Got Sleep? The Do's and Don'ts of Restful Sleep

I frequently tell my patients and their care partners that sleep is one of the most important things we can do for ourselves. Of course, 'life' may get in the way of that — work, parenting, home responsibilities, social engagements.

Thanks to scientists hard at work in their labs, and the individuals willing to sacrifice sleep to be a part of research, we're learning just how crucially important sleep is. In the past decade, we've come to learn that sleep is critical for:

• Allowing us to think clearly
• Laying experiences down into long-term memory
• Helping our bodies fight off illnesses
• Making our moods more positive
• Helping us to recover from neurological injury
• Reducing seizure risk and slowing the progression of some dementias

Sleep and Brain Power

During sleep, our brains restore chemicals important for cognition (thinking skills). Currently, there is no 'magic pill' you can take to replenish these chemicals if you don't get enough shut-eye. Our brains use this chemical during sleep while they also practice memories repeatedly. The repetitive practice allows our brain cells to convert experiences and conversations into long-term memory storage. These are primary reasons that new moms, students burning the midnight oil to finish homework or projects, and others staying up late feel more distracted for one or more days after lost sleep. Getting the right amount of sleep will make us solve problems faster, recall information better, and be able to handle more information.

Sleep and Emotions

It's easy to see young children becoming cranky or wound-up when they're tired. However, fatigue and sleep deprivation affect adults just as much. Research has shown that depriving people of sleep leads them to interpret cues in their environment as being negative when they are not, making these individuals more sensitive, reactive or easily triggered, irritable, or angry. It's important to recognize that we trust our emotional response to things as realistic and appropriate, so if we are the sleep-deprived individual, we are unlikely to recognize that we are misinterpreting things or being irrational, reactive, or overly negative.

Another consequence of chronic inadequate sleep for some individuals is the experience of anxiety, depression, and other mental health illnesses. Unfortunately, this will only compound our reactivity as well as our ability to sleep, if our minds are too busy with worried or negative thoughts.

Sleep and Neurobiology

Many people who have epilepsy experience sleep deprivation as a trigger for their seizures. Then, after a seizure, you may find that you need more sleep. You are not alone.

Individuals who have suffered brain injuries, infections to the brain, and both small and large strokes are especially reliant on sleep to help the physical aspect of brain recovery. What's frightening is that millions of Americans will have a silent stroke in their lifetime — that is, a stroke that they're not overtly aware of, but that does impact either movement, thinking skills, emotions or behavior. Factors such as diabetes, hypertension, obesity, sleep apnea, and dehydration are frequent causes of these silent strokes. That means that we should all be focusing on getting good sleep.

More recently, we have come to learn that good sleep also clearly helps protect against dementias such as Alzheimer's disease, and that it slows the progression of movement disorders such as Parkinson's disease. This applies both to the sleep we obtain during our adulthood as well as the sleep we get once we've begun to show signs of neurological decline. That means that being a too-busy-to-sleep adult can increase your risk of dementia later. For individuals at-risk or clinically experiencing any neurological syndrome, sleep is one of the best — and cheapest — gifts we can give ourselves!

How Much Sleep Is Ideal?

It is difficult to answer how much sleep each person should obtain because everyone is different. Some rules of thumb can help you determine if you're getting enough sleep, though these are not 'hard and fast rules.' Ideally, if you're getting enough sleep, you should:

• Awaken naturally at about the same time each day
• Not have trouble getting out of bed in the morning
• Not be cranky in the morning
• Feel rested when you wake up
• Not need to 'sleep in' on your day off — this is an important predictor!
• Not doze off at inappropriate times, such as during conversations, interesting television programs, or meals
• Not need naps or feel as if you run out of "brain power" later in the day

The need for a nap is less reliable of a rule, because as we get older, if we're falling ill, if we've had an unusually demanding day, or if we have certain neurological conditions, we are likely to need an afternoon rest break.

The amount of sleep that one needs in hours varies by age, medical condition, and genetics. Believe it or not, as we get older we typically need less sleep. You should not assume you're getting insufficient sleep because you're sleeping hours less than you did years ago. On the other hand, it's important to be aware that those of us getting a couple of hours too little sleep every night will lose awareness that our cognitive performance drops, usually about 1½ weeks into this chronic sleep deprivation. This is in contrast to blatantly sleep-deprived individuals, who experience that cognitive performance drop very soon.

Abrupt or unusual changes to our sleep quantity can give us information about our physical or emotional health. Many with epilepsy know that if they have seizures at night, they may awaken and then have trouble sleeping for one or more nights afterwards. Using a sleep tracking device such as a watch can help you or your loved ones monitor sleep patterns.

How Can We Get Better Sleep?

Individuals often think of taking a pill to help with sleep, but research is showing that "tranquilized sleep" does not necessarily lead to better cognition. Additionally, most sleep aids — including those with happy sheep, clouds, moons, and stars on the box — are not safe for the brain. Most sleep aids work by depleting the "cognition chemicals," which you read earlier need to be present at nighttime. Melatonin is a safe exception. Talk to your doctor before changing any sleep medication, and avoid alcohol prior to sleep, as it disrupts sleep cycles and can lead to early awakening.

Training your brain to fall asleep, to stay asleep, and to get better quality sleep can take time and practice, but it is possible for nearly everyone. The first step is to recognize that you need to commit to prioritizing sleep, even if it means making sacrifices or bringing in extra help. Follow these additional tips to help your sleep:

1. Avoid caffeine after noon
2. Turn a blue-light filter on for all of your electronic devices after sundown
3. Have a set time to start your bedtime routine and to go to sleep, and a set time to wake up — it will take trial and error to figure out how much sleep you need
4. Try melatonin (3, 5, or up to 10 mg) as part of your bedtime routine — up to 90 minutes before sleep
5. Create a wind-down routine that you perform in about the same order every night: stretches, washing your face, reading a favorite passage, or meditating or praying
6. Avoid difficult or emotionally-charged conversations — and upsetting programming — close to bedtime
7. Use the bed only for bed-related activities; the bed is not the place for planning or worrying
8. If you cannot sleep, don't just lay there — get up and do something meditative, boring, or fatiguing, like reading, coloring, or a sudoku puzzle (no blue-light devices)
9. If you wake up with worries or ideas, write them on a notepad next to your bed and commit to tackling them tomorrow
10. Try classical conditioning: build a 60–120 minute playlist of familiar, non-emotional music you can sing along to, played in the same order every night — over time, pressing play will cue your brain to sleep
11. Sleep hypnosis tracks on YouTube can also help

Lastly, if you have sleep apnea, always use your treatment — even when napping — to protect your brain. If you have any questions, talk to your trusted doctor. Happy sleeping!