Beyond sleep hygiene: a 5-step plan to get a better night’s sleep

Sleep problems can cause a fair amount of frustration for healthcare professionals. That’s because sleep hygiene is something that a lot of us — especially those in primary care or mental health/psychiatry — advise patients on every day. So if you’re struggling to get a good night’s sleep yourself, it can be hard to feel authentic in the suggestions you make to patients. You may find yourself having thoughts like “Does any of this really work?” or “I should really take my own advice.”

The truth is, sleep is critical to your ability to function. Without sleep, you’re way more likely to be irritable, short on patience, and low on empathy. This might show up as yelling at your kids, lashing out at your spouse, or making snide comments about difficult patients. Being in so-called “sleep debt” also makes it harder to think clearly and make quick, efficient decisions. You’re at greater risk of making careless medical errors or even getting into a car accident, depending on how badly deprived you are.

You probably know all this on an intellectual level, but so many of us downplay the importance of sleep in our own lives.

There are a few common reasons why physicians, nurses and other helping professionals get inadequate sleep:

• Home life factors: new baby, disruptive pet, child illness or a child’s chronic sleep problems
• Environmental factors: bedroom is too hot/too cold (or too light if you work nights and sleep during the day)
• Mental health factors: chronic anxiety or depression, or attentional/perfectionism issues that cause you to stay up too late
• Lifestyle factors: poor diet, overconsumption of alcohol, stimulating screen time before bed, insufficient exercise
• Situational factors: worries about finances, loan debt, aging parents, the threat of a lawsuit, being behind at work, your child’s well being
• Job factors: shift work, unpredictable or inconsistent schedules, too many demands on time

The culture of health care in some ways perpetuates sleep deprivation. Even with new restrictions in place, many medical residents don’t get enough sleep due to the crushing demands of documentation and other responsibilities. Some of this “I can get by” mentality can end up spilling into the rest of your career. And I hear from a lot of nurses who struggle with the way their employer requires alternating day and night shifts; this can make getting good-quality sleep really difficult.

You know basic sleep hygiene. It’s boilerplate. Here’s what to do if you’re still stuck:

1. Go through the list of factors above and jot down anything that seems like it’s relevant to your current situation. BE HONEST WITH YOURSELF! You don’t need to commit to changing any of it just yet.
2. Does anything stand out as relatively easy to change? e.g. If you consistently go to bed too late because you lose track of time, try setting a recurring bedtime alarm on your phone or watch and stick to it for a week. If you are always waking up in a sweat, turn down the thermostat or dress in lighter clothing. These sorts of things may sound obvious, but sometimes we don’t acknowledge the easy tweaks we can do to make sleep come more easily.
3. Implement a bedtime ritual. Make a commitment to set your phone aside an hour before bed, and use this time to read, take a shower, meditate, listen to music, or otherwise wind down. If you find yourself shooting this idea down because you’re too busy, then start with a 10 minute ritual. The ritual is not only meant to help relax you, but to cue your brain that it’s time to fall asleep. It’s a cognitive-behavioral strategy.
4. Free write for 5 minutes before bedtime. This is especially helpful if you struggle with anxiety or racing thoughts at bedtime. Jot down anything and everything that’s on your mind: to-do’s, worries, problems. Tell yourself that you will revisit the list in the morning, but at this point you’ve done all you can for today. Fold up the paper and put it in a safe spot.
5. Choose one of the more complicated interfering factors and begin brainstorming solutions (but not at bedtime). Maybe it’s your alcohol use or your diet… maybe it’s chronic worries about your job or undertreated depression… whatever the “big” or seemingly impossible problem may be, there may be ideas or solutions that you haven’t tried. And if you’re resisting change, it might be worth seeing a therapist to talk through what’s getting in your way.

This isn’t to say that basic sleep hygiene strategies aren’t useful. It never hurts to take a look at the timing and quantity of caffeine consumption, for example. And one of my favorite sleep hygiene suggestions is getting out of bed if you’re having trouble falling asleep. If you are lying in bed getting frantic about how many hours are left in the night, it won’t help to keep lying there for two hours, staring at the clock. You’re better off getting up, putting on some lotion and reading a calming book until you start feeling sleepy again, and then returning to bed.

What works for you? What doesn’t seem to help?