Procrastination and other bedtime stories: Building the case for getting a good night’s sleep
It was during a casual conversation discussing sleep and the lack of because of our busy lives, family commitments etc. when I innocently asked my colleague how long it had been since she had last enjoyed a really good night’s sleep.
Her answer floored me.
She paused for a moment before answering, “Probably some time when I was in High School.”
It’s been estimated that one third of the population in developed countries are sleep deprived and results from the Phillips 2019 Global Sleep Survey of 12,000 people from 12 countries around the world report:
- 67% of adults typically wake up at least once during the night and 6 in 10 experience day-time sleepiness at least twice a week
- Of the 80% reporting wanting to improve their sleep, 60% have not sought medical assistance.
According to the sleep study conducted by the Western University Mind and Brain Institute about half of the 10,000 people surveyed were getting around 6.3 hours of sleep each night, far less than the recommended 7-8 hours of good quality uninterrupted sleep required for best health and function.
This matters because busy lives, long working hours, too little down time and poor sleep can lead to a variety of physical and mental health problems. This is where taking a sleep history can provide valuable information to determine what might be contributing to a person’s chronic fatigue, irritability, mood disorder or declining work performance.
What are their beliefs about sleep?
Many people are convinced they can train themselves to do with less sleep or are one of those people who can get by on 4-5 hours.
While their delusion is understandable, after all think how much more we could get done if we didn’t have to the inconvenience of needing sleep, raising awareness of how sleep works and the purpose of sleep is the first step to elevating the idea of just how valuable sleep is to good health and cognition.
What’s their current sleep pattern?
Sleep duration is important. Asking what time they go to bed and get up on a typical weekday night and weekend provides a clue to the level of sleep deprivation they are dealing with.
Are they reducing the amount of sleep time available by choosing to delay going to bed and or getting up super early?
The bedtime procrastinator being the person who despite being tired stays up late to catch up on emails, do some work or study, or watch the latest episode of the Netflix series they’ve currently hooked on.
While the early bird might be seeking time for peace and quiet, to get a head start on their day, or to undertake those wellbeing practices of exercise, meditation or journaling because when else will there be the time to fit these in?
What are the roadblocks to a good night’s sleep?
The top five lifestyle factors getting in the way of good sleep are
- Worry and stress (54%)
- Poor sleep environment (40%)
- Work/school schedule (37%)
- Entertainment (37%)
- Health condition (32%)
Shift work sleep disorder resulting from working outside the typical 9 to 5pm work schedule can lead to disturbed sleep patterns, excessive sleepiness, mood disorders, health problems and fatigue.
Jet lag can be a serious problem for long distance commuters especially on the east bound part of their journey. “Go west!” is sound advice for anyone of any age when travelling to minimise the impact the associated potential health risks of sleep deprivation.
What’s their quality of sleep?
Do they experience difficulty falling asleep, staying asleep or waking too early?
Is their sleep fragmented due to having small children, a partner that snores, a furry friend who takes up too much of the bedspace or sleeps on their head, or are they lying awake thinking about unsolved problems and worries?
Feeling unrefreshed on waking can indicate a lack of deep sleep from waking up too many times during the night.
Needing longer than the recommended amount of sleep i.e. greater than 9 hours may warrant further investigation because of the increased risk of heart disease, type two diabetes, stroke, all-cause mortality, chronic inflammation and cognitive impairment.
Do they have any associated medical conditions, or are they taking any medication that may be interfering with their sleep?
What’s their associated mood?
Are they frustrated because they see life and work getting in the way of getting enough sleep?
Are they tired of feeling tired but resigned to this being their norm?
Are they experiencing problems with worry or anxiety?
Do they wake feeling low? This is a red flag indicating the person may be experiencing symptoms of depression.
Set the Stage for a Better Night’s Sleep
Providing some simple sleep hygiene tips is the ideal way to nudge the adoption of better lifestyle habits.
1. Consistency of habit
Knowing when to go to bed is a question of identifying the preferred wake up time and then subtracting the hours required to get enough sleep, and then sticking to it on weekdays and weekends. Tempting as it is, a weekend catchup isn’t ideal as it further disrupts a person’s sleep pattern.
2. Adopt a pre-bedtime routine
Just like our kids, allowing 60-90 minutes to wind down and disengage from the day’s activities is the perfect preparation for a better night’s sleep.
3. Create the perfect sleep environment
This is about keeping the bedroom cool (16-18 degrees centigrade) dark (putting in blackout blinds if needed) and comfy. If using a Doona avoid putting a sheet under the quilt which impairs the breathability of the cover. Keep the bedroom for sleep and sex only and keep all technology out of the bedroom to avoid hyper stimulating the brain and exposure to the blue light that interferes with melatonin production.
4. Avoid known sleep poisons
Many people are aware of the impact of caffeine on sleep, but alcohol and smoking are the other two big culprits with smoking being the worst for disturbing sleep architecture causing insomnia, fragmented sleep, snoring and sleep apnoea.
Alcohol leads to more fragmented sleep with 2 glasses of wine is sufficient to halve the amount of time spent in REM sleep. It’s recommended to stop drinking alcohol within 4 hours of bedtime which means it’s important to build awareness sleep quality will be reduced on those evenings when alcohol has been consumed.
5. Adopt a relaxation practice
What this looks like doesn’t matter it’s what the individual finds helpful whether it’s mindfulness or other form of meditation, a breathing practice, progressive muscular relaxation, a soak in a warm bath or a regular massage.
6. Have Plan B (or C, D, E) ready if sleep remains elusive
Stressing about not sleeping is unhelpful and counterproductive. When sleep is elusive it’s better to get up (unless comfortable dozing) to drink a herbal tea or warm milk or undertake a non-stimulating activity, (this is not the time to do the tax returns) until the feeling of sleepiness returns indicating it’s time to get back into bed for “Take Two.”
7. Try a sleep tracker
While these vary in quality and accuracy, they can be a useful pointer to determine whether there’s a problem or not.
8. Take a nap
With a multitude of reasons why sleep at night can be a problem science has shown the benefit of a short 15 to 20-minute power nap taken shortly after lunch reduces sleepiness and boosts cognitive performance while not interfering with sleep patterns at night. Falling asleep is not being essential as resting quietly with the eyes closed works just as well.
9. Practice healthy daytime habits for better sleep at night
This is about encouraging regular physical activity (preferably outside and in the morning) and avoiding heavy fatty or sugary meals late at night.
10. Seek social support
Nights can feel long and lonely when sleep is elusive. If job stress is the chief problem talking with the boss or colleague is a positive first step because poor social support has been shown to be an independent risk factor for sleep disturbance.
Simply providing the facts and tips doesn’t lead to behavioural change which is why the gold is always in the follow up.
- Ascertain how much their poor sleep is an issue by asking them to rate the quality of their sleep on a scale 1-10 and their level of interest in learning how to get a better night’s sleep
- Ask what they’ve tried so far, how effective those methods were and what they might be willing to explore next.
- Ask them to keep a sleep journal indicating the number of hours spent in bed, how long they believed they were asleep, the quality of the night’s sleep and how they felt before going to bed and on waking. This is where a sleep app can provide additional useful information.
- Arrange a follow up visit to check in on
- What progress they’ve experienced so far and celebrate all wins no matter how small
- Whether they were able to implement any of the suggested changes
- To discuss what would help them to take the next step if they got stuck
- To reinforce the need for embedding small positive habits for better sleep and to expect the occasional lapse. This is about practice and repetition not perfection.
Sleep is a high value item for better physical, mental and cognitive wellbeing, which is why tuning in to evaluate all sleep problems great and small is essential to enjoying a healthier lifestyle.
- Phillips Global Sleep Survey 2019: The Global Pursuit of Better Sleep Health https://images.philips.com/is/content/PhilipsConsumer/Campaigns/HC20170918_sleeprespiratorycare/2019-Philips-WorldSleepDay-Report.pdf
- Conor J Wild, Emily S Nichols, Michael E Battista, Bobby Stojanoski, Adrian M Owen. Dissociable effects of self-reported daily sleep duration on high-level cognitive abilities. Sleep, 2018; DOI: 10.1093/sleep/zsy182
- Lovato N1, Lack L.Prog Brain Res. The effects of napping on cognitive functioning. 2010;185:155-66. doi: 10.1016/B978-0-444-53702-7.00009-9.
- Weingarten, Jeremy & Collop, Nancy. (2013). Air Travel Effects of Sleep Deprivation and Jet Lag. Chest. 144. 1394-1401. 10.1378/chest.12-2963.
- Jae-Woong Hwang, Isaac K. Sundar, Hongwei Yao, Michael T. Sellix, and Irfan Rahman (2014)
- Circadian clock function is disrupted by environmental tobacco/cigarette smoke, leading to lung inflammation and injury via a SIRT1-BMAL1 pathway
- The FASEB Journal 2014 28:1, 176-194
- Nakata, Akinori & Haratani, T & Takahashi, Masaya & Kawakami, Norito & Arito, H & Fujioka, Y & Shimizu, H & Kobayashi, Fumio & Araki, S. (2002). Job stress, social support at work, and insomnia in Japanese shift workers. Journal of human ergology. 30. 203-9.
- Total daily sleep duration and the risk of dementia: a prospective population-based study. Benito-León J1, Bermejo-Pareja F, Vega S, Louis ED. Eur J Neurol. 2009 Sep;16(9):990-7. doi: 10.1111/j.1468-1331.2009.02618.x. Epub 2009 Mar 31.
- Grandner MA; Buxton OM; Jackson N; Sands M; Pandey A; Jean-Louis G. Extreme sleep durations and increased C-reactive protein: effects of sex and ethnoracial group. SLEEP 2013;36(5):769-779.
- Patel SR, Malhotra A, Gottlieb DJ, White DP, Hu FB. Correlates of long sleep duration. Sleep. 2006;29(7):881–889. doi:10.1093/sleep/29.7.881
- Jehan S, Zizi F, Pandi-Perumal SR, et al. Shift Work and Sleep: Medical Implications and Management. Sleep Med Disord. 2017;1(2):00008.
