Feel Well Again Blog

Whenever I meet with a new patient for the first time, one question I always ask is, “how are you sleeping?” This is because sleep plays an enormous role in maintaining good mental and physical health.

I also ask about sleep hygiene because it is rare to see a patient with a wide variety of mental health symptoms who doesn’t also suffer from insomnia. And it’s guaranteed that resolving insomnia will reduce other symptoms during the daytime. A single good night’s sleep can do wonders to lift one’s mood and sense of well-being.

However, it can be tough to obtain decent sleep in modern times. So let’s discuss some of the factors that can disrupt both the duration and quality of sleep, what optimal sleep really looks like, as well as what you can do to improve your sleep habits.

The Factors at Play

When we lived in a mostly agrarian society, insomnia was largely unheard of. That is because the day-to-day experience of doing physically demanding work outside from sun up to sun down is quite conducive to getting enough sleep.

For us, getting enough, high quality sleep is more challenging. Consider some of the factors at play:

• Because most of us do not spend our days plowing fields, but working at a desk in our home or office, we don’t get as much exposure to natural daylight. This is especially true in the winter and plays a huge role in Seasonal Affective Disorder (SAD). Exposure to sunlight during the day helps to keep our body’s circadian rhythm functioning well.
• Spending so much time at our desks, working in front of our computers also means that we are quite sedentary (at least, compared to our ancestors). Minimizing sedentary behavior and getting plenty of exercise (at least 30-60 minutes) during the day ensures that we feel tired when we go to bed at night.
• We also tend to spend our evenings in front of screens or other electronics, which means we are exposed to artificial light in the evening. Minimizing artificial light can keep our brains from being overstimulated, keeping us awake. 

There are countless other factors that affect sleep, but these are the three biggest ones. And while many of us struggled to get enough, high quality sleep before the pandemic, sleep has been even harder to come by since March of 2020. 

With the boundaries between school or work and home life getting blurred, it is more important than ever to prioritize sleep.

Why do we need sleep?

As I mentioned in the introduction, poor quality sleep contributes to mental health problems. Many psychiatric symptoms, including anxiety, depression, mania, and suicidal thinking, are triggered or worsened by failing to achieve good sleep.

In addition, many chronic illnesses can be tied to individuals not prioritizing good sleep throughout their lives. Habitual short sleep duration has been strongly associated with adverse health outcomes including obesity, type 2 diabetes, hypertension, and cardiovascular disease. 

Even the occurrence of relatively minor illnesses (colds, mild flu symptoms, etc.) in an otherwise healthy individual can be linked to shortchanging your body when it comes to appropriate sleep. As any college student who has come down with a cold after cramming late into the night during finals week can attest, lack of sleep affects your immunity and can cause you to get sick more often.

What Does Optimal Sleep Look Like?

Okay, so we know that sleep is a good thing and we know that there are a number of factors at play in determining whether we get decent sleep. But what does optimal sleep look like?  

According to the National Sleep Foundation and the American Academy of Sleep Medicine, adults (age 18+) should aim to get at least 7 hours of sleep, teens (age 13-17) should aim for at least 8 hours of sleep, and children (age 6-12) should aim for at least 9 hours of sleep. 

However, it’s important to realize that these recommendations are based on the best available evidence and expert consensus. They are derived largely from observational studies using self-reported data. And it is well known that people overestimate how much sleep they actually get. As a result, it’s likely that the above recommendations are higher than what most of us actually need.

Still, sleep should be prioritized. And while there’s no “magic number” for the ideal amount of sleep, your best bet is to listen to your body. Sleep needs vary according to age, genetics, the environment, and our daily physical and mental performance requirements. For example, high performance athletes need more sleep to perform at a high level and recover from their physical training.

So the notion of “optimal sleep” is complex, poorly understood, and the definition varies in the literature. 

My recommendation: Get the amount of sleep you need to (a) feel well rested during the day and (b) optimize outcomes (e.g., in terms of physical performance, cognitive functioning, mental health, physical health, and quality of life).

Finally, it’s crucial to remember that many other dimensions of sleep are important beyond getting a sufficient amount each night. These include aspects of sleep quality such as:

• Sleep efficiency (proportion of time in bed actually asleep), 
• Sleep timing (bedtime, wake time), 
• Sleep architecture (sleep stages), 
• Sleep consistency (day to day variability in sleep duration), 
• Sleep consolidation (organization of sleep across the night), 
• and sleep satisfaction.

Tips for Improving Sleep

Typically, in order to naturally obtain good sleep, many other habits also have to be implemented. Typical habits to start out with to help obtain good sleep include (but are not limited to):

1. Avoiding or minimizing alcohol consumption and the use of any other illicit substances, especially in the evening
2. Maintaining a strict, consistent sleep schedule (e.g., 11 p.m. to 6 a.m., seven days a week)
3. Making it a point to obtain exposure to direct sunlight during the day or using “bright light” therapy for 30-60 minutes per day, if you don’t have access to strong daylight during the day (i.e., if you work indoors most of the day)
4. Including physical activity (30-60 minutes per day) as part of your daily routine

By practicing one or more of these habits on their own, you will see improvements in your sleep, as well as physical and mental health. But doing them all collectively will skyrocket your sleep quality, energy during the day, productivity, quality of life, and overall physical and mental well being.