I don’t recall many nights during my childhood without hearing two words before going to sleep, “Schluff Gezunt.” I doubt that our children, and our grandchildren when they visit, still to this day, wouldn’t say the same thing.
“Schluff Gezunt” a Yiddish expression, means “sleep well.” What a lovely way to put yourself in the best position to sleep well each and every night with a wish from a loved one to sleep well. While that sounds sweet, innocent, and childlike, for millions of people suffering with insomnia disorder and circadian rhythm sleep-wake disorders (delayed type), about a third or more of the population, a simple wish before bedtime unfortunately isn’t enough to promote a restorative night’s sleep, essential for health and wellbeing.
The current COVID19 pandemic is certainly a major contributor to increased stress with consequent changes in sleep behavior, key factors linked to poor sleep hygiene. Disruptions in our daily lives, anxiety and worry, isolation and depression, family and work stresses, overindulgence in screen time, and physical symptoms of a constant state of weariness all feed poor sleep.
Earlier this month, the SleepFoundation.org updated its description of the most telling signs of poor sleep hygiene to include “a hard time falling asleep, experiencing frequent sleep disturbances, and suffering daytime sleepiness…An overall lack of consistency in sleep quantity or quality can also be a symptom of poor sleep hygiene.”
I want to help the sleepless get some needed sleep with a few simple ABC’s of ZZZ’s. First some facts:
Adults do best with about 7-9 hours of sleep each night.
Teens thrive with about 8-9 hours of sleep each night.
School-age children are at their best with about 10-11 hours of sleep each night.
Got that? Yet, the average adult sleeps less than 7 hours per night and two-thirds of adults report never feeling well rested. And they pay a price.
When we get less sleep than is healthy, our reaction times slow down, our blood pressure rises, our testosterone decreases (10-15%), and we have a 50% greater likelihood of having a heart attack over time. Our respiratory system is affected and we are more likely to catch a cold – or worse. We are more prone to depression and anxiety. And our metabolism gets all out of whack so that our grehlin and leptin hormones, responsible for normal satiated and hungry feelings, reverses—to the point that if we sleep less than 6 hours, we feel up to 25% hungrier and add the equivalent of eating a cheeseburger, 350-500 calories, to our nutrition the next day. By not sleeping we also actually do eat more during those opportune hours we are awake. Sleeping less than 5 hours a night for a year or longer, results in a threefold higher risk of type 2 diabetes compared with those people who get a healthy amount of sleep. Finally, as if all that isn’t enough, short sleepers have decreased longevity. Just one night of sleep deprivation, according to a small study in the journal SLEEP, was linked to signs of brain tissue loss.
So what’s this mean? Do you have to beat yourself up if you stay out too late on the weekends and get less than 8 hours of sleep on occasion? No, of course not anymore than you have to thrash yourself for having a wonderful piece of cake once in awhile.
Arianna Huffington, founder and CEO of Thrive Global says, “Sleep is central to every aspect of our well-being—our physical health, our mental health, our productivity and our decision-making. Our world is facing huge crises on multiple fronts, and we need all the resilience, wisdom and sound decision-making we can muster. We can’t take care of our world if we don’t take care of ourselves—and that begins with sleep.”
Yet, for productivity, positive mood, general health and wellbeing, healthy sleep is a necessity. Simply said, healthy sleep plays a cardinal, non-negotiable, role for better health along with physical activity and proper nutrition. Look at the benefits that high quality sleep offers, especially during COVID19, according to the experts at the SleepFoundation.org:
- Sleep empowers an effective immune system. Solid nightly rest strengthens our body’s defenses, and studies have even found that lack of sleep can make some vaccines less effective.
- Sleep heightens brain function. Our mind works better when we get good sleep, contributing to complex thinking, learning, memory, and decision-making. For adults and children adapting to work and school at home, good sleep can help them stay sharp.
- Sleep enhances mood. Lack of sleep can make a person irritable, drag down their energy level, and cause or worsen feelings of depression.
- Sleep improves mental health. Besides depression, studies have found that a lack of sleep is linked with mental health conditions like anxiety disorder, bipolar disorder, and Post-Traumatic Stress Disorder (PTSD).
John Miller, M.D., Medical Director, Brain Health, Exeter, NH, and Editor-in-Chief of Psychiatric Times, recently observed that for those living with a poor sleep cycle, turning to medication, prescribed by a physician or over-the-counter, is an increasingly common and often first step on the pathway for help.
Dr. Miller noted that the most common medication people turn to is Diphenhydramine, found in Benadryl, Aleve PM, others. Diphenhydramine is a sedating antihistamine with side effects that may include daytime drowsiness, dry mouth, blurred vision, constipation and urinary retention. Taking this chronically may also lead to other unexpected and paradoxical results.
Dr. Miller observed that taking Diphenhydramine steadily, results in the “histamine receptor to start to upregulate and it then expects you to take it.” If you do miss it after taking it consistently, your brain will have withdrawal insomnia or withdrawal anxiety, both negatively impacting healthy sleep.
So what does good sleep hygiene look like? Turning to Alcohol? Cannabis? No. According to Dr. Miller, “all medications or mind-altering agents have adverse effects and risks.”
Good sleep hygiene includes, but isn’t limited to, the following according to Dr. Khazenay Bakhsh, Pulmonary and Sleep Medicine specialist at Jefferson Health in New Jersey:
- First thing’s first: Keep a schedule! Stick to a normal bedtime and set an alarm in the morning, even if you aren’t working from home. It may be helpful to make a list of tasks you want to complete the next day; that way you feel that “cue” to wake up.
- Limit your screen-time in front of bright lights, prior to bedtime. Try not to stay up on your phone or computer out of boredom. The bright lights will keep you alert and communicate with your brain that it’s time to wake up, even when it’s not.
- Create a comfortable sleep environment. It’s helpful for many people to keep their room dark and quiet. It’s also recommended to keep the atmosphere peaceful by not working in your room; you don’t want to associate it with stress when you try to sleep.
- Stay active. This is simple – it’s important to fit physical activity into your day, even when you’re stuck at home, to stay healthy. Exercise is also key to making you feel more tired at night, thus improving sleep quality. However, you should avoid any strenuous workouts prior to bedtime, as it might have the opposite effect.
- Above all else, give yourself time to decompress. This is beneficial all the time, but it is especially helpful during the pandemic. Don’t keep everything bottled up during the day. Express your concerns and socialize with your friends and family. Before bed, create a relaxing routine and give yourself plenty of time to wind down.
Of course no one path is right for everyone. Experiment with adjustments to find out what helps you sleep best. Make small changes to promote better sleep hygiene, knowing that what works for a friend, may not be friendly to a good night’s sleep for you.
This image from the World Sleep Society includes the “10 Commandments of Sleep Hygiene.” Follow these to maximize the three essential elements of good quality sleep: duration, seamless and continuous sleep and deeply restorative sleep quality.
Well, there you have it, the ABC’s of ZZZ’s. Leonardo Di Vinci once said, “A well-spent day brings happy…schluff…” Di Vinci probably didn’t say schluff, but you get his point.
Fortunately, most sleep difficulties are managed by changing behaviors as described above. Medical therapy including supervised medication and/or cognitive behavioral coaching may also be part of a structured plan for good sleep hygiene…to “Schluff gezunt.”