Virtually every prescription for good health and mental wellness emphasizes the importance of sleep, the consistent, deep, restful kind.
If only, you say. Many of us settle into bed with our smartphones, tablets and laptops — the latest enemies of sleep.
The bedtime electronics habit is pervasive: A study by Anne-Marie Chang of Brigham and Women's Hospital in Boston found that 90% of Americans used some type of electronics at least a few nights a week within one hour of bedtime. More important, the study, which compared the effects of using electronics with reading a printed book, found that the bright light from the devices prolongs the time it takes to fall asleep, interrupts the circadian clock, suppresses sleep-promoting melatonin and reduces next-morning alertness.
The array of anti-sleep temptations seems bigger than ever, making poor sleep a near epidemic, said Dr. Alon Avidan, director of the UCLA Sleep Disorders Center and the Neurology Clinic. "Oftentimes, patients come in with sleep disturbances, and they are completely oblivious that what they do before bedtime has a significant impact on the quality and duration of their nighttime sleep," Avidan said.
It's not just because some people naturally sleep better than others. "It's behavior. It's caffeine. It's watching TV. It's not getting enough light during the day and too much at night," he said.
No wonder there are an estimated 60 million insomniacs in America. Lack of sleep has been associated with increased risks of depression, cancer, diabetes and obesity.
Before you lay all the blame for your restless nights on your iPad or reach for sleeping pills, it's wise to examine your total sleep habits, what experts call "sleep hygiene," and address any persistent bad practices. You can train yourself to sleep well again if you change your sleep routine gradually and consistently over days and weeks, starting with these suggestions.
Limit screen use at night
Create a fake sunset indoors, ideally two hours before a habitual bedtime, said Dr. Shelby Harris, director of behavioral sleep medicine at the Sleep-Wake Disorders Center at Montefiore Medical Center in New York. Avoid using your electronic devices and start dimming the lights of your environment to trigger the production of the sleep hormone melatonin. Use timers on lamps or dimmers in ceiling fixtures.
"Melatonin is the hormone of darkness," Harris said. "It is afraid to come out into the light."
Avoid the blues
Blue wavelengths, including those emitted from electronic screens, tell our circadian rhythm that it's daytime. Avidan suggests changing the color temperature of electronic screens from daylight's blues to nighttime's reds. Software such as f.lux can automatically adjust the color temperature of your screen to a warmer range, helping trigger production of adequate melatonin. Studies have shown that melatonin can fall by more than 20% after spending two hours using an electronic device. Similarly, Avidan recommends donning tinted goggles when you Google: Wearing amber lenses, such as the Uvex brand, can limit sleep disruptions caused by computer use within two or three hours of bedtime.
Keep a bedtime routine
It's not just for children, said Brandy Roane, a behavioral sleep medicine specialist at the University of North Texas Health Sciences Center in Fort Worth. A routine can trigger physiological responses that cue the body to feel sleepier with each step. She suggests grouping five or six nighttime activities to repeat every night right before bedtime. They should move you from activity in your kitchen, office or living room and closer to your bedroom.
"The last step in your bedtime routine should be turning off the light and stopping all other activities," Roane said. Sleep experts agree that the bed should be used only for sleeping and sex, but romantic activity doesn't always act like a sleep aid, said Roane.
"Sex, like exercise, can help with sleep," said Roane, who cautioned that the activity can increase body heat that can impede sleep onset. Engaging in sex an hour or two before bedtime can help your body cool to its preferred sleep temperature, she said.
Avidan frequently counsels patients to stop caffeine consumption at noon. "The half-life of caffeine is about six hours, so if someone gets coffee at 3 or 4 in the afternoon because they feel a little tired, at 10 or 11 p.m., the caffeine in your bloodstream can be almost as much as a can of Red Bull."
Further, the effects of caffeine and nicotine are underestimated, said Dr. Jeffrey Durmer, chief medical officer for FusionHealth, a sleep management company in Atlanta. "These are compounds that have much more impact on sleep than any other pharmaceutical drug we can prescribe," Durmer said. "When you get a lull around 2 in the afternoon, instead of reaching for coffee, get out of your work environment and go get 20 to 30 minutes of sun."
Watch the prescriptions
"Many medications have intended and unintended consequences on sleep," said Durmer. "Drugs to treat hypertension can reduce melatonin." Underlying, untreated medical conditions can be a poor-sleep culprit.
Avoid late cocktails
Though a nightcap may help you fall asleep faster, alcohol can give you lousy sleep quality.
"If you go to sleep with alcohol in your system, alcohol will become a natural inhibitor of REM sleep," said Durmer. REM sleep helps the brain fine-tune what it has learned during the day and consolidate memories. "You not only go into REM later, but your brain and REM become hyperactive, and you have long, dramatic dream cycles. It is very difficult to wake from that kind of sleep and feel refreshed because it is a very active physiological state."
Ask any cranky toddler about the value of a nap and you'll know that they are restorative, except when they're not. For adults, naps may be a symptom of an ongoing, undiagnosed chronic disease that's interrupting sleep, or they may come at a time that disrupts the sleep cycle. Naps that are too long — over 90 minutes — can shift into a non-restful REM cycle, said Durmer. Problem sleepers shouldn't nap, especially in the afternoon after 2 p.m. or even for five minutes at night, said Harris. That quick doze on the couch can interfere with the body's total sleep signals, diffusing the sleep drive, Harris said. For good sleepers, however, even a 20-minute nap can help with memory consolidation and energy.
So what's a poor sleeper to do? Go old school, the experts said, and get a nice, boring book and read it in your TV-free bedroom, where it's quiet and cool. And if you use your phone to buzz you awake, stop. An alarm clock won't text you in the middle of the night.