Published on: December 10, 2020
by Women’s Brain Health Initiative:
Sleep is essential for our overall health and wellbeing. This is perhaps not surprising if you think about how fantastic you feel getting up after a great night’s sleep – one where you fell asleep with ease, slept soundly through the night without disruption for the ideal length of time, and woke up feeling refreshed and alert, filled with enough energy to get through the day without a nap (or significant amounts of caffeine and sugar). For many, a great night’s sleep is one of life’s greatest pleasures, but it can be elusive to experience consistently.Far too often, we struggle to fall asleep, wake up frequently throughout the night (and have difficulty falling back asleep), wake up too early in the morning, and/or generally feel like our sleep quality is dissatisfactory.
Poor sleep is very common
A large proportion of individuals worldwide do not meet guidelines for optimal sleep duration. While some people sleep more than the recommended amount, vast numbers sleep less than they ideally should each night.
One study conducted by Dr. Earl Ford and colleagues, published in 2015 in SLEEP, looked at sleep duration among more than 250,000 U.S. adults aged 18 years and over, and found that 29.2% of the participants reported sleeping six hours or less on an average night. A Canadian survey of nearly 11,000 participants between the ages of 18 and 79 found that an even higher percentage of respondents reported inadequate sleep duration. The survey – conducted by Dr. Jean-Philippe Chaput and colleagues, and published in a Statistics Canada Health Report in September 2017 – revealed that approximately one-third of participants reported sleeping fewer hours than what is recommended for their age group.
Not only are thousands of people not getting enough sleep, many are also experiencing poor sleep quality for a variety of reasons.
One of the best indicators of whether you are getting enough good-quality sleep is how you feel in the morning.
The 2019 Sleep in America® poll found that only 47% of respondents reported feeling extremely or very well-rested on weekdays (54% on weekends).
Sleeping poorly is not just unpleasant, it is harmful for your health
Inadequate sleep, whether due to short duration or poor quality, is associated with a range of negative health effects. For example, there is evidence indicating that long-term sleep deprivation and sleep disorders are linked to increased risk of cardiovascular disease, obesity, type 2 diabetes, injuries, psychiatric disorders (such as anxiety and depression), and even premature death.
Poor sleep can also affect your cognitive function and increase the risk of neurodegenerative disease, especially dementia.
Below are summaries of two recent studies that highlight the importance of good sleep for better brain health:
“We found that altogether, sleep problems – including short and long sleep duration, poor sleep quality, circadian rhythm abnormality, insomnia, and obstructive sleep apnea – significantly increased risk of cognitive impairment or Alzheimer’s disease,” said Dr. Bubu, a Research Assistant Professor at NYU Grossman School of Medicine. “We estimate that approximately 15% of Alzheimer’s disease cases may be attributed to sleep problems. That suggests that addressing sleep issues could play a large role in reducing dementia risk.”
“In our global sample of over 10,000 people, we found that cognitive performance was impaired – specifically on tasks that measured problem solving and verbal ability – in the participants who reported typically sleeping less, or more, than seven to eight hours each night – and that was about half of the participants,” said Dr. Conor Wild, lead author of the paper and a Research Associate at The Owen Lab at Western University.
People who are highly sleep deprived are at particular risk. We estimate that, in terms of overall cognition, a typical sleep duration of four hours per night is equivalent to aging eight years.
What to do (and not do) if you are not sleeping well
There are various strategies that you can try on your own if you are experiencing trouble sleeping from time to time. For example, taking steps to manage your stress levels might help, and so might having positive sleep-supportive habits such as keeping your bedroom cool and dark, and avoiding use of devices with bright screens before bed. Below you will find some other scientifically supported strategies to consider.
Avoid sleep medication, except for short-term use
Reaching for a sleeping pill, either prescribed or over-the-counter, might feel like the easiest solution to sleep problems, but researchers consistently conclude that sleep medications are not the best solution for long-term sleeping problems. All medications used to aid with sleep are meant to be used for the short term, typically seven to ten days at the most; however, numerous people are using these aids for much, much longer.
The side effects of long-term use vary depending on the drug, but can include constipation, confusion, dizziness, next-day drowsiness, addiction, and impaired cognitive function.
Some sleep medications, when used over a long period of time, have also been associated with increased risk of falls, accidents, and even dementia.
One strategy for better sleep is being physically active. An academic review, published in 2017 in Journal of Evidence-Based Medicine, looked at three previous meta-analyses involving 950 adult participants and concluded that exercise improves selected sleep outcomes in adults.
“More research is needed before any specific recommendations can be made directed solely at sleep outcomes, but enough is known now to recommend that people follow current guidelines for exercise in general,” said Dr. George Kelley, lead author of the study and a Professor at West Virginia University’s School of Public Health.
Exercise is a great strategy for people struggling with poor sleep to explore because it’s free or low-cost, accessible to most people, doesn’t have side effects, and provides numerous health benefits beyond those from sleeping well.
Try light therapy
Light plays an important role in sleep and wakefulness, and so it has been used as a therapy to treat sleep disorders. Bright light therapy is a natural, relatively low-cost treatment that involves using a specially-designed device that mimics outdoor light – commonly a light box, but also lamps or visors. These devices, available with different strengths of light, are used to provide exposure for varying lengths of time at differing times of day, depending on the sleep disorder being treated.
An academic review and meta-analysis conducted by Dr. Annette van Maanen and colleagues investigated the effects of light therapy on sleep disorders and concluded that light therapy was effective in the treatment of sleep problems in general, and for certain problems in particular – namely, circadian rhythm sleep disorders, insomnia, and sleep problems related to dementia. These findings were published in 2015 in Sleep Medicine Reviews.
Light therapy devices are available in stores and online, and the cost may be covered by health benefits or insurance in some cases. According to the U.S. National Sleep Foundation, it is best to use light therapy under the supervision of a health professional who will develop a specific treatment plan and determine the appropriate type of device to purchase and how/when to use it.
Try alternative/complementary therapies
There are several alternative/complementary therapies being promoted to assist with sleep problems, many of which are supported by anecdotal evidence (i.e. individuals who personally claim the treatment worked for them). But, have any of the alternative/complementary therapies been proven to help with sleep problems in rigorous scientific studies?
One section of the “European guideline for the diagnosis and treatment of insomnia,” published in 2017 in the Journal of Sleep Research, examined the existing evidence for using a variety of “complementary and alternative medicine” approaches to help with insomnia in particular. The researchers concluded that while overall the available studies were methodologically poor, there was some evidence suggesting that acupuncture is effective, and that music therapy offers a potential positive effect, as does foot reflexology, moxibustion, and meditative movement therapies including yoga. They found no evidence supporting the efficacy of aromatherapy or homeopathy for treating insomnia.
If there is an alternative therapy that you would like to try, one that has no negative side effects and might perhaps even be pleasurable to use (like aromatherapy), you might choose to give it a try notwithstanding the absence of solid scientific proof.
Try mindfulness-based treatments or hypnotherapy
The above-noted 2017 European guideline also reviewed the evidence for usefulness of mindfulness-based treatments and hypnotherapy on sleep. The researchers reported finding moderate to good effects of mindfulness-based treatments on sleep parameters.
Hypnotherapy was found to have a positive impact on sleep onset latency (i.e. the time it takes to fall asleep). However, the overall quality of the available studies was poor. You might nevertheless want to explore this treatment option, given these initial promising findings.
See your doctor
If you are experiencing chronic sleep problems, be sure to see your doctor.
There are many potential underlying causes for sleep difficulties that your doctor can help you explore and address.
For example, urinary incontinence, nighttime pain, or menopause symptoms might be playing a role, or perhaps medications you take for other conditions are having a negative impact on your sleep. If there are no underlying factors in your case, your doctor may direct you to a sleep clinic or sleep specialist, or recommend other steps you should take.
Your treatment plan will vary depending on your unique situation. For example, if it is discovered that you have sleep apnea – a condition in which breathing stops and restarts repeatedly during sleep – you may be advised to use a continuous positive airway pressure (CPAP) device and/or lose weight if you are overweight or obese. For insomnia, Cognitive Behaviour Therapy for Insomnia (CBT-I) is the recommended first-line treatment.
CBT-I is a structured therapy that typically includes educational, behavioural, and cognitive components designed to change actions or thoughts that interfere with one’s ability to sleep. It often incorporates techniques such as mindfulness to aid in relaxation as well. As part of CBT-I, a participant might set goals to control her or his sleep environment, restrict the amount of time spent in bed, reduce outside stimuli, relax through meditation or yoga, limit caffeine and alcohol consumption, and/or avoid daytime napping.
CBT-I is traditionally conducted face-to-face with a trained therapist in four to eight sessions. There is currently a shortage of professionals trained to deliver CBT-I so demand for the therapy outweighs availability, making it difficult to access CBT-I for many people. One way of reaching more people with the existing number of therapists is by offering CBT-I in a group format, rather than on an individual basis. Research has shown that group CBT-I is effective. There is also research supporting the effectiveness of brief versions of CBT-I (e.g. with two face-to-face sessions and two phone calls, or even just one session).
Yet another innovation to help more people access CBT-I is offering the treatment as a digital/virtual program.
Research suggests that digital CBT-I also provides good treatment efficacy.
An academic review conducted by Dr. Annemarie Luik and colleagues, published in 2019 in Current Psychiatry Report, found that studies have consistently supported the use of digital CBT-I to treat insomnia.
In particular, the researchers found evidence of large effects in the short term, and smaller effects over the long term – up to 1.5 years after treatment. They concluded that the evidence in support of digital CBT-I is strong and suggested that it is suitable for more widespread use in standard healthcare. (Examples of digital CBT-I include https://somryst.com/ and https://www.sleepio.com/.)
Sleep is not a luxury
The importance of sleep is often underestimated. Many people, from students to busy professionals, often boast about how little sleep they get, as if it is a badge of honour, indicative of how hard they work or their importance. With what is known about how critical sleep is for your health, boasting about inadequate sleep is like bragging about eating fast food or engaging in some other unhealthy behaviour every day.
It is a misconception to think that sleeping less will make you more productive by giving you more time; it actually tends to make you less productive in the long run.
The bottom line is that everyone needs good sleep to function well each day and to stay both physically and mentally healthy over the long term. If you are struggling to get a good night’s sleep, take action today to turn that around. Your body and brain will thank you, and you will feel so much better!
Recommended sleep duration
The U.S. National Sleep Foundation recommends that individuals between the ages of 18 and 64 should get seven to nine hours of sleep each night, and those aged 65 and over should get seven to eight hours.
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