Resolve to Get 30 More Minutes Of Sleep in 2015

Imagine I told you that I had a new pill I had developed. It would improve your mood and your ability to pay attention. It would reduce your appetite and help you to be more active and lose weight. It would lower your cholesterol, improve your blood sugar, lower your blood pressure, and lower your risk of heart attack, stroke, depression, and attention deficit disorder.

If you took the pill, you would be less likely to get into a car accident, or be injured on the job. If you gave it to your children, they would have similar benefits, as well as improved test scores, better school attendance, decreased impulsive behavior and risk taking, and overall be more pleasant to be around. Moreover, there are no side effects and the cost is zero. Oh, and it will help you live longer.

Interested? Me too. Here’s the great news: these are all benefits of getting more sleep at night.

You may feel like there aren’t enough hours in a day to go to bed earlier, or that you really want to stay up and catch up on that show you’ve heard so much about. I am not suggesting anything drastic: I’m challenging you to get just thirty minutes more a night.

I promise you that you can find the time. For whatever reason, our culture has come to glorify sleep deprivation for teens and adults. However, getting adequate sleep is like a superpower that can make you feel better, be healthier, and live longer.

SuperLéo (boy of steel)
(“SuperLéo (boy of steel)” from AP Photographie  on Flickr. Click the photo to go to the original)

Sleep is a biological function, like breathing. We can only restrict our breathing until we pass out, but we are able to restrict our sleep for lifestyle demands. This has resulted in an epidemic of sleep deprivation in our country. According to the CDC, about 40% of adults are getting an insufficient amount of sleep at night. The results are even worse for high school aged students: 90% of them aren’t getting enough sleep.

Sleepy parket
(“Sleepy parket” from clement127 on Flickr. Click the photo to go to the original)

How to know if you are getting enough sleep:

There are many complicated ways to measure sleep need. I’m going to propose a simple one:

How do you feel in the morning when it is time to get up? Do you wake up before your alarm, or even without an alarm? Do you feel refreshed in the morning? Other than a brief interlude of sleepiness after lunch, do you feel wide awake during the day? Are you getting between 7-9 hours of sleep at night? (Note that the amount of sleep you need may vary from your peers. I feel great with 7.5 hours of sleep; my wife and her sisters need about nine hours). If the answers to all of these questions are yes, you likely are getting an adequate amount of sleep.

My own story:

For better or worse, I’m a bit of a night owl. I really enjoy staying up late and reading, working, exercising, or even gaming online with a group of friends who include a minister, a lawyer, three physicians, and various other professionals. Lately, I’ve noticed that I’ve been staying up later and dragging a bit in the mornings. I get up reluctantly between 6–7 AM in the morning, and I need to caffeinate on days when I commute longer distances. I feel it is time to make a change.

This year, I’m making it a New Year’s Resolution to get 30 minutes more of sleep each night. Will you join me? Many people choose losing weight, exercising more, or improving relationships. Sleeping more will help with all of these goals.

I picked 30 minutes because it is attainable, for me and for you. It may not sound like much, but it is almost an extra half a night of sleep per week, or two extra nights of sleep per month for the average adult.

Throughout the month of January, I’m going to share as many tips as I can think of in a series of brief blog posts on this topic. I hope to have input from some friends as well. Some of them will be applicable to everyone; some will be specific to parents of younger children, or teenagers, or other groups.

Do you want to feel better and less tired? Will you join me on this journey? What is keeping you from getting enough sleep? What has helped you get more? Please comment and let’s start a conversation on this. Use the hashtag #30moreminutes on social media and share your story.

How Children and Adults With Chronic Pain Can Get More Sleep

I first met Dr. Valerie Crabtree several years ago at the Sleep Meeting in Boston after going to a great talk which she gave. Since then she has been a great help to me as I try to learn more about behavioral sleep medicine. Like Dr. Honaker, she is a psychologist. She is knowledgeable about all aspects of behavioral sleep medicine, but her special expertise in helping children with pain, especially pain related to cancer at St. Jude’s. She also has two school aged kids and is constantly finding ways to extend her own sleep (Me too!) I asked her to provide some guidance for both children and adults regarding our goal this month of finding ways to get 30 more minutes of sleep per night in 2015.

09/04 - Worst. Bed. EVAR!
(“09/04 – Worst. Bed. EVAR!” by Erik Ogan on Flickr. Click the photo to go to the original)

People with chronic pain often find it hard to fall asleep. Or, if they fall asleep, they may wake up repeatedly during the night and find it hard to get back to sleep. Research shows that poor sleep actually makes pain worse the next day. In fact, newer research is beginning to show that sleep may affect pain MORE than pain interferes with sleep. Finding ways to protect your sleep can actually make your pain better too! [Bold is mine–CC] Wanting to get better sleep? Try this:

  1. Get physical activity. If you are in pain during the day, you may want to lie in bed because it is more comfortable. This can actually have the opposite effect, though, causing pain, fatigue, and sleep to get worse. For many people with chronic pain, following a physical activity program (as prescribed by their doctor or physical therapist) can improve pain, function, AND sleep. Here is a great post on seven ways to exercise with chronic pain.
  2. Rest somewhere other than your bed. If you DO need to rest because of your pain, try to lie on the couch or a reclining chair and reserve your bed just for sleep. This helps your body learn that your bed is only for sleeping, not just for resting.
  3. Try not to nap. When you are resting, try to stay awake. Napping (especially for a long time) during the day can make it very hard to fall asleep or stay asleep at night.
  4. Plan the timing of your pain medication. If your pain medication makes you sleepy, take advantage of this at night. Take sedating medications just before sleep and ask your doctor for other medication options during the day–those that don’t make you feel like you need to nap.
  5. Use non-medicine treatments to improve pain. These techniques can include progressive muscle relaxation, breathing exercises, and guided imagery. What is nice about these strategies is that they can improve both pain and sleep simultaneously.

Here are some links which may be helpful:
Tips for patients with fibromyalgia
Healthshare tips for getting more sleep with chronic pain

Above I highlighted the critical point– bad sleep makes pain worse, just as pain can worsen sleep. Do you struggle with chronic pain? If not, do you have a child or other family member who does? Please share your advice about what has worked and what has not below.

Terra Ziporyn Snider on Building a Sleep Friendly Community

One of the best parts of writing this blog has been getting to know many people who, like myself, are passionate about the importance of sleep. One of the best champions for healthy sleep in teenagers is Terra Ziporyn Snider. Terra is a mother of three and a successful author. She is a former associated editor of the Journal of the American Medical Association and co-author of The Harvard Guide to Women’s Health.Terra is also one of the founders of Start School Later, a non-profit dedicated to improving the sleep of teenagers.

I’ve been living and breathing this issue on both a personal and professional front for years. However, after working futilely to change the 7:17 a.m. high school start times in my local school system, I came to see that even when schools want to change, they often can’t: politics, money, and myth often trump research, common sense, and the best interests of the kids. I also saw that local efforts alone were largely doomed to repeating failed history if left to fight this battle in isolation. The whole idea of Start School Later, a nonprofit organization dedicated to ensuring safe, healthy school hours, is that we can address this issue more effectively by joining forces among health professionals, educators, policymakers, and community advocates working to raise awareness at local, state, and national levels.
For most of us, even us “sleep evangelists,” sleep often gets bumped to bottom of the priority list. This is partly because we live in a culture that equates sleep with laziness, weakness, and apathy. It is also because sleep itself makes us feel vulnerable and takes us out of the action. But simply reminding ourselves that sleep is not a luxury, but a necessity as vital as eating and breathing, is a great way to bump sleep up on anyone’s list of priorities.
That said, it’s equally important to remember that many of us cannot get close to enough sleep no many how hard we try. This is because not all health matters are under personal control. For example, many people work jobs that conflict with their sleep needs and patterns. Even more troubling are the many adolescents whose school clocks require waking before sunrise. Many middle and high schools today start the day in the 7 am hour, with buses starting as early as 5:15 a.m. – hours that require 16-year-olds to be sound asleep by 8 or 9 p.m. to get the 9 or so hours of sleep that most of their growing brains and bodies need. Even teenagers with impeccable sleep hygiene cannot possibly get close to enough sleep with these hours.
If we want our children – and teenagers are still children – to get the sleep they need for optimal health and learning, we can’t just work on ourselves. We also need to work on our communities to get them to set sleep-friendly, developmentally appropriate school hours. Families should certainly resolve to ensure reasonable bedtimes. But their resolutions will mean little until communities resolve to ensure reasonable wake times.

I would challenge you to think about how can you change the culture in your community to make sleep a priority, and not an afterthought. If you are a manager, make sure that you have sleep friendly policies for your employees. Model good sleep behaviors (like getting 30 more minutes of sleep every night) for your friends and your family, especially your children. I would love to hear your ideas on how to make sleep a priority in your community, and in our culture.

Manage Your Mornings: Sarah Honaker on Maximizing Sleep

Breakfast Propulsion
(“Breakfast Propulsion” by Stéfan. Click the photo to go to the original)

I’m really excited that Dr. Sarah Honaker has agreed to provide some great advice on how to get 30 more minutes of sleep every day in 2015. I met Sarah last summer at the AASM meeting in Minneapolis. She was the course director for a terrific section on behavioral sleep medicine in pediatrics, and I furiously took notes during her lecture. She is a clinical psychologist at Riley Children’s in Indianapolis where she has behavioral sleep clinics. She also the mother of two girls age three and six, which is an important part of any sleep doctor’s training. Her post is on the importance of morning planning in getting enough sleep at night.

Although a lot of sleep advice tends to focus on getting to bed earlier, it’s sometimes easier to control the time that we wake in the morning, assuming we don’t have early rising little ones at home. This is particularly true for adolescents and young adults, who tend to operate on a delayed sleep phase (meaning that biologically they are prone to go to bed later and sleep later). Here are some tips for extending your morning sleep:
Limit morning activities to whatever is absolutely necessary. You might shower in the evening, prepare the clothing and items you will need the night before, and eat a simple breakfast.
Don’t “snooze.” Get out of the habit of setting your alarm for earlier than you actually need to wake up. The sleep you obtain in the seven minutes between alarms is generally light sleep.
Encourage younger children to be independent in the morning, when developmentally appropriate. The OK to Wake alarm can be used to teach younger children who cannot tell time when they are allowed to get up for the day. Before the alarm turns “green,” they can read books in bed or play quietly in their room, which means that mom or dad can sleep a little longer.
Take your kids to school, especially middle and high-schoolers. Long bus rides mean even earlier wake times for kids. If you can drive them or arrange a car pool, those extra thirty minutes can make a big difference.
Advocate for later school start times. Research over the last decade has consistently found that teens sleep more and function better when schools start later.
One caveat: be wary of too much weekend oversleeping. While some weekend oversleep (1–2 hours) may be restorative, particularly for those who have to wake extremely early during the week, sleeping too late on weekends usually results in less sleep during the week.

Personally, I have to leave for my clinic in Norwalk at 6:30 AM on Monday mornings. I have found that preparing the night before really helps me get out the door. Specifically, I shower, prepare the coffeemaker and breakfast, put out my clothes, and lay out everything I will need to take with me. If I don’t do this, it takes me about 15–20 minutes to get out the door, as I am blearily looking for the coffee grinder or (on more than one occasion) pouring orange juice into my granola. A carefully planned morning routine helps me minimize friction and decision fatigue before I start my day.

Do you plot your mornings to maximize your sleep? If so, what has worked for you in the past?

“Tune Out Before You Tuck In”: Dennis Rosen on Mindfulness and Getting More Sleep

(“Elu” by Harry Koopman on Flickr. Click the photo to go to the original)

As part of my New Year’s Resolution to get 30 more minutes of sleep a night in 2015, I have been asking friends and colleagues to contribute ideas on how to achieve this. I’m really pleased that Dennis Rosen has agreed to help out.

I’ve known Dennis for about ten years now. He was a bit ahead of my in training in Boston. He has been an invaluable resource through my sleep training and afterwards. Like me, he is a pediatric pulmonologist and sleep physician. He is also an accomplished author who writes for the New York Times and Psychology Today, among other publications. He has written a terrific book for parents on sleep issues called :Successful Sleep Strategies for Kids (Harvard Medical School Guides)
. His most recent book is called Vital Conversations: Improving Communication Between Doctors and Patients
and has been published to great acclaim. Here’s Dennis’s advice on how to get more sleep at night, which is applicable to both kids and adults. :

Many are familiar with the concept of sleep hygiene, namely, making your sleeping environment more conducive to sleep. This includes taking steps such as removing the television, computer, and smartphone from the bedroom and keeping the bedroom dark, quiet, and at a comfortable temperature.

As important as maintaining good sleep hygiene is, however, it doesn’t address the mental state of the person in the bedroom. It’s really hard to fall asleep when your head is full of racing thoughts, and diffcult to shut them off just because the clock (or your parents) tell you it’s time to go to bed.

One way to overcome this is to include mindfulness practice as part of getting ready for bed. This can be done through breathing exercises, yoga, or guided imagery. There are many recordings available commercially and on YouTube that can be used to guide you or your child through the process. By focusing on being present, instead of on what just happened that day, or on what needs to happen tomorrow, it can become much easier to clear one’s mind, relax and ultimately to fall asleep faster.

I have intermittently tried to incorporate a mindfulness practice into my daily routines. My difficulty is that my best opportunity for this is at the end of the day when I’m tapped out. Many advocates of mindfulness recommend practicing first thing in the morning, but this is next to impossible when my kids are my alarm clock. I think that “powering down” the brain at bedtime is as important as turning off your cell phone.

Dennis recommends this workbook (Insight Meditation Kit (Step-By-Step Course on How to Meditate)) as a good place to start. I also like this article from the Harvard Business Review on the value of meditation. Finally, I met a yoga teacher the other day who recommended that breathing in for a count of four, holding for a count of seven, and breathing out for a count of eight may be a useful way to settle the mind before bedtime.

Do you use meditation or another mindfulness practice in your daily routine? Do you think that it helps with your sleep?

Put that Smartphone Down! A Key Step in Getting More Sleep

This month I’m soliciting advice from my friends and colleagues on how to get 30 more minutes of sleep a night in 2015.

I’m pleased to start with advice from Dr. Meir Kryger, who is a legend in the sleep community and a strong advocate for improving sleep in everyone from infancy through adulthood.  He is a full professor here at Yale and I’m pleased to call him a friend and mentor. Here is his advice for improving your sleep:

It is 11:30 pm. You are on your computer responding to emails, paying bills, doing work, Tweeting, posting on Facebook and/or LinkedIn. You realize that you need shut-eye because you have to get up at 6:30 am. You get ready for bed. It is now midnight. Your smartphone is on your nightstand. You are lying in bed. Eyes wide open. You are too wound up to sleep. What happened?

In my book, The IGuide to Sleep, I have have 13 commandment to help people sleep better. Number 3 reads:

“3. Avoid any activity that might cause your brain to be excessively aroused before going to sleep. That means no arguments, no discussions about money or major problems, and no exciting TV or books. Avoid any vigorous activity for 4 to 5 hours before bedtime bed (however, sex seems not to present a problem). Turn smartphone off.”

Excerpt From: Kryger, Meir. “The iGuide to Sleep.” v3.6. Meir Kryger, 2014. [You can find this for iBooks (in a really cool interactive version) or for Kindle here.

My advice is to give yourself a TIMEOUT from anything that arouses your brain for the hour before you intend to fall asleep. When your brain is aroused, there is a burst in chemicals that stimulate the brain, and it takes time for the level of these chemicals to drop. Also, the light from electronic screens may suppress the brain’s production of melatonin making it more difficult to sleep. The smartphone on your nightstand may beep or chirp all night as notifications of incoming Tweets and emails (usually spam) in the middle of the night.

If you are reading this in bed, turn off the device!

To me, both personally and professionally this is very germane. Going on a light diet at night is probably a great idea to help you sleep better. There is recent research to suggest that ebook readers which emit light disrupt your sleep. Another recent study showed that elementary school age students with smartphones in their room got less sleep, even when compared with children who had televisions. And you know my feelings on televisions in kids’ rooms.

I have a hard time winding down at night and it always tempting to read a few tweets, update Zite, or check on friends on Facebook. This is compounded by the fact that I use my phone as a back up for my pager for call for the sleep lab. Wendy Sue Swanson and I have both implemented automatic “Do Not Disturb” on our phones from 10pm-7am which has helped a bit.

I’m going to try to put the phone down by 10 PM. Do you think your phone disrupts your sleep or keeps you up? How have you managed this? Join me to make getting 30 more minutes of sleep a reality in 2015. 

Notes for Guilford School Board Meeting

Tonight I am speaking at a meeting to discuss school start times in Guilford. I firmly believe that our high school start times are too early (7:25 AM) and that this results in chronic sleep deprivation in our teenagers. Structural sleep deprivation is a significant problem for teenagers which results in less than 10% of students getting an adequate amount of sleep nationwide. We know that later school start times have many benefits; perhaps the most pressing of which is preventing car accidents and saving lives.

Here is a copy of the slides which Craig Mullet and I are presenting:

GPS Start Times Jan 7 Presentation

Here is the report commissioned by Fairfax County. This is the best information availability on the experience that various school districts have had moving their school start times later:

Change School Start Time Report Fairfax

Here are the American Academy of Pediatrics recommendations and technical reports on recommending later school start times:

“Insufficient Sleep in Adolescents and Young Adults: An Update on Causes and Consequences” by Judith Owens. “School Start Times for Adolescents”, by the Adolescent Sleep Working Group and Committee on Adolescence, and Council School Health

“Insufficient Sleep in Adolescents and Young Adults: An Update on Causes and Consequences” by Judith Owens.

And finally, here is a terrific link addressing myths, misconceptions, and concerns about school start times.