Insomnia is complicated!
Poor sleep and feeling tired are one of the topics that we engage in the most with our patients who experience depressed and/or elevated moods. We have found that there is a very strong belief among Americans that 8 hours’ sleep is the ideal towards which we should always be striving. This paradigm comes from the early 20th century labor movement whose slogan was “8 hours’ work, 8 hours’ sleep, 8 hours’ recreation”. Which makes sense in that context, where many low-wage workers were being forced to work upwards of 12, 16, even 20 hours per day, and the labor movement focused on their rights and health.
Neither too much nor too little
But was the idea of 8 hours for sleep based on some kind of scientific research? Well, no, it just fit nicely into the paradigm whose main point was to limit working hours to eight per day, with a five day week. Nowadays research is showing a U-shaped curve wherein less than seven hours’ sleep is not enough, but too much more also becomes unhealthful. Most people should aim to get around seven to seven-and-a-half hours’ sleep per night.
In fact, our advice is to stick with 7 to 8 hours’ time in bed whether you feel like you are getting a “sound” sleep or not. Establishing a regular, early wake time and sticking to getting out of bed at the same time each day no matter how you feel is the best way to establish a long-term healthy circadian rhythm.
People also believe that in pre-industrial or “natural” settings humans used to get more and better sleep, but this is also not borne out by research. Studies done among people living in subsistence and foraging environments without electricity also find that around seven to seven-and-a-half hours is the norm. We tend to assume that without electricity their sleep is less disturbed, but researchers point out that sleep is also disturbed when sleeping in poorly insulated huts, where insects may invade, families are densely packed together in a small space, and wild animals may enter the camp during the night (when was the last time your sleep was interrupted by an elephant in the house?)
Quality sleep
The other issue we hear from patients a lot is feeling tired during the day, which may or may not be caused by poor sleep. Our colleague, Cara Hoepner, who just a few weeks ago sent us a great list of resources for ADHD, also has a list of things that can cause fatigue – and it’s a long list!
•Depression
•Anxiety that disrupts sleep
•Hypervigilance/exhaustion secondary to Trauma or Moral Injury
•ADHD with a second wind (norepinephrine) or delayed sleep phase
• Sleep disorder
Obviously many of the items on this list are things that cannot be affected by simple behavioral change, and one is always well-advised to discuss sleep issues with a doctor in order to eliminate some of the physical and neurological possible causes of insomnia. Cara also comments that feeling groggy in the morning upon rising is not a good indicator of poor sleep, since grogginess is common for many people. She prefers to measure sleep insufficiency by how a person feels in the late afternoon.
As always, MoodSurfing recommends:
pay attention to your circadian rhythms and keeping as much as possible to a steady schedule of sleep/wake times.
Try SHUTi, or another cognitive based therapy approach, which is almost always better than medication for sleep.
Shield yourself from blue light and screens in the hour or so before bedtime, and try to get a blast of blue light, or, better, outside light upon rising each morning.
Eat a sensible diet and get regular exercise, even if it’s only a 20-minute walk each day.
Good luck and sleep well!