Podcast: Simple Ways To Improve Sleep Hygiene

Jenn talks to Eriana Kirwin about the importance of a good night’s sleep. Eriana shares facts about consistent poor sleep, shares tips to help us develop a nighttime routine, and talks about ways to improve our quality of sleep.

Eriana Kirwin, OTD, is an occupational therapist at McLean’s Pathways Academy. Pathways Academy is a year-round, therapeutic day school developed to meet the social, sensory, psychological, and educational needs of children and adolescents ages 6 through 22 with autism spectrum disorders.

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Episode Transcript

Jenn: Welcome to Mindful Things.

The Mindful Things podcast is brought to you by the Deconstructing Stigma team at McLean Hospital. You can help us change attitudes about mental health by visiting deconstructingstigma.org. Now on to the show.

Hi there. Thanks so much for joining the session, and I hope wherever you are, you’re doing well. I’d like to introduce myself. I’m Jenn Kearney, and I am a digital communications manager at McLean Hospital.

And before I introduce Eriana and get the session started, I want to ask you, how’d you sleep last night? How’d you sleep the night before? If you thought to yourself and said, “Pretty good, I feel pretty well-rested,” you’re in a really small percentage, and that’s awesome.

If you feel like you could have used about another week or so of uninterrupted slumber, welcome to the club. So during this session, Eriana and I are going to talk all about sleep hygiene, what it is, how it can impact your mental health and how we can improve our sleep hygiene.

We’ll be answering your questions on the subject all the way from blue light emissions to setting up better sleeping conditions.

So Eriana Buteau is a doctor of occupational therapy and is an occupational therapist at Pathways Academy at McLean Hospital. Pathways Academy is a year-round therapeutic day school developed to meet the social, sensory, psychological and educational needs of children and adolescents with autism spectrum disorders.

She’s also a professor of pediatrics and mental health at Mass General Hospital’s Institute of Health Professions.

So Eriana thank you so much for joining me today, and let’s get started. I would love to know, first and foremost, what exactly is sleep hygiene, and what factors into having good sleep hygiene?

Eriana: Thank you, Jenn, and I’m so happy to be here. This is a topic that is so relevant for everyone. The term sleep hygiene, I would love if it could be looked at just like hygiene for the body as well.

It refers to the series of these habits that we create for ourselves to fall asleep and stay asleep. And so these could be habits that are not helpful and habits that are. And our bodies, our hygiene that we use to take care of our bodies, we have habits, routines. We use soap and showers and shampoo daily.

We brush our teeth twice a day with toothpaste. We wash our hands now, especially with antibacterial soap, and for our specific protocols. So we have these hygiene habits already in other areas of our life.

Sleep hygiene really refers to the hygienes that we create, good and bad, that keep us asleep, quality and consistency of a good sleep.

Jenn: So how do you actually know if your sleep hygiene is good or not? What criteria are there for assessing if your sleep quality is good, beyond how much coffee you actually need the next morning?

Eriana: That’s a great question. How can you tell? In some ways it can feel obvious, like if you’re waking up a lot throughout the night. In some ways it can be a little more discreet. So sleep hygiene consists of a sensory component, right?

Our environment, our environmental factors, how we’re purposefully setting up our sleep space, how we’re using our sleep hygiene items and our routines based on our preferences.

So signs that you might be, your sleep is affected in this area, in this sensory component and this environmental component might be, are you waking up too hot or too cold? Or are you waking up to noise? Are you waking up to light that’s affecting your sleep?

Our sensory systems also affect our insides. So are you waking up to headaches? Are you waking up to a sore or injury? These types of sensory components can be a factor into why you’re not sleeping well.

But then also a huge portion of sleep hygiene is your relaxation skills, your stress reduction skills and your routine maintenance skills. So those two major components could both play a huge role in if you’re able to stay asleep, if you’re able to fall asleep.

In terms of how you might present throughout the day, if you’re not sleeping well, that lack of consistency in quality might leave you with less resources.

And so managing emotions, making decisions, thinking clearly, these are all effected, even just feeling out of it or feeling clumsy, dropping things might be a sign that you’re too tired. Another big one that people don’t often think of is snoring could be a huge sign that you’re not sleeping well.

And there is a lot of studies that link snoring and sleep apnea to anxiety, to depression, these kind of bigger emotions that are linked to our ability to breathe at night and our ability to have a sound night’s sleep without waking up feeling panicked, you know, several times to many times throughout the night.

So you could have presentations and signs that are from that sensory environment component. You could also have sleep deprivation signs that are from that relaxation, stress reduction, routine maintenance area.

Jenn: So one thing that we, I think we all struggle with is using technology right before we go to bed. We’re living in a time where, you know, people are actually like in love with our phones. It’s really hard to even disconnect, so to speak.

How bad is tech usage before bedtime affecting our sleep, and when should I start putting my phone down or shutting my laptop off, if I don’t want to start impacting my quality of sleep?

Eriana: That is such a relevant question, especially right now when our technology is really what’s connecting us to the world around us.

And so to put it down means something different than it used to, especially I think even so specifically around the holidays approaching and this kind of feeling of winter coming, and we want to be connected.

And that’s really one of the tools that’s at our fingertips, literally to have us connected with the outside world. And that’s our current social world that we live in. But when we take a few steps back and we look at more of the innate, instinctual, what causes us to feel sleepy, what causes us to fall asleep? Our circadian rhythms.

We have these chemicals that are very innate inside of us that are triggered by our sensory world. Is it getting dark? Is my brain letting me know that I should be getting tired? It’s time to recharge.

An article I read a little while ago, but I thought it was so interesting is that city lights are starting to affect migratory birds that fly at night. And so their internal navigation is being thrown off by these pockets of lights that are cities at night. And it just goes to show how much innate chemicals are going on in our bodies.

And a circadian rhythm, for just as a side note is that, for those who don’t know, is a natural internal process that regulates our sleep-wake cycle, and it repeats on the rotation of the Earth.

So it’s every 24 hours. It’s very, you know, it’s grounded in something we can’t even control necessarily. So this artificial light keeps our brain chemicals going, and the sensory inputs keep our circadian rhythm from getting on the right time for what we need, for what our life needs.

And so it’s hard to shut off our brain when those artificial lights are still triggering our neurons and keeping our brain awake. There’s even studies that straight up say, evening use of light-emitting technology negatively affects sleep, circadian timing, and next morning alertness.

And so the National Sleep Foundation recommends that 30 minutes is the kind of like at least 30 minutes, put down your technology, do something in the bedroom that is not tech based, or in your house that’s not tech based for at least 30 minutes before you’re expecting to lay down and go to bed.

Jenn: Alright. So if I’m waking up during the night, and I can’t go back to sleep for hours, how do I stay asleep? How do I even achieve that deep sleep that’s going to keep me from waking up?

Eriana: This can be the most frustrating part for people experiencing sleep deprivation is I keep waking up or I can’t fall asleep, and I’m just sitting there thinking about how I can’t fall asleep. A lot suggests that getting up is helpful.

So try for 20 minutes. If you’re in that zone where you’re just zombieing out and can’t fall asleep, every 20 minutes or so, get up, do a lap around the house, take a look out the window. You know, it’s kind of nice sometimes to see the world at three in the morning, but then try again.

I hate when people get stuck on this idea that sleep looks like you’re a mummy in a bed and everything’s quiet and dark, and it doesn’t have to be, there’s no golden standard. It doesn’t have to be this one way for every person.

For example, I kind of love sleeping on the floor. I find that very comfortable. So sometimes if I can’t fall asleep, I’ll give myself that 20 minutes and then I’ll go try a different place. I’ll go try, I call it a floor palette, somewhere cozy in my house, or think outside the box for yourself. You don’t have to fit into this cookie cutter of what everyone thinks sleep should look like.

Jenn: That makes me think so much of when, like you can’t sleep and you get up and you sleep on the couch instead and having it be kind of like that surface palate cleanser to see if you could actually like, if something else is going to work for you in the interim.

Do you have any suggestions about helping sleep issues that are due to menopause?

Eriana: So not specifically because my specialty is with pediatrics. But I do know that there’s a huge sensory component involved in that and then a huge medical side as well that your doctors are working with you on, certain medications and melatonins and things that can help with sleep.

But again, I feel like the sensory component, if you’re overheating, get up and have a Popsicle and sit for 10 minutes and read on the couch and then try again or really look into the basics of your bedding.

Is your down comforter too hot in the middle of the night? Is your mattress too firm or too soft? Those are the things we have a lot of control over that you might not be necessarily thinking about. Are you hydrated? These kinds of things, kind of like a checklist before bed.

Jenn: So I know that you had mentioned melatonin, and there are so many supplements for melatonin that are now on the market. Are they useful to use? Is there a certain threshold of like how much you should take or shouldn’t take, or can you become too dependent on melatonin?

Eriana: I’m not quite sure of that answer in terms of the use of supplements over time. I do know that melatonin is a really popular go-to for over-the-counter supplements to help with sleep.

That is the chemical that’s released during your circadian rhythm, but that would be a question more for your healthcare provider, just to make sure it fits your specific needs.

Jenn: So if you work night shifts like three times a week, I know we have a lot of healthcare providers on here, which first and foremost, thank you so much for your service, but if you’re working varying shifts, how do you have good sleep hygiene, if your internal clock can get thrown off?

Eriana: That is such a good question and such a tricky way to start getting patterns introduced into your neurology and into your calendar. So I would suggest if that part is a little bit out of your control, then really being purposeful about your sleep space and your sleep environment.

It might be in an on-call room. It might be, you know, you might have to kind of get sleep where you can. And so therefore, a lot of those external factors are out of your control. But some things that might be in your control is maybe a sleep kit or a little bag of things that help you wherever you go.

For example, I have, you know, something that’s from my grandmother, a tea that’s a little sentimental to me, some pictures, some imagery, so things that are kind of your things you can take with you, an eye mask. Something I always suggest a lot is playlists.

So something that you can control that maybe starts creating a routine in your neurology is a 30-minute sleep playlist. And so no matter where you are, you can have that 30 minutes, and it can help you gauge where you are in your sleep routine, and it will start to help your brain remember, this is my cue to start getting tired.

Again, we’re creating habits. So it doesn’t start automatically. And we might even have bad habits that we have to work on at the same time. So it is, we want our brain just to start recognizing these patterns that we’re introducing it to.

Jenn: So my partner told me that I snore, and I wasn’t aware that I snored before this happened. What should I do? Is this a problem? Should I get a sleep test? Or how do I gauge if there is an issue?

Eriana: Such a great question. My partner snores like a wild animal. And so I’ve bought, I’ve been through the process with them of getting a sleep study, looking into it with his doctor, getting a CPAP machine, working on the medication routine. So it’s not just all on you.

There’s a team of people out there that are there to help you, if this seems like you’re trying everything, and it’s still not working. Snoring is such a big sign of, you might not realize that you’re losing sleep.

And if someone that can hear you is telling you you’re snoring, I would suggest telling that to your doctor. If you experience anxiety or something in that realm, it might be interesting to you to see if there’s a connection if you also are a snorer.

It might be a connection you didn’t make before. And then I think that’s still valuable information to tell your doctor. You would have to tell your primary care, of course, first. And then that goes into the referral for a sleep study and further investigation. But my partner has a CPAP and it has changed his sleep. And it’s amazing. So I wouldn’t be afraid of that route, if you think that that might be helpful for you.

Jenn: I mean, it’s probably also changed your sleep too-

Eriana: Yes.

Jenn: If he’s not waking you up.

Eriana: Maybe that’s really what I mean.

Jenn: So how do we understand our own personal REM cycles? I feel like that’s something that if we’re constantly waking up or getting extra sleep, you can still wake up groggy, even if you got like miraculously 10 hours of sleep the night before.

Eriana: Right, yes. The science of sleep, this REM cycle. I’ve heard that we’re on a 90-minute cycle. And so an average person, and a sleep study can tell you this as well. An average person will go through an hour and a half of a full cycle with REM being in the middle.

And so they say even, you should set your alarm clock based on that hour and a half theory. So never wake yourself up breaking one of those hour and a half chunks.

So say if you go to bed at nine at night, average out an hour and a half chunk until maybe you have to wake up a little bit earlier than you would expect, but it’s better than breaking into one of your REM cycles.

Jenn: So when thinking about breaking into a REM cycle, if you’re getting not enough or too much sleep that it’s throwing off your functioning, do you have any recommendations for like helping you or a partner find a balance beyond that 90-minute timer?

Eriana: Can you clarify that a tiny bit?

Jenn: Yeah, so an individual wrote in, just saying that they’ve experienced that they can either get not enough or too much sleep and that it’s not good for their functioning.

How can they achieve that balance without, you know, considering that like the understanding the 90 minutes might not actually work for them.

Eriana: Especially if you’re waking up and like it’s almost even another thing to think about. So one thing that immediately came to my mind is I would suggest, and I would suggest this with anyone interested in starting here is to make a two-week sleep journal to keep track of your night’s sleep over the course of two weeks.

And notice any patterns and notice if you notice Tuesdays or a certain hour of the night you’re waking up, or there might be patterns you’re not recognizing.

So to give yourself a little more information about your own sleep patterns, keep a two-week journal just to start keeping track of patterns. I think this is great information for your doctor as well.

They might ask for that if you go to them. So it might be good to have it already. Does that answer the question?

Jenn: Yeah. If we’re having trouble falling asleep, because we’re spending hours worrying about everything, which in this day and age makes sense, any advice for ways to cut off that worry before we’re trying to fall asleep?

Eriana: Absolutely. So anxiety and our senses are so linked, and sleep and our senses are so linked. And so it really depends on, you know, what calms you and what doesn’t.

And everyone says with sleep hygiene, read, but I don’t know about you, but I’m not much of a reader, and it doesn’t really turn my thoughts off necessarily.

Things that maybe might fill those thoughts, audio books, even if it’s, I know someone that listens to the first Harry Potter every single night before they go to bed, and they fall asleep at the exact same time every single time.

But if you think about it, it’s creating a neurological pattern that your brain recognizes. And so the anxiety, you know, we can’t necessarily control our emotions. We can’t control the feelings we’re feeling, but we can control the actions we do and the routines and the patterns we create for ourselves.

So there’s a thousand apps out there that are so helpful in terms of meditation, mindfulness, relaxation. You can go towards the more old fashioned route. I hate to say, but like crossword puzzles, Sudoku, coloring.

Try and think of a multisensory approach that are things that are calming for your anxiety, sensory oils, candles, just try and be purposeful about that routine. Those are things that could help your anxiety at any point in the day. And so purposely putting them into your night routine and making even a checklist.

Sometimes we feel anxiety of that lack of control. Create control for yourself. Create a checklist that has exactly what you want to do and when you want to do it, and feel good checking those boxes off and completing it.

A multisensory approach can also be helpful with this too. So not just thinking about one smell and that’s it, or one weighted blanket and that’s it. Think about doing stretches while drinking hot tea and listening to a calming song and then journaling.

Think about more than one sensory input you can put into your checklist, into your routine, into those things that you do have control over.

Jenn: So when thinking about senses, how important is it for your bedroom to be dark? I know that there’s a little bit of a jury that’s out on it, but what are your thoughts?

Eriana: I personally will wake up with the sunrise. So in the summer when the sun comes up at 5:45, I’m up. In the winter, so I’m someone where light in terms of my sensory profile, light very much affects me.

I am a big fan of light-blocking shades, as long as you open them during the day when you’re supposed to be awake and letting your brain have that light when it’s supposed to be alert. And I’m a big fan of face masks, and they come like jelly, weighted, fuzzy, anything you can think of.

So I would hate for someone to compare themself to a category that wouldn’t be beneficial for them.

You know, if you’re someone where you’re super sensitive to light and that super affects your sleep, then it is important that you have a dark room, and it is important that you can control the darkness, especially on those days where you work night shifts or where you’re actually trying to get some sleep during the day.

No, I would think light has a huge component into the sensory part of sleep.

Jenn: Yeah, I mean, from my personal experience, I have a sleep mask. I use the light-blocking curtains, and I also have one of the alarm clocks that mimics sunrise.

So there’s birds and it eventually grows lighter. So for me, I know for like my good to get better sleep, I need to have that like multisensory approach. So I totally appreciate that question.

When it comes to blocking light, have you heard anything about people that wear blue light blocking glasses overnight to help them sleep? Would it be something to consider? And do you have any thoughts on using blue light glasses during the day?

Eriana: The only research I’ve read is using blue light glasses when you’re in front of a lot of screens and a lot of technology. And there seems to be a lot of benefit to using that in terms of that circadian rhythm and that ability to calm your brain back down.

But in terms of overnight, I have not read a lot about that. I’d be very interested. I will look it up after this. I’m very interested to see that research.

Jenn: I think I’d just be concerned about squishing them, because I move a lot when I sleep. So I feel like I’d just break an investment, because I roll over onto them. I don’t think I would love that, but I use them during the day.

I know these have a blue light filter on them too. And I find that it helps so much with eye strain. I think it’s been, you know, from personal experience, it’s been super helpful. Alright, do you have suggestions for kids or adults that have ADHD to help them fall and stay asleep?

Eriana: Yes, I work with a lot of kids who experience ADHD, and that can be one of the hardest things they experience is even throughout the day, let alone trying to go to sleep is focusing on turning your mind off, being present, being in the moment, calming your body down.

What I have found successful working with that population is more of those CBT style relaxation methods, stress reduction methods. They say typically physical exercise might, too much might wake you up before you need to go to sleep.

It’s important throughout the day so that your body feels tired, but typically they say not to do it right before bed. But I have found with sleep hygiene and my teenagers especially who experience ADHD that some type of kind of vigorous stretching or like a quicker paced yoga, something that’s not necessarily like running or cardio, but something that gets a little bit of energy out.

And again, a multisensory approach, maybe doing some stretching while... Multisensory approaches are great for kids who experience ADHD, because you would think, like I was about to say doing stretching while reading something or a while participating in other, you know, stretching while brushing your teeth might be overwhelming for someone who doesn’t have, who can concentrate on that one thing at a time.

But a multisensory approach might be really refreshing for someone experiencing ADHD. And it might help them kind of categorize where they are, what they’re doing and getting ready for bed, but I’m also able to get a little bit of energy out.

Jenn: Do you have any insight for folks that go to bed comfortable, but in the middle of the night are waking up because they’re too hot? Are there any solutions to this?

Eriana: So that happens to me all the time. And I find that when I go, just on a personal level, when I go to bed, you’re so cozy. And then in the middle of the night, you’re like stripping things off. So I find that really look into the material of your bedding, even the what’s underneath you.

So I don’t know if you have a pillow topper, or if you’re using a flannel bottom sheet, that can get very hot. A feather down comforter, that can, especially if you have pets and things that are running a hundred degrees inside your bed and other people maybe. So it might feel comfortable going to bed.

But if you’re waking up hot often, I would suggest using a heavier, thinner blanket, maybe a quilt that’s got a little bit of a weight to it, but it’s also breathable. A lot of materials that aren’t breathable are so warm and cozy, but then if you spend five hours wrapped up in it, it can get really hot.

So that would be my first suggestion is look into your bedding, look into the breathability of the materials and then go from there.

Jenn: Alright. Is it possible to get a headache from oversleeping, or is it because you’ve just been sleeping for so long that you’re dehydrated?

Eriana: That was my first thought is a headache after eight or more hours of not drinking water makes sense. That’s a long time to go without drinking water.

If you’re someone who needs that much sleep, I would suggest having water by your bed, making sure you’re drinking a lot of water throughout the day, maybe not right before you go to sleep, but making sure that you’re extra hydrated if you can sleep that long. That’s both impressive and you need to stay hydrated.

Jenn: So if someone has experienced a lot of trauma and loss during this time, and it seems more daunting at night, when you lie down you don’t have those distractions, how can they sleep better, knowing that these thoughts are just reemerging at night?

Eriana: That is a heavy situation. And I know a lot of people are experiencing this intense level of stress right now, let alone if you’ve gone through something even more personal. So at that point, I think that if you feel like you can’t really get a control over your sleep and it’s affecting your day, I really suggest you reaching out to your healthcare provider.

I don’t know if you have a behavioral health or a mental health professional you work with. But then I would say the next step is making sure that you have a team with you working through all of that, ‘cause you don’t need to do it alone.

And there’s a lot of professionals out there that, you know, trial and error or whether they have an exact help, I would really want more people on your team. So make sure that you’re reaching out.

Jenn: So this next question, I feel like can impact so many people. After a few nights of having a hard time falling asleep, it’s possible to get more anxious and stressed about going to bed thinking that you’re not going to be able to get another good night’s sleep. Do you have any suggestions for breaking this anxiety, stress, exhaustion cycle?

Eriana: Yes, that’s the whole beast of anxiety, isn’t it? Is sometimes we get anxious because we know it might happen, and it’s so uncomfortable and miserable that it caused that cyclical effect, yes.

So a lot of studies suggest that a good amount of, I always hate to like say the basic stuff, like a good amount of exercise helps, but again, like if you’re feeling in a funk, you might not want to exercise. You kind of get into a rut.

And so I would say if you’re not already exercising every day, try and find some type of exercise that you can do. We’re about to go into the winter time. The daylight is decreasing as we speak. And this is a new kind of era of challenges for us as humans.

And so there is a bit of personal responsibility, and with new challenge comes new solutions. And we need to find maybe some more hobbies, some more routines, some more things at home we can be doing that we weren’t necessarily doing before.

Jenn: So if you’re dealing with constantly being unable to fall asleep, and you’ve already tried walking around the house, trying new surfaces, trying a book, these techniques still aren’t resulting in getting sleep, what would you recommend the next step be in trying to fall asleep better and stay asleep longer?

Eriana: If you feel like you have exhausted kind of your own personal resources in exploring why you can’t sleep, I really do strongly suggest you contact your health provider, talk to your therapist.

I think that is the next tier. If it really feels out of your own control, there’s a team of professionals that are there to step in and start helping you figure it out.

Jenn: So if a person can fall asleep in the afternoon really quickly if they lay down to rest, but at night it’s taking them hours to fall asleep, do you have any insight as to why that might be happening?

Eriana: So a lot of factors that I don’t know about that specific situation, but research does say that if you take big naps during the day, it might affect your ability to fall asleep and stay asleep at night.

So you might need that nap during the day, but I’d be curious to how long you’re napping and if you could put more parameters on it so that you’re intentionally more tired later in the day.

Jenn: If you have the flexibility and the ability to wake up naturally, should you avoid using an alarm, or is it a good idea to just keep that as part of that routine that you understand and are used to?

Eriana: That’s a really good question. I think if you wake up naturally, that’s beautiful, and you should not interrupt your body’s natural ability to wake itself up and feel alert. Alarms can often be very disruptive and cause a little bit of panic in the morning, or I’ll give you...

We associate the, even when you hear it in commercials, we associate that alarm sound as something so awful. If your body wakes up naturally, I would not interrupt that. I think that’s a gift.

Jenn: And I know so many people are using smartphones too for their alarms and the alarms on those can be so abrasive sounding that it’s just like, you almost get your day started on the wrong foot by using something that’s so jarring and like makes you want to jump out of bed and shut it off.

Eriana: Absolutely.

Jenn: So an individual asked about using a website’s sleep calculator that advises when they should wake up, when they should be going to sleep or when they should be going to sleep, if their goal is to wake up at a certain time.

Do you have any thoughts around using supports like this in order to achieve better sleep quality?

Eriana: I’m always a fan of using as many resources as you can get your hands on. I would not take it too seriously though, because it really depends on how you feel. So they’re putting you into a statistically average calculation, and that might not fit you perfectly.

So you might feel great and it says you shouldn’t, and that doesn’t make any sense. So really go off of your own personal experience. But I think it’s good to keep track of stuff like that.

And there’s a lot of apps that can help you have more of a structure and more of a control to it. And there’s nothing wrong with that ever.

Jenn: After a really hectic workday, this individual often listens to classical music tuned to a very low sound level throughout the night. But they’re asking if this practice has the potential to be harmful.

Eriana: I’m not aware of any harm that would cause, unless someone else doesn’t like it, but I don’t know who wouldn’t. That sounds lovely.

Jenn: So my impression of this would be that if they’re associating this music with a stressful work day, that it could have the, it would have a connotation later on that might actually like reignite stressful thoughts.

Eriana: Yeah, that makes sense. Well, and then if you start, we’re always growing and we’re always changing. So if you find a sensory tool, you find a strategy for sleep that’s working for you, you do still have to be flexible, that might change.

Your current experiences might, and your past experiences might alter that. So just keeping vigilant of your sensory reactions, and if something starts to be unpleasant, that is your job to take it out of your routine, does not belong there.

Jenn: So if you’ve got a constant running to-do list in your head that just is keeping you up at night, is it good to get up and actually write it out or keep track of it somewhere else? Or should you just let it go and flip your pillow over and try sleeping again?

Eriana: So I might speak for at least some people when you try to ignore it and flip over and not think about it, that does not work. I’m a lister, I’m a checklister. I love lists.

I make five a day, even if it’s repetitive, because I have found that that is a tool that helps my anxiety. I’d rather make five to 10 checklists a day than toss around thinking about it at night.

So if that strategy helps you get it out of your brain and you’re able to find a calm body afterwards, then that’s a good strategy for you, absolutely.

Jenn: So there have been a lot of ads and products that are coming up for ways to sleep better. And one of them is actually a cooling blanket that you sleep on.

Is there any evidence around better sleep and having a lower body temperature or feeling cooler at night?

Eriana: So I have not read any direct research that supports that, but from a personal standpoint, I think that makes a lot of sense, because I think at night we’re laying still under a lot of covers. We’re in the 98 degree range of temperature.

It makes sense that we get hot at night. And so I have not read any direct research that supports those products, but I’d be interested to hear from people who have tried them and see if it’s helped at all.

Jenn: If I’m getting a lot of headaches and migraines and I’m not sleeping for days, do you have any suggestions as to how I can go about fixing this?

Eriana: So what I hear in that question is that you’re not sleeping for days, and that’s a big deal and that can affect a lot of things.

I would suggest, again, talking to your healthcare provider about that, if some of these other kind of sensory environmental type of suggestions have not been working. Sleeping for days would make a huge impact on you, headache and a lot of other things too.

Jenn: What do you do if you don’t have time for a pre-sleep routine? And I know that there are plenty of parents, there are people who are working weird hours.

You just don’t have that time for yourself. Would sensory suggestions like playing Sudoku work, even if you only have 10 minutes?

Eriana: Quick answer, yes. Five minutes, two minutes, 10 minutes. As long as it’s intentional, as long as it’s with the purpose of creating a sleep routine, anything’s better than nothing. I would also challenge you to look at your routines as a whole throughout the day.

Is there anything that you’re doing at night that you could do in the morning or in the afternoon, or rearranging something throughout your day that so you have a little bit more time at night, or incorporating some of those things into your night routine. Maybe you’re done with your technology a half hour before bed, and in that half hour, that’s when you make your lunches for the next day.

That’s when you listen to music and do your stretches or take care of some of the routines that you might take care of throughout the day instead of at night.

Jenn: So if you’re having trouble falling asleep, is there any proof that mindfulness and mindful breathing are helpful?

Eriana: Mindfulness, mindful breathing, meditation, body scanning, visual imagery, these are all really powerful strategies and have had a lot of research-based evidence in helping with sleep, with helping with anxiety.

If you haven’t tried them yet, I suggest exploring, and I can always get in touch with you with some intro resources. I find it very helpful in being able to manage being present, which is a huge part of anxiety at night is not delving into the past, not worrying about the future, being able to just be here now.

And those types of exercises can help you with your night routine, can help you get the most out of that routine that you set for yourself.

Jenn: And speaking from personal experience, I know for mindfulness, just envisioning, closing your eyes and envisioning that you’re putting, you’re powering down each of your body parts.

So each of your feet, each of your shins, each of your thighs and working all the way up to your head, by the time you get to about your shoulders, you should probably be asleep, but I’ve noticed even anywhere like one to five minutes of actively powering down has been really helpful.

And there’s another method that’s called 4-6-7 breathing where you breathe in for four counts, you hold for six and you exhale for seven, because it’s scientifically proven to lower your heart rate to be more optimal for sleeping.

If you have asthma or any cardiovascular conditions, please talk to your doctor, I’m not an MD. So please do not jump into that without talking to your doctor. But back to the questions, how would you manage your own sleep if you are sharing a bed with somebody else who probably has different sleep than you do?

Eriana: I’m sure that’s something we have experienced a lot at one point or another. So there’s all different types of varying sleep routines. What time you go to bed, if you’re a snorer, what time you wake up, and so I think that just has to be an open conversation, and the agitation and frustration can build up very quickly when it comes to not having similar or copacetic sleep patterns.

And so, as long as I think that’s an open conversation and you establish some rules, like my partner knows that he can’t come into the bedroom and turn the TV on.

And if you can be able to make these, you know, clear expectations for it’s okay if you don’t go to bed at the same time, it’s okay if you wake up earlier, but respect each other’s need for sleep.

As long as there’s that type of agreement, I think you should be able to make it work. Otherwise, you know, that’s a bigger conversation, I think.

Jenn: What suggestions do you have for balancing good sleep habits and being able to fall asleep again in the middle of the night, if you’re getting up to use the bathroom, which you are definitely hydrating well, if that is the case?

Eriana: Absolutely. And medications can absolutely affect that as well. So to a certain extent, it might not be in your control. If you’re taking a medication at night that makes you need to use the restroom more often-

Jenn: Of course.

Eriana: But I would, so I would suggest, if you do need to use the restroom and that is an expected part of your night routine, obviously make sure the path is clear, make sure that you maybe even have like a little nightlight in your bathroom, you know that you’re going to have to get up and use it.

In terms of if it’s not a medication thing, just try to be more vigilant of being hydrated throughout the day and give your chance, give your body a chance to use the restroom before you go to bed.

Jenn: Going to ask you the $64,000 question, what is the ideal amount of sleep?

Eriana: Again, it depends. So always, I hate the answer, it depends. But they say six and a half to eight. It all depends on age, but again, like I’ve gotten less than that and felt fine.

So it’s more of a long-term thing. You can go a day with less than that. You can spend a day of sleeping in, but overall, are you able to have consistent, quality sleep?

Jenn: Yeah, I feel like there is a rule of thumb I read about that depending on how many hours you’re awake, you should be aiming to be asleep for half of that the following evening. Is that like a decent rule of thumb to go by?

Eriana: I haven’t directly heard that one, but it does bring up a lot of questions about circadian rhythms and differences in genealogy even, that’s very interesting.

Jenn: I would also hope that people would not be awake for 36 hours straight and then have to sleep 18, though if you are like a surgeon or something, and you do necessitate being awake that long, I totally understand.

So let’s talk about people taking over-the-counter medications when they don’t sleep well. Some folks rely on Benadryl. There are other drowsiness inducing medications.

Is it safe? Is this good for short-term use? What are the side effects for long-term use? Any insight?

Eriana: So I would think using a antihistamine as a sleep aid wouldn’t necessarily be the main use of that medication or that over-the-counter drug. It does help with drowsiness or like a NyQuil, if you have a cold will help fall asleep.

But if you’re using that just as a sleep aid, as an over the counter, I would think that maybe that’s the time to start talking to your doctor about actual sleep aid medications, a sleep study.

And then there’s a lot of, like we said before, a lot of talk about melatonin and some more herbal supplements that might help, some Sleepytime tea if you’re looking more of the over-the-counter route.

But if you’re starting to use a medication over the counter consistently for sleep that’s not necessarily prescribed to you, I think then that’s a time to have a conversation with your doctor, because there might be something that’s even less invasive than a Benadryl that might help you.

Jenn: So if my parents are having the same sleep disturbances that I have is that because sleep issues are hereditary? Is this something that runs in families?

Eriana: That’s a really good question. I would love to see more research on hereditary sleep disorders.

I know sleep apnea and things of that type of sleep disorders, when you get into the diagnoses of sleep disorders, that can be genetic, but in terms of, it’s hard to tell what like you and your parents experience, but it could also just be nature versus nurture type deal.

So you might have the same sensory profile that your parents might experience as well.

Jenn: So I know previously in the hour, you had talked about the short-term physical effects of lack of sleep. You might be a little bit clumsier. Your memory might not be as great the next day. You might be more irritable.

What are the long-term effects of constant sleep deprivation? And is there any way for us, I guess this is a two-part question, is there any way for us to pay off our sleep debt, so to speak? Can we catch up on it later and negate these effects?

Eriana: I’ve been asked that question a lot. Can we catch up on sleep? And I think that’s a really good question, but it doesn’t take long to see the effects of sleep deprivation, in terms of long-term sleep deprivation.

I would think that would mean just a few days. So that’s when we start talking about things like insomnia and apnea, snoring, or you know, where your breathing gets disrupted throughout your sleep, and one of the signs of sleep apnea is snoring can cause insomnia.

You’re waking up so many times from not breathing well that you’re creating an apnea based insomnia, and insomnia is when you’re not sleeping well. I don’t think it takes very long to see those long-term effects, and they can be very detrimental.

You know, you might not be able to operate a machine or a car. You might not be able to cook a dinner. You might lose where you are. You might feel very euphoric. You might be very forgetful.

So it doesn’t take long to see the sleep deprivation and long-term side effects, and they can be very serious. And it can really affect your day. I would think it would be extremely obvious if you were experiencing that for yourself.

Jenn: Is it true that lack of sleep is actually the equivalent or worse than drunk driving?

Eriana: I would agree. The severity is just as severe. If you fall asleep at the wheel and hit someone, or if you’re under the influence and hit someone, that outcome is still just as awful.

And yes, absolutely. I wouldn’t say it’s more or less. I would say it’s just as severe as being under the influence.

Jenn: And I know you’ve talked a ton about the importance of having a bedtime routine. What about a wake-up routine?

Is this just as important, and how do we establish one, especially when there’s so many things happening, it can be kind of impossible or seem impossible to craft getting up in the same way every day?

Eriana: Absolutely. Especially if you live in a circus of a house, which a lot of us do. So my biggest suggestion was, again, go back to that what you do control, go back to that checklist, go back to evaluating your environment.

And what is the most productive use of your time? Relaxation strategies. Morning routines are just as important, not necessarily for the grade of your sleep but for the consistency of your day and the consistency of the patterns we want our brain to recognize.

And so the more patterns we can give our brain to recognize, the more consistency, the more onboard it’s going to be with this, alright, it’s time to do this. Alright, it’s time to do this.

And so if you do the same thing every morning, or try to, at least a few things the same thing, your brain will start to pick up on that.

Jenn: We had a couple of folks asking for a little bit more clarity around whether or not you could make up lost sleep. So is that truly possible to do so? And like, how do we bank things into our sleep debt, if so?

Eriana: So I do think that you can make up REM sleep, but I’ve also heard a lot of contrary research saying that it’s useless. Again, that’s when I go with, there’s no golden standard for you. And if you’re tired, you need sleep. If you’re not tired, then you don’t.

And so you don’t need to necessarily gauge your own sleep patterns and your own ability to have consistent quality sleep on research studies necessarily. They’re a great rule of thumb, a great place to start in exploring your own sleep patterns, but you might be different.

Jenn: So this actually concludes our session. Eriana, I just want to say thank you so much for all of the information that you’ve shared with us today. I personally think I’m going to be sleeping a lot better from all of the advice you’ve given, and I hope that you do too.

This actually concludes the webinar in our Mental Health Education series. Thank you so much for joining us, and I hope you have a great day. Take care.

Thanks for tuning in to Mindful Things! Please subscribe to us and rate us on iTunes, Spotify, or wherever you listen to podcasts.

Don’t forget, mental health is everyone’s responsibility. If you or a loved one are in crisis, the Samaritans are available 24 hours a day at 877.870.4673. Again, that’s 877.870.4673.

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The McLean Hospital podcast Mindful Things is intended to provide general information and to help listeners learn about mental health, educational opportunities, and research initiatives. This podcast is not an attempt to practice medicine or to provide specific medical advice.

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