Getting a good night’s sleep is extremely important for both physical and mental health. However, many people struggle to fall asleep and stay asleep throughout the night. There are a variety of reasons why people may have trouble sleeping, including stress, underlying health conditions, medication side effects, inconsistent sleep schedules, uncomfortable sleep environments, and more. Fortunately, there are many effective strategies that can help improve sleep. Establishing healthy sleep habits, optimizing the bedroom environment, trying relaxation techniques, and consulting with a doctor if necessary, can all contribute to higher quality sleep at night.
What is healthy sleep?
Healthy sleep involves getting enough total sleep time as well as enough of each stage of sleep. The amount of sleep needed can vary between individuals but most adults need 7-9 hours per night. There are five stages of sleep that cycle throughout the night:
| Stage | Type | Description |
|---|---|---|
| 1 | Light sleep | The transition period between wakefulness and sleep, eye movements slow and muscle activity decreases. This stage makes up about 5% of total sleep. |
| 2 | True sleep | Eye movement stops, body temperature decreases, and heart rate slows. This accounts for about 50% of total sleep time. |
| 3 | Deep sleep | The most restorative sleep stage when muscles relax and blood supply increases to muscles and tissues. This makes up 15-25% of sleep. |
| 4 | REM sleep | Rapid eye movement sleep has dreaming, irregular breathing and heart rate, and paralysis of arm and leg muscles. REM takes up 20-25% of sleep time. |
| 5 | Awakening | A brief period of returning to semi-consciousness before fully waking up. |
Getting enough deep, uninterrupted sleep is key for allowing the body to go through all the proper stages and get adequate rest.
What causes poor sleep?
There are many different factors that can disrupt sleep and reduce sleep quality:
Stress and anxiety
Worrying about responsibilities, replaying events from the day, and anticipating what needs to get done can make it very difficult to quiet the mind at night. Stress causes the body to release cortisol and adrenaline hormones that interfere with feeling relaxed and sleepy.
Underlying health issues
Conditions like sleep apnea, restless leg syndrome, acid reflux, and chronic pain can significantly interfere with sleep. Mental health disorders like depression and anxiety are also linked to sleep disruption.
Medication side effects
Some medications can disrupt sleep as a side effect. These include certain antidepressants, blood pressure medications, steroids, and stimulants.
Inconsistent sleep routine
Varying bedtime and wake up schedules can worsen sleep. The body’s natural circadian rhythms get thrown off by irregular routines.
Electronics use before bed
The blue light emitted from phones, tablets, and laptops can suppress natural melatonin production and make it harder to fall asleep. The mental stimulation from electronic devices also counters relaxation.
Caffeine, alcohol, large meals
Consuming stimulating substances like caffeine or heavy foods too close to bedtime can interfere with sleep onset. While alcohol may help induce early sleep, it reduces overall sleep quality.
Uncomfortable sleep environment
Factors like noise, light, extreme temperatures, and an uncomfortable mattress can all hinder quality sleep. Poor air quality and lack of ventilation can also play a role.
Tips for better sleep
The following are some of the top evidence-based recommendations for improving sleep:
Maintain a regular sleep schedule
Going to bed and waking up at consistent times reinforces the body’s natural sleep-wake rhythm. Try to limit schedule variations to no more than 1 hour.
Optimize sleep environment
Keep the bedroom quiet, completely dark, and around 60-67°F. Use window curtains, a comfortable mattress, and sound blocking devices like a fan or white noise machine.
Wind down before bed
Spend the last hour before bed doing relaxing activities like reading, stretching, taking a bath, or listening to soothing music. Dim the lights during this time to boost melatonin.
Avoid electronics before bed
Shut off phones, tablets, computers, and TV’s at least 1 hour before lying down to sleep. The light exposure can hinder melatonin release.
Limit caffeine, alcohol, and large meals
Restrict caffeine to mornings only, avoid alcohol for 3-4 hours pre-bedtime, and don’t eat substantial meals within 2-3 hours of bed.
Exercise regularly
Moderate exercise during the day can significantly improve nighttime sleep quality. However, avoid strenuous workouts close to bedtime.
Use relaxation techniques
Methods like deep breathing, progressive muscle relaxation, meditation, imagery, and mindfulness can reduce stress and racing thoughts at night.
Evaluate medication effects
Speak to a doctor about potential medication adjustments if current prescriptions are interfering with sleep.
Seek treatment for health issues
Consult a physician about addressing any underlying medical or mental health conditions that may be disrupting sleep. Therapies and treatment plans could improve sleep.
Use bright light during the day
Exposure to natural sunlight in the morning and bright light during the day reinforces circadian rhythm. Dim lights at night.
Manage worries and racing thoughts
If anxiety or constant thinking is delaying sleep, get up and write down thoughts or practice calming techniques like mindfulness until the mind clears.
Allow time to fall back asleep
Don’t watch the clock or get frustrated over intermittent awakenings. Give yourself at least 20 minutes to fall back asleep before getting out of bed.
When to seek medical treatment
If poor sleep persists for over 3 weeks despite good sleep hygiene, consult a physician or sleep specialist. They can assess for underlying issues and provide personalized treatment recommendations or referrals to specialists like pulmonologists, psychiatrists, neurologists, or behavioral sleep doctors.
Signs that indicate a need for medical evaluation include:
| Symptoms |
|---|
| – Difficulty falling or staying asleep 5-7 nights per week |
| – Frequent tiredness and sleepiness during the day |
| – Waking up gasping or short of breath |
| – Loud snoring or breathing pauses reported by partner |
| – Persistent morning headaches |
| – Leg twitching or tingling while trying to fall asleep |
Diagnostic tests like overnight sleep studies can objectively measure sleep stages, breathing, and limb movements to identify any underlying disorders.
Sleep medications
Sleep medications, also called hypnotics, may be prescribed in certain cases under a doctor’s supervision. These can help induce and maintain sleep in the short term. However, they are not a long term solution and can lead to dependence if taken regularly.
Some common types of sleep medications include:
| Medication | Uses | Side Effects |
|---|---|---|
| Benzodiazepine hypnotics (Estazolam, Triazolam) | Reduces sleep onset time and nighttime awakenings | Drowsiness, dizziness, confusion |
| Non-benzodiazepine hypnotics (Zolpidem, Zaleplon, Eszopiclone) | Provide sedation to help induce sleep | Headache, nausea, parasomnias |
| Melatonin receptor agonists (Ramelteon) | Helps regulate sleep-wake cycle | Dizziness, fatigue, insomnia rebound |
| Orexin receptor antagonists (Suvorexant) | Blocks chemical that promotes wakefulness | Sleep paralysis, daytime drowsiness |
Sleep medications can provide short term relief on occasion but should not be relied upon as an ongoing sleep aid. Making sustainable improvements through lifestyle changes is preferable.
Conclusion
Improving sleep requires a multifaceted approach of optimizing sleep habits, environment, diet, mental health, and health conditions. Simple changes like maintaining a consistent bedtime routine, limiting light exposure at night, reducing bedroom disruptions, and managing stress can go a long way. However, underlying physical or mental health issues may also need to be addressed, sometimes requiring medical support. Sustaining a healthy sleep routine takes commitment but pays off through better performance, concentration, mood, and overall well-being.