By Dr. Adam Amodeo, ND
Do you have trouble sleeping? You’re not alone. Poor sleep quality is a common problem. 1/3 of the population experiences insomnia to some degree.
Poor sleep quality is characterized by one or more of the following: difficulty falling asleep, difficulty maintaining sleep, waking too early, and non-refreshing sleep. It is considered acute if it occurs one night per week, and chronic if occurring for at least three nights per week for a month or more. Sleep logs can be helpful to get a better idea of the situation.
Another helpful tool is the Epworth Sleepiness Scale. You can use the Epworth Sleepiness Scale to figure out if your sleep quality is causing daytime dysfunction.
Proper therapeutic order dictates that first we establish the conditions for health. This is where sleep hygiene comes into play.
Proper sleep hygiene means minimize noise, light, clutter, and excessive temperature. Ideally, the bedroom should be for sleeping and intimacy only. There should be no television, laptops, or even cellphones in the bedroom. If a cellphone is used for the alarm, it should be on airplane mode to avoid disturbances. Light emitted from screens interferes with melatonin production, making it much more difficult to get to sleep when we should. Dark-out blinds can be purchased and placed over windows to ensure streetlight doesn’t enter the bedroom at night. A clean non-cluttered room will result in a clearer mind, and less to think about when falling asleep. Our body temperature reduces naturally when we are sleeping, so the room temperature should allow for this as well.
Exercise and Sleep
Regular, moderate-intensity exercise can improve self-rated sleep quality.1 Exercise should be done during the day, not in the evening. A regular schedule is important as well. Some people may rely on a “nightcap” to fall asleep but we know that alcohol, SSRIs, and benzodiazepines are good at inducing stage 1 and 2 sleep, but deplete stages 3, 4, and REM. Often sleep hygiene along isn’t effective enough. In these cases, stimulus control and behavioural approaches are needed
The most effective behavioural approach is sleep restriction therapy. It focuses on increasing sleep efficiency, where the total time spent in bed should be as close as possible to the total time spent sleeping. Record how long you sleep for 5 days, and find the average. This average sleep time is now the maximum amount of time allowed in bed. It is important to continue this even on weekends. Once sleep efficiency in over 90%, you go to bed 15 minutes earlier. This pattern is repeated until 7 hours of sleep at 90% efficiency is achieved. If sleep efficiency is under 90%, you go to bed 15 minutes later. Behavioural therapy can be as effective as sleep medication.2
1- JAMA. 1997 Jan 1;277(1):32-7. Moderate-intensity exercise and self-rated quality of sleep in older adults. A randomized controlled trial. King AC, Oman RF, Brassington GS, Bilwise DL, Haskell WL.
2- Am J Psychiatry, 2002 Jan;159 (1):5-11. Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia. Smith MT, Perlis ML, Park A, Smith MS, Pennington J, Giles DE, Buysse DJ.