers in Neurology. 2012 Apr 18;3:54.
Lin HH, Tsai PS, Fang SC, Liu JF. Effect of kiwifruit consumption on sleep quality in adults with sleep problems. Asia Pacific journal of clinical nutrition. 2011 Jun 1;20(2):169-74.
Nødtvedt ØO, Hansen AL, Bjorvatn B, Pallesen S. The effects of kiwi fruit consumption in students with chronic insomnia symptoms: a randomized controlled trial. Sleep and Biological Rhythms. 2017 Apr 1;15(2):159-66.
Pigeon WR, Carr M, Gorman C, Perlis ML. Effects of a tart cherry juice beverage on the sleep of older adults with insomnia: a pilot study. Journal of medicinal food. 2010 Jun 1;13(3):579-83.
Howatson G, Bell PG, Tallent J, Middleton B, McHugh MP, Ellis J. Effect of tart cherry juice (Prunus cerasus) on melatonin levels and enhanced sleep quality. European journal of nutrition. 2012 Dec 1;51(8):909-16.
Kopparapu N, Puranik DS, Nargund LG, Samuel B, Shahapurkar AA, Mathew VK. Natural sleep Aids; Boon or Bane. Journal Of Pharmacy Research. 2012 Oct;5(10):4950-6
Fismer KL, Pilkington K. Lavender and sleep: A systematic review of the evidence. European Journal of Integrative Medicine. 2012 Dec 1;4(4):e436-47.
Lillehei AS, Halcon LL. A systematic review of the effect of inhaled essential oils on sleep. The Journal of Alternative and Complementary Medicine. 2014 Jun 1;20(6):441-51.
McCarty DE, Chesson Jr AL, Jain SK, Marino AA. The link between vitamin D metabolism and sleep medicine. Sleep medicine reviews. 2014 Aug 1;18(4):311-9.
Sarris J, Byrne GJ. A systematic review of insomnia and complementary medicine. Sleep medicine reviews. 2011 Apr 1;15(2):99-106.
Steptoe A, O'Donnell K, Marmot M, Wardle J. Positive affect, psychological well-being, and good sleep. Journal of psychosomatic research. 2008 Apr 1;64(4):409-15.
Wood AM, Joseph S, Lloyd J, Atkins S. Gratitude influences sleep through the mechanism of pre-sleep cognitions. Journal of psychosomatic research. 2009 Jan 1;66(1):43-8.