# Sleep Soundly

—Attaining essential rest and restoration

## Introduction

Although researchers understand the many benefits of sleep, many of us are chronically sleep deprived. Understanding the importance of sleep, along with practicing a few guidelines for attaining better sleep can bring many benefits.
It is wise to sleep soundly.

## Objectives

The objectives of this course are to help students:
* Understand the importance of acquiring adequate sound sleep,
* Identify practices they can follow to increase the quality and quantity of their sleep.
This course is part of the Applied Wisdom curriculum.

## An Epidemic of Sleep Deprivation

The Centers for Disease Control and Prevention (CDC) in the United States has declared insufficient sleep a “public health problem.” Indeed, according to a recent CDC study, more than a third of American adults are not getting enough sleep on a regular basis.$^,$
An individual that sleeps on average less than six hours per night has a ten per cent higher mortality risk than someone sleeping between seven and nine hours. An individual sleeping between six to seven hours per day still has a four per cent higher mortality risk.
Inadequate sleep duration has been associated with seven of the leading causes of death in the United States, encompassing cardiovascular disease, cancer, cerebrovascular disease, accidents, diabetes, sepsis, and hypertension. Beyond its impact on health and overall well-being, substantial evidence underscores the crucial role of sleep in determining cognitive performance and workplace productivity. Insufficient sleep has been directly linked to an increased occurrence of traffic accidents, industrial mishaps, medical errors, and a notable reduction in work productivity.
Moreover, the consequences of sleep deprivation and sleep-related disorders extend to major accidents and catastrophes, including the Chernobyl nuclear explosion, the Three Mile Island nuclear incident, the Exxon Valdez oil spill, and the tragic Space Shuttle Challenger disaster. These examples underscore the far-reaching implications of sleep insufficiency on safety and the potential for devastating consequences in various domains.

## The Importance of Sleep

Many people view sleep as merely a “down time,” when their brains shut off and their bodies rest. People may cut back on sleep, thinking it won’t be a problem, because other responsibilities seem much more important. But research shows that a number of vital tasks carried out during sleep help people stay healthy and function at their best.
While you sleep, your brain is hard at work forming the pathways necessary for learning and creating memories and new insights. Without enough sleep, you can’t focus and pay attention or respond quickly. A lack of sleep may even cause mood problems. Growing evidence shows that a chronic lack of sleep can also increase your risk of obesity, diabetes, cardiovascular disease, and infections.
Despite growing support for the idea that adequate sleep, like adequate nutrition and physical activity, is vital to our well-being, people are sleeping less. The nonstop “24/7” nature of the world today encourages longer or nighttime work hours and offers continual access to entertainment and other activities. To keep up, people cut back on sleep.
A common myth is that people can learn to get by on little sleep (such as less than six hours a night) with no negative effects. Research suggests, however, that adults need at least seven to eight hours of sleep each night to be well rested. Indeed, in 1910, most people slept nine hours a night. Recent national surveys show that 30 percent of U.S. adults sleep fewer than seven hours a night. As many as 30 percent of adults also report daytime sleepiness so severe that it interferes with work, driving, and social functioning at least a few days each month.
Evidence from other national surveys indicate that 70 percent of adolescents sleep less than the recommended 8 to 9 hours each night. Lack of sleep may have a direct effect on children’s health, behavior, and development.
These effects are pronounced on college campuses where students often stay up late to complete assignments and study for exams.

## Sleep and Chronic Diseases

As chronic diseases have assumed an increasingly common role in premature death and illness, interest in the role of sleep health in the development and management of chronic diseases has grown. Notably, insufficient sleep has been linked to the development and management of a number of chronic diseases and conditions, including type 2 diabetes, cardiovascular disease, obesity, and depression.

### Diabetes

Research has found that insufficient sleep is linked to an increased risk for the development of type 2 diabetes. Specifically, sleep duration and quality have emerged as predictors of levels of Hemoglobin A1c, an important marker of blood sugar control. Recent research suggests that optimizing sleep duration and quality may be important means of improving blood sugar control in persons with type 2 diabetes.

### Cardiovascular Disease

Persons with sleep apnea have been found to be at increased risk for a number of cardiovascular diseases. Notably, hypertension, stroke, coronary heart disease and irregular heartbeats (cardiac arrhythmias) have been found to be more common among those with disordered sleep than their peers without sleep abnormalities. Likewise, sleep apnea and hardening of the arteries (atherosclerosis) appear to share some common physiological characteristics, further suggesting that sleep apnea may be an important predictor of cardiovascular disease.

### Obesity

Laboratory research has found that short sleep duration results in metabolic changes that may be linked to obesity. Epidemiologic studies conducted in the community have also revealed an association between short sleep duration and excess body weight. This association has been reported in all age groups—but has been particularly pronounced in children. It is believed that sleep in childhood and adolescence is particularly important for brain development and that insufficient sleep in youngsters may adversely affect the function of a region of the brain known as the hypothalamus, which regulates appetite and the expenditure of energy.

### Depression

The relationship between sleep and depression is complex. While sleep disturbance has long been held to be an important symptom of depression, recent research has indicated that depressive symptoms may decrease once sleep apnea has been effectively treated and sufficient sleep restored. The interrelatedness of sleep and depression suggests it is important that the sleep sufficiency of persons with depression be assessed and that symptoms of depression be monitored among persons with a sleep disorder.$^,$

## Guidelines for better sleep

Following these guidelines can help you sleep more soundly.
* Stick to a sleep schedule. Go to bed and wake up at the same time each day. As creatures of habit, people have a hard time adjusting to changes in sleep patterns. Sleeping later on weekends won’t fully make up for a lack of sleep during the week and will make it harder to wake up early on Monday morning.
* Exercise is great, but not too late in the day. Try to exercise at least 30 minutes on most days but not later than 2—3 hours before your bedtime.
* Avoid caffeine and nicotine. Coffee, colas, certain teas, and chocolate contain the stimulant caffeine, and its effects can take as long as 8 hours to wear off fully. Therefore, a cup of coffee in the late afternoon can make it hard for you to fall asleep at night. Nicotine is also a stimulant, often causing smokers to sleep only very lightly. In addition, smokers often wake up too early in the morning because of nicotine withdrawal.
* Avoid alcoholic drinks before bed. Having a “nightcap” or alcoholic beverage before sleep may help you relax, but heavy use robs you of deep sleep and REM sleep, keeping you in the lighter stages of sleep. Heavy alcohol ingestion also may contribute to impairment in breathing at night. You also tend to wake up in the middle of the night when the effects of the alcohol have worn off.
* Avoid large meals and beverages late at night. A light snack is okay, but a large meal can cause indigestion that interferes with sleep. Drinking too many fluids at night can cause frequent awakenings to urinate.
* If possible, avoid medicines that delay or disrupt your sleep. Some commonly prescribed heart, blood pressure, or asthma medications, as well as some over-the-counter and herbal remedies for coughs, colds, or allergies, can disrupt sleep patterns. If you have trouble sleeping, talk to your healthcare provider or pharmacist to see whether any drugs you’re taking might be contributing to your insomnia and ask whether they can be taken at other times during the day or early in the evening.
* Don’t take naps after 3 p.m. Naps can help make up for lost sleep, but late afternoon naps can make it harder to fall asleep at night.
* Relax before bed. Don’t overschedule your day so that no time is left for unwinding. A relaxing activity, such as reading or listening to music, should be part of your bedtime ritual.
* Take a hot bath before bed. The drop in body temperature after getting out of the bath may help you feel sleepy, and the bath can help you relax and slow down so you’re more ready to sleep.
* Have a good sleeping environment. Get rid of anything in your bedroom that might distract you from sleep, such as noises, bright lights, an uncomfortable bed, or warm temperatures. You sleep better if the temperature in the room is kept on the cool side. A TV, cell phone, or computer in the bedroom can be a distraction and deprive you of needed sleep. Having a comfortable mattress and pillow can help promote a good night’s sleep. Individuals who have insomnia often watch the clock. Turn the clock’s face out of view so you don’t worry about the time while trying to fall asleep.
* Have the right sunlight exposure. Daylight is key to regulating daily sleep patterns. Try to get outside in natural sunlight for at least 30 minutes each day. If possible, wake up with the sun or use very bright lights in the morning. Sleep experts recommend that, if you have problems falling asleep, you should get an hour of exposure to morning sunlight and turn down the lights before bedtime.
* Don’t lie in bed awake. If you find yourself still awake after staying in bed for more than 20 minutes or if you are starting to feel anxious or worried, get up and do some relaxing activity until you feel sleepy. The anxiety of not being able to sleep can make it harder to fall asleep.
* See a health professional if you continue to have trouble sleeping. If you consistently find it difficult to fall or stay asleep and/or feel tired or not well rested during the day despite spending enough time in bed at night, you may have a sleep disorder. Your family healthcare provider or a sleep specialist should be able to help you, and it is important to rule out other health or emotional problems that may be disturbing your sleep.

## Recommended Reading

Students interested in learning more about sleeping soundly may be interested in the following materials:
* Walker, Matthew (June 19, 2018). Why We Sleep: Unlocking the Power of Sleep and Dreams. pp. 368. ISBN 978-1501144325.