Light, Screen Time and Bedtime

  image courtesy of  KROMKRATHOG


image courtesy of KROMKRATHOG

I often advise clients who have difficulty sleeping to be mindful of their levels of light exposure throughout the day.  The reason is that our bodies have an internal circadian biological clock, which responds to light exposure, that regulates sleep and alertness throughout the day.

When light enters our eyes, specialized cells (i.e., suprachiasmic nucleus) in the brain send signals to orchestrate changes that lead to wakefulness, such as increase in body temperature, cortisol release, and delaying release of a hormone called melatonin, which is involved in promoting sleep onset.

Hence, to promote wakefulness, it is a good idea to get exposed to light, ideally natural light, first thing in the morning and during the day (even on a cloudy Vancouver day).  In the early evening, to encourage sleepiness and melatonin release, limit light exposure by turning off or dimming lights and limiting screen time from devices such as computers, tablets and smart phones.  Blue light emitted from these devices can be especially disruptive to sleep.

Recent research suggests that pre-bedtime screen time, compared to reading a printed book, is associated with reduced sleepiness, suppressed melatonin levels, and decreased alertness the next morning (even after sleeping eight hours).

For other ideas on how to sleep better, see my other blog posts on sleep strategies and CBT for Insomnia.

   
 

Strategies for Improving Sleep

 Image courtesy of  Feelart

Image courtesy of Feelart

In my previous post, insomnia and Cognitive Behavioural Therapy for Insomnia (CBT-I), a non-medication based therapy, for insomnia were discussed.  Drawing from the CBT-I approach, here are some behavioural strategies for improving sleep:

1. Establish a regular sleep routine and stick to it, even on the weekends and while on vacation.  Sleeping in on the weekends or during vacation can delay sleep onset on Sunday evening as it disrupts our circadian rhythm, a 24 hour biological cycle influenced by light and temperature, which regulates sleeping and eating patterns.

2. Reserve your bedroom for sleep and intimacy only.  Refrain from mind activating, and thus sleep incompatible activities in the bedroom such as working, studying, reading, or watching tv.

3. Learn a relaxation strategy or practice meditation to help calm your mind and body in preparation for sleep.

4. Have a wind-down period 1-2 hours before bedtime. This is the time to take a shower or bath, floss and brush your teeth, change into your bed clothes, dim the lights, and unwind from the day's activities.

5. Limit caffeine and have your last cup of coffee or tea by mid-day.

Many factors can set the stage for and maintain insomnia - the ideas above need to be practiced consistently to be of benefit. For more information, consult a health professional familiar with CBT-I.

Getting a Good Night's Sleep, Without Medication

coco sleeping.JPG

Most of us know the difference between a good night's sleep and a poor one. Having an occasional sleepless night is not necessarily cause for concern. However, sleep troubles (e.g., difficulty falling asleep or staying asleep) that persist and cause distress and/or impair daily functioning may indicate insomnia, a clinical sleep disorder.

Insomnia is a chronic condition in about 50% of sufferers and is a risk factor for physical and mental health conditions (1). According to a Canadian Study of 2000 adults published in 2011, insomnia is prevalent: about 40% have trouble falling asleep or early morning awakenings three or more nights per week in the previous month, about 20% were dissatisfied with their sleep, and 13.4% met full criteria for insomnia (one symptom of insomnia plus distress or disruption to daily function as a result of the insomnia) (2).  Females, older adults, and individuals with poorer physical and mental health were more likely to report insomnia. Regarding treatments, 10% had used prescription medication in the past year to manage their sleep, 9% used natural remedies, about 6% used over the counter products, and about 5% used alcohol (2).

Concerns about psychological dependency on sleep medication to fall asleep is an often cited reason for not wanting to start a sleep medication.  For individuals who are not keen on taking sleep medication to manage their insomnia, Cognitive Behavioural Therapy for Insomnia (CBT-I) is an excellent alternative.  CBT-I has been shown to be effective for improving sleep and it has been shown to reduce healthcare visits and costs (3).  In CBT-I, patients work with a trained therapist to build awareness of their sleep patterns and behaviours, learn to eliminate sleep disruptive behaviours and activities (e.g., watching tv in bed, not keeping a regular sleep schedule, worrying in bed), and implement sleep promoting behaviours (e.g., regular exercise, learning strategies to manage worries, re-establishing a regular sleep routine).

For further information about CBT-I, consult a trained health professional.  NPR also published a short health blog article last week on CBT-I:

http://www.npr.org/blogs/health/2014/02/14/276503025/working-with-a-therapist-can-help-when-sleeping-pills-dont