This is an excerpt from Foundations of Wellness.
Methods to Attain Sound Sleep
Sleep duration and quality have both genetic and environmental components. Your genetic heritage accounts for about 31 percent to 55 percent of your sleep pattern (Heath et al. 1990; Watson et al. 2012). Altering the environment through good sleep hygiene, however, can moderate this genetic influence or change how your genes express themselves. In terms of biology, epigenetics is the study of how gene expression occurs without necessitating changes in the gene's actual DNA sequence. But in developmental psychiatry, epigenetics relates to the bidirectional interchange between genetics and environment. Therefore, your genetic expression is not fixed, but it can be modified to some extent. Achieving sound and regular sleep is easier if you engage in mindfulness, regular physical activity, and judicious napping, and developing a normal sleep routine. Knowing your sleep preferences and creating an environment conducive to sleep are also important.
The National Sleep Foundation (Healthy Sleep Tips 2011) makes the following recommendations:
- Perform 30 minutes of daily physical activity.
- Retire at the same time every night, weekends included.
- Turn off your cell phone before retiring for the night.
- Avoid e-mailing and texting for one hour before going to bed.
- Avoid caffeine for at least six hours before going to bed.
- Sleep in a comfortable, dark, and quiet environment.
- Employ white noise (a soft, rhythmic, constant sound ) to block disrupting sounds and provide a soothing environment.
Mindfulness as a Sleep Aid
Mindfulness represents a means of bringing flexibility to your beliefs about sleep and can lessen secondary arousal. For example, if you choose to be mindful and nonjudgmental at bedtime, you lessen your tendency toward overthinking or worrying about what will happen tomorrow. Without mindfulness, you are vulnerable to the runaway or catastrophic thinking patterns that guarantee insomnia. Focusing on breathing and accepting your emotional and mental state without attachment or aversion can help you attain equanimity, the quality of feeling calm (Ong, Ulmer, and Manber 2012). This practice lessens the stress and anxiety that you experience while trying to go to sleep.
Jon Kabat-Zinn (2013) uses the example of preparing your parachute before jumping out of a plane. A person does not wait until it is time to jump before making sure the parachute is in order. Rather, one will have spent quite a bit of time in advance checking out the systems involved. Similarly, mindfulness should be practiced before it is needed. You obviously can't wait for a catastrophe to occur before getting such a critical skill right. Instead, you must commit yourself to practicing it in advance. Then, when a crisis arises, you can access your reserve capacity to address the problem. Twice-a-day mindfulness sessions of 20 minutes each can set the stage for greater awareness, equanimity, and peace of mind, which can contribute to better sleep.
Regular mindfulness establishes refined coping skills. A positive correlation exists between time spent in mindfulness and reductions in hyperarousal (Ong, Shapiro, and Manber 2008). The more you practice mindfulness, the more your state of arousal decreases (inverse relationship). The more your arousal decreases, the easier it is for you to fall and remain asleep.
Research evaluating the efficacy of mindfulness processes and sleep is in the embryonic stage. Mindfulness promotes high-quality sleep, which then further mediates balance in your life (Howell, Digdon, and Buro 2010). Mindfulness also promotes improved sleep duration, which promotes the self-regulation of behavior (Brown and Ryan 2003). Better sleep improves your mood, and you are more likely to make healthy behavioral choices.
Getting a good night of sleep is a special challenge for people who are recovering from substance abuse. A multicomponent pilot program among adolescents in substance abuse recovery included mindfulness training sessions. Follow-up observations made at 12 months showed improved sleep and reduced substance abuse relapse among those who completed the program, compared with noncompleters (Bootzin and Stevens 2005).
Sleep problems encountered when undergoing treatment for breast cancer (and likely for any cancer) often persist for years afterward. Andersen et al. (2013) randomly assigned 336 women to an eight-week mindfulness-based stress reduction program or to treatment as usual. The research team looked at changes in sleep. Immediately after intervention, those with the most severe sleep problems reported better sleep compared with the control group, although this improvement disappeared 12 months later. In another study, improvements in sleep quality and overall quality of life were experienced among both breast and prostate cancer patients who practiced mindfulness for eight weeks (Carlson et al. 2004).
Improved sleep quality with mindfulness is not limited to self-report. In a small study, Gross et al. (2011) compared the practice of mindfulness to use of the sleeping pill eszopiclone (Lunesta), using diaries and electronic devices, called actigraphs, to monitor movement, quantity, and quality of sleep. Initially, no differences were observed between the two approaches, but in the long run, the mindfulness group demonstrated earlier sleep onset and longer total sleep times.
Mindfulness cultivates a nonjudgmental response to your primary and secondary insomnia arousal. By contrast, mindless reactions to insomnia exacerbate the situation (see figure 1.1, p. 5, stress-reaction cycle). Nonjudgmental awareness helps you view your insomnia more objectively. When you are falling asleep, you can be more peaceful when you let go of your concerns or at least when you don't overreact to your first-level concerns (Bonnet and Arand 1997). You also avoid elevating first-level thoughts to second-level status. For example, a second-level thought such as, "If I do not sleep seven hours, I will fail my test tomorrow," can become a monumental barrier to falling asleep.
The attitudinal foundations of mindfulness, as detailed in chapter 2, are processes that enable you to gain awareness of your thoughts within a nonjudging context. You are then less likely to exaggerate the first-level thoughts into catastrophic ones, which can further heighten your arousal.
Concentration Exercise to Return to Sleep
When waking during the night, try the following concentration exercise as an aid to relax and return to sleep:
- Try repeated breath counting as follows: Count 1 with the in breath, 2 with the out breath, 3 with the in breath, 4 with the out breath, 1 with the in breath, 2 with the out breath, and so on with each in and out breath. When you find yourself distracted, just focus on where your mind has wandered and return to the breath counting. This form of mindfulness and paying attention serves to clear your thoughts and permits your brain to relax.
- Light reading or listening to the radio in dim light for 30 to 60 minutes during the night may enable you to return to sleep. As part of good sleep hygiene, you should move to another room and then return to your sleep room as you become sleepy (National Sleep Foundation 2014). Don't read in bed.
- Trust yourself. If you find healthful patterns and techniques that have worked well, that help you relax your mind, fall asleep, and sleep well, then you should practice those techniques.
- If you wake up during the night, the breath counting recommended earlier may go on for some time. But this form of mindfulness is intrinsically restful. Being nonstriving will result in rest for the body and mind, independent of sleep. If you accept yourself, don't fret about not sleeping, and trust in the mindfulness process, then you are more likely to fall asleep. Getting frustrated will only ensure your failure to sleep that night.
Physical Activity and Sleep
Regular physical activity and exercise should be a part of everyone's daily life for many reasons, including its important contribution to a good night's sleep. The effects of exercise on sleep are consistent across studies (Youngstedt and Kline 2006). On average, people who exercise regularly tend to have less trouble falling asleep compared with those who do not (Brand et al. 2010). In addition to this, the quality of sleep for regular exercisers is usually much better (Passos et al. 2010).
The preliminary evidence is that physical activity and exercise are at least as good as hypnotic medications for the treatment of chronic insomnia. Exercise has the added benefit of having no side effects, which are commonly associated with pharmaceuticals (Passos et al. 2012).
The time of the exercise does not seem to matter in relation to sleep effects. Sixty-five percent of late-evening exercisers reported falling asleep more quickly, 62 percent sleeping deeper, and 60 percent waking feeling better (Vuori et al. 1988). The authors of this book and many of their students have found exercise one of the best remedies for insomnia.
Creating an Environment for Sleep
Although the lifestyle of the sleeper is important, so too is the sleeping environment. Living in a nocturnally noisy area, such as a dormitory, can reduce the amount and quality of your sleep (Muzet 2007). Loud music, partying neighbors, bright lights, and road noise will also rob you of sleep.
The standard advice is to sleep in a quiet, dark environment to avoid outside stimulation. Paradoxically, you typically fall asleep easier when it is warm but awaken more comfortably to a cooler environment (Pan, Lian, and Lan 2012). A white-noise machine or fan that generates constant background hum will block out other potentially sleep-disruptive noises (Zaharna and Guilleminault 2010). Sleep apps for smart phones are available to use in lieu of buying a sound machine.
Napping tends to be part of life for people of all ages (Campbell and Murphy 2007). Among the elderly, naps are associated with subsequent improved cognitive performance with only mild to moderate disturbance of nighttime sleep (Campbell, Murphy, and Stauble 2005). This finding is good news because it suggests that a nap can serve to make up for sleep deprivation without negatively affecting sleep during the following night. Napping should be avoided close to bedtime, however, because it will interfere with subsequent sleep efforts.
Know Your Sleep Preferences
People are divided into those who prefer working in the mornings ("larks") and those who prefer evenings ("owls"). Although these preferences can be lifelong, they can change as you grow older. All people benefit from a better understanding of their own circadian preferences. Core body temperature drops during the night (lowest temperatures are recorded at approximately 4 a.m.) and begins to increase back toward the baseline at about 7 or 8 a.m., which signals arousal.
Sleep-related problems can be caused by everyday occurrences, such as stress, anxiety, and depression. A daily routine, regular physical activity, healthy eating, and mindfulness can help restore personal lifestyle balance and reduce stress and anxiety. Consider meeting with a mental health professional if stress, anxiety, and depression persist. Physical issues may be causing sleep problems independent of your best efforts to sleep. Note that negative emotional and psychological states will erode your sleep and diminish your quality of life.
Normal Sleep Routine
Establishing a set, nightly sleep routine is an important and simple method of achieving high-quality sleep. During the hour or so before going to bed, you should follow a habitual pattern. Common recommended presleep activities include reading and mindfulness (Winbush, Gross, and Kreitzer 2007). You should also go to bed and wake up at approximately the same time every day of the week (How Much Sleep Do Adults Need? 2014). Exceptions should not be made for weekends or holidays.
The National Sleep Foundation suggests eating heavy foods and drinking alcohol can, contrary to popular belief, make it much more difficult to fall or remain asleep (Healthy Sleep Tips 2011). Alcohol may help you fall asleep more quickly, but sleep later becomes disrupted in the second half of the night. The regular use of alcohol to fall asleep is a sign of alcohol abuse (Vinson et al. 2010). Generally, it is best to avoid drinking alcohol or coffee during the six hours before bedtime.
The electronic era offers the constant temptation to browse the Internet, channel surf, or check the cell phone immediately before retiring. But engaging in these activities in the hour or so leading up to bedtime can be detrimental to your sleeping. The artificial light of computer or television screens seem to disturb human circadian rhythms, making falling and staying asleep more difficult (Brunborg et al. 2011).
Test Your Sleep Sense
The National Center on Sleep Disorders Research (n.d.) web page provides excellent information, including a 10-item quiz titled Test Your Sleep IQ (www.nhlbi.nih.gov/about/ncsdr/patpub/patpub-a.htm). This quiz contains important insights about sleep issues.
Do the quiz results provide you any new information to help you sleep better?
Learn more about Foundations of Wellness.