Recommendations from multiple sources to help your patient sleep better.
by Kruti Vora and Rich Strongwater, M.D.
Healthy sleep is essential to maintain a good quality of life and mental and physical well-being. Although people are unconscious when they sleep, their brains and bodies are active. An understanding of what biological processes occur during sleep, why sleep hygiene is important, and how sleep quality can be promoted can encourage restful sleep and refreshed daily functioning.
What happens when you’re asleep?
Your brain progresses through different stages of sleep that are characterized by varying brain activity. These stages can be divided into rapid eye movement (REM) sleep and non-REM sleep, which is further subdivided into three stages. Stage 1 represents the transition from wakefulness to sleep and lasts a short period of time; it is characterized by slower brain-wave activity. Stage 2 involves deeper sleep, and stage 3 refers to deepest sleep. Cycling through these stages takes 90-110 minutes; as the night progresses, the REM period takes up a larger proportion of the cycle.
During REM sleep, the eyes move, and most dreaming occurs. The sleeping person has brain activity much like that during waking hours but becomes extremely relaxed or even paralyzed. Children experience higher percentages of REM sleep during a sleep cycle than do older sleepers.
Why is sleep so beneficial?
As the brain is cycling through sleep stages, the body uses sleep to heal and become strong. Non-REM sleep, in particular, can help rejuvenate bone, muscle, tissues, and the immune system as it helps the body release growth and sex hormones needed for proper growth and puberty. Both REM and non-REM sleep may aid memory consolidation. On the other hand, bad sleep hygiene may affect both mental and physical health and increase the risk of depression, high blood pressure, obesity, infections, and kidney disease.
How can I get good sleep?
The amount of sleep needed each day changes as people age. The National Institute of Health recommends that newborns sleep 16-18 hours per day, since they are growing and developing rapidly. Sleep requirements decrease as children age, dropping to 9.5 hours per night for teenagers.
Adults typically require 7-9 hours per night, although the elderly may find their sleep to be lighter and more interrupted.
Not only is getting enough sleep important, but the quality of the sleep must also be ensured. Sleep hygiene is a set of lifestyle habits that promote healthy sleep. Behavioral therapy to teach patients the elements of sleep hygiene is an important initial step in treating insomnia.
The National Library of Medicine recommends several measures that may help improve sleep, including:
keeping to a regular schedule of rising from and getting into bed (weekend sleep hours ideally should not vary excessively from weekday hours);
avoiding consumption of large meals, caffeine, nicotine, and alcohol, especially later in the day;
exercising regularly, but avoiding physical activity close to bedtime;
sleeping in a cool environment;
avoiding use of electronics before bedtime;
doing something relaxing before bed, especially if you can’t fall asleep;
using the bed only for sleep and sexual activity, although reading a relaxing book may help promote sleep; and
going to bed when sleepy, doing something relaxing/enjoyable before bedtime.
Other good sleep habits include:
making your bedroom quiet, dark, and comfortable;
removing your clock from sight;
avoiding naps during the day (any nap should last only 30 minutes and take place in the early afternoon);
avoiding frequent use of sedatives or hypnotics;
spending time outdoors at the same time each day;
checking medicines with a pharmacist to find out if they may affect sleep;
avoiding blue light-emitting screens (eg, from cell phones) before bedtime;
avoiding or limiting use of products containing nicotine before bedtime;
avoiding watching violent television programs before bedtime; and
avoiding working in bed.
People who work shifts have a particularly difficult time obtaining restful sleep. They may try:
limiting consumption of caffeine-containing products during the early part of the shift;
limiting changes from one shift to another to help the body adjust;
taking naps and making more sleeping time available;
maintaining bright lighting in the workplace; and
using light-blocking curtains and avoiding distracting sounds in the bedroom when sleeping during the day.
What if I still can’t sleep well?
Sometimes people have sleep disorders that cause them to have too little sleep(insomnia), inappropriate sleep (narcolepsy), or abnormal occurrences during sleep (eg, sleep apnea, restless leg syndrome, and REM sleep behavior disorder). A consultation with a physician is important if symptoms of these conditions occur or if good sleep is not obtained after the recommendations above are followed. Further treatment may produce restful sleep and productive, energetic, and active waking hours.
About the Authors
Kruti Vora
Kruti Vora is a fourth-year medical student at Harvard Medical School planning on specializing in internal medicine. Her interests are in medical oncology, advocating for health equity, mentorship, and medical education.
Rich Strongwater, M.D.
Dr. Strongwater is an Assistant Clinical Professor of Medicine at Columbia UniversityMedical Center in New York, and is a diplomate of the American Board of FamilyMedicine. He has been a practicing family physician for 35 years. He completed his residency in Family Medicine at Overlook Hospital in Summit, New Jersey. Prior to this,he completed his undergraduate studies at Washington University in St. Louis, and received his MD degree from the State University of New York in Syracuse, New York.His hobbies include snow shoeing, hiking, and windsurfing.
References
Cleveland Clinic. Sleep basics. Cleveland Clinic Web site. https://my.clevelandclinic.org/health/articles/12148-sleep-basics. December 7, 2020. Accessed January 31, 2021.
Jermaine DM. Sleep disorders. In: Carter BL, Angaran DM, Lake KD, Raebel MA, eds. Pharmacotherapy Self-Assessment Program. 2nd ed. Psychiatry Module. Kansas City: American College of Clinical Pharmacy, 1995:139–154.
National Institutes of Health; US National Library of Medicine. Healthy sleep. MedlinePlus Web site. https://medlineplus.gov/healthysleep.html. Updated November 16, 2020. Accessed January 31, 2021.
National Institutes of Health; National Institute of Neurological Disorders and Stroke (NINDS). Brain basics: understanding sleep. NINDS Web site. https://www.ninds.nih.gov/Disorders/patient-caregiver-education/Understanding-sleep. August 13, 2019. Accessed January 31, 2021.
Rehman A, Fry A. What is healthy sleep? Sleepfoundation.org Web site. https://www.sleepfoundation.org/sleep-hygiene/what-is-healthy-sleep. Updated January 8, 2021. Accessed January 31, 2021.
Rehman A, Pacheco D. Sleep disorders. Sleepfoundation.org Web site. https://www.sleepfoundation.org/sleep-disorders. Updated December 1, 2020. Accessed January 31, 2021.