April 16, 2020 - Wellness
Jacob Hess, Ph.D., Executive Director, The Council for Sustainable Healing
“Just get a good night’s sleep.” Oh, how nice and easy that rolls off the tongue! And how easy it sounds to make happen—until you actually try it. Anyone who has tried getting better rest knows this can be surprisingly tricky, especially after a long period of sleeping poorly.
What about those coping with depression or anxiety? Is it possible to improve your quality of sleep even when facing serious emotional struggles?
Surprisingly, yes. As long as you’re willing to be persistent in adjusting and trying new things, you can find sleep improvements that not only help you navigate serious emotional distress, but start to get at one of its most well-known, root contributors. Research consistently finds that both teenagers and adults—especially in the United States—are seriously sleep deprived. So generally speaking, most of us are simply not getting the rest we need.
That’s a big deal! Did you know that after only a few nights of sleep deprivation, laboratory rats start to break down and show signs of serious illness? Humans are not so different. A few nights of poor sleep is more than enough to trigger physical pain, emotional heaviness, and mental cloudiness.
These effects, of course, only multiply with longer periods of sleep loss. Going without sleep has been connected to weight gain, serious disease, and impaired ability to reason and think clearly—not to mention reduced immune function, so important in this time of pandemic. One study at the University of California, San Francisco found a “clear, linear relationship” between infection rates and amount of sleep in the week prior.
For all these reasons, it’s essential then that we make getting better sleep a top priority. If anything is interfering with your sleep, take it seriously because it’s probably messing with your physical and emotional health. One man who realized the role fatigue was playing in his downward emotional spiral told me, “As soon as I notice myself losing sleep over too much work or stress, I drop everything until I restore my sleep-wake cycle.”
As he put it, losing sleep was part of his “recipe for madness.”
That man is not alone. Statistics show 4 out of 5 people had some form of sleep disturbance preceding their first episode of depression. Thus, experts point out, “Anything we can do to improve our sleep can help combat depression [and anxiety] and render these disorder[s] less likely to occur in the future.”
If that’s something you’re interested in, let’s focus on five main areas of adjustments people have found helpful in improving sleep.
1. Design a sleep-friendly routine at the end of your day. One of the most common pieces of advice you’ll hear from both sleep experts and expert sleepers is the value of paying more attention to your end-of-day routine. Our natural tendency, of course, is not to pay much attention to this routine, and then get frustrated when our brain doesn’t cooperate after our head hits the pillow.
Maybe we shouldn’t be so surprised. After all, the complex circuitry throughout the body is intimately connected to the continuous input of our surrounding environment in the moment and the following hours, days, and weeks. Like Google-search algorithms, our bodies can be trained to act in certain ways after months and years of training.
None of this is bad news, though, as long as we recognize it enough to take control and begin to consciously direct the process ourselves. In other words, it’s possible to proactively reengineer conditions to eventually “reprogram” the brain to fall asleep automatically. A good place to start is setting up a physical space conducive to deep sleep. It’s common for people to go years without realizing how the environment of their home—and especially their bedroom—is working against refreshing rest. Even seemingly small details, from the nature of pillows and mattresses to the precise temperature of the room, can make a measurable difference in sleep quality. Keeping the bedroom pitch dark (and not too warm) can be surprisingly helpful.
Next, identify any ways you have accidentally “programmed” your brain to stay awake in the later evening hours without realizing it. The best example of this is bright-light exposure right before bed, which can “trick” the brain into thinking it's still day, even when the sun has gone down. Dr. Stephen Ilardi, an expert in depression at the University of Kansas, reminds people, “The brain won’t allow sleep drive to kick into high gear until it thinks the sun has been down for at least an hour or so.” When people don’t realize this, they “keep the lights on until their head hits the pillow, and then they wind up having to lie awake in the dark for an hour before their brain finally gets the message that it’s time to sleep.”
This helps explain why screen time before bed can leave us a bit wired. Try avoiding other activities potentially interfering with your body’s drift into drowsiness, including scary movies, late-evening exercise, and intense working. It’s also good practice to dim or turn off lights an hour before bedtime so your brain gets the hint.
2. Remove hidden sleep disruptors in the middle of your day. While the last few hours of the night are especially important to your sleep routine, don’t forget what happens earlier in the day. For example, naps are a great option for people who sleep well at night, but for others, naps can significantly disrupt a readiness for eventual sleep.
What we eat and drink (and when) influences sleep, too. For instance, caffeine (with a half-life of four hours) can stay in the body longer than you think. Imagine you have an energy drink with 110 milligrams of caffeine around 2 p.m. when you’re a little drowsy. That means by 6 p.m., you’ll still have 55 milligrams in your body and over 20 milligrams of caffeine at 10 p.m. (which is equivalent to a cup of green tea—enough to disrupt your sleep). While alcohol in the early evening might seem calming, studies often show it interferes with restful sleep.
Better sleep isn’t just about minimizing certain activities or substances during the day, though. So many other things can be increased as a way to improve sleep later on. This includes any kind of physical activity, earlier exposure to bright light, healthier food, social connection, and ways to calm the mind and reduce rumination (the compulsive thinking and mental churning that wears us out).
3. Establish an overall “rhythm” of sleeping and waking. Once you get your evening and daytime “reengineered,” step back and take a look at the overall picture of your sleep-wake cycle. For instance, it’s common for most of us to go to bed and wake up at separate times in a randomly changing pattern. Then, we find ourselves needing to sleep whenever we have a few extra minutes. While these patterns might be normal in society today, this kind of irregularity can be detrimental to those facing depression or anxiety.
As psychiatrist Judith Pentz explains, “We tend to burn the candle at both ends; not go to bed on time and get up really early, and then think that caffeine can help us through the day. It ends up really creating a vicious cycle for the person: not enough sleep, maybe caffeine plus sugar, and the end result being really jangled nerves.”
For those sleeping less during the week and then “catching up” on the weekend, it’s important to realize that “unused sleep minutes” don't roll over (like phone minutes). So, think carefully about what it would take to become more consistent in patterns of sleeping and waking up. A good way to start is beginning to wake up a little earlier each morning, which will naturally start to tug your bedtime earlier.
And for all the night owls out there, let me throw out a little temptation: Even if you get the same sheer amount of sleep every night, there’s good evidence that getting in bed earlier leads to more powerful rejuvenation. If you can reclaim mornings in your life, there’s a strong chance you will feel more alert, energized, and “alive.” On top of that, if you can get up and get to bed at the same time each day, you’re going to start finding a “rhythm,” which —as with all natural cycles—is how the body operates best.
4. Learn to relax a little more. Despite their best efforts, many people fall into the painful rut of insomnia, where sleep simply doesn’t come. The most common advice in this case is to “get up when you’re not sleeping” so you’re not associating the bed with anything other than sleeping. This means reading, texting, watching TV, or eating in bed, which many have found to be helpful.
But there’s another activity that people have a hard time stopping, even when they are completely still. The hamster wheel where the mind churns over and over, ruminating on all sorts of things even when they’re exhausted. The good news is there are learnable ways of stepping out of this hamster wheel, getting “out of your head,” and feeling grounded again.
After learning these soothing practices, you can discover something even more relieving: that even if you don’t fall asleep quickly, lying down in a state of deep relaxation will rejuvenate the body for the next day. After estimating that people can get 88 percent of normal rejuvenation by remaining peacefully calm at night (even if not sleeping), psychologist Bert Karom found that once individuals with insomnia stop worrying so much about being exhausted the next morning, they’re often relaxed enough to fall asleep. (Which makes sense, since it’s typically the fear of not going to sleep that can trigger fight-or-flight stress chemicals that keep us awake).
5. Resolve deeper barriers to sleep. For many people, these first four adjustments are all that is necessary to sleep better. For others, however, there may be undiagnosed sleep disorders that trigger repeated awakening from periodic limb movements. Other medical disorders can also interfere with sleep, especially anything involving chronic pain, allergies, colds, respiratory issues, or the thyroid.
Without people realizing it, many kinds of medications can disrupt sleep as a side effect, including sleep medications, which can cause rebound insomnia on nights they are not used. It’s especially common for medications used for depression and anxiety to disrupt sleep (or cause excessive sleepiness) as a side effect. You can go online and search for “patient reports of sleep problems on [whatever you’re taking]” to research this as a possible factor. And if it’s messing with your sleep, consider adjustments with your doctor to ensure your sleep is free of medication-induced disruptions.
So, let’s get you sleeping better! Hopefully these five adjustments can help you move in that direction. In addition to whatever physical health benefits might occur, the best evidence also shows this will make a difference in reducing depression and anxiety as well.
This article was adapted and expanded from “Getting Good Sleep When You're Anxious or Depressed” –one of the audio lessons in Week 6 of Lift’s online training. Lift is a digital platform available online, and in iOS and Android, to provide additional support to those seeking deeper, more sustainable healing from depression or anxiety.