“I want some of what she’s having, please!” David pleaded with me for help with his sleep troubles after watching his newly hormone-taking wife, wake refreshed after yet another night of good sleep. Obviously, the hormone replacement which can enable a woman to sleep blissfully all night would not be the solution needed by her husband!
David is not alone: whether you count those dissatisfied with sleep OR the even larger number of people whose sleep diaries worry their physicians, it seems to be true that we are indeed sleeping less than we have in the past, and less than we should for optimal health.
All creatures sleep, even though it means a significant part of life is spent not eating, not hunting, not reproducing and generally being vulnerable to what might befall such a creature while snoozing unaware of the world.
We know many ways in which sleep provides an invaluable reset:
- Deep sleep enables us to learn from the experiences of the day, and helps normalize our metabolism and correct blood sugar problems.
- REM sleep (during which we are paralyzed! Except for breathing and swallowing) allows us to integrate new memories with old and be open to creative approaches to our lives.
- Avoid all the risks of short sleep detailed below!
How MUCH sleep? (my last camping trip, Sitka, AK, 2019!)
When people are removed from society, living off the grid in outdoor camping situations, they generally revert to what we might consider our birthright as humans. They wake with the sun and return to sleep when the sun sets, with perhaps a short nap in the afternoon, perhaps a brief nocturnal waking to stir the fire or find a toilet. Overall, most humans in such environments tend to sleep 7 ½ to 8 ½ hours a night, increasing a little with advancing age.
Alarmingly, that's not how we're living these days. Turns out that reported sleep time by adults in the US ranges from < 5 to > 10 hours. 64.3 % sleep 7 hours or less and 8 percent sleep 9 hours or more. . If you take out the folks who DO sleep 7 hours a night, that number is cut in half, so is the problem really that a third of us sleep too little, or two-thirds? Is seven hours enough, some say it’s optimal, what’s the truth?
While there are indeed some studies suggesting that 7 hours is the sweet spot, there are a number of sources, myself included, who consider that to be a problematic contention.
I’ll start with my favorite sleep expert: Matthew Walker. Walker made a big hit in our world—and my practice—with the release of his book Why We Sleep as well as the numerous and generous appearances he has made on various podcasts (e.g., notably those of Rhonda Patrick and Peter Attia ) He’s also added his own sponsored online Q&A column for readers ( ).
There is a lot of data to pore through and I’d say there are several reasons to question the suggestion that 7 hours is optimal sleep length:
- Observed, “in-the-wild” sleep patterns as described above, tend to fall in the 7.5-8.5 hours range, and
- What if you’re wrong? IF 7 hours is actually insufficient, a Pandora’s box of woes awaits those short sleepers.
- Ultimately, it’s individual, so let’s go with that anyway. The bottom line is truly as follows, “Are YOU getting enough sleep?”
That Box of Pandora's
We’ve long known and discussed elsewhere some of the hazards of insufficient sleep , I wanted to make a brief summary for any readers who insist that they get by fine on 7 hours or less.
Inadequate sleep (which yours may or may not be) has been strongly associated with problems in almost every realm you can imagine:
- Increased motor vehicle accidents, somewhere between 70,000 and 1.2 million fender-benders a year
- Weight gain: Women particularly tend to gain weight with less sleep. Sleep deprivation increases calories consumed by about 175 the next day and every day you’re sleep deprived
- Type 2 diabetes
- High blood pressure, risk of stroke or heart disease
- For adolescents, and college-age youth: increased rate of injuries., not talking about MVA’s here but athletic or simply body mechanic dysfunction types of exercise!
- Certain cancers including cancers of the lung, ovary, thyroid, melanoma, and breast
- Depression and anxiety, and finally
- Neurodegenerative disease, especially Alzheimer’s
HOW TO KNOW
If you answer yes to any of the following questions, try getting a bit more sleep and see if the answers change!
- Do you ever fall asleep while driving?
- Do you readily nap more than 20 minutes at a time?
- Do you fall asleep if someone else is driving and sleep more than 20 minutes?
- Do you fall asleep as soon as your head hits the pillow?
- Still not sure? Give yourself a completely unscheduled weekend: do you sleep extra hours?
Answering yes to one or more of those questions suggests that you might benefit from allowing yourself about 8-9 hours in bed every night, which should enable you to get close to 8 hours of sleep. A proper and comprehensive article about “How to Sleep” would include about 500 suggestions, from which you might discern that five of them work for you! I’m going to confine myself to what I call “scheduling solutions” and will list some other options after these suggestions.
While some people choose to sleep less than they might be able to, the more common problem in my practice is the one referred to by David, above: he would LOVE to sleep 7 or 8 or even 9 hours a night, he just can’t do it! In David’s case, he falls asleep quickly but wakes once or twice a night, and usually is unable to return to sleep. What can David try?
FIRST Schedule your sleep time! Start by choosing a single wake-up time that will work for your entire week. If you MUST get up by 7 a.m. to get to work on time, then 7 a.m. is the time to get up EVERY day. (Every day that you sleep a little later, it’s MUCH harder to go to bed and to sleep as early as you did the night before.)
SECOND, schedule a “go to bed time” and set an alarm if you must, but respect that hour. If you want 8 hours of sleep, your go to bedtime is 9 hours before your rising time. That gives you half an hour to get ready, and then some time in bed to allow yourself to fall asleep.
THIRD schedule those activities which have been shown to affect sleep.
- First outside time of the day should be in the morning, earlier is better, and last 15 minutes at a minimum.
- Start your day with coffee, tea or water, but your first meal is best scheduled at least an hour after waking. Include some protein in that meal (actually, in every meal).
- Vigorous exercise should be completed six hours before bedtime. Gentle exercise, such as walking or stretching, can sneak right up close to bedtime.
- Last meal should be finished (including snacks or desserts) by 2-3 hours before bed: experiment with what’s best for you. (If you have any tendency to night-time indigestion or heartburn, make it more like 3-4 hours.
- If you take dinner supplements, take them with or right after dinner.
- Vitamin D is probably best taken in the morning, just like the sunshine that helps us make it!
- Bedtime supplements can be 20-60 minutes before getting in to bed.
- Turn off before bedtime:
- Significant liquids: 2-4 hours before bed, and alcohol 3-5 hours before bed.
- Another tip to decrease night time urination is to wear compression stockings during the day, and/or
- Elevate your legs as much as possible afternoon and evening, and
- Women, talk to your doctor about hormone replacement, your bladder is happier when it’s bathed in a bit of estrogen.
- Computers off 3 hours before bed and wear blue-blocking glasses for afternoon and evening computer exposure.
- Bright lights and exciting work, games or television, 2 hours.
- Music and quiet television, 1 hour. When the lights are low, preferably orange or warm-toned lights, spend your time reading, chatting, or writing letters.
- Or love-making! Experiment: for some, sex seems to wake them up and for most, has a secondary calming effect.
If you DO stay up later than your scheduled bedtime, keep the same rising schedule: a little fatigue the next day is a small price to pay for confirming a good sleep pattern.
For your bedroom: dark, cool, quiet and free of significant electronics. No Wi-Fi in your room, if you can manage it.
For your body:
- A warm bath or shower 30-60 minutes before bed can help cool off your core body temperature, helping sleep.
- Do you have a foam roller? Roll out your back a bit before you go to sleep
Sleep supplements are countless, but the basics are:
- Glycine 1-3000 mg 30-60 minutes before bed calms the brain and cools the body.
- 5-hydroxy tryptophan, 50-100 mg can help some people stay asleep.
- Melatonin 1-10 mg. can help you fall asleep and provide excellent immune support.
- GABA is a brain-calming messenger and can be supported with GABA supplements or GABA’s precursor, L-Theanine 200-600 mg.
- Correcting any nutrient deficiencies you are aware of!
- In general, non-intoxicating CBD is respected as a sleep aid, dose can vary widely among individuals.
- Vitamin D, taken in the morning, sufficient to achieve a level of 60-80 ng/mL has resolved some sleep issues.
Hormones are crucial for sleep, have a chat with your doctor about:
- Vitamin D and melatonin, as mentioned above, are both hormones
- Cortisol is a day-time hormone, helpful for energy, good to not have too much at night time!
- Estrogen helps women sleep
- Testosterone and progesterone, in different amounts, help both men and women sleep!
- Thyroid balance is crucial: you need enough, but not too much!
Alcohol and THC (from cannabis) can both, for some people, seem to send them off to sleep. However, much like sleeping pills: the sleep created is not of natural sleep quality and may not be anything close to the same value as natural sleep, generally tending to impair REM sleep.
Sleeping medications are best used on a temporary basis, as they can be addictive and cause problems of their own. There are, however, two generally safe prescriptions which can sometimes be used to bolster good sleep, on top of the above-described sleep habits. Gabapentin and Trazodone, both in lower than conventionally prescribed dosages, can help people fall asleep and stay asleep, possibilities to discuss with your doctor.
Oh, right: David!
David's fix was a fairly simple one: cutting off night-time fluids and relaxing in a hot tub with his sweetheart, with a bit of melatonin thrown into the mix.
My mind fills, however, with examples of individuals who have benefitted from one or more of all the suggestions listed above. Tell me, if you will, what works best for you to help you sleep!