Developing Good Sleeping Habits

While we are all aware of the importance of getting enough sleep, a recent editorial in the Annals, a journal by the Singapore Academy of Medicine, has found that one in three people is getting so little sleep that badly affects health. 

 Read on for tips to achieve better quality of sleep. 

 

Even a moderate sleep debt can interfere with a person’s stamina, judgement, coordination, mood and immune system. Over a longer period, a person can be put at risk to a host of lifestyle diseases such as obesity, heart problems and diabetes. A study showed that such individuals exhibit higher levels of coronary artery calcium, which pre-dispose them to heart attacks. Lack of sleep also causes people to crave either very sweet or salty-greasy food, which are bad for health and lead to obesity. Numerous studies have linked partial sleep deprivation or disruption to decreased longevity and increased mortality, while other studies have also shown that bad sleeping habits have a stronger correlation with mortality than smoking or lack of nutrition and exercise.

A person’s performance at work or in school can be negatively affected due to a diminished attention span and ability to focus. Shortage of sleep may also result in migraines and tension-type headaches, which cause attention difficulties and affect memory and academic performance.

Research has shown that sleepdeprived individuals are more prone to making mistakes. While lack of sleep may affect a person’s mood and relationships, bearing associations to psychiatric conditions, it has also correlated to an increase of transport and industrial accidents at work.

In an increasingly connected cosmopolitan world, people are getting less sleep from prioritising work, social needs, studies and commuting. A study of 2,000 students at the National University of Singapore and the Nanyang Technological University found that Singaporeans sleep as little as an average of 6.2 hours a day. While this is a couple of hours shy of the widely recommended seven to eight hours of sleep for adults, pre-schoolers and children require even more sleep, with a recommended duration of 11-13 hours a day.

How do we achieve better sleep quality?

The Department of Otorhinolaryngology (Ear, Nose and Throat) at Tan Tock Seng Hospital has a Sleep Clinic that provides holistic solutions for patients with obstructive sleep apnoea problems. The Sleep Clinic has a multidisciplinary team including the ENT surgeon, respiratory physician, dietitians, physiotherapists, bariatric surgeons and prosthodontist.

For more information on the Sleep Clinic, please contact Clinic 1B at 6357 8384 (GP) / 6357 8007 (Enquiry).

Here are some suggestions to help lead the mind into compliance with a healthy sleeping schedule. 

a) Maintain good sleep hygiene. A regular schedule and routine for sleep will condition your body to become drowsy in preparation for sleep. Getting habituated to a set routine at bedtime works well because it programmes the mind and body to a set of expectations: sleeping at the same time every night, in the same bed with the same routines. Likewise, getting up every day at the same time, even on weekends, will help to reset your biological clock.

It may be difficult forcing yourself to sleep at the beginning of the routine, but persisting with the schedule will have you falling asleep with ease throughout the first week. According to a report in the Boston Globe, a study of insomniacs found that those who had successfully established proper sleep routines were able to reduce their sleepless periods (after retiring to bed) by 54%. This percentage is significant, considering that a control group using relaxation therapy only experienced a 16% reduction, while a placebo group only had a 12% reduction.

Pre-bedtime routines can add a sense of security and stability to an otherwise stressful and fragmented life. They calm and eliminate stress for the individual, thus facilitating sleep. Try a relaxing activity 30-60 minutes before going to bed. Anything that is relaxing will help you unwind such as dimming the lights, taking a warm bath, practising guided meditation, listening to soothing music or having a cup of herbal tea.

b) Sleep at a temperature that is comfortable for you. Lower the temperature of your bedroom before sleep. Cool temperatures make for better sleep because they lower your body temperature and help you achieve deep sleep.

An internal clock triggers the body’s temperature. Although the average body temperature for human beings is about 36.9 degrees Celsius, it fluctuates in a regular pattern on a daily basis. Body temperature hits its lows between 3am and 6am, then climbs steadily through the morning before dipping again at around 3pm. The ideal range for a good sleep should be 20-22 degrees Celsius, though this can differ from one person to another.

c) Wear socks and mittens to bed. Wearing socks and mittens to bed can also trick the mind and body into getting better sleep.

Socks and mittens widen blood vessels in the hands and feet, which are a necessary step in inducing sleep, according in a Swiss study. This dilation of the blood vessels precipitates the cooling of the blood as it flows through the open channels near the surface of the skin. When body temperatures fall, sleep automatically follows.

d) Do not go to bed hungry. Hunger will keep you alert and tense.

A bedtime snack containing the amino acid, tryptophan, is best. The body converts tryptophan to sleep-inducing chemicals. Having a small, lean slice of turkey (rich in this amino acid) with a piece of toast is best.

Another alternative is an oatmeal cookie with a glass of milk (also rich in tryptophan). Also, this does not mean that one should indulge in a sumptuous supper before bedtime because overeating also disrupts sleep.

e) Avoid drinking caffeinated beverages and smoking. Both caffeine and nicotine are stimulants and disrupt your ability to get to sleep.

Try not to have any drinks containing caffeine for at least six hours before you go to bed and if you are a smoker, put a ban on smoking cigarettes at night.

f) Avoid having mobile phones in the bedroom. 

If these are in your room, switching them off will give you a better night’s rest. Many people who own smartphones use them as alarm clocks, making it all too easy to check emails one last time before falling asleep. This makes it difficult to ever feel unplugged from work and social networks. The itch to check in at all hours of the night or wake up to the sound of a text message disrupts our sleep.

While there is no scientific evidence that the wavelengths emitted by electronics affects sleep, shutting mobile phones off removes the subtle stress of needing to be responsive and connected. This, in turn, will help you achieve more restful sleep.

 

g) Get up and do something if you cannot fall asleep. 

If you are still awake 30 minutes after retiring to bed, get up and read a book, preferably one that you know is difficult to read. Research shows that the longer you lie awake in bed, the less likely you will have a night of uninterrupted sleep. It is far better to get up and do something else until you feel sleepy. Try to be in a different part of the bedroom or in a different room. Return to bed only when you feel sleepy and do this as many times during the night as needed. This conditions the body to sleep when you eventually fall into bed.

Focusing on staying awake rather than trying to fall asleep can also do the trick. In what is known as “paradoxical intention”, the mind that focuses on being awake will relax sooner than the mind struggling to fall asleep.

h) Get sufficient sunlight each day. 

Getting at least one to two hours of sunlight each day can also help a person get better sleep. Research suggests that getting enough sunlight keeps our biological clocks on track. The hypothalamus controls basic functions such as food intake and body temperature. It is influenced by light, which regulates the secretion of melatonin, a hormone that controls the circadian rhythm of our body (when we sleep and when we stay alert). During the day, sunlight slows the production of melatonin, which is a reason why we feel so alert during the day. However, the production of this hormone increases during the night, allowing us to feel relaxed and drowsy. Getting two hours of sunlight during the day will ensure that the natural waking and sleeping cycles of the body are maintained.

i) Exercise to sleep better. 

People in good shape tend to have better sleep. Numerous studies have described the links between exercise and mental health benefits such as reductions in depression and anxiety and improvements in self-esteem. Many of our bodily functions depend on physical movement to work properly, but regular exercise also raises cortisol levels, which are responsible for keeping us awake.

Exercising early in the morning when cortisol levels should be elevated or mid-afternoon well before bedtime, will make sure that they are returned to low levels by the time you go to bed. Try separating your training routine from your bedtime routine by at least three hours.

j) Do not engage in vigorous exercise just before going to bed. 

Engaging in stimulating activities just before bed increases your state of arousal and puts the body in a sympathetic tone (fight or flight state). This makes it difficult to wind down and sleep.

k) Create a good environment conducive for sleeping. 

Sleeping in total darkness is great for improving the quality of your sleep. Make sure your bedroom is dark, cool and well-ventilated. Use blackout blinds, turn off or remove all lightemitting diode (LED) lamps and alarm clocks and TVs from the bedroom and reduce any ambient light.

l) Read before bedtime. 

Watching TV or working on a laptop before bedtime will increase your exposure to blue light and suppress your melatonin production. Reading is a relaxing activity, which can also be tiring. Sitting in front of a TV is generally more passive and overly stimulating.

m) Melatonin is the primary sleep hormone. 

We generally produce it in the pineal gland and it is produced as we prepare for sleep. However, modern day life comes in the way of this production. In addition, some occupations such as shift-based workers or cabin crew/plane pilots are more prone to erratic sleep patterns.

In some instances, melatonin supplements can help. Low doses of about 3mg before bed have been shown to work fine.

If you still have difficulty falling and staying asleep, make sure you see a physician because insomnia can be triggered by physiological conditions such as sleep apnoea, menopause or depression. Some drugs that can disturb sleep include antidepressants, beta-blockers, diuretics and painkillers. Some of these patients may benefit from onward referrals to specialised sleep disorder clinics based in hospitals.

 

Dr Chong Yaw Khian is a Consultant with the Department of Otorhinolaryngology at Tan Tock Seng Hospital (TTSH). He currently runs the Snoring and Sleep Apnoea Clinic at TTSH and his main clinical interests are in otology and sleep disorders.