Medical school and residency training have a long tradition of putting physicians through sleep deprivation. We even pride ourselves on how long we have gone without sleep through our studies and our nights on call.
We also know that sleep deprivation can have its consequences. These consequences put both us and our patients at risk. Sleep deprivation affects our reaction time and makes it equivalent to alcohol intoxication.
Even with the work duty hours being monitored for residents you still may have times that you do not get the rest you want or need. (Sorry med students, there are no work duty hour restrictions for you.) I can help you improve the quality of the sleep you are able to get.
Let’s start with Sleep Hygiene
When I first heard the phrase “Sleep Hygiene” in medical school, I thought it was related to taking a shower before you went to sleep. According to sleepfoundation.org, “Sleep hygiene is a variety of different practices and habits that are necessary to have good nighttime sleep quality and full daytime alertness.” Somehow we all seem to sleep through the sleep lecture and forget that we really need this information.
Ideally, you want to put practices and habits in place that improve both the quantity and quality of your sleep. Some of your sleep hygiene should address both intrinsic and extrinsic factors.
You will want to optimize three things
- Your Routine (Extrinsic and Intrinsic)
- Your Cocoon (Extrinsic)
- Yourself (Intrinsic)
Optimize Your Routine
Whenever possible, go to bed and wake at the same time every day, even on the weekends. (Your circadian rhythm doesn’t change on the weekend.) The one time you want to try to sleep in later is when you are catching up on sleep. Use one day as a “cheat” day and allow yourself to sleep in until you wake up once a week.
This can be difficult when you are taking call every third night, but even that has a rhythm to it. The timing of your routine will signal your body that it is time to go to sleep. Limit the amount of blue light (light that comes from electronic devices) when you are preparing to go to sleep. You might consider using some LED candles to provide a lower light environment. Also, consider limiting the amount of caffeine you consume in the afternoon. Even if you are able to fall asleep easily, caffeine close to bedtime can disrupt the quality of your sleep.
Blue light sources (like televisions and computer screens) affect melatonin levels in your body. Try to not use these at night. If this isn’t a possibility, then turn down the intestate of the light.
Prepare for the next day by laying out your clothes for the next day, prepare your lunch for the next day, shower/shave, prepare your coffee maker for the morning. (The best investment I ever made in my morning routine was the automatic coffee maker.) Not only does this prep your body to go to bed, but it will also allow you to save time in the morning and will make the morning less hectic as well.
Doing these things help provide both extrinsic and intrinsic cues to your body that it is time to go to sleep. This is your pre-cocoon stage.
Optimize Your Cocoon
Think of your sleeping space like a cocoon. You want to optimize this space so that you can fall asleep fast and stay asleep.
Temperature – Bedroom temperature is imperative to get right. Usually cooler temperatures help with falling asleep.
Light – Your bedroom should be pitch black. No light should be coming from anything – this includes clocks, your cell phone, night lights, anything. While you are preparing to go to bed, dim lights, or use strategically placed LED candles around your bedroom. Buy blackout curtains if your blinds don’t give you total darkness.
Sound – Constant background noise, such as white noise from a fan, humidifier, or sound machine is a good way to drown out unwanted noise. The humidifier also gives you the added bonus of adding mouser to the air in the winter. You can set your air-conditioning fan from “auto” to “on” to keep the blower running constantly throughout the night.
Setting – Optimize the setting, get rid of extra clutter around your bed, nightstand, and in your bedroom. You want your setting to have the least amount of stress-producing elements. Declutter and minimize the amount of work-related things in your cocoon. There is a reason why hotel rooms tend to be relaxing … there is not work-related clutter to look at.
Activity – You should reserve the activity in your room for the “s” words – sleeping and sex. (Not studying) Your mind should not be revving up when you get to your bedroom. Also consider not watching TV in your bedroom. Watching TV is a double hit to your sleep because produces blue light and can potentially activate your brain instead of turning it off.
Interruptions – Limit the number of interruptions that you get. Schedule your phone on “Do Not Disturb” so that texts and phone calls don’t wake you up. There are few things worse than getting in bed early and getting looped into a group “textfest” which results in constant text notifications.
Optimize Yourself
Most articles on getting better sleep focus on your cocoon. No matter how well you prepare for sleep by having a good routine and an optimized cocoon, you can still sabotage your sleep with yourself.
Nighttime Diet – Eat a meal with some fat and protein meal three hours before going to sleep to help prime yourself. Don’t drink caffeine after 7 pm and if you are sensitive to caffeine, then don’t drink caffeine after 3 pm. Avoid alcohol at night which decreases deep wave sleep. (I know, I know, when are you going to drink? If you are having problems with sleep deprivation and fatigue, then you will want to maximize everything you can.)
Shut Down Your Brain – along with dimming the lights in your home and avoiding TV and computer screens, don’t read on your tablet in bed. If you want to read, then use a device that uses indirect light such as Kindle Paperwhite E-reader or real books with a lamp. Consider reading fiction to shut down your brain and allow yourself to sleep. (If you still have not read The Martian, you should. It is a great tale of survival that has nothing to do with medicine.) If you enjoy meditating or journaling, then use these activities to help shut down your thinking processes.
Get in Some Exercise – It sounds counterintuitive, but exercise during the day increases deep wave sleep later at night. Try not to exercise too close to bedtime, but you may be able to build exercise into your bedtime routine.
Breathing Issues – Being able to breathe properly during sleep is impressive in reaching deep sleep and being able to stay there. You may have a physical problem with your nasal cavity, your oral cavity, or nervous system which is causing you to have trouble sleeping. Nasal Congestion due to a congested nose, allergic rhinitis, or deviated septum may be the culprit of not getting good sleep. Consult your doctor, but you may benefit from an over-the-counter allergy medication or using a nasal flush to clean out your nasal cavity to allow you to breathe well at night before you go to sleep. (I love my Neti Pot.)
Conclusion
You may not be able to increase the amount of sleep you get, but you might be able to improve the sleep you do get. Take some time and optimize your routine, your cocoon, and yourself.
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