Sleep rituals and habits you could be going wrong with

According to a survey done by Fitbit in 2019, Indians emerged as the second most sleep deprived nation after Japan among 18 countries. Indians get an average night sleep of 7 hours and 1 minute ,48 and 32 minutes less than average sleep in UK and US respectively. 1 Although the average duration of sleep varies with age, for optimal health, an adult needs 7 to 9 hours of restorative sleep every night.

Should sleep be a priority

Good quality sleep should no longer be considered optional as there is no aspect of health which is not affected by lack of sleep whether it is weight loss or chronic diseases like heart disease and diabetes. 2 Also disease and sleep have a bidirectional relationship. Poor sleep increases risk of chronic diseases and diseases disrupt sleep.
What aspects of modern living could be costing us a good night’s sleep?

Using the bedroom as an office and TV room

Bedrooms have become multipurpose spaces especially after Covid and that can be a big sleep disrupter. A bedroom cluttered with work papers, laptop, phones, TV can condition the mind to regard it as a place of activity and not restfulness. This can interfere with sleep and one can especially have trouble falling asleep. It is best to use bedrooms as places for sleeping and intimacy only.

Exposure to blue and bright lights before bedtime

Our circadian rhythms determine the level of alertness and sleepiness. Melatonin is the sleep promoting hormone and is very light sensitive.4 Its levels start to rise in the evening and is very sensitive to light especially short wavelengths of light (blue light ~480 nm). All devices (phones and laptops) emitting blue light should be switched off at least 2 hours before sleep time.

Not just the blue light from phones but also exposure to bright bedroom lights before sleeping leads to melatonin suppression. Use warmer tones of light at night in the bedroom.

Low daylight exposure
Yes, get that daily dose of sunshine as the sunlight exposure during the day determines how well you would sleep at night. It has been found that low daylight exposure causes more melatonin suppression from light at night time. So, to sleep well, do not miss on the dose of daytime especially morning sunshine.

Heavy exercise close to the bedtime
Thanks to the modern-day schedules, evening time has become the preferred time to exercise for many people. While exercising regularly undoubtedly improves the sleep quality, a heavy workout close to the bed time can disrupt sleep. According to a study published in Oct. 29, 2018, in Sports Medicine, avoid vigorous activity at least an hour before bedtime.5

Researchers also noted that a higher core temperature – which can occur after intensive workouts – was associated with lower sleep efficiency and less restful sleep after sleep onset. So heavy workouts in the hour leading up to bed can affect sleep efficiency and total sleep time.

Alcohol and caffeine close to bedtime

Alcohol will probably make you sleep faster than normal making it ‘sedative of choice’ for many but alcohol disturbs the architecture of sleep, the normal phases of deeper and lighter sleep we go through every night producing fragmented sleep. It is the second half of night that gets affected as initially alcohol is sedating, but as it’s metabolized, it’s very activating. 6 Alcohol can also disturb sleep by promoting increased urine output as it is a diuretic. In people with sleep apnoea, it can worsen snoring due to increase in muscle relaxation of upper airways and making them collapse.

Caffeine found in tea leaves, coffee, cacao and energy drinks is consumed by vast majority of adults
for its energizing effects to enhance their mood and optimize their performance.7

Caffeine consumption can make you fall asleep later, sleep less hours overall, and make your sleep
feel less satisfying by disturbing the slow wave sleep.

Caffeine affects the brain by blocking adenosine receptors. Adenosine is a sleep-promoting chemical that builds up in the brain the longer you are awake. The more it builds up, the sleepier you become. When caffeine blocks this process, you remain alert and vigilant. But this may also be why caffeine consumption can disrupt sleep. People with chronic insomnia and disturbed sleep rely on endless cups of tea and coffee to keep themselves energized and this in turn worsens sleep at night. Avoid caffeine related products 4 to 6 hours (in some cases 8 hours depending on the sensitivity) before bedtime and do not consume alcohol in the last 4 hours before bedtime.

Last but not the least, following a good sleep hygiene is of paramount importance. Sleep hygiene refers to both your behaviour and sleep environment. A good sleep hygiene means having a bedroom environment and daily routines that promote consistent, uninterrupted sleep.

Preparation for a good night sleep begins in the morning itself by sticking to consistent wake up
times and getting the morning sunshine. Let a good night sleep not be a dream as that is the only way the mind body complex reset and renew on a daily basis.

References
1. Indians least active, second most sleep-deprived: Fitbit – BusinessToday.
https://www.businesstoday.in/technology/top-story/story/indians-least-active-second-mostsleep-deprived-fitbit-235036-2019-10-30.
2. CDC. Sleep and Chronic Disease. Centers for Disease Control and Prevention
https://www.cdc.gov/sleep/about_sleep/chronic_disease.html (2022).
3. Dedhia. Sleep and Health—A Lifestyle Medicine Approach. J. Fam. Pract. 71, (2022).
4. Giménez, M. C. et al. Predicting melatonin suppression by light in humans: Unifying
photoreceptor-based equivalent daylight illuminances, spectral composition, timing and duration
of light exposure. J. Pineal Res. 72, e12786 (2022).
5. Does exercising at night affect sleep? Harvard Health https://www.health.harvard.edu/stayinghealthy/does-exercising-at-night-affect-sleep (2019).
6. Colrain, I. M., Nicholas, C. L. & Baker, F. C. Alcohol and the Sleeping Brain. Handb. Clin. Neurol.
125, 415–431 (2014).
7. Drake, C., Roehrs, T., Shambroom, J. & Roth, T. Caffeine effects on sleep taken 0, 3, or 6 hours
before going to bed. J. Clin. Sleep Med. JCSM Off. Publ. Am. Acad. Sleep Med. 9, 1195–1200
(2013).
8. Tired or Wired? NIH News in Health https://newsinhealth.nih.gov/2020/10/tired-or-wired (2020).
9. Troy, D. Healthy Sleep Habits. Sleep Education https://sleepeducation.org/healthy-sleep/healthysleep-habits/.
10. Foundation of Lifestyle Medicine Board Review Manual 3rd edition