Sleep Hygiene (Ugh...)

There are so many thing that impact mood, but sleep happens to be one of those biggies. The term “sleep hygiene” is familiar to therapists, but maybe not so much to the general public. Take a listen to learn some of the bottom line, basic tips and tricks for maximizing yours and your child’s chances for a good night sleep, but keep in mind, you may not like what you hear!

Full Transcript Below:

Stephanie: Okay, taking a little tur and talking more generally about topics that everybody I think can benefit from, that’s kids and adults. Today we’re going to be talking about…

Stephanie & Sarah: Sleep hygiene.

Stephanie: Nothing more exciting, than sleep hygiene. So what is sleep hygiene?

Sarah: Although it’s not our sexiest topic that we could be talking about it is something that impacts everyone, adult or kid and its really, really important that we all work to incorporate. Sleep hygiene is just a fancy way of saying, making sure that you are getting enough sleep per night and regulated sleep per night, meaning that your sleep schedule does not vary much depending on whether it’s a weekday, weekend, vacation, etc.

Stephanie: Yes so the hygiene part is what is the tidiness of your repertoire of going to bed and the practices that you have just before bed. And, how likely are you like to vary up your schedule, and are you reading in bed or playing with your electronics. How tidy is the practice of the sleep routine for you? So some of the things we’re just kind of throwing them our there will nilly but I think as an intro we kind of need to talk about sleep in general, sleep is obviously important. The amount of sleep that each person needs is really dependent, it varies from person to person so some people need, you know, if you’re an adolescent you’re going to need much more sleep than you are at my age. And I’m at 41, so I actually need a lot less sleep than my kids do. Yet, we hear all the time, and I know kids try to restrict their sleep and end up getting six hours a night or something. So it’s going to vary depending on the age, it’s going to vary depending on just like your brain, and you know who knows what that is for you. And it’s also going to vary based on stress level and illness, so there’s insomnia and then there’s also hypersomnia. And insomnia is the inability to fall asleep or when you’re waking up in the middle of the night and not getting enough sleep and hypersomnia is sleeping too much. The irony is that for hypersomnia, the person who sleeps too much, one of the treatments is what’s called sleep restriction, so instead of getting the ten hours you thought you did need you’re actually getting six or seven and it makes the person feel more refreshed. But we’re not talking primarily about insomnia or hypersomnia today, we’re talking about just the basic practices of how you regulate your sleep and how you get the amount that you need. So let’s say you need eight, let’s say you need six, let’s say you need ten. That’s irrelevant to us right now, we’re just talking about the practices themselves.

Sarah: I thank an important question, or an important place to start is knowing how much sleep to get because I have patients that a lot of times say well you know I’m sleeping ten or eleven hours and I’m just tired all the time. So, contrary to popular belief that may not mean sleeping extra, that may mean, okay let’s cut it back to eight or nine hours and let’s see how you feel. Let’s see if you feel more refreshed. So, I think playing around with that a little bit to kind of figure out what your sweet spot is, is really important because it will vary and sometimes it its very counterintuitive to what we think we need.

Stephanie: Oh yeah, the beliefs about sleep can be really off base. Some people believe that if I don’t get “x” amount of sleep then I’m just non-functional, and then they have that belief and it sort of perpetuates itself and you start seeing that it’s true. You know, they call that confirmation bias and so I didn’t get enough sleep, and I needed more sleep and so the rest of my day is going to be bad. And we see that confirmation bias play out, just like a self-fulfilling prophecy. So you do want to check your beliefs about sleep and many times we need less than we actually think that we do ad we’re more functional than we think we are with less sleep. I will never forget there was a time the dog was up in the night barking and I was angry that the dog was barking the next day because I couldn’t sleep and I was going to complain about the dog and I stopped to check my belief because the next morning I was like “You know, I only got five hours of sleep and it was terrible” so I’m just sort of ramping myself up in my head and I’m thinking I’m going to confront the person who’s responsible for this dog episode in the night and just as I’m getting ready to check my belief, I go okay, am I tired, like am I tired? And you know what I was not tired.

Sarah: Shocking.

Stephanie: it’s so embarrassing, but I wasn’t tired. And so I find myself you know, ok well I’m not going to confront this person because it, there’s no negative outcome. Just because I didn’t end up getting the sleep that I actually ended up feeling pretty good, ironically. So we do want to check our beliefs about if this then that. If I get this amount of sleep then I will feel badly, or then I will feel good. And then it just changes throughout the day too, sometimes first thing in the morning you’re tired sometimes at two o’clock in the afternoon you’re tired. So, we just want to revisit, use mindfulness to see, how am I actually feeling right now. But to experiment with the amount of sleep that you get, I think that’s a great idea and to, I would recommend using a journal or a log and I would recommend writing the time that you get to bed and the time that you wake up. And then, try to shift that thirty minutes at a time, that’s usually the recommendation for thirty minutes, shifting it back. And then, just rating how do you feel when you wake up, rating how you feel the rest of the day, the sleep log is so important when you’re working on sleep.

Sarah: That’s a good idea, a sleep log.

Stephanie: Yeah, sleep log is huge in CBT, you go online and type in sleep log or CBT sleep log and you’re going to find all kinds of spreadsheets that list all kinds of factors. So the factors that can impact your sleep include, the obvious like caffeine and dogs, you know, in the room.

Sarah: Right

Stephanie: But then there are more subtle things like if you keep a light on in the bathroom…

Sarah: Or exercising close to bed time, some people need to exercise earlier in the day and give themselves time to go to bed. Or using electronics.

Stephanie: No I did not.

Sarah: I mean that’s not a subtle one that’s a big one.

Stephanie: Yeah, it is a big one. But for some people it’s the subtle, because I mean it’s just a small little screen when you’ve got your phone. A small little screen, and you check your small little screen, with your small little email, or your small little Instagram pic or whatever and the problem is two-fold. One is the light that’s in your face, which research has suggested is dysregulating and it impacts our brain in ways that we’re not even fully aware of yet. But it doesn’t look real bright. And the other part is you could run up on something that not only is dysregulating but can give you bad dreams and you know, you may feel compelled to ruminate or think about it on and on all night. Or pop back on that person on facebook or something and so it can ramp up that blood pressure and make it more difficult.

Sarah: Absolutely, I was talking to a friend a couple of weeks ago, not my patient a friend, who was just telling me how stressed she was. And with a little therapy exploration just sitting on her husband’s kickball game, found out that she was having those automatic messages of work emails come through on her phone just as she was innocently looking at Instagram and so that was enough for to keep her up at night and to keep her thinking, and you know hate her life the next morning. And so, we were able to come up with some interventions to turn off those notifications at night so then at least that one piece of triggering or anxiety provoking stimulus was not coming through.

Stephanie: Yeah that’s a good point, I mean sometimes it takes a third party to be able to look at your life. Or sometimes you can just decide to be the third party that looks at your life and takes a step back and really observe your rituals. I mean we call them rituals, but your rituals before bed. Do you have a ritual? If you don’t have a ritual and you have sleep problems let me be the first to tell you to develop one.

Sarah: You know I’m just thinking about that, I, I don’t know exactly what my ritual would be maybe taking vitamins before bed, which I do right before bed. Making sure I have a glass of water, taking out my contacts. I mean, I will say that my sleep ritual is probably not the best because I am guilty of looking on my phone at night, however, I do not feel like I have sleep problems at this point in time. So, yes my ritual could be a little more stringent if I needed to tighten up.

Stephanie: Yeah, I mean if you don’t have the sleep problems then why are you listening to this to begin with. Unless you’re learning about sleep hygiene or something as a student but if you do then I’ll be the first to tell you yes get the sleep ritual and the ritual really is priming your brain to expect sleep. And the more we can use that, what we refer to as classical conditioning, the better. I mean my dog Boo even knows when it’s time for bed because the ritual, and it’s not really, I don’t really have ritual per say but we’re doing the same things over and over so that there’s a predictability and we do have that animal part of our brain like Boo and he has the animal part of his brain and he doesn’t understand language so much as he understands these patterns of doing the same thing over and over, he knows what to expect. So there’s a phrase I always say about taking the dogs out and he knows that’s the time to get up and he sees that I’ll turn a certain light on, he sees that I’ll, if we’re watching television, I’ll turn the television off. So there’s certain things that happen and he knows that it’s time for bed. So we want to utilize that same predictability for the animal part of our brain so that it knows, okay start winding down, instead of starting to get revved up.

Sarah: A good indicator of a time to start winding down is actually getting in bed, you know, you should not be in bed during the day or be in bed doing anything like homework, or studying, or watching TV if it’s not time for bed. So that in and of itself could be a ritual of just like, when you’re getting in bed it’s a signal to your brain of like, okay I’m getting ready to go to sleep.

Stephanie: Yes, we call that a discriminative stimulus. So the bed, if you are only sleeping in bed, then the bed becomes a discriminative stimulus for sleep. Meaning, brain says, when I’m in bed I sleep. Which is why sometimes I’ll have trouble if I get in bad and I’m reading something it’s just like my brain says okay it’s time for sleep. So, instead I would need to sit in a chair or somewhere else that my brain had not conditioned me, okay it’s time to go to sleep. We want to think about, not just caffeine or any other kind of stimulants, like you said exercise. But also if you’re drinking a lot of water and then you’re going to have to get up in the night and go to the bathroom.

Sarah: Or even certain foods, like chocolate if you have a snack at night that has caffeine in it. You know certain foods make us feel different ways, which could be one of the things you log on your sleep log, what did I eat that night and how does it make me feel.

Stephanie: Yes, so depending on what time you usually start heading to bed, I would recommend about thirty minutes of wind down time, if that incorporates your ritual, you know, if you’re taking a shower, if you’re doing some meditation, if you’re doing a little journaling. If you’re doing something like journaling or reading you want to make sure that you’re not reading something stimulating. No scary novels, nothing that you feel like you can’t put down, like you have to get to the end of. I mean some of this is not rocket science but the conversations also that you have with other people, this is such a big thing at our practice, the conversations that you have with other people may make the difference between whether you get a good nights sleep or not. I mean what’s the rule Sarah?

Sarah: The rule that we have for parents and adolescents and even adults that we see is to have no emotionally charged conversations after 8 pm. Emotionally charged is a very lose way of saying that you got to use your wise mind as to what’s emotionally charged. But anything that’s going to rev us up or be any kind of a heart to heart or any conversation that just doesn’t need to happen after 8 pm.

Stephanie: Yeah, are we opening up a new book so to speak, you know? Whereas, things are winding down, and it’s like the lullaby starts and we’re getting into bed to go to sleep and then we open up a new book of well tell me what’s your grade in English this semester or are we going to spend this amount of money on this trip coming up this Spring. And so then we’re opening up a new can of worms and that could be something that goes on and on for hours, I’ve heard and you too. I’ve heard of people staying up all night in conflict about something that they brought up at eight or nine o’clock. If it’s worth talking about late then it’s worth talking about early. And if it’s not on fire then it can wait. And on fire means both literally and figuratively. So you know if it’s a crisis, and you need to be real certain that you understand what a crisis is. Does it need to be handled right now, or could it wait until the next day. And if so, when in doubt just zip it, just shut your mouth and don’t bring it up, and then bring it up the next day. So this goes with your spouse, your kid, your friend, your social media, you know, when in doubt just close it down, clos your mouth and then the next morning its six, or seven, or five whatever time you wake up, if it’s still worth doing then by all means do it then.

Sarah: I think this even goes into thoughts that we have as we’re getting ready for bed. I’m sure you have had dreams about work, but I you know I will think about work when I’m lying in bed, I will solve problems about work when I’m lying in bed, I’ll create behavior plans. I know it impacts my sleep, and yes it may be productive but its not necessarily what I want to be dreaming about at night. So I think that’s important too to be thinking about what’s on the forefront of our brain. And then that could be a great time to incorporate some mindfulness, some meditation and you know do something to shake it up and get your focus on slowing down your thoughts.

Stephanie: Sometimes I will say, I will like announce, and this may be weird, but I will like announce to myself, it is time for sleep, it is okay to sleep, it is okay to let it go. When your brain is going and you work too late, sometimes I think that’s what happens, that you work too late until eight or nine, or ten, just that one last thing that you’re going to do and so your mind is still going, it’s like a wheel that just keeps going and so when you close your eyes it’s still spinning. It’s trying to slow down but it’s still spinning, so we have to give it time to be able to slow down, but if you didn’t give it time and you find that you, you are waking up or you find yourself trying to multitask or do behavioral plans in your sleep, or I remember when I waited tables when I was in college, I remember getting up and trying to wait tables in my sleep, and if you find yourself doing that it doesn’t hurt to just say out loud it is time for sleep, it’s okay to sleep, now is the time for sleep. And then, that communicates to your brain, it also wakes you up a bit to be able to break up that cycle and then you go back to sleep. But there’s so many like podcasts, like you said guided mediations that are for free online and apps that you can listen to that will help wind you down. Now, if you were to have trouble, let’s say you wake up at two o’clock in the morning or if you have trouble falling asleep, I’ll get a little into insomnia, what’s the thing to do? So the recommendation is don’t lay in the bed without sleeping for more than 45 minutes. And some people say 30 minutes. Instead get up, go into another room and do something that’s not stimulating, something that’s quiet until you feel your wakefulness decrease. Not until you get sleepy, but until your wakefulness decreases and then you find yourself just a little sleepier then go back, rinse and repeat. And I say rinse and repeat like on a bottle of shampoo, but you do the same thing if another 45 minutes goes by, then do the same thing again. One way I like to look at it, is if you’re not sleeping it’s not an either or, you know, either I’m sleeping or I’m not. We have different levels of sleep, we’ve got the stages of sleep and if you’re in stage one or two that’s great, you may not be in stage four or five where you would like to be but it’s something and it’s not doing roofing work you know, you’re laying in bed and so the mindfulness practice of noticing the field of sheep, noticing that you have a white noise machine which can also be very helpful for people to drown out some neighbor sounds or train sounds, whatever then notice that and be where you are as opposed to be being in your head. And, nothing will make you more of an insomniac than saying I have to go to sleep, I have to go to sleep, I have to make sure…

Sarah: If I go to sleep now I’ll get five hours of sleep. If I go to sleep now I’ll get three hour of sleep.

Stephanie: And looking at the alarm clock, I mean that’s just going to make things worse or I have to sleep, if I don’t sleep things are going to be really bad, catastrophizing the, your body will make up, most of the time, most of the time, your body will actually make up for sleep deprivation and what that unfortunately looks like is what is sometimes called micro-sleeps where you’ll sometimes nod off and that’s where you have to be careful you know if you’re driving but if you’re not driving or operating heavy machinery or doing some sort of surgery then the worst that can happen is you get these little micro-sleeps and you offend someone or something. And so our bodies tend to compensate even though it might not psychologically feel like the greatest thing ever, medically our bodies most often will compensate.

Sarah: Yes, we have not really gone into yet regulating the time that you go to sleep and the time that you wake up, because I think that’s really important. And it’s sometimes really hard for people to incorporate given the variability of our schedules and just day to day what we have going on. So just as much as possible if you can go to sleep around the same time each night and wake up around the same time each morning, regardless of the day, your brain and body are going to get more on a schedule that’s going to be self-sustaining. I’m actually working with a patient on this right now and he used to text me a picture of his dog, that’s what we’re doing, to show me that he’s out of bed each morning and we’ve been doing that for several weeks now, and he actually said to me this week, I’m actually getting up before my alarm’s going off.

Stephanie: Oh that’s a nice feeling.

Sarah: And I said, good that’s exactly what we want to have happen. It’s for your body to get in a regulated pattern so that it knows when it’s time to wake up.

Stephanie: Yeah, and that way you’re not as groggy, I mean when you get that nice rhythm and pattern down, we all know what it feels like to wake up in the middle of a sleep cycle when our alarm goes off and so we want to try and avoid that as much as possible, if you get woken up in the middle of a sleep cycle you’re going to feel groggy. So if you’re training your brain to wake up at a certain time it gets the picture, you know the brain learns pretty quickly. And so, it’s going to start raping that sleep cycle up at the right moment so that you can wake up between your sleep cycle and feel more refreshed. There are apps that I use them. I don’t know if you use them?

Sarah: Yes I’ve used them ever since you told me about them, five or six years ago.

Stephanie: Yeah that you can download them for free, you put your phone in your bed, with the ringer off of course and it will track your movement, or you have, does your watch do that?

Sarah: Yes, and I’m sure a lot of the smart watches do it too. You know it’s kind of like you set a range, a thirty minute or so range of when you want to get up by and so it will track your body movements and will wake you up when you’re in the lightest sleep cycle. Which is really nice, to get up that way.

Stephanie: It is really nice, it feels a lot better. And I have to setup mine for 45 minutes, most people’s its 30, I don’t know what that means about me but I have to set it up for 45 because if I set it up for 30 sometimes it will still wake me up in the middle of a sleep cycle. So I think..

Sarah: You have like an extra-long sleep cycle.

Stephanie: Yeah, like an extra-long sleep cycle so you may want to experiment with that but it feels so much better to wake up in between than it does to be woken up in the middle.

Sarah: We also have one of those alarm clocks that is a light that it starts off dim and gets brighter, we’ve been just excited about having the days be shorter and the mornings be darker because it’s a really pleasant way to be woken up, without any sound, it’s just a light that comes through. So play around with it, see what you like, what you don’t everyone has different preferences.

Stephanie: Yeah and one of the things I can recommend if you have trouble getting up in the morning is making sure that you have obligations so if you have obligations to…I mean for parents it’s a no brainer you have obligations to, you have to get up and you have to feed your kid. With animals, sometimes it’s that way. It doesn’t matter what happens, Boo is going to get up that morning and he wants to go to the bathroom outside, you know. But if you’re going to work, for some people that don’t have a set schedule, getting up first thing in the morning can be really difficult so you can set those things in place for yourself so you can, if you’re supposed to meet a friend in the gym, you’re less likely to say, “Aww, I’m going to hit the snooze button for another fifteen minutes or so” and by the way that’s a really bad idea because if a sleep cycle is in between 30 and 45 minutes and you hit the snooze button ten minutes, guess what? You’re going to be waking up in the middle of a sleep cycle over and over and over and over. So, it’s no wonder you’re hitting the snooze button because you’re going to be fatigued all the time.

Sarah: And not even, say we don’t have obligations to do first thing in the morning, we can put things in place that make us want to get up in the morning. When I was in a very tiny apartment with my husband, we both loved having some alone time. You know, with the one bedroom apartment, and I would love to get up one hour early, while he was still asleep and you know have my coffee, read my book, watch the sun come up, you know something that I really looked forward to actually motivated me to get out of bed.

Stephanie: Yes, and so, if we’re going from absolutely asleep to the jolting sound of an alarm that’s not the greatest way to wake up. I mean if you thing evolutionarily I don’t think that was in place a hundred years ago, three hundred years ago, naturally we were supposed to wake up with like Sarah’s lights that come up in the morning which was the sun at that point. But now, we have these artificial lights but that can help ease us into wakefulness instead of the jolt of a really loud alarm clock and if you are looking forward to whatever it is that you are doing. If it’s yoga or meditation, or a little reading, it’s not just a run for the kitchen and trying to throw a lunch together and jumping in the shower and you’re just constantly checking, it’s a stressful way to come into the day. If you’re not doing that then you might actually want to get up. And that’s a really good point.

Sarah: Yeah, it’s a nice feeling. One thing I’d be remised if we did not talk about when it comes to sleep hygiene is napping.

Stephanie: Oooh, I cannot believe I forgot that.

Sarah: It’s such a big one and it’s usually such a sticking point with my clients when we’re working on this. I’m a firm believer in not napping, and if you must, keeping it very short. But I am always surprised at how surprised other people are when they nap two and three hours a day and then wonder why they’re not sleeping at night.

Stephanie: Oh yeah, I agree. I mean I see it all the time and really we’re condensing the sleep down into how many hours are you getting at night and how many hours are you napping, it ends up the wash is the same. It’s well you know, you end up with seven hours of sleep based on getting a two hour nap and five hours at night in a 24 hour period. And so if you want to get more sleep at night, then you’ve got to be willing to sacrifice those naps in the day because the bottom line is you’ve got this sleep budget and your brain is only needs so much, and if you try to get more than that and it doesn’t want more than that you’re not going to get it. So if you want to sleep more at night, get rid of the naps, if you are willing to do five hours a night, or four hours and then nap during the day, fine. But if you have trouble sleeping the first thing you have to ask yourself is am I sleeping during the day. And, but what if Sarah, I only get three hours one night so then at, the next day, I’m going to work and I decide I can leave work early and I can just go home and take like a three or four hour nap and make up for it.

Sarah: Yeah, I mean, to me, you will make up for it the next night. What is the phrase that like your grandfather used to tell you?

Stephanie: He used to say, so my grandfather’s from Georgia and like old school and he used to say, I tell you what, I’ll get you to pick cotton for a day and you’ll sleep tonight.

Sarah: So I believe sleep naturally regulates itself and the nights always going to come, there’s always going to be another night. I, I would recommend against going home on your lunch break and sleeping a few hours, and maybe just going to bed a little bit earlier the next night if you’re that tired.

Stephanie: Absolutely. Yeah and I do that from time to time. You know, it’s better go to bed at eight o’clock at night, super early, than to take a nap and they try to go to bed at 11 or 12 that night. You’re really messing up your sleep pattern that way, so just hold out. That’s the main message here, if you don’t sleep a night, hold out the next day and then if you want to go to bed a little bit early then by all means do that.

Sarah: The world will not end if you do not get that nap.

Stephanie: Yeah, and that’s not to demean sleep problems, because sleep problems are a really big deal and especially for people with mood disorders they can really get, you can set off a bipolar episode from not getting enough sleep. The irony really is for depressive episodes, research has shown that sometimes a treatment is sleep restriction. I think if it’s sort of like one of the first symptoms, I mean reportedly, I’ve never frozen to death, one of the first symptoms if you’re walking in the snow, you got hypothermia and you’re about to die because you’re freezing to death one of the first symptoms is sleepiness. The person wants to like bury themselves in the snow and go to sleep, but that’s the thing that you do not need to do obviously, you have got to keep going, you have to keep that blood flowing. So I think if it’s sort of like that with a depressive episode and what you want to do if bury yourself under the covers and go to sleep what you have got to do is get moving and do that have behavioral activation stuff that we talked about in our other podcast.

Sarah: Which is a lot easier said than done, which we get. I mean we would be remised if we did not say that. We have on occasion taken some naps while traveling, you know I mean we’re not perfect, and napping is not evil.

Stephanie: No napping is not evil, and of course you want to make sure if you are using a medication for sleep that you let your physician know, if you have a psychiatrist that you let them know. If you’re taking supplements, especially if you’re taking supplements like melatonin those kinds of things can impact medications that your psychiatrist will prescribe you, especially SSRI’s so you want to communicate that to your psychiatrist.

Sarah: And I forgot to mention this when we were talking about a sleep ritual but taking evening medications at the same time each night each night is really important too as we’re kind of regulating everything.

Stephanie: And don’t forget, as we’re speaking about fall and the light to if you can first thing In the morning expose yourself to that light, get one of the lamps that is used, there’s tons of them now but they use them to treat seasonal affective disorder,  that can help regulate your sleep cycle as well so for everybody who’s listening we wish you a good night’s sleep and good sleep hygiene and pleasant dreams.

Sarah: Yes pleasant dreams and have a good day.