Self-care revisited: Restorative Sleep

We covered why self-care is important and addressed a few common objections last week. Let's delve into arguably the most essential self-care basic -- Restorative Sleep. In fact, it’s the foundation of self-care. Keep in mind that if you're already waking up feeling refreshed and not sleepy throughout the day – you can keep doing whatever it is that is working for you.  Most physicians, however, will tell you they are low on sleep – some of it out of their control and some within their control.

First, let’s remind ourselves of the proven benefits of restorative sleep:

            -Improves memory and learning

            -Improves safety (fewer accidents and errors)

            -Improves mood

            -Improves metabolism

            -Improves cardiovascular health

            -Improves immunity

            -Improves efficiency and productivity

            -Improves overall quality of life

Second, let’s review the sleep hygiene tips we give our patients but through the lens of our own lives as sometimes, we aren’t the best at applying what we counsel our patients.

Consistency:

-Consistently get 7-9 hours of sleep.

-Consistent bedtime/wake time within your control (including days off).  The sleep alarm on many smartphones is helpful as it gives both a gentle reminder to get ready for bed and it gives a calming awakening sound that grows louder every few seconds.

-Consistent temperature of the sleep environment

-Consistent bedtime routines (Pj’s, brush teeth, dim lights, relax, stretch, journal)

-Consistent morning light (100,000 lux in the first 2-4 hours). Sunlight outdoors or artificial light (there are light meter apps). Viewing natural sunsets is also helpful as the position and spectrum of light signals the end of the day. Using dim lights mainly in the later ½ of the day and brighter lights the first ½.

-Consistent exercise times and mealtimes.

The consistency works with your natural circadian rhythms and helps to point the brain that it's time to relax and sleep. It creates a natural neuropathway to signal it’s sleep time. So, when it is within your control, aim for routines as much as possible.

Optimal Environment-

-Temperature (65 degrees or a little cooler)

-Dark (blackout blinds and eye mask)

-Quiet (earplugs or white note/fan)

-Comfort (pillow, linens, mattress)

-Focused (limit to sleep and intimacy-no reading, TV, or other screens in bed)

-Neutral smells of calming scents – (lavender, etc.)

Avoid:

-Caffeine within 8 hours

-Alcohol for sleep (though it may help with sleep initiation, it disrupts the sleep pattern and often leads to nighttime awakenings)

-Screens within 1-2 hours of sleep

-Exercise close to bedtime

-Fatty, spicy, or large meals close to bedtime (ideally supper is 2-4 hours before bedtime)

-Lying in bed for prolonged times without sleep. If it’s been a while (likely more than 30 min or so), get up, go to a comfortable dim place in your home and do something boring (read a hard copy of the Merck Manual). When you feel sleepy, go back to bed.

-Naps if you are on a routine schedule.

Third, let’s look at ways to maximize sleep with float/swing shift/call.

Notes about adjusting circadian rhythm:

-If you are changing your clock for 2 days or less, you want to just keep the routine as close to usual as possible and not worry about resetting or adjusting your circadian rhythm.

-If the change is for 2 weeks or more, it is worth resetting with a couple of strategies below. (One week at a time is in a nebulous gray zone that is more difficult as you won't fully adjust, but that's a long time to go without trying) 

-Adjusting your internal clock forward is easier than back (just like it’s easier on your system to travel West than it is East)

Adjusting the circadian rhythm:

-Pre-adjust sleep time, meals, exercise, other routines by up to 2 hours per day max.

-Begin to concentrate light exposure in new “morning” hours.

Dealing with the loss of sleep:

-Consider moderate caffeine in doses

-4-8 oz cups coffee, spread out every 1-2 hours over shift (300-400mg of caffeine)

-None in the 6-8 hours before new bedtime

-Take a Power nap (10-20 min) +/- caffeine immediately prior.

Improving sleep:

-Consider 0.5 – 3mg Melatonin 30-60 min before new bedtime (trial lower doses first) OR Magnesium Threonate or Threonine

Safety:

-Ask for help if you’re thinking isn’t clear.

-Don't drive sleepy. Sleep in the call room or call Uber or a friend.

Readjust:

-Lessen the sleep deficit and reset the times of your sleep/light/routines by up to 2 hours a day.

Fourth, other tips you may find helpful:

-Place a Journal by the bed for those middle-of-the-night ideas or things you're afraid you'll forget so you can stop trying to rehearse them as you sleep.

-Remind yourself the clock has nothing useful to say. Your brain will make it mean something terrible no matter what time it is and alert the sympathetic nervous system. (I'm already awake after only an hour of sleep? I'm awake in the middle of the night; this is so disruptive! I only have 30 minutes left to sleep!)

-Manage your thoughts about being awake. I offer a couple to consider.

“At least I’m resting.”

“Even if I only doze another 10 minutes, there’s evidence it’s helpful.”

“My mind is so amazing to offer me all these thoughts trying to keep me safe and/or be so creative. I’m so grateful." (Judgement about all the thoughts doesn't help calm the brain – it's like yelling, "Stop crying!" to a crying kid). 

“It feels good to relax. I am so grateful to have a bed and roof over my head in a safe place.”

“Where do I feel any tension? I'm now releasing it” (Relax your jaw, shoulder, legs, etc.)

-Some do well with a sunrise clock.

-Some improve sleep with bedtime meditations as part of their routine.

-You may want to check out Yoga Nidra iRest program, Shut-I CBT sleep app, or formal CBT for sleep.

Last, what other things get in the way for you?

-Are you staying up to do all-the-things because your to-do list seems more important than the fundamental need for sleep? Remind yourself that you’ll be more efficient and productive tomorrow with sleep.

-Are you staying up late out of guilt or people-pleasing? (On occasion, maybe you decide your teenager needs you, and that's fine. Try to make it an exception but never make it the rule).  

-Do you have FOMO, so you're catching up on social media?

-Are you Netflix binging (or any other form of numbing)?

So often, we are down, depressed, stressed, and feeling the need to unwind when in reality, we are behind in sleep. 

Give yourself what you need. Give your body sleep. Next week we will look at nutritious fuel.

Have a joy-filled and rested week! Tonya

Check out my 12-week individual coaching course on Enjoying Life and Thriving in your Career here.