Sleep Q&A: Why You Should Sleep On It + More

Q&A with Lara Trevino, AGNP-C, MSN

Our primary care provider, Lara Trevino, AGNP-C, MSN, led a webinar recently on the importance of sleep, particularly during this period of quarantine. She also wrote an article, Five Ways to Improve Your Sleep During and After COVID-19 Quarantine, which provides tips on how to evaluate and reflect on daytime and nighttime habits that influence the quality and quantity of your sleep.

During the webinar, Lara addressed a host of great questions from our members. So many that we felt another article was in order.

“The old adage says, ‘You should sleep on it,’ which is true, because it’s been shown that sleeping helps with problem solving in both personal and professional relationships.”

– Lara Trevino, AGNP-C, MSN

Q: Are there any food and drinks recommended for a good night’s sleep?,

A: Ideally, you should not eat anything within three hours of sleep. Avoid water an hour before bed so you do not have to wake up to urinate. When you go to sleep, your gastrointestinal system does its housekeeping. Housekeeping waves that start in the stomach move to your small intestine to sweep out debris and bacteria into your colon when you are asleep.

Consider the nutritional perspective: If you had a balanced dinner, you are adding additional calories during a time when your metabolism is slowest. If you are still hungry before bed, you likely did not have a satiating dinner. A hunger-busting meal contains healthy fat, fiber, and protein. You can speak with a provider to discuss how to bulk up your dinner to feel satiated and satisfied. 

Consider the gastrointestinal perspective: When you eat, your digestive system has to digest food instead of going through the nightly housekeeping. Your stomach cooks up acid that is enough to break fatty foods and late-night snacks like ice cream. When you lie down, your stomach acid is hammering away on food without the assistance of gravity. A seemingly harmless warm glass of milk curdles in your stomach giving your body more work to do when it would rather be sleeping. Alcohol is particularly problematic because it relaxes the door of your stomach to your esophagus so you are more likely to get gastric reflux causing unpleasant awakenings.  

Q: Could you walk me through a healthy nighttime routine?

A: Below is an example of a healthy evening routine for the bear chronotype. According to sleep specialist Dr. Michael Breus, the bear chronotype makes up 40-55% of our population. Bears are most productive from 11 am – 6 pm and fall asleep around 11 pm.  Feel free to contact a provider to customize a routine that works for you.    

8:00 – 9:00 pm: Enjoy your screen time, group chats, Netflix binges, Instagram, TikTok, whatever you like. At 9 pm, cut off screens. If you must use a screen, wear blue light blocking glasses. Remember that blue light decreases your natural melatonin levels, making your body think it is in an earlier time zone than it is.

9:30 or 9:45 pm: 15-30-minute meditation. Recommended guided meditation apps such as Headspace, Peloton, and Buddhify. Haven’t meditated before? Start with five minutes a few times a week then move up from there.

10:00 pm: Take a warm shower or bath. Put on cream like CeraVe or La Roche Posay directly afterward so your skin locks in moisture. Do your bedtime ritual as advised by Dr. Noelani Gonzalez, our dermatologist.

10:30 pm: Read a physical book. Need ideas of what to read? Consider Amazon’s or New York Times best sellers. Want something lighter with plot twists? Consider Reese Witherspoon’s Hello Sunshine Book Club. 

11:00 pm: Fall asleep for a 7 am wake up.

Q: How long does it take for your body to develop a sleeping routine?

A: It is highly individualized. The best way to get into a sleep routine is waking up at the same time in the morning and going to bed the same time at night seven days a week. After a week, evaluate the quality of your sleep. Does the start or end time need to be moved up or down? Change accordingly.

Q: My partner is restless in bed and it messes with my sleep. Any advice on how to fix that?

A: First, to be a supportive partner, help your partner figure out what is hampering his or her sleep. Sleep hygiene requires a heavy dose of self-reflection and experimentation to identify what works.

Second, figure out a healthy boundary for both of you. Consider what you need for your own sleep hygiene and discuss it with your partner. If you feel hesitant to speak to your partner about it, evaluate why you feel hesitant and address that too.

To help your partner figure out how to improve his or her sleep hygiene, use the following factors.

Sleep Environment
Is your room 68 degrees or below? Do you have black out curtains and draft/noise/light blocker beneath the door? Would a white noise or rainfall machine be helpful? If you took a picture of your partner with their head on a pillow, is their neck aligned with their body and comfortable? Do your sheets keep you cool? Is there a sweet child or pet in bed unintentionally disrupting the peace?

Mental Health
Has your partner identified an effective and repeatable wind-down routine? Are anxious or depressive thoughts ruminating? Has social distancing loneliness or lack of connectedness crept in? Has it contributed to substance use that is disrupting the quantity and quality of sleep? How are you spending your alone time? Are you starting or renewing hobbies that keep your brain occupied in positive ways? Studies show that feelings of social connectedness are strengthened by not only relationships with close friends but also reaching out to weaker ties like your college buddies you have not caught up with in ages.

Medical Considerations
Does your partner snore and maybe have sleep apnea? Is your partner suffering from urinary frequency that is keeping them going to the bathroom? Are you eating a big meal before bed and it is still digesting? Remember that Adderall is a stimulant that can keep you awake. Are there new side effects of medications or herbal supplements? Are tight muscles making it hard to sleep in your go-to comfortable position? Want an insomnia fighting yoga routine? Check out yoga for insomnia by our physical therapist, Shraddha Bhatia, PT, DPT.

Chronotype
Is your partner a night owl on an early bird’s schedule? What daytime schedule changes can be made to accommodate your partner’s genetically determined sleep schedule? For more on chronotype, see my webinar on sleep hygiene. 

Lifestyle considerations
My father is a 13-time marathoner. To his befuddlement, I will choose pilates, boxing, or yoga over running any time. If an exercise works for someone else, it does not mean it will work for you. Keep trying different exercise routines until you find one that you look forward to. That could mean figuring out which instructor you like and following them. It could mean curating a motivational playlist and identifying YouTube exercises that you enjoy. Also, consider caffeine and alcohol use and timing relative to bed.

Q: Is it possible to train yourself to wake and sleep at certain times or is it predetermined that I will either be a morning or a night person?

Your circadian rhythm and chronotype are genetically determined. Your most restful sleep will align with your natural rhythm. There is about a 30-45-minute flexibility window so if you are already a morning person this may work. If not, it will be likely that you will continue to feel jet lagged.

Q: Should I take melatonin?

Melatonin is like the start gun for recruiting sleep chemicals to go to sleep but is not involved with sleep itself. Melatonin is helpful when changing time zones. For young, healthy patients, studies show that melatonin does not reliably work. The placebo effect is one of the most common effects in pharmacology. If you feel like melatonin is working for you, it is low risk so feel free to keep taking it.

Q: What about napping?

Throughout the day, your body is building up a sleepiness chemical called adenosine. Your body’s goal is to have enough adenosine by the time your head hits the pillow to sleep soundly for the whole night. When you nap, imagine some of your adenosine leaking out like a pressure valve. If you can nap regularly for about 10-20 minutes then your body will release some adenosine and keep enough for a full night’s sleep. If you are an irregular napper or nap longer than twenty minutes your body may not have enough adenosine for both the nap and your sleep. That means you do not have enough adenosine at night for uninterrupted rest.

Patients who nap irregularly may feel like they are making up for a sleep debt. Your body does not work on sleep credits or debits. New mothers may feel that their night owl ways have changed and now they can fall asleep at 8 pm. If you fall asleep earlier or absolutely need a nap, then it is more likely that you are sleep deprived. A nap will increase your reaction times but will not provide restorative functions of a regular night of sleep.

In short, figure out when your energy levels naturally increase and dip. Think about why you are taking a nap – are you exhausted from a lack of sleep or are bored? Plan appropriate activities while your energy level is naturally lower like yoga, a walk with your dog, or tedious chores: laundry, cleaning, or reviewing your credit card bills for errors.

Q: Why do I have crazy dreams?

A: Dreams occur during your REM sleep, which is largely the second half of your eight-hour slumber. Based on MRI analyses, neuroscientists have found that the prefrontal cortex (the part of your brain responsible for managing logical thoughts and decision making) is turned off during the dreaming state REM sleep. During REM sleep, there is a strong activation in emotional, visual, and autobiographic regions of the brain. REM sleep is for emotional regulation, creativity and problem solving.

Neuroscientist and sleep specialist Dr. Matthew Walker hypothesizes that REM sleep helps people digest and cope with painful memories. In his book, Why We Sleep, Dr. Walker invites you to think back to your childhood memories. Some of the clearest memories are of an emotional nature. The memory is no longer accompanied by the same fear you had during the experience. You remember the memory but have discarded the emotional charge thanks to REM sleep. If REM sleep did not perform this function, people would likely suffer from chronic anxiety and relive the same emotional charge as first experienced.

Feel free to send me a MyChart message through the member portal if you want any support to identify how to improve your sleep.

Interested in learning more about sleep? Many of these answers are from sleep specialists and neuroscientists Dr. Matthew Walker and Dr. Michael Breus. A good book to understand the science and importance of sleep is Why We Sleep by Dr. Matthew Walker.

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