Written by Dr. Katie Takayusa
Photo by Cottonbro Studio
Sleep makes almost everything better. Taking time for adequate rest is one of the best things you can do for your body, as it’s the time our bodies use to heal and recharge our systems.
How much sleep do we need?
How much sleep we need is an individual answer based on your homeostatic sleep drive and circadian rhythm. Your homeostatic sleep drive is the amount of sleep you naturally need to feel rested. Most of us need 7 to 8 hours per night, but there are certainly some who only need 5 hours or some who need a whopping 12 hours. The best way to know your homeostatic sleep drive is to remember back to your younger years (when fewer of us had sleeping issues) and think about how much sleep you needed to feel great. There’s your answer.
Sleep changes as we age, and my elder patients often have unrealistic expectations that they will sleep through the night uninterrupted like most teenagers do. When we’re older, our sleep pattern can become more like that of a small baby or child, where we sleep a few hours and then are up for a little while, and then fall asleep again. If napping is necessary during the day, I recommend limiting nap time to 20 minutes or less to avoid getting into the deeper sleep that’s hard to shake during daytime.
Circadian rhythm is the natural feeling of sleepiness and wakefulness during the night and day, and - no surprise - our high-powered 21st-century lifestyle can be very disruptive. Devices and work (or stimulating activities) are often the most disruptive, so I encourage people to follow the 3-2-1 Sleep Rule:
3 hours before bed: no meals
2 hours before bed: no work
1 hour before bed: no devices
Insomnia
What if you can’t sleep?
As one who has struggled with insomnia, which started during my stressful Intensive Care Unit rotation in residency and was refueled after a stressful home renovation, I understand how it feels to not sleep.
Insomnia is characterized as difficulty falling or maintaining sleep and associated with daytime fatigue, poor memory, or concentration difficulties. Insomnia affects 15% of us during our lifetimes and is often in conjunction with chronic pain or mood disorders like anxiety and depression.
Insomnia is typically initiated by stressful life events and then becomes a cycle where we start to worry about our performance the day following a sleepless night, which just furthers the cycle.
When asked, most people who struggle with insomnia don’t actually find themselves sleepy. They say they are fatigued or tired. If you’re not sleepy, you could be hyper-aroused or excessively wakeful. We call this the “tired-but-wired” feeling.
My own savior for insomnia didn’t come from sleep botanicals, but from a combination of meditation and Cognitive Behavioral Therapy for Insomnia (CBT-I), a form of psychotherapy that identifies thoughts and behaviors and addresses the underlying causes of sleep problems. It generally includes:
Stimulus control therapy
Sleep restriction
Sleep hygiene
Sleep environment improvement
Relaxation training
Work on paradoxical intention (the idea that worrying about falling asleep can actually keep us awake)
Biofeedback
I recommend working with a skilled therapist who can help you navigate CBT-I if you want a non-pharmacologic approach to slumber.
Sleep Tips
Over the years, I’ve come up with some sleep tips that help, but recognize they can take 2 weeks or more of regular practice to work.
Comfortable room: 65 to 67 degrees, quiet, white noise if needed, high-quality linens (this is the time to spend your hard-earned money!)
Avoid caffeine after early-afternoon
Avoid intense exercise within 2 to 3 hours of sleep
Same schedule 7 days per week with the same awake time each day
Limit to one alcoholic beverage