Five Ways to Improve Your Sleep

During and After COVID-19 Quarantine

by Lara Trevino, AGNP-C, MSN

View Lara’s recorded webinar with extended Q&A.

If there is a silver lining to the coronavirus pandemic, it is that people are more motivated than ever to try to strengthen their immune system and live a healthy lifestyle. Our current circumstances may make it difficult to follow all of the advice, but seeking the information out and wanting to improve your habits is an essential first step that will likely start to influence your everyday routine. 

To strengthen your immunity, focus on:

• Minimizing stress
• Eating nutrient rich foods
• Exercising regularly
• Getting adequate sleep

Sleep is often overlooked, but is essential to a healthy immune system.

Sleep deprivation can decrease disease-fighting antibodies and affect how quickly you recover if you get sick. The American Academy of Sleep Medicine recommends at least seven hours of sleep per night. Now that many people are working from home, it is a good time to evaluate sleep hygiene and develop a routine that will benefit you post-quarantine. 

The most common sleep hygiene tips include:

• Decrease your blue light exposure (screen use) before bed
• Keep your room cool, comfortable, and quiet
• Use your bed only for sleep and sex

But let’s dive deeper. 

Below are five tips to help you evaluate and reflect on daytime and nighttime habits that influence the quality and quantity of our sleep. 

1. Recognize and replicate your body’s ideal time to go to sleep and wake up
2. Consider your sensitivity to caffeine
3. Consider your sensitivity to alcohol
4. Identify stress triggers and extinguishers
5. Find exercise you enjoy and look forward to

For best results, grab a pen and write down your answers to the reflection questions below to identify where you are doing well and where you could improve.

1. Recognize and replicate your body’s ideal time to go to sleep and wake up.

Reflection question: When was the last time I slept continuously and woke up feeling rested? What parts of the day do I generally feel a boost or a dip in energy levels?

The most restful sleep aligns with your circadian rhythm, or your brain’s 24-hour internal clock that cycles between alertness and sleepiness at regular intervals. Your circadian rhythm changes with age so the sleeping hours that were effective ten years ago may not be the same effective hours today.

You have to figure out your rhythm: how many hours of sleep you need and the optimal timing of the hours. Some patients feel rested with seven hours of sleep, some need eight hours and others might feel more tired if they do sleep eight hours. Early birds like to be asleep around 10 pm and wake up around 6 am. If an early bird gets seven hours starting at midnight, they will not feel as rested. Night owls go to sleep by midnight and wake up at 8 am. Both options are highly personal and restorative.

No matter the number, to realistically obtain at least seven hours you must plan and prioritize it. That means planning 30-60 minutes of a wind-down activity like a bath, yoga, reading, or journaling. It could also mean telling your loved ones about your plans so they can support your efforts for better sleep. Feeling rested decreases irritability and increases empathy which improves personal and professional relationships.

It is important to monitor your energy throughout the day. Does your circadian rhythm sleepiness cycle kick in between 1 and 3 pm? Is it altered by caffeine or medication? If so, how? Consider scheduling a mid-day routine that restores your energy instead of beating yourself up for not being productive. A walk outside increases your bright light exposure during the day and improves the quality of sleep and duration at night. After restful sleep, you are more productive during your waking hours.

Make small incremental changes to your daytime and bedtime routines until you find the schedule that consistently makes you feel rested. For optimal results, keep this schedule on weekends too.

2. Consider your sensitivity to caffeine

Reflection question: How much caffeine am I drinking now and how does it impact my sleep/wake cycle?

Caffeine is metabolized by an enzyme CYP1A2 in the liver, then is excreted by the kidneys. Caffeine is soaked up into the intestines to the blood that then travels into the brain. The half-life of coffee is five to seven hours. That means if you drink a cup of coffee at 1 pm then half of the caffeine is eliminated by 6 to 8 pm and half of it is circulating through your body when it is time for you to go to bed. A quarter of it is still working as if you drank a quarter cup of Starbucks at midnight.

In your brain, a sleepiness chemical called adenosine has been building up all day in preparation for sleep as soon as your head hits the pillow. Caffeine reaches the brain and binds to the adenosine receptors to prevent sleepiness and prolong wakefulness. Studies show that when people drink caffeine six hours before bed it decreases total sleep time by an hour. The cumulative effect of sleep deprivation has detrimental effects on daytime productivity.

Genetics also play a large role in how sensitive you are to caffeine. If your CYP1A2 enzyme is highly active, then you metabolize caffeine quickly, shortening the half life so less caffeine is circulating in your body keeping you awake. If your CYP1A2 enzyme is slower, you metabolize caffeine at a slower rate; caffeine hangs around longer and results in prolonged wakefulness. If you are more sensitive to caffeine, try moving up your last dose of caffeine and see how it impacts your sleep.

CYP1A2 activity tends to decrease with age. The same cup of joe or black tea in your forties will feel stronger than it felt in your thirties. Women typically have lower CYP1A2 activity than men. Estrogen can slow down activity of CYP1A2 thus birth control use and pregnancy can make women more sensitive to caffeine. Consider how much caffeine you are drinking, the time of the day you are drinking it and how it impacts your sleep/wake cycles. 

Some food for thought. Below are some caffeine averages. The Mayo Clinic recommends no more than 400 mg of caffeine daily.

3. Consider your sensitivity to alcohol

Reflection question: How much alcohol am I drinking now that it is more readily available? Am I using alcohol instead of other coping mechanisms? How is my sleep after I drink?

The impact alcohol has on sleep is often misunderstood. Alcohol acts as a sedative. It works on the same receptors of your brain as sleeping pills. Alcohol relaxes your brain so after a nightcap it may feel like you fall asleep sooner but you actually lose consciousness sooner. Alcohol changes the architecture of your sleep so you wake up more frequently. The awakenings are short so patients often do not remember them. The awakenings fragment your overall sleep so that you spend less time in the deepest, most restorative sleep (REM sleep). When you wake up the next morning you do not feel as refreshed due to the decreased restorative sleep. Many patients then rely on caffeine to feel awake; this can be a vicious cycle.

Remember that a serving size of alcohol is 12 ounces of beer with 5% alcohol, five ounces of wine that is 12% alcohol or 1.5 ounces of liquor which are 40% alcohol. If you have a generously sized wine glass, consider how many servings of five ounces of alcohol are poured. Some patients would do well to think about alcohol in terms of dessert. They would be more hesitant to have three to five slices of cake per night multiple nights per week.

4. Identify stress triggers and extinguishers

Reflection question: What makes me feel stressed? What coping mechanisms do I use when I feel stressed? Does my current evening routine relax me?

Some patients have a laundry list of items that make them feel stressed. For other patients, it is not so clear; they just know they are stressed. If you fall into the latter category, take inventory throughout the day of how your body feels. You may find it easier to identify physical indicators and then trace it back to a stressful conversation or event. Some common physical indicators include neck pain, back pain, digestive issues, appetite changes, a clenched jaw, increased heart rate, headaches, changes in libido, or insomnia. When you see a busy day in your calendar, set an hourly reminder in your phone to check in with yourself in a systematic way. Write down your stress level from 1-10, what you are thinking about, and results of a 30 second body scan starting at your head and moving down to your toes to identify where your body is holding tension.

Once you identify the cause of your stress, consider the coping mechanisms that are in your toolbox. The sun exposure and exercise of a mid-day walk has proven to increase quality of sleep. A five-minute Zoom chat with a coworker deflates pent up stress and strengthens feelings of social connectedness leading to a shorter, easier evening wind-down. Engage your mind in an activity that involves a different part of your brain. The process of making art decreases levels of anxiety regardless of talent level and if you think the end result is good or bad. Some patients find themselves picking their guitar back up from college, teaching themselves how to paint, or enjoying a comedy. 

If you are feeling overwhelmed and want to increase the tools in your toolbox, one of the most effective psychological tools for reducing anxiety, depression, and insomnia is cognitive behavioral therapy (CBT). CBT is short term, talk therapy that teaches patients to find new ways of addressing difficult situations by changing their thought patterns. If you are interested in virtual CBT, contact our practice to schedule an appointment with our psychologist, Molly Sherb, PhD.

5. Find exercise that you enjoy and look forward to

Reflection question: When did I last enjoy exercise? Are there any streaming classes I can do at home?

Remember that any exercise is better than no exercise. The American Heart Association advises 150 minutes of exercise per week for cardiovascular benefits. In an ideal world, that means 30 minutes a day, five days a week. Exercise reduces stress cortisol levels and relieves anxiety. Exercise reduces daytime sleepiness, decreases the time it takes to fall asleep, and increases the quantity of time spent in the deepest, most restorative sleep. Mind-body exercises like yoga help muscles relax, decrease cortisol levels and reduce blood pressure. One important caveat: avoid vigorous exercise one hour before bedtime as it results in poorer quality of sleep.

Consider if you enjoyed a boxing, pilates, or yoga class at a studio that is now streaming videos. Also consider that there are many platforms streaming free videos for the next three months. Think about the time of day that it would be easiest to stream a workout. If you are restarting a workout plan, think about the classes you want to stream two or three times a week. Variety increases sustainability and prevents boredom and overuse injuries. 

Also consider if there are any other reasons you may not be exercising. Is an injury flaring and bothering you? Do you feel your stride may be off or that your running shoes do not support you appropriately? Want a personalized yoga wind-down routine? Schedule a telemedicine visit with our Director of Physical Therapy, Shraddha Bhatia, PT, DPT who is also a certified yoga instructor.

Still having trouble identifying the culprit for poor sleep? 

Keep a sleep diary and review with one of our providers via a telemedicine consult. We can listen to your symptoms, review any medications and medical conditions that could be causing insomnia. We can work together to problem solve for healthy, sustainable sleep.

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