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How to restore and maintain a healthy sleep pattern?

How to restore and maintain a healthy sleep pattern?


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Background: Some people over holiday periods or weekends get into sleep patterns that involve waking up very late in the day (e.g., 1pm), and then going to bed quite late (e.g.,, 4am). Such people can find it very difficult to bring back their sleep pattern to be in line with more regular day time rhythms (i.e., waking up between 6am and 10am). When earlier wake-up is attempted, this can result in feelings of fatigue and low mood. Such attempts can even fail, when the person sleeps through the alarm clock.

General questions:

  • How can a sleep pattern be effectively re-aligned with normal day time rhythms?
  • What are effective strategies for maintaining a regular sleep pattern?
  • Is there any specific research on what strategies work best?

Yang et al. (2001) study this exact question. They administered 6 mg of melatonin on Sunday afternoon to subjects that had delayed sleep-wake schedules for the two prior days. They found that

On Sunday, melatonin administration increased the sleepiness throughout the evening and reduced sleep onset latency at bedtime. On Monday morning, subjective sleepiness was decreased in the melatonin condition.

Kolla & Auger (2011) deal with resetting the internal clock for jetlag and night shift workers. Even though the situation is not identical, I think their main recommendations for adjusting the internal clock are relevant:

Exposure to bright light in the hours leading up to the patient's minimum core body temperature tends to push the internal clock later in time, whereas bright light in the hours immediately afterward pushes the clock earlier in time.

(minimum core body temperature is usually 2-3 hours before wakeup time). So in other words, in order to re-align from wakeup at 1pm to 6-10am one should wake up as early as possible, and go out to be exposed to sunlight (or use an artificial light source).

They also discuss the use of drugs such as melatonin and caffeine.

References

  • Yang, C. M., Spielman, A. J., D Ambrosio, P., Serizawa, S., Nunes, J., & Birnbaum, J. (2001). A single dose of melatonin prevents the phase delay associated with a delayed weekend sleep pattern. Sleep, 24(3), 272-281. Full text PDF
  • Kolla, B. P., & Auger, R. R. (2011). Jet lag and shift work sleep disorders: How to help reset the internal clock. Cleveland Clinic Journal of Medicine, 78(10), 675-684. Full text.

(1) Re-aligning sleep pattern

In addition to Ofri Raviv's answer (get sunlight), I would like to stress that the only way to re-align your sleep pattern is to get up at the time you want to get up, and keep getting up for as long as it takes for your pattern to re-align, no matter how tired you are. Because, as soon as you give in and sleep longer, you re-inforce the "late" pattern you want to overcome. You will be tired for a day or two, because you didn't manage to get to bed in time, but this tiredness will enable you to go to bed earlier on the following evenings. All you have to do it go to bed when you feel sleepy.

Tiredness is a great help in building a new sleep routine, and sleep restriction (so you are tired enough to actually sleep) is a regular part in many behavioral therapies of sleep disorder. Because one fundamental problem in sleep disorders is that people spend to much sleepless time in bed, causing them to want to sleep in in the morning. When you go to bed, you want to be tired enough to fall asleep immediately, so that you get at least five hours of undisturbed sleep. But always keep your wake-up time, and work at the go-to-bed time end of your sleep cycle.

Also, avoid computer and television monitors in the evening, because they have the same effect as sunlight and will tell your body that it is still day and you should be active. So, get sun (and computer screens) in the morning, as Ofri Raviv wrote, and avoid them in the afternoon and especially evening. Sleep with the blinds open, so the morning sunlight helps wake you. An open window and fresh air will also help you feel less groggy in the morning.

(2) Maintaining a regular sleep pattern

The answer is already given in the question. As simple and tautological as it may seem, a regular sleep pattern can best be maintained by maintaining a regular sleep pattern. Behavioral therapy for children and adults with sleep disorders includes one fundamental rule, which is to go to sleep and wake up at the same time every day. No surprises there.

So, the best idea would be to not party so late that you need to sleep more than two or three hours longer than regular, and not for more than one night per week. If you need to party, you better don't go to bed at all or get up at your regular time, no matter how short your sleep was, and got to bed at your regular time (or a bit earlier) on the following evening. This will minimize the disruption. The important part is that you get up regularly on the next day.

Source:

Witnessing sleep therapies in our local psychotherapeutic day clinic.

Short introduction to behavioral sleep therapy at Wikipedia:

http://en.wikipedia.org/wiki/Cognitive_behavioral_therapy_for_insomnia


I've read that avoiding eating for 12+ hours and then eating breakfast helps reset your sleep pattern to wake up before that breakfast on subsequent days. I tried tat, and it seems to help


Liver Health

Like the rest of your body, your liver — your largest internal organ — is attuned to a certain rhythm that varies with the time of day. For example, the liver produces the most cholesterol in the evening hours. Being behind on sleep can throw off this rhythm, making it less able to efficiently carry out functions like detoxifying, breaking down adrenaline, and managing blood sugar levels. “It doesn’t respond well when the liver clock is desynchronized,” Twery says. Yet another reason to get your rest tonight.


Why Is Sleep Important?

Many people are unaware of how essential it is to get a good night’s sleep on a regular basis. When work or school deadlines arise, many consider staying up late or “pulling an all-nighter” an efficient way to get everything done.

However, studies show that this is the worst thing you can do—skimping on sleep can cause concentration problems, drowsiness, and irritable moods that affect the way your work is delivered the next day.

For example, a student may decide to drink coffee and stay up all night to “cram” for a test. While this approach may offer more hours for studying, the detrimental effects of sleep deprivation will likely impair her performance on the test the next day.

What else happens when you don't get the sleep you need?

Short-term health impact

Sleep is such an important part of our lives that its effects show up quickly when we don’t get enough of it. Getting too little sleep for just one night can:

Increase stress

Disturb mood

Impair ability to concentrate

Long-term health impact

Some people might say that it’s a fair trade-off to skimp on sleep now and then, saying that a day or two of tiredness and crankiness is worth the extra time they earned. But while returning to a regular sleeping pattern can restore the negative short-term effects of one night of poor sleep, the long-term consequences of regular sleep deprivation that arise under the surface are much more dangerous. Long-term effects of poor sleep include:

Heightened risk factor for diabetes

Increased risk for breast cancer

High blood pressure

Decreased immune function

Major depression

Obesity

Impact on relationships

The consequences of poor sleep extend far beyond personal health—they can also affect our interactions with others. At the 2013 Society for Personality and Social Psychology (SPSP) annual meeting, scientists from UC Berkeley presented new research suggesting that inadequate sleep can impair our ability to appreciate our partners and loved ones, which can lead to stress and tension in the relationship. The SPSP reports that less sleep means fewer feelings of gratitude and higher levels of selfishness, both of which can make a partner feel unacknowledged and underappreciated.

Financial and economic impact

On a broader scale, poor sleep can have costly and often tragic consequences for society.

  • The U.S. Department of Health & Human Services estimates that chronic sleepiness has cost the nation $16 billion in healthcare expenses each year.
  • The same study found that poor sleep costs an estimated $50 billion in lost productivity annually.
  • Insomniacs lose 11.3 days of productivity a year, costing companies $2,280 per person.
  • According to the National Highway Traffic Safety Administration, drowsy driving causes 100,000 car crashes each year, costing about $12.5 million dollars annually.

Beccuti, G., Pannain, S. (2011). Sleep and obesity. Current Opinion in Clinical Nutrition and Metabolic Care14(4):402-12.

Bromley, L.E., Booth, J.N. 3rd, Kilkus, J.M., Imperial, J.G., Penev, P.D. (2012). Sleep restriction decreases the physical activity of adults at risk for type 2 diabetes. Sleep 35(7):977-84.

Buxton, O. M., & Marcelli, E. (2010). Short and long sleep are positively associated with obesity, diabetes, hypertension, and cardiovascular disease among adults in the united states. Social Science & Medicine, 71(5), 1027-36.

Cappuccio, F.P., D'Elia, L., Strazzullo, P., Miller, M.A. (2010). Quantity and quality of sleep and incidence of type 2 diabetes: a systematic review and meta-analysis. Diabetes Care 33(2), 414-20.

Franzen, P.L., Gianaros, P.J., Marsland, A.L., Hall, M.H., Siegle, G.J., Dahl, R.E., Buysse, D.J. (2011). Cardiovascular reactivity to acute psychological stress following sleep deprivation. Psychosomatic Medicine 73(8), 679-82.

Fraser, M., Conduit, R., Phillips, J.G. (2013). Effects of sleep deprivation on decisional support utilisation. Ergonomics 56(2), 235-45.

Goel, N., Rao, H., Durmer, J., Dinges, D.F. (2009). Neurocognitive consequences of sleep deprivation. Seminars in Neurology 29(4): 320–339.

Guo, X., Zheng, L., Wang, J., Zhang, X., Zhang, X., Li, J., Sun, Y. (2013). Epidemiological evidence for the link between sleep duration and high blood pressure: A systematic review and meta-analysis. Sleep Medicine 14(4), 324-32.

Hack, M.A., Choi, S.J., Vijayapalan, P., Davies, R.J., Stradling, J.R. (2001). Comparison of the effects of sleep deprivation, alcohol and obstructive sleep apnoea (OSA) on simulated steering performance. Respiratory Medicine 95(7), 594-601.

Joo, E.Y., Yoon, C.W., Koo, D.L., Kim, D., Hong, S.B. (2012). Adverse effects of 24 hours of sleep deprivation on cognition and stress hormones. Journal of Clinical Neurology8(2):146-50.

Kessler, R. C., Berglund, P. A., Coulouvrat, C., Hajak, G., Roth, T., Shahly, V., . . . Walsh, J. K. (2011). Insomnia and the performance of US workers: Results from the America insomnia survey. Sleep, 34(9), 1161-1171.

Killgore, W.D.S., Schwab, Z.J., Weber, M., Kipman, M., DelDonno, S.R., Weiner, M.R., Rauch, S.L. (2013). Daytime sleepiness affects prefrontal regulation of food intake. NeuroImage 71, 216-223.

Lim, J., Dinges, D.F. (2010). A meta-analysis of the impact of short-term sleep deprivation on cognitive variables. Psychological Bulletin 136(3), 375-89.

Patel, S.R. (2009). Reduced sleep as an obesity risk factor. Obesity Reviews10 Suppl 2:61-8.

Tempesta, D., Couyoumdjian, A., Curcio, G., Moroni, F., Marzano, C., De Gennaro, L., Ferrara, M. (2010). Lack of sleep affects the evaluation of emotional stimuli. Brain Research Bulletin 82(1-2), 104-8.


What Is Sleep?

There was a time when people thought that sleep was simply a time when the body and brain “shut off” for a few hours each night to rest in preparation for the next day. But now scientists understand that neither the body nor the brain “shut down” when we sleep in fact, they are often working even harder than they do during the day, undergoing processes to restore cells, process information, and improve health.

Circadian rhythm

Much like the daily opening and closing of tamarind tree leaves, the human body follows a natural, (approximately) 24-hour pattern called the circadian rhythm. This rhythm is influenced by the environment (such as lightness or darkness) as well as your genetic makeup and determines your sleep patterns by releasing hormones when it’s time to sleep. Abnormalities in the circadian rhythm can lead to sleep disorders like insomnia.

Stages of sleep

Sleep has two main phases—REM and non-REM. We spend about a quarter of our sleeping lives in the REM phase, which is a period of vigorous brain activity, marked by vivid dreams. This stage may be responsible for consolidating information and processing memories, which is why babies (whose entire days are full of new experiences the brain needs to process) spend twice as much time in REM sleep than adults do.

Non-REM sleep has three to four distinct stages (depending on which experts you ask). These grow gradually deeper throughout the night until it becomes very difficult to be disturbed from sleep. During this time, the body works to gently lower the heart rate, temperature, and breathing rate.

The purpose of sleep

Scientists still haven’t pinpointed a succinct reason why animals need to sleep every night. However, based on research and monitoring the brains of sleeping humans, they have some ideas. Among its many functions, sleep:

  1. Offers the body a chance to recover from wear and tear of daily life. Many researchers have suggested the restorative effects of sleeping. This doesn’t just mean that the body rests during sleep—rather, the cells busily regenerate themselves and the body temperature, heart rate, and breathing drop in order to conserve energy.
  2. Facilitates learning & memory. Not only do you need rest to sustain the attention and concentration necessary to learn new tasks, but according to Harvard’s Division of Sleep Medicine, sleep is a time for the brain to consolidate memories, which makes learning new things easier. People who sleep after learning how to play a video game generally perform much better in the game later than those who stay awake. Even more intriguingly, a recent study in Natural Neuroscience showed that people can even learn completely new behaviors (in this case, to associate unpleasant and pleasant odors with certain sounds) while they are completely asleep.
  3. Plays a role in immune function. Your body produces special proteins called cytokines, which help your immune system fight off infection. According to the U.S. Department of Health and Human Services, more of these proteins are produced during sleep when you are sick, which is one of the reasons you may feel so tired when you have the flu. Rest gives the body the time it needs to produce these infection-fighting proteins and to restore itself to wellness.

Alcohol and sleep

While many people believe that having a drink will help them get to sleep faster, alcohol actually increases the number of times you awaken during the night, leaving you tired and sleep-deprived the next day.


Resetting Your Sleep Clock and Improving Your Rest

Based on the knowledge of our sleep-wake cycle and how the body’s circadian clock works, there are a few ways to adjust sleep schedules and fix patterns.

1. Manipulate Lighting

Research suggests that manipulating light exposure may help reset the body clock, particularly for disturbances caused by jet lag. Light remains a key focus of researchers, and is often a point of treatment for sleep phase disorders.

The daily cycles of lightness and darkness are a key “zeitgeber” or cue that acts on the mechanisms of your sleep clock and circadian rhythm. Retinal ganglion cells in your eyes detect light cycles and transmit information to your SCN. In the presence of light, the SCN prompts the pineal gland to produce melatonin (the sleep hormone). When melatonin levels are high (in the absence of light), you grow drowsy and fall asleep. When your body senses light again, it ceases melatonin production to wake you.

Essentially, this means you should follow earth’s natural cues. Expose yourself to natural sunlight and bright light in the morning and throughout the day. Start dimming lights in the evening as the sun winds down, with your bedroom being virtually black and devoid of any screens.

Of course, you’ll want to limit screen time and strategically avoid blue light while resetting your sleep schedule. Blue light can trick your body into thinking its daytime when it’s really dark outside. Devices such as laptops, televisions, and cell phones all emit blue light. The longer you expose yourself to this light in the evening, the longer melatonin production is delayed. To prevent hindering your own night’s sleep, utilize the Night Mode feature on your devices or avoid them altogether.

2. Fast, Then Normalize Meal Times

Digestion and metabolism also play a role in wakefulness and sleepiness. When you eat, and to some extent, what you eat, can help you reset your sleep clock.

Harvard researchers found that, in animals, circadian rhythms shifted to match food availability. Researchers suggest that fasting for about 16 hours (for example during flight and until the next local meal time) could help reset sleep clocks for humans and reduce jetlag when traveling across time zones.

For non-jetlag sleep clock disturbances, you could try a 16-hour fast as well. Eat an early dinner (around say 4 p.m.), and then avoid food until breakfast time (8 a.m.) the following morning.

Once your sleep is back on track, stick to regular breakfast and dinner times to help support consistent circadian rhythms, with about 12 hours between breakfast and dinner. Eat dinner at least a few hours before bed, and a filling breakfast shortly after waking.

Some research also shows that saturated fats in meat and dairy may be bad to eat near bedtime, so sticking with leaner fare for dinner and eating heavier meals earlier in the day might be better.

3. Go Camping

Since natural light schedules help aid the body’s circadian rhythm, it makes sense that spending plenty of time outdoors could help restore natural cycles. For your next vacation, consider taking to the tents to reset your sleep clock.

Research published in the Current Biology journal put this hypothesis to the test, with eight participants spending one week camping without electrical lighting, smartphones or laptops.

They found this natural pattern helped synchronize biological clocks to solar time, with people sleeping earlier and waking earlier than in their normal routines. The biggest changes were seen in evening types, or “night owls.”

4. Pull An All-Nighter (or All Day-er)

One approach to reverse temporary sleep clock setbacks is to stay up one full day until the next normal bed time. This method is essentially planned sleep deprivation, so it is best done under doctor supervision.

There is not a lot of specific research on this method outside of anecdotal accounts for overcoming sleep clock problems, but it is a clinical part of chronotherapy and has been researched for depression treatment.

If you have been going to bed at 4 a.m. and waking at noon, you would wake at your normal time (perhaps on a Friday) then not sleep again until perhaps 10 p.m. the next day (Saturday). Light and mild activity could be helpful for staying awake.

Be aware that you should expect to be tired, and that you should never drive or perform any other dangerous tasks when sleep deprived.

5. Take Gradual Steps

For many people, slow and gradual changes are best when it comes to achieving long-term results. Small changes can also be easier on you physically and mentally, especially if you don’t have days to recover from sleep deficits.

Adjust your schedule by no more than 30 minutes per day, and remain at each phase until your body catches up to the changes. Once you are sleeping and waking at ideal times, don’t forget to maintain a consistent schedule every day of the week.

For example, if your sleep clock is running late by two hours, here’s a potential plan for getting back on track painlessly within one month. Each week, set your bedtime and wake time 15 minutes earlier on Sunday nights, then again on Wednesdays. After four weeks, you should be on back on track.

For large delays, it may actually be more helpful to push bedtimes forward by one to two hours until you reach a normal bedtime. If your sleep clock is delayed by several hours and gradual steps aren’t cutting it, a doctor or therapist may be able to plan a more regimented chronotherapy approach for your situation.

Practice Healthy Sleep

Don’t forget to follow essential sleep hygiene principles during, and after, your sleep clock reset.

  • Stick with your plan.
  • Go to bed early enough to ensure you’re getting the recommended hours of sleep (the CDC says adults need 7 to 9).
  • Maintain a strict and consistent sleep schedule—go to sleep and wake up at the same time every day (even on weekends).
  • Don’t take naps longer than 20-30 minutes.
  • Limit caffeine after lunch.
  • Create a relaxing bedtime routine.
  • Avoid electronics, bright lights and stress in the hours before bed.
  • Keep your bedroom quiet, dark and cool.
  • Don’t stress about not sleeping—think in positive terms.

If improving sleep hygiene doesn’t help or your sleep schedule is impacting your daily life, you may also want to reach out to your doctor or sleep specialists. They would be able to help you set up a plan, suggest supplements, and diagnose any sleep disorders or underlying conditions to help you fix your sleep cycles.


How to Adjust Your Sleep Schedule

This article was co-authored by Alex Dimitriu, MD. Alex Dimitriu, MD is the Owner of Menlo Park Psychiatry and Sleep Medicine, a clinic based in the San Francisco Bay Area with expertise in psychiatry, sleep, and transformational therapy. Alex earned his Doctor of Medicine from Stony Brook University in 2005 and graduated from the Stanford University School of Medicine's Sleep Medicine Residency Program in 2010. Professionally, Alex has dual board certification in psychiatry and sleep medicine.

There are 7 references cited in this article, which can be found at the bottom of the page.

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The sleep schedule is one of the most important rhythms in the human body. Our body needs anywhere from 6 to 8 hours of sleep every day in order to repair itself and refresh itself for the next 24 hours. Unfortunately, events outside of our control may interfere with our sleep patterns and it may be necessary for us to change sleeping habits, whether temporarily or permanently. As long as you take the time to understand your sleeping habits and practice discipline, you can learn how to adjust your sleep schedule.


WHAT IS SLEEP?

You have read that sleep is distinguished by low levels of physical activity and reduced sensory awareness. As discussed by Siegel (2008), a definition of sleep must also include mention of the interplay of the circadian and homeostatic mechanisms that regulate sleep. Homeostatic regulation of sleep is evidenced by sleep rebound following sleep deprivation. Sleep rebound refers to the fact that a sleep-deprived individual will tend to take a shorter time to fall asleep during subsequent opportunities for sleep. Sleep is characterized by certain patterns of activity of the brain that can be visualized using electroencephalography (EEG), and different phases of sleep can be differentiated using EEG as well ([link]).


Sleep-wake cycles seem to be controlled by multiple brain areas acting in conjunction with one another. Some of these areas include the thalamus, the hypothalamus, and the pons. As already mentioned, the hypothalamus contains the SCN—the biological clock of the body—in addition to other nuclei that, in conjunction with the thalamus, regulate slow-wave sleep. The pons is important for regulating rapid eye movement (REM) sleep (National Institutes of Health, n.d.).

Sleep is also associated with the secretion and regulation of a number of hormones from several endocrine glands including: melatonin, follicle stimulating hormone (FSH), luteinizing hormone (LH), and growth hormone (National Institutes of Health, n.d.). You have read that the pineal gland releases melatonin during sleep ([link]). Melatonin is thought to be involved in the regulation of various biological rhythms and the immune system (Hardeland et al., 2006). During sleep, the pituitary gland secretes both FSH and LH which are important in regulating the reproductive system (Christensen et al., 2012 Sofikitis et al., 2008). The pituitary gland also secretes growth hormone, during sleep, which plays a role in physical growth and maturation as well as other metabolic processes (Bartke, Sun, & Longo, 2013).



Sleep May Help Prevent Cancer

Did you know that people who work the late shift have a higher risk of developing breast and colon cancer? Researchers believe light exposure reduces melatonin levels.   Melatonin, a hormone that regulates the sleep-wake cycle, is thought to protect against cancer as it appears to suppress the growth of tumors.

Be sure that your bedroom is dark and avoid using electronics before bed in order to help your body produce the melatonin it needs.


Sleep and Health

Adequate sleep contributes to a student&rsquos overall health and well-being. Students should get the proper amount of sleep at night to help stay focused, improve concentration, and improve academic performance.

Children and adolescents who do not get enough sleep have a higher risk for many health problems, including obesity, type 2 diabetes, poor mental health, and injuries. 1-4 They are also more likely to have attention and behavior problems, which can contribute to poor academic performance in school. 1,2

How much sleep someone needs depends on their age. The American Academy of Sleep Medicine has made the following recommendations for children and adolescents 1 :

Recommended Hours of Sleep Per Day by Age Group
Age Group Recommended Hours of Sleep Per Day
6&ndash12 years 9 to 12 hours per 24 hours
13&ndash18 years 8 to 10 hours per 24 hours

The data from the 2015 national and state Youth Risk Behavior Surveys, a CDC study, shows that a majority of middle school and high school students reported getting less than the recommended amount of sleep for their age. 5

Middle school students (grades 6&ndash8)

  • Students in 9 states were included in the study.
  • About 6 out of 10 students (57.8%) did not get enough sleep on school nights.

High school students (grades 9&ndash12)

  • National sample.
  • About 7 out of 10 students (72.7%) did not get enough sleep on school nights.

The American Medical Association, 13 the American Academy of Sleep Medicine, 14 and other medical associations have since expressed support of delaying school start times for adolescents.

Good sleep hygiene in combination with later school times will enable adolescents to be healthier and better academic achievers.

Provide Sleep Education

Schools can add sleep education to the K&ndash12 curriculum to help children and adolescents learn why sleep is important to maintain a healthy lifestyle. Lessons in sleep patterns and sleep disorders, snoring, drowsy driving, and insomnia are among topics teachers can cover in the classroom to help students develop healthy sleep habits.

Sleep education programs in school may result in significantly longer weekday and weekend total sleep time and improved sleep hygiene (habits that support good sleep) after completion. 6 However, more research is needed to determine how best to maintain these improvements long term. One possible strategy is to incorporate refresher sessions for students.

Review School Start Times

The combination of late bedtimes and early school start times results in most adolescents not getting enough sleep. In recent years, evidence has accumulated that later school start times for adolescents result in more students getting enough sleep. 10,11

School officials can learn more about the research connecting sleep and school start times. School districts can support adequate sleep among students by implementing delayed school start times as recommended by the American Academy of Pediatrics (AAP), the American Medical Association, and the American Academy of Sleep Medicine.


Sleep Matters: The Impact Of Sleep On Health And Wellbeing

In 2020, we will be publishing brand new research on sleep and mental health for Mental Health Awareness Week. To get the latest updates on the Mental Health Foundation campaigns, sign up to our newsletter.

This version published: May 2011

Sleep is as important to our health as eating, drinking and breathing. It allows our bodies to repair themselves and our brains to consolidate our memories and process information.

Poor sleep is linked to physical problems such as a weakened immune system and mental health problems such as anxiety and depression. Sleep Matters provides sound, evidence-based advice on how to improve the quality of your sleep. This includes simple ways to improve your '˜sleep hygiene'™, such as adjusting the light, noise and temperature in the bedroom and changing your eating, drinking and exercise routines, advice which can also be found in Sleep Well, our handy pocket guide to better sleep.

The report also includes advice on how Cognitive Behavioural Therapy can be more effective in helping people with long-term insomnia than medication, and how NHS policy could be changed to reflect this fact.


Sleep Matters: The Impact Of Sleep On Health And Wellbeing

In 2020, we will be publishing brand new research on sleep and mental health for Mental Health Awareness Week. To get the latest updates on the Mental Health Foundation campaigns, sign up to our newsletter.

This version published: May 2011

Sleep is as important to our health as eating, drinking and breathing. It allows our bodies to repair themselves and our brains to consolidate our memories and process information.

Poor sleep is linked to physical problems such as a weakened immune system and mental health problems such as anxiety and depression. Sleep Matters provides sound, evidence-based advice on how to improve the quality of your sleep. This includes simple ways to improve your '˜sleep hygiene'™, such as adjusting the light, noise and temperature in the bedroom and changing your eating, drinking and exercise routines, advice which can also be found in Sleep Well, our handy pocket guide to better sleep.

The report also includes advice on how Cognitive Behavioural Therapy can be more effective in helping people with long-term insomnia than medication, and how NHS policy could be changed to reflect this fact.


Liver Health

Like the rest of your body, your liver — your largest internal organ — is attuned to a certain rhythm that varies with the time of day. For example, the liver produces the most cholesterol in the evening hours. Being behind on sleep can throw off this rhythm, making it less able to efficiently carry out functions like detoxifying, breaking down adrenaline, and managing blood sugar levels. “It doesn’t respond well when the liver clock is desynchronized,” Twery says. Yet another reason to get your rest tonight.


Sleep and Health

Adequate sleep contributes to a student&rsquos overall health and well-being. Students should get the proper amount of sleep at night to help stay focused, improve concentration, and improve academic performance.

Children and adolescents who do not get enough sleep have a higher risk for many health problems, including obesity, type 2 diabetes, poor mental health, and injuries. 1-4 They are also more likely to have attention and behavior problems, which can contribute to poor academic performance in school. 1,2

How much sleep someone needs depends on their age. The American Academy of Sleep Medicine has made the following recommendations for children and adolescents 1 :

Recommended Hours of Sleep Per Day by Age Group
Age Group Recommended Hours of Sleep Per Day
6&ndash12 years 9 to 12 hours per 24 hours
13&ndash18 years 8 to 10 hours per 24 hours

The data from the 2015 national and state Youth Risk Behavior Surveys, a CDC study, shows that a majority of middle school and high school students reported getting less than the recommended amount of sleep for their age. 5

Middle school students (grades 6&ndash8)

  • Students in 9 states were included in the study.
  • About 6 out of 10 students (57.8%) did not get enough sleep on school nights.

High school students (grades 9&ndash12)

  • National sample.
  • About 7 out of 10 students (72.7%) did not get enough sleep on school nights.

The American Medical Association, 13 the American Academy of Sleep Medicine, 14 and other medical associations have since expressed support of delaying school start times for adolescents.

Good sleep hygiene in combination with later school times will enable adolescents to be healthier and better academic achievers.

Provide Sleep Education

Schools can add sleep education to the K&ndash12 curriculum to help children and adolescents learn why sleep is important to maintain a healthy lifestyle. Lessons in sleep patterns and sleep disorders, snoring, drowsy driving, and insomnia are among topics teachers can cover in the classroom to help students develop healthy sleep habits.

Sleep education programs in school may result in significantly longer weekday and weekend total sleep time and improved sleep hygiene (habits that support good sleep) after completion. 6 However, more research is needed to determine how best to maintain these improvements long term. One possible strategy is to incorporate refresher sessions for students.

Review School Start Times

The combination of late bedtimes and early school start times results in most adolescents not getting enough sleep. In recent years, evidence has accumulated that later school start times for adolescents result in more students getting enough sleep. 10,11

School officials can learn more about the research connecting sleep and school start times. School districts can support adequate sleep among students by implementing delayed school start times as recommended by the American Academy of Pediatrics (AAP), the American Medical Association, and the American Academy of Sleep Medicine.


Why Is Sleep Important?

Many people are unaware of how essential it is to get a good night’s sleep on a regular basis. When work or school deadlines arise, many consider staying up late or “pulling an all-nighter” an efficient way to get everything done.

However, studies show that this is the worst thing you can do—skimping on sleep can cause concentration problems, drowsiness, and irritable moods that affect the way your work is delivered the next day.

For example, a student may decide to drink coffee and stay up all night to “cram” for a test. While this approach may offer more hours for studying, the detrimental effects of sleep deprivation will likely impair her performance on the test the next day.

What else happens when you don't get the sleep you need?

Short-term health impact

Sleep is such an important part of our lives that its effects show up quickly when we don’t get enough of it. Getting too little sleep for just one night can:

Increase stress

Disturb mood

Impair ability to concentrate

Long-term health impact

Some people might say that it’s a fair trade-off to skimp on sleep now and then, saying that a day or two of tiredness and crankiness is worth the extra time they earned. But while returning to a regular sleeping pattern can restore the negative short-term effects of one night of poor sleep, the long-term consequences of regular sleep deprivation that arise under the surface are much more dangerous. Long-term effects of poor sleep include:

Heightened risk factor for diabetes

Increased risk for breast cancer

High blood pressure

Decreased immune function

Major depression

Obesity

Impact on relationships

The consequences of poor sleep extend far beyond personal health—they can also affect our interactions with others. At the 2013 Society for Personality and Social Psychology (SPSP) annual meeting, scientists from UC Berkeley presented new research suggesting that inadequate sleep can impair our ability to appreciate our partners and loved ones, which can lead to stress and tension in the relationship. The SPSP reports that less sleep means fewer feelings of gratitude and higher levels of selfishness, both of which can make a partner feel unacknowledged and underappreciated.

Financial and economic impact

On a broader scale, poor sleep can have costly and often tragic consequences for society.

  • The U.S. Department of Health & Human Services estimates that chronic sleepiness has cost the nation $16 billion in healthcare expenses each year.
  • The same study found that poor sleep costs an estimated $50 billion in lost productivity annually.
  • Insomniacs lose 11.3 days of productivity a year, costing companies $2,280 per person.
  • According to the National Highway Traffic Safety Administration, drowsy driving causes 100,000 car crashes each year, costing about $12.5 million dollars annually.

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Resetting Your Sleep Clock and Improving Your Rest

Based on the knowledge of our sleep-wake cycle and how the body’s circadian clock works, there are a few ways to adjust sleep schedules and fix patterns.

1. Manipulate Lighting

Research suggests that manipulating light exposure may help reset the body clock, particularly for disturbances caused by jet lag. Light remains a key focus of researchers, and is often a point of treatment for sleep phase disorders.

The daily cycles of lightness and darkness are a key “zeitgeber” or cue that acts on the mechanisms of your sleep clock and circadian rhythm. Retinal ganglion cells in your eyes detect light cycles and transmit information to your SCN. In the presence of light, the SCN prompts the pineal gland to produce melatonin (the sleep hormone). When melatonin levels are high (in the absence of light), you grow drowsy and fall asleep. When your body senses light again, it ceases melatonin production to wake you.

Essentially, this means you should follow earth’s natural cues. Expose yourself to natural sunlight and bright light in the morning and throughout the day. Start dimming lights in the evening as the sun winds down, with your bedroom being virtually black and devoid of any screens.

Of course, you’ll want to limit screen time and strategically avoid blue light while resetting your sleep schedule. Blue light can trick your body into thinking its daytime when it’s really dark outside. Devices such as laptops, televisions, and cell phones all emit blue light. The longer you expose yourself to this light in the evening, the longer melatonin production is delayed. To prevent hindering your own night’s sleep, utilize the Night Mode feature on your devices or avoid them altogether.

2. Fast, Then Normalize Meal Times

Digestion and metabolism also play a role in wakefulness and sleepiness. When you eat, and to some extent, what you eat, can help you reset your sleep clock.

Harvard researchers found that, in animals, circadian rhythms shifted to match food availability. Researchers suggest that fasting for about 16 hours (for example during flight and until the next local meal time) could help reset sleep clocks for humans and reduce jetlag when traveling across time zones.

For non-jetlag sleep clock disturbances, you could try a 16-hour fast as well. Eat an early dinner (around say 4 p.m.), and then avoid food until breakfast time (8 a.m.) the following morning.

Once your sleep is back on track, stick to regular breakfast and dinner times to help support consistent circadian rhythms, with about 12 hours between breakfast and dinner. Eat dinner at least a few hours before bed, and a filling breakfast shortly after waking.

Some research also shows that saturated fats in meat and dairy may be bad to eat near bedtime, so sticking with leaner fare for dinner and eating heavier meals earlier in the day might be better.

3. Go Camping

Since natural light schedules help aid the body’s circadian rhythm, it makes sense that spending plenty of time outdoors could help restore natural cycles. For your next vacation, consider taking to the tents to reset your sleep clock.

Research published in the Current Biology journal put this hypothesis to the test, with eight participants spending one week camping without electrical lighting, smartphones or laptops.

They found this natural pattern helped synchronize biological clocks to solar time, with people sleeping earlier and waking earlier than in their normal routines. The biggest changes were seen in evening types, or “night owls.”

4. Pull An All-Nighter (or All Day-er)

One approach to reverse temporary sleep clock setbacks is to stay up one full day until the next normal bed time. This method is essentially planned sleep deprivation, so it is best done under doctor supervision.

There is not a lot of specific research on this method outside of anecdotal accounts for overcoming sleep clock problems, but it is a clinical part of chronotherapy and has been researched for depression treatment.

If you have been going to bed at 4 a.m. and waking at noon, you would wake at your normal time (perhaps on a Friday) then not sleep again until perhaps 10 p.m. the next day (Saturday). Light and mild activity could be helpful for staying awake.

Be aware that you should expect to be tired, and that you should never drive or perform any other dangerous tasks when sleep deprived.

5. Take Gradual Steps

For many people, slow and gradual changes are best when it comes to achieving long-term results. Small changes can also be easier on you physically and mentally, especially if you don’t have days to recover from sleep deficits.

Adjust your schedule by no more than 30 minutes per day, and remain at each phase until your body catches up to the changes. Once you are sleeping and waking at ideal times, don’t forget to maintain a consistent schedule every day of the week.

For example, if your sleep clock is running late by two hours, here’s a potential plan for getting back on track painlessly within one month. Each week, set your bedtime and wake time 15 minutes earlier on Sunday nights, then again on Wednesdays. After four weeks, you should be on back on track.

For large delays, it may actually be more helpful to push bedtimes forward by one to two hours until you reach a normal bedtime. If your sleep clock is delayed by several hours and gradual steps aren’t cutting it, a doctor or therapist may be able to plan a more regimented chronotherapy approach for your situation.

Practice Healthy Sleep

Don’t forget to follow essential sleep hygiene principles during, and after, your sleep clock reset.

  • Stick with your plan.
  • Go to bed early enough to ensure you’re getting the recommended hours of sleep (the CDC says adults need 7 to 9).
  • Maintain a strict and consistent sleep schedule—go to sleep and wake up at the same time every day (even on weekends).
  • Don’t take naps longer than 20-30 minutes.
  • Limit caffeine after lunch.
  • Create a relaxing bedtime routine.
  • Avoid electronics, bright lights and stress in the hours before bed.
  • Keep your bedroom quiet, dark and cool.
  • Don’t stress about not sleeping—think in positive terms.

If improving sleep hygiene doesn’t help or your sleep schedule is impacting your daily life, you may also want to reach out to your doctor or sleep specialists. They would be able to help you set up a plan, suggest supplements, and diagnose any sleep disorders or underlying conditions to help you fix your sleep cycles.


Sleep May Help Prevent Cancer

Did you know that people who work the late shift have a higher risk of developing breast and colon cancer? Researchers believe light exposure reduces melatonin levels.   Melatonin, a hormone that regulates the sleep-wake cycle, is thought to protect against cancer as it appears to suppress the growth of tumors.

Be sure that your bedroom is dark and avoid using electronics before bed in order to help your body produce the melatonin it needs.


WHAT IS SLEEP?

You have read that sleep is distinguished by low levels of physical activity and reduced sensory awareness. As discussed by Siegel (2008), a definition of sleep must also include mention of the interplay of the circadian and homeostatic mechanisms that regulate sleep. Homeostatic regulation of sleep is evidenced by sleep rebound following sleep deprivation. Sleep rebound refers to the fact that a sleep-deprived individual will tend to take a shorter time to fall asleep during subsequent opportunities for sleep. Sleep is characterized by certain patterns of activity of the brain that can be visualized using electroencephalography (EEG), and different phases of sleep can be differentiated using EEG as well ([link]).


Sleep-wake cycles seem to be controlled by multiple brain areas acting in conjunction with one another. Some of these areas include the thalamus, the hypothalamus, and the pons. As already mentioned, the hypothalamus contains the SCN—the biological clock of the body—in addition to other nuclei that, in conjunction with the thalamus, regulate slow-wave sleep. The pons is important for regulating rapid eye movement (REM) sleep (National Institutes of Health, n.d.).

Sleep is also associated with the secretion and regulation of a number of hormones from several endocrine glands including: melatonin, follicle stimulating hormone (FSH), luteinizing hormone (LH), and growth hormone (National Institutes of Health, n.d.). You have read that the pineal gland releases melatonin during sleep ([link]). Melatonin is thought to be involved in the regulation of various biological rhythms and the immune system (Hardeland et al., 2006). During sleep, the pituitary gland secretes both FSH and LH which are important in regulating the reproductive system (Christensen et al., 2012 Sofikitis et al., 2008). The pituitary gland also secretes growth hormone, during sleep, which plays a role in physical growth and maturation as well as other metabolic processes (Bartke, Sun, & Longo, 2013).



What Is Sleep?

There was a time when people thought that sleep was simply a time when the body and brain “shut off” for a few hours each night to rest in preparation for the next day. But now scientists understand that neither the body nor the brain “shut down” when we sleep in fact, they are often working even harder than they do during the day, undergoing processes to restore cells, process information, and improve health.

Circadian rhythm

Much like the daily opening and closing of tamarind tree leaves, the human body follows a natural, (approximately) 24-hour pattern called the circadian rhythm. This rhythm is influenced by the environment (such as lightness or darkness) as well as your genetic makeup and determines your sleep patterns by releasing hormones when it’s time to sleep. Abnormalities in the circadian rhythm can lead to sleep disorders like insomnia.

Stages of sleep

Sleep has two main phases—REM and non-REM. We spend about a quarter of our sleeping lives in the REM phase, which is a period of vigorous brain activity, marked by vivid dreams. This stage may be responsible for consolidating information and processing memories, which is why babies (whose entire days are full of new experiences the brain needs to process) spend twice as much time in REM sleep than adults do.

Non-REM sleep has three to four distinct stages (depending on which experts you ask). These grow gradually deeper throughout the night until it becomes very difficult to be disturbed from sleep. During this time, the body works to gently lower the heart rate, temperature, and breathing rate.

The purpose of sleep

Scientists still haven’t pinpointed a succinct reason why animals need to sleep every night. However, based on research and monitoring the brains of sleeping humans, they have some ideas. Among its many functions, sleep:

  1. Offers the body a chance to recover from wear and tear of daily life. Many researchers have suggested the restorative effects of sleeping. This doesn’t just mean that the body rests during sleep—rather, the cells busily regenerate themselves and the body temperature, heart rate, and breathing drop in order to conserve energy.
  2. Facilitates learning & memory. Not only do you need rest to sustain the attention and concentration necessary to learn new tasks, but according to Harvard’s Division of Sleep Medicine, sleep is a time for the brain to consolidate memories, which makes learning new things easier. People who sleep after learning how to play a video game generally perform much better in the game later than those who stay awake. Even more intriguingly, a recent study in Natural Neuroscience showed that people can even learn completely new behaviors (in this case, to associate unpleasant and pleasant odors with certain sounds) while they are completely asleep.
  3. Plays a role in immune function. Your body produces special proteins called cytokines, which help your immune system fight off infection. According to the U.S. Department of Health and Human Services, more of these proteins are produced during sleep when you are sick, which is one of the reasons you may feel so tired when you have the flu. Rest gives the body the time it needs to produce these infection-fighting proteins and to restore itself to wellness.

Alcohol and sleep

While many people believe that having a drink will help them get to sleep faster, alcohol actually increases the number of times you awaken during the night, leaving you tired and sleep-deprived the next day.


How to Adjust Your Sleep Schedule

This article was co-authored by Alex Dimitriu, MD. Alex Dimitriu, MD is the Owner of Menlo Park Psychiatry and Sleep Medicine, a clinic based in the San Francisco Bay Area with expertise in psychiatry, sleep, and transformational therapy. Alex earned his Doctor of Medicine from Stony Brook University in 2005 and graduated from the Stanford University School of Medicine's Sleep Medicine Residency Program in 2010. Professionally, Alex has dual board certification in psychiatry and sleep medicine.

There are 7 references cited in this article, which can be found at the bottom of the page.

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The sleep schedule is one of the most important rhythms in the human body. Our body needs anywhere from 6 to 8 hours of sleep every day in order to repair itself and refresh itself for the next 24 hours. Unfortunately, events outside of our control may interfere with our sleep patterns and it may be necessary for us to change sleeping habits, whether temporarily or permanently. As long as you take the time to understand your sleeping habits and practice discipline, you can learn how to adjust your sleep schedule.



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