“BEEP. BEEP. BEEP.”
The alarm is blaring. Time to get up. Do you hit snooze? …
What’s in a “Zzz?”
On average, we spend 33 percent of our lives asleep. When
assessing your overall health, have you considered your sleep habits?
Sleep hygiene, as researchers call it, involves a variety of
different behavioral practices that are necessary for quality sleep and full
alertness during waking hours.
“One of the most beneficial ways to ensure a healthy
lifestyle is to prioritize your sleep, the same as you do your best eating and exercise
habits,” Maj. Jaime Harvey, Human Factors and Operational Safety Issues chief
at Headquarters Air Force Safety Center, said. “One of the key ways you can do
that is by trying your best to maintain a regular wake and sleep pattern, every
day of the week.”
The ABCs of Zzzs
Sleep allows our bodies to rest and refuel for the next day.
The sleep process is complex and active. As we sleep, there is important
internal restoration and recuperation taking place. A lot of the information we
take in throughout the day is processed and stored while we sleep.
The sleep-wake cycle is regulated through two systems that
interact and balance each other out. These two systems are known as the
circadian rhythm and the sleep-wake homeostasis.
The regulatory internal circadian biological clock controls
the length of periods of wakefulness and sleepiness throughout the 24-hour
cycle. The system of sleep/wake homeostasis helps the body track how much time
we have spent awake and when it is time to sleep.
Sleep occurs in two states: non-rapid eye movement, or NREM,
and rapid eye movement, or REM, sleep.
During NREM sleep, there is a slowdown of physiological and
mental activities. While in NREM, the body experiences physical restoration,
hormone production and tissue repair. NREM sleep is divided into four stages.
The deepest sleep occurs during stages three and four, when there is usually
very little mental activity. Dreaming occurs during REM sleep, when the brain
is extremely active.
“Circa Dian!”
“Circa” meaning approximately and “dian,” a 24-hour period
of day, are the basis for the circadian rhythm. The 24-hour circadian rhythm
follows a cycle incorporating changes in physical, mental and behavioral
changes in accordance with periods of natural light and dark in our environment.
Staying in synch with the circadian rhythm includes being
exposed to light first thing in the morning and going to bed at the same time
every night.
“The human body thrives on routine,” Harvey said. “When we
incorporate a regular sleep/wake pattern, our bodies follow like a well-tuned
orchestra, performing in synch. When sleep is off, our bodies behave like an
orchestra warming up, with each component following its own rhythm, out of
synch as a whole.”
Circadian highs and lows are based on the circadian rhythm,
which has different peaks and dips throughout the day. On the assumption that
the average person wakes up at 6 a.m. and goes to bed at 10 p.m., the circadian
flow, goes like this:
• Circadian low: 12-6 a.m. • Circadian high: 9-10 a.m. • Post
lunchtime dip: 1-3 p.m. • “Happy hour” high: a 30 to 60-minute burst of energy
around sunset • Dip: around 6 p.m. • Lowest dip: 3 a.m. to 5 a.m.
Steps to good sleep hygiene
When considering Zzzs, remember RRR: Routine, routine,
routine.
Bring back bedtime. Bedtime is not just for children.
Remaining cognizant of sleep time is crucial. Setting a routine bedtime can
have immense effects on improving overall health.
Create a winding down routine. In preparation for bedtime,
create a routine to help relax your mind. Try reading, journaling, showering or
any other non-stimulating activity.
Set a wake time. The flip side of maintaining a routine
bedtime is setting a regular wake time. A regular sleeping and waking pattern
will help your body adjust to its natural circadian rhythm. Once awake, avoid
lying in bed. This helps maintain bed space as sleep space.
Use an alarm clock. Phone alarms work, too, but phones
should be kept out of arm’s reach and placed on “do not disturb” during sleep
time. Make sure your phone is not disturbing your sleep.
Get in seven to nine hours of sleep. Adults require this
amount of uninterrupted sleep each night and are only meant to be awake 16
hours a day. Lost sleep, or “sleep debt” accumulates. Unfortunately, we cannot
“bank” sleep so the only way to reduce sleep debt is to get sufficient, quality
rest every night.
Avoid electronics before bed. As a rule, 30 minutes before
bed, avoid having backlit devices that give off blue light in front of your
face. Blue light washes out melatonin, the natural hormone in the brain that
triggers sleep. Each text answered, tweet posted and comment liked increases
your exposure to blue light and contributes to disruption of melatonin. With
loss of melatonin, we become more alert and enter a vicious cycle of returning
to a state of wakefulness. Soon, eight hours of sleep goes down to seven, to
six and so forth.
Eat healthy, live actively. Keep in mind principles of
healthy eating and active living. Maintaining a good balance of nutritious food
and daily exercise can promote quality sleep.
Be aware of sleep-inducing and wakefulness-promoting foods.
Some sleep-inducing foods are carbohydrates, pasta, corn, white bread and
potatoes. Some foods that promote alertness are protein, nuts and seeds, peanut
butter, cheese, eggs, fish and other meats, yogurt and beans.
Perform a self-check. If you find yourself experiencing
difficulty getting a good night’s rest, ask yourself these questions:
• When did you last consume caffeine?
• Did you exercise before bed? How long before?
• Did you consume a large meal before bed?
• Did you not have enough to eat before retiring for the
night?
• Are you taking over-the-counter medications, vitamins,
etc.?
Some products may have hidden caffeine, including some daily
multivitamins. Find the culprit. Complete your self-check and take action
accordingly. Consuming too much caffeine or too close to bedtime can adversely
affect sleep. Give yourself a “caffeine cut-off” time and try to cut back by at
least one caffeinated beverage.
Try exercising earlier in the day and cut down on food
intake before bed. Have a light snack 30 minutes prior to bed. Be sure to
discuss the use of over-the-counter medications and vitamins with your health
care provider.
If you are still experiencing difficulty sleeping, try
keeping a log of your sleep habits. Many free apps are available to provide a
log of your sleep, track how restful your sleep has been and wake you up in a
REM cycle so you are not groggy.
Incorporate a meditative sound, such as “pink noise.” Pink
noise layers noises on top of each other – such as rain on a tin roof – and
helps to relax your mind from the worries of the day.
Get out of bed and do something boring. Find a monotonous
activity that is nonstimulating. Keep the lights dim and remember the
importance of getting out of bed while not sleeping – this practice maintains
the sacredness of the bed as a place for sleep.
Look for symptoms of underlying health issues. Problems with
sleep can be signs of other health issues, such as sleep apnea or restless leg
syndrome. If you experience any of the following or other ongoing symptoms,
consult your physician.
Symptoms of restless legs syndrome:
• Uncomfortable sensations in legs, arms or other parts of
the body
• Irresistible urge to move legs to relieve sensations
• Discomfort in the legs, including an “itchy,” “pins and
needles,” or “creepy crawly” sensation
Symptoms of sleep apnea:
• Chronic, loud snoring
• Pauses during snoring, followed by choking or gasping
• Rapid onset of sleepiness during quiet, inactive moments
of the day
Sleep deprivation is real. One out of three adults is sleep
deprived. Inadequate sleep or insufficient restorative sleep accumulated over
time can cause physical or psychiatric symptoms and affect routine task
performance.
Sleep deprivation can cause memory problems, a weakening of
the immune system and may lead to depression. Long-term effects of sleep
deprivation may include a high risk of obesity, heart disease, hypertension,
cancer, mental distress and stroke.
Sustained wakefulness also affects daily performance. Going
without sleep or continuing in a sustained state of wakefulness can have
effects on performance similar to effects of alcohol consumption on cognitive
function.
After 17 hours of sustained wakefulness, performance
decreases to a level similar to performance under a .05 blood alcohol content.
After spending a full 24 hours in a continued state of wakefulness, performance
decreases to a level similar to performing with a .10 BAC. The legal BAC limit
for operating a motor vehicle is .08.
Fatigue can be fatal. Persistent exhaustion is a constant
state of weariness or fatigue. Fatigue reduces concentration, energy and
motivation. Fatigue decreases a person’s cognitive abilities by 20 to 50
percent. Cognitive abilities affect everything from attention to reaction time
and judgement.
According to Harvey, the chance of an accident occurring
increases by 400 percent after a worker is on shift 12 hours. The leading cause
of fatigue is inadequate amounts of sleep.
Since we cannot flip-flop our circadian rhythm, it is
important to maintain a routine. Some of the worst accidents happen at night.
Remember to remain vigilant if you work night shift by double-checking your
work and using break times.
If you believe your sleep is being disrupted and you are
experiencing problems at work or at home, see a primary care doctor and ask for
a visit with the local Internal Behavioral Health consultant.
Lt. Col. William Isler, Clinical Health Psychology
Postdoctoral Fellowship director at Wilford Hall Ambulatory Surgical Center at
Joint Base San Antonio-Lackland, advises that the Behavioral Health
Optimization Program is the frontline for Airmen experiencing sleep disruption.
What are some tools that can be obtained for developing
better sleep habits?
CBT-i Coach is a web application for self-management of
sleep habits. This app can also be used to augment face-to-face care with a
health care professional, by people engaged in cognitive behavioral therapy for
insomnia (CBT-i).
For more information on sleep hygiene, contact your local
behavioral health clinic.
(Supplemental information for this article was retrieved
from the National Sleep Foundation.)