The alarm goes off. Is it that time already? Just 5 more minutes. You hit the snooze button a few more times and before you know it, you’re late. We’ve all been there. Mornings are tough. Especially when you’re not getting enough sleep. So, how can you sleep better naturally?
We often take sleep for granted. It’s something we should all be experts at by now, but the reality is most of us are probably sleep deprived yet wondering why we’re so tired all the time. But getting good sleep is more than just feeling rested, it’s critical to our survival. One study found that not getting enough sleep led to an increased risk of all-cause mortality.
Insufficient Sleep Syndrome
So how much sleep should we be getting? The consensus is that adults need between 7 and 7.5 hours of shut-eye. Getting less than the ideal leads to a sleep debt that continues to accumulate over time. Everyone handles sleep deprivation differently and not all tasks are affected equally. Older adults seem to handle lack of sleep better than young adults.
How much sleep are you getting? Are you sleeping the minimum recommended 7 hours? If not, why? Perhaps you’re just too busy to sleep. You have too much to do. You spend all day at work and then come home only to work on other projects. If you have young kids, you probably haven’t had enough sleep in years.
Busyness shouldn’t be an excuse, however. Busyness, especially for the sake of being busy, has been labeled both a problem and a disease. On the other hand, staying mentally and physically active has been associated with improved cognition and lower rates of dementia in older adults but “the busyness of modern life” has also been implicated in the emotional exhaustion and burnout of healthcare professionals and it’s a barrier to sleeping better naturally.
After the careful clinician has ruled out sleep deprivation, better known as insufficient sleep syndrome, the focus turns to sleep disorders. The data suggests that 70 million Americans have at least one sleep disorder and the vast majority go undetected. Many sleep disorders are interrelated. Insomnia, for example, maybe a standalone diagnosis or a symptom of sleep apnea.
At least 1 in 10 adults at any time struggle to fall asleep. Most of the time, insomnia is related to some other condition such as stress or pain. The relationship between insomnia and general health is bidirectional. For example, depression may cause insomnia and insomnia can contribute to depression.
The medical definition of insomnia, according to the International Classification of Sleep Disorders (ICSD-3), is the inability to attain sufficient sleep for at least three nights a week for three months or longer. Negative daytime consequences must be present.
Many patients want a quick fix for their insomnia and come into the clinic looking for a prescription. While effective in the short-term, long-term use of medication for insomnia should be avoided.
Medication for Insomnia
No prescription sleep-aid is without side effects and many are habit-forming. Some available drugs are better viewed as sedatives rather than something to aid natural sleep. Trazodone, for example, suppresses REM sleep, and studies are mixed with regard to improvement in sleep quality.
Zolpidem, also known as Ambien, is a commonly prescribed sleep aid with a bad reputation though it works well for some patients. Zolpidem reduces the amount of light sleep (stage N1), which is considered a therapeutic effect. But it has also been linked to a higher risk of cancer.
Despite an array of available sleep aids, experts agree that they aren’t the best treatment for chronic insomnia. The healthiest and most effective option is to learn how to sleep better naturally. For those suffering from insomnia for longer than a month, CBTi, or Cognitive Behavioral Therapy for Insomnia, is the best approach. Unfortunately, CBTi is not effective for everyone and is not readily accessible due to cost and lack of practitioners.
How to Sleep Better Naturally with CBTi
CBTi is not a single intervention but rather the union of several complementary interventions such as sleep hygiene, sleep restriction, stimulus control, cognitive therapy, and relaxation training. Not only has it been shown to improve sleep onset and duration but it may also be an effective stand-alone treatment for depression.
Sleep hygiene is the term used to describe healthy sleep habits such as:
- Keeping the bedroom dark, cool, and quiet
- Avoid stimulants like caffeine in the afternoon
- Having a consistent bedtime routine
- Decreasing or eliminating screen time before bed
These good habits won’t necessarily cure insomnia but you’re not going to be very successful without a solid foundation.
One of the more powerful tools in the CBTi arsenal is sleep restriction. If insomnia is the difference between how much sleep you get and how much sleep you want, start restricting time in bed to match the amount of sleep you’re actually getting. The result is that the time spent sleeping starts to completely match the time spent in bed.
For example, if you spend 1-2 hours trying to fall asleep each night and say 5-6 hours actually sleeping, we delay your bedtime until you have only 5-6 hours to go before waking. The idea is that building a sleep debt will improve your sleep efficiency or the time you actually spend sleeping in bed. Sleep time is gradually extended by a few minutes every week until you’re getting the recommended 7-8 hours and you’re happy with the time you spend getting to sleep.
Another critical part of CBTi is taking advantage of natural wakefulness stimuli and controlling anxious tendencies. Some of the most powerful stimulus control techniques include:
- Waking at the same time every morning. Yes, every morning.
- Exposing yourself to natural sunlight after waking (or a sufficiently bright therapy light)
- Exercising right after waking
- Avoiding naps
- Going to bed only when sleepy (which means getting out of bed if not asleep after a comfortable period of time)
- Using the bed for sleep and sex only
The cognitive therapy component of CBTi works to address negative, self-defeating, and catastrophizing thoughts regarding insomnia. The basis of any CBT-based therapy is identifying incorrect beliefs and understanding why they are incorrect and then replacing or rewriting them with correct ideas. This can also be accomplished by:
- Expressive writing
- Roleplay (“What would really happen if I didn’t get the sleep I want?”)
One of the worst things a patient with insomnia can do is to worry about insomnia! The same can be said for trying to fall asleep rather than allowing the body to succumb to sleep. Learning to relax both body and mind would cure many who otherwise struggle endlessly. Sleep is a natural drive like hunger–we may just need to get out of the way.
Another common sleep disorder causing fatigue and daytime sleepiness is sleep apnea. Sleep apnea is usually categorized as either central (coming from the brain) or obstructive (resulting from blocked airways). Insomnia and sleep apnea commonly occur together.
Central sleep apnea
Less common than its obstructive counterpart, central sleep apnea begins in the brain’s respiratory centers. It is often related to heart failure, stroke, and opiate use. Many people have “mixed” apneas or pauses in breathing that constitute both central and obstructive events. Continuous Positive Airway Pressure, or CPAP, is the standard treatment for obstructive sleep apnea (OSA) and can uncover central apneas in what is called complex sleep apnea.
Obstructive sleep apnea
Obstructive apneas occur when there is a mismatch between the brain’s signal to breathe and the free flow of air. This is typically caused by a soft tissue obstruction such as tongue or tissues in the throat that become too relaxed and collapse the airway. Large tonsils, adenoids, and a deviated septum are other causes of airway obstruction. The standard treatment is CPAP which opens blocked airways with continuous airflow.
While there are surgical treatments for OSA, they are not generally very successful and multiple procedures can be required. Patients with mild sleep apnea may be able to use an oral device that repositions the jaw and helps to maintain an open airway. Weight loss is critical as most, but not all, patients with OSA are overweight or obese.
Sleep-Related Movement Disorders
Movement disorders such as restless leg syndrome (RLS) are quite common and rob patients of precious sleep. Bruxism, or grinding of the teeth, is another common condition that can also lead to morning headaches and worn or fractured teeth. Periodic limb movements disorder is a less common sleep-related movement disorder that involves jerking and twitching on the lower limbs.
Now you are prepared to sleep better naturally!
Sleep is absolutely essential to good health and it deserves more of our attention. Many of us simply aren’t sleeping enough while others have some bad habits that need correction. It’s even more important, however, that healthcare providers adopt healthy habits and model them for their patients so that they can continue caring for those who need them. Anyone can sleep better naturally with CBTi.
This article was written by PA Doctor staff and was medically reviewed by Jennifer Harrington, DMS, MHS, PA-C