After diet and exercise, sleep comes to mind as an obvious way to improve quality of life. As it’s often repeated, humans spend a third of their lives asleep. But curiously, this significant aspect of health isn’t fully under our control. We can simply decide to go on a jog, but we might lie in bed for hours hoping in vain for sleep to arrive.
Dr. Farbod Ghods is a pulmonologist with a specialty in sleep science. He’s the clinical director of the Kaiser San Leandro and Fremont Sleep Medicine Labs. In an interview, he shared some causes of insomnia and ways of improving sleep.
Although sleep is something all humans share, misconceptions still proliferate. One is about the need for sleep.
“As we move on through the journey of life…we’re seeing some changes in terms of the need for sleep as we go from infant, pediatric, children, adulthood,” said Ghods. “However there’s sometimes the misconception that as we move and journey through life we don’t need as much sleep.”
For most people, between seven and nine hours is ideal. People should ask for help if they’re getting less than six hours, or if they’re having daytime insomnia symptoms such as daytime tiredness, anxiety or irritability, and problems concentrating.
Another sleep disrupter people dismiss as simply annoying is snoring. Snoring can be an indicator of sleep apnea, a condition where oxygen flow is interrupted during sleep. Someone with sleep apnea has to keep waking up to clear their airways, getting much less restful sleep—even the wakings are so brief they’re forgotten by morning.
Another common myth: “Sleep is only sleep. It will not impact any part of my health.” The impact of lack of sleep can spiral out into depression, anxiety and high blood pressure. Sleep apnea can even impact memory in later stages of life.
In fast-paced modern life, people can get used to deprioritizing sleep. “We’re busy, we do a lot of work,” said Ghods. “And on the weekend we catch up on our sleep. I don’t think that’s appropriate, because we’re not able to catch up on that amount of sleep that we lost. We call it our sleep debt.” A day or two is not enough to compensate for the negative effects of insufficient sleep such as delayed reaction times.
Sometimes, life disrupts sleep. Ghods himself is on call and occasionally has to wake up for emergencies in the middle of the night. People might need to wake up early for work, or might be caring for a baby too young to sleep through the night. In these cases, the sleep disruption isn’t insomnia because the person is still physically able to fall asleep. The trouble is planning around a difficult routine.
Still, outside factors can cause or worsen insomnia. Caffeine is a big one, especially after 4pm. Alcohol can help people fall asleep, only to lead to disrupted sleep. Some medications can disrupt sleep. Environment also makes a difference: a cool, dark, quiet room is optimal for transitioning to sleep.
Don’t forget stress. Insomnia can even bring on its own patented brand of stress. “If I have insomnia,” said Ghods, “the moment I go to the bedroom or think of going to bed, it reminds me of all of the history. All of the stresses of lying in bed looking at the ceiling and not sleeping. It starts to make me more anxious.”
When people seek treatment for insomnia, the first step is to be aware—that a problem exists and what their actual sleep patterns are. “First of all, know how much you’re sleeping,” said Ghods. “Sometimes you start with a sleep diary. It’s a simple fact. When did I go to bed, when did I wake up?”
Sometimes Ghods sees an “aha” moment in patients as they begin to observe their sleep and notice a pattern they weren’t aware of.
“We establish, ‘Ok so you’re not able to fall asleep,’” he said. “Let’s think about: is it something predisposing you? Is it something perpetuating this? Or is it something that would cause you to have other issues?”
Changing behavior and attitudes around sleep—cognitive behavioral therapy for insomnia, or CBT-I—is the standard for care. Medication can be tried in moderation with guidance from a doctor, but it’s better as a short-term solution for two reasons. Most meds haven’t been studied for long-term side effects, and they can create psychological dependence, even relatively harmless ones like melatonin.
“Your mind thinks, This is the reason I’m sleeping,” Ghods said. “I should take that pill.”
Everyone can do with practicing better sleep hygiene, around schedules and sleep environment, and ditching the phones. The blue light from screens wakes people up, so Ghods recommends making the bedroom a “no phone zone.”
No one’s immune from disrupted sleep, even sleep specialists. “I was on call over the weekend,” said Ghods. “I got paged at 3am. I couldn’t fall asleep until 5am. I had to get out of the bed—do what I tell my patients: go to the living room, dim the lights, not be on my phone.”
Sleep reminds everyone daily that life isn’t under our control. It won’t come on command. But if people shift their focus to developing good health habits, sleep might stop by.
