Sleep expert: The best solution to a night's bad sleep is... Do nothing?

In a society that glamorizes efficiency, sleep deficiency is becoming a global epidemic. Some people even express "guilt" about sleeping early and regularly sacrifice sleep in the name of productivity (which only does the opposite). Meanwhile, it can be tempting to reach out for "quick fixes," such as swallowing a pill and waiting for it to knock you out when you have trouble falling asleep.

If you search online, there doesn't seem to be any strong evidence on the drawbacks of taking over-the-counter sleeping pills (i.e., melatonin, GABA candies). Does that mean we can take it regularly?

Neuroscientists suggest against them due to the following reasons:

1. The dosage of over-the-counter(OTC) melatonin is very poorly regulated. The actual dosage found in pills from different vendors was shown to vary anywhere between 80% less or 400% more than indicated on the bottle [1]! As a result, you don't know how much dosage you are actually taking in, and most people tend to overdose [1]. In addition, while most OTC melatonin claims to be between 5mg to 10mg, it is still ~25 times or higher than the amount of melatonin our pineal gland naturally produces [2]!

2. Melatonin helps you fall asleep faster, but many people wake up 3-5h afterward, unable to fall back asleep [1]. Similarly, sleeping pills that interact with the GABA pathway (the main inhibitory neurotransmitter of CNS) sedate the brain instead of inducing naturalistic sleep [4]. They shorten the time it takes to fall asleep, but their efficacy in improving sleep quality and maintaining sleep remains questionable [4]. Therefore, OTC sleeping aids could help time your sleep in the short-term (i.e., adjusting jet-leg) only.

3. Besides being a sleep hormone, melatonin communicates with hormones in other brain regions to suppress puberty onset in children and interferes with the production of sex hormones [6]. Although more evidence is needed, neuroscientists suspect that taking melatonin could also mess up the adult endocrine system [7].

There are also a lot of supplements and food that claim to help with sleep, such as magnesium, apigenin, camomile tea, and tart cherry. However, experts say that there is still insufficient evidence to prove their efficacy [1].

Okay, minimize OTC sleeping aids. What can I do for my sleep problems then?

Some neuroscientists believe that the sequence to manipulating any aspects of our biology should be:

1st: behavioral tools

2nd: nutrition

3rd: supplementation (after consulting physicians)

4th : prescription drugs

People should not be asking "what should I take" without even considering changing their behaviors that could be causing the problem [7].

Disclaimer: If you have serious and chronic sleep issues, please consult a licensed physician.

Below we have organized eight unconventional sleep advice from Matthew Walker, a sleep expert, a professor at UC Berkeley, and the author of the book "Why we sleep."

Advice 1: How to recover from a night of bad sleep? Do Nothing.

When we experience a bad sleep and feel like sh*t in the morning, it's tempting to nap/drink a lot of coffee or go to bed earlier than usual to fight the fatigue. However, doing any of these things will only mess up your sleep schedule further. Napping or consuming extra caffeine will likely make you more awake at night, leading to a vicious cycle. Your body's circadian cycle is used to your routine sleep time therefore, you will probably end up staring at the ceiling if you go to bed a lot earlier than usual. [7]

Advice 2: Counting sheep is not helpful

A study found that counting sheep made it harder to fall asleep because the more you suppress your thoughts, the more you want to think of them. Instead, you could try taking yourself onto a mental walk to somewhere relaxing like in nature or to the beach and visualize yourself being there. Just allow your thoughts to run their course! [8]

Advice 3: Remove all clock faces in your bedroom, including your phone

If you are having a tough night, knowing that it's 3:05 am does not help you for the slightest and will only make you more anxious about not falling asleep [7].

Advice 4: Individuals respond differently to naps

If you don't nap regularly and wish to use a nap as a way to compensate for a night of bad sleep, don't do it (you will lose sleep again at night)!

If you nap regularly and still sleep well, then keep doing what works for you!

If you have to nap (you are feeling soooo exhausted, then don't feel guilty about tending to your needs), limit it to 20-25min. This way, you won't go into the deepest stage of sleep, for which if the alarm rings, you wake up feeling worse. Also, avoid napping in the late afternoon. [7]

Advice 5: Write all your concerns down (i.e., in a worry journal) an hour before bed

Writing your worries out before bed is like closing down all the emotional tabs on the browser before shutting down the computer, so it doesn't overheat in the morning. Dr. Walker also observed that people tend to ruminate on worries and catastrophize more at night vs. during the day (exact mechanism unclear) [7]. Therefore, writing out the things you need to do/are worrying about before sleep can make you feel more reassured when going to bed (I'll get back to it tmr and won't forget).

🛒 today well spent attn journal 🛒

Advice 6: Having a wind-down routine and stick to it

Sleep is a physiological process rather than an "on or off" switch: Think of it as landing a plan. It takes time to go down onto the terrain of good solid sleep gradually. To help yourself ease progressively into sleep, you could experiment with different things (but avoid things involving blue light exposure!) and customize your night-time routine. [7]

*A sticky note (handwriting-like font):*

Bed-time routine

- hot shower 🛀

- Micro-journaling with TWS handbook ✍️

-Read 15min 📖

-10min meditation 🧘‍♀️

-Sleep (11pm) 😪

Advice 7: Sleep is not like a credit card: you can't accumulate debts and pay them back later.

Accumulating sleep debts and hoping to pay them off at the end of the weekend by sleeping a lot will only result in a "social jet-leg."

Social jet-let

It occurs when you are being forced to shift between two time zones: one dictated by work and social obligations (staying up during the week), the other by our circadian clock (binge-sleep on weekends to catch up) [9].

Data shows that short sleepers (<7h/night) have at least a 12% greater risk for all-cause mortality [10]. They are also far more likely to report more health problems than those who consistently sleep 7-9h on weekdays and weekends (recommended) [7].

Advice 8: Set several go to bed alarms

To prevent things like showering from taking up an extra 30min after you plan to go to bed, set multiple alarms to prompt yourself for bed. You could also get into your pajamas and dim the light an hour before your desired sleep time. [3]

The alarms you can set up on the phone:

-an alarm at 9:45pm named :

"wrap up!" 

-next alarm at 10pm named:

"brush teeth and shower."

-next alarm at 10:40pm named:

"get ready for bed."

Quiz:

Which of the following are not true?

A. Melatonin can help you fall asleep faster.

B. It is okay to sleep less during the week as long as you sleep more during weekends.

C. Going to bed one hour earlier would be a good idea if you had a bad sleep the night before.

D. People should try different behavioral tools before seeking sleeping pills.

References:

[1]Walker, M. (2019, July 17). Is melatonin a good sleep aid? | Matthew Walker - YouTube. YouTube. Retrieved October 25, 2021, from https://www.youtube.com/watch?v=MZLo5N3vco8.

[2]Hershner, S., & Matsumura, A. (2020, October). Melatonin. Sleep Education. Retrieved October 26, 2021, from https://sleepeducation.org/patients/melatonin/#benefits-of-melatoninwhile.

[3]Duggal, N. (2018, August 23). Pineal gland function: What you should know. Healthline. Retrieved October 26, 2021, from https://www.healthline.com/health/pineal-gland-function#:~:text=The%20pineal%20gland%20is%20a,are%20also%20called%20circadian%20rhythms.

[4]Hepsomali, P., Groeger, J. A., Nishihira, J., & Scholey, A. (2020). Effects of Oral Gamma-Aminobutyric Acid (GABA) Administration on Stress and Sleep in Humans: A Systematic Review. Frontiers in neuroscience, 14, 923. https://doi.org/10.3389/fnins.2020.00923

[5]Pugle, M. (2021, October 12). GABA: What it is, functions, and disorders. Verywell Health. Retrieved October 26, 2021, from https://www.verywellhealth.com/gaba-5095143.

[6]Cipolla-Neto, J., Amaral, F. G., Soares-Jr, J. M., Gallo, C. C., Furtado, A., Cavaco, J. E., Gonçalves, I., Santos, C. R., & Quintela, T. (2020). The crosstalk between melatonin and sex steroid hormones. Neuroendocrinology. https://doi.org/10.1159/000516148

[7] Huberman, A., & Walker, M. (2021, August 2). Dr. Matthew Walker: The Science & Practice of Perfecting Your Sleep | Huberman Lab Podcast #31. YouTube. Retrieved October 26, 2021, from https://www.youtube.com/watch?v=gbQFSMayJxk.

[8] Chaudhry, S. (2002). Counting sheep will not help you sleep. Student BMJ, 10. http://dx.doi.org/10.1136/sbmj.020353a

[9] Geddes, L. (2019, January 21). Social jetlag – are late nights and chaotic sleep patterns making you ill? The Guardian. Retrieved October 26, 2021, from https://www.theguardian.com/lifeandstyle/2019/jan/21/social-jetlag-are-late-nights-and-chaotic-sleep-patterns-making-you-ill.

[10] Cappuccio, F. P., D'Elia, L., Strazzullo, P., & Miller, M. A. (2010). Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies. Sleep, 33(5), 585–592. https://doi.org/10.1093/sleep/33.5.585