If you attend Method Health for your health, then optimising your sleep is a no-brainer. Also, sleeps a common issue; 10-30% of people globally don’t meet recommended sleep duration and have trouble falling asleep (called having trouble with sleep “latency”) and sleeping with high quality Sleep Health - PubMed (nih.gov) + Prevalence and comorbidity of sleep conditions in Australian adults: 2016 Sleep Health Foundation national survey - PubMed (nih.gov) + Epidemiology of Insomnia: Prevalence, Course, Risk Factors, and Public Health Burden - PubMed (nih.gov)
Here are our top tips for improving your sleep health and habits or “hygiene” that is often helpful. We will also debunk some common sleeping myths.
Tips for good sleep habits.
Meet your sleep duration needs
Every 24 hours (including naps), most sleep guidelines recommend:
7-9 hours of sleep for adults,
12-16 hours for Infants (4 to 12 months of age),
11-14 hours for children 1 to 2 years of age,
10-13 hours for children 3 to 5 years of age
9 to 12 hours for children 6 to 12 years old
8 to 10 hours for teenagers 13 to 18 years
“But I'm in bed 7-9 hours”.
Recommendations are for true sleeping hours not time spent in bed. You must account for the normal 5-30 min it might take to fall asleep when getting into bed rather than including that time into what you are calling “sleep” You might need to prioritise more than 9 hours of time in bed to ensure adequate sleep time.
As you can see, most athletic types require between 8-9 hours each night and most athletes are just not meeting their needs normally.
Have a helpful sleep routine.
Most find a consistent sleep routine is helpful.
Although screen time (TV, phone or E-reader) is not recommended in the last hours before attempting sleep, due to increasing your alertness, some studies have showed no effect of removing electronic viewing on sleep quality. Many anecdotal reports of watching or reading something familiar has a calming effect and improves sleep onset. To make screen time less stimulating, try adding blue light filters to your laptop (See Flux software) or wearing blue light filter glasses before bed Blue blocker glasses as a countermeasure for alerting effects of evening light-emitting diode screen exposure in male teenagers - PubMed (nih.gov) If however, screens or reading does not help you fall asleep, remove it from your sleeping routine. Most sleep guidelines encourage only using your bed for sleep or sex.
Using a sleep diary might help assess the right routine for you Sleep Diary - Sleep Education + The Consensus Sleep Diary: Standardizing Prospective Sleep Self-Monitoring - PMC (nih.gov)
Warm showers or baths create a body-cooling effect that improves sleep onset https://pubmed.ncbi.nlm.nih.gov/31102877/ + https://jphysiolanthropol.biomedcentral.com/articles/10.1186/s40101-023-00337-0
Keep room temperature stable and on the cooler side.
Below 20 degrees Celsius tends to be a sweet spot for most for a helpful room temperature which keeps your body temperature lower which is helpful for sleep Nighttime temperature and human sleep loss in a changing climate - PMC (nih.gov) + Effects of thermal environment on sleep and circadian rhythm - PMC (nih.gov)
Keep your room quiet.
Use white noise (fan sounds, whale song or rain) or wear earplugs to avoid unexpected noise disruptions.
Keep room dark at night and light during the day, especially early morning which sets up the day well, to ensure sunlight exposure regulates your natural circadian rhythm to optimise sleep health Light Modulates Leptin and Ghrelin in Sleep-Restricted Adults - PMC (nih.gov) + Timing of light exposure affects mood and brain circuits - PMC (nih.gov) Wear eye pads to assist falling asleep if you can’t control your room lighting.
Be aware of any pre-sleep food or drink.
Most find big meals are not helpful 1-2 hours before bed.
Food can also be nocebic for sleep, so be aware of creating a negative association between a food type and sleep that might have been a negative coincidental experience Sleep and Nutrition Interactions: Implications for Athletes - PMC (nih.gov)
Many might have improved sleep onset with a meal high in carbohydrates (and low-fat plant or meat protein before bed. These macronutrients might positively influence the rise in melatonin to improve sleep onset (melatonin is created from tryptophan, found in dietary protein). However, individual responses to food types vary so experiment Isocaloric Diets with Different Protein-Carbohydrate Ratios: The Effect on Sleep, Melatonin Secretion and Subsequent Nutritional Response in Healthy Young Men - PMC (nih.gov) + Associations of disordered sleep with body fat distribution, physical activity and diet among overweight middle-aged men - PubMed (nih.gov) + Objective Measurements of Energy Balance Are Associated With Sleep Architecture in Healthy Adults - PubMed (nih.gov)
Pre-sleep supplements.
These options should not replace other sleep habits included in this article and should be only consumed after consultation with your doctor in case you have contraindications to their use.
Melatonin: Natural body melatonin secretion from within the brain occurs as body temperature reduces at night to create good sleeping quality. Before supplementing with melatonin, you should be asking yourself why your body is not producing enough on its own (lifestyle stress, lack of exercise, room temperature too warm, food choices). For the supplement form taken orally, intake ranges from 0.2-3mg seem to be most helpful before bed, but some might not feel a benefit or need more as guided by their doctor Effect of melatonin supplementation on sleep quality: a systematic review and meta-analysis of randomized controlled trials - PubMed (nih.gov)
Other supplements with weak to moderate evidence for assisting sleep include ashwagandha root extract and magnesium. Most forms of magnesium (citrate, sulfate, chloride etc) seem to have similar effects. Adaptogenic and Anxiolytic Effects of Ashwagandha Root Extract in Healthy Adults: A Double-blind, Randomized, Placebo-controlled Clinical Study - PubMed (nih.gov) + The Role of Magnesium in Sleep Health: a Systematic Review of Available Literature - PubMed (nih.gov) + Oral magnesium supplementation for insomnia in older adults: a Systematic Review & Meta-Analysis - PubMed (nih.gov)
Hydration: Many might avoid drinking before bed to reduce the need for getting up at night to urinate. However, dehydration stimulates the urge to urinate. Experiment with ingesting a helpful amount of fluid or food that contains lots of water before bed to reduce any thirst stimulus while reducing the need to get up more than once a night to urinate.
Avoid napping, especially over 20 minutes, and especially if you have sleeping difficulties. Sleep “pressure” increases throughout the day to assist in falling asleep at night. Napping reduces this pressure or “sleeping inertia” that makes falling asleep later more difficult. Yes, a poor night's sleep can be offset by a nap shorter than 60 minutes, but again, where possible, avoid napping for long-term sleep health. To Nap or Not to Nap? A Systematic Review Evaluating Napping Behavior in Athletes and the Impact on Various Measures of Athletic Performance - PMC (nih.gov) A one-off 15-30 min nap before performance, especially if you have had previous poor sleep, can improve outcomes but might still affect sleep quality that night Sleep and Athletic Performance - Sleep Medicine Clinics (theclinics.com) + Sleep and muscle recovery: endocrinological and molecular basis for a new and promising hypothesis - PubMed (nih.gov) + Sleep Hygiene for Optimizing Recovery in Athletes: Review and Recommendations - PMC (nih.gov)
Meet the Australian physical activity guidelines for exercise to increase sleep pressure and ensure your sleep is high quality. Higher or lower than your “normal” doses of exercise might impair sleep until you adapt that level of exercise dosage Bidirectional, Daily Temporal Associations between Sleep and Physical Activity in Adolescents - PubMed (nih.gov) + A cross-sectional study to examine the association between self-reported sleep and the frequency, duration and intensity of exercise - PubMed (nih.gov) + Walk to a Better Night of Sleep: Testing the Relationship Between Physical Activity and Sleep - PMC (nih.gov) + Unfolding the role of exercise in the management of sleep disorders - PMC (nih.gov)
Avoid alarms. Use lighting and routines to guide your brain to wake up without an alarm as much as possible. Avoid sleeping with animals such as dogs and cats if they disturb you during the night.
Seek regular weekly high-quality help for conditions that affect sleep (or when sleep affects recovery), like persistent pain, depression, anxiety, sleep apnoea, low muscle mass, high-fat mass, lung disease, and side effects of heart, lung, and neurological medications. The Efficacy of Cognitive Behavioral Therapy for Insomnia in Patients with Chronic Pain - PMC (nih.gov)
These tips assume that you, like all of us, have commute times, work schedules, and family obligations that can affect your sense of control over sleep quality. We know your climate and external noise levels are not always modifiable. We know that as a reader, you might be a shift worker or work late at night changing what your “optimal” might look like. We know that some of these tips might not be achievable for you in the short term. Any habit change in a positive direction is good for your sleep health, even if you don’t notice a change initially. Just like how sleep deficits can have gradual negative effects, the effects of good sleep can occur gradually.
We know that changing sleep habits on their own might not be adequate to improve sleeping troubles, and it might benefit to seek help from a sleep specialist for further input if none of these principles have felt helpful. Also, if you have had disrupted sleep for prolonged periods, don’t expect suddenly to get great sleep when starting to test some of these tips. For you, it might be more helpful to judge changes in your weekly sleep quality rather than nightly. Trust the process, track when things go well (online templates are freely available Sleep Diary - Sleep Education), and be optimistic your sleep will improve with time.
If you are concerned about your sleep health, book an appointment with one of our physios to speak more about health generally, or for a more personalised chat about how to improve your sleep health without any barriers (such as exercise or pain from exercise) reducing sleep health Meta-Analysis of Quantitative Sleep Parameters From Childhood to Old Age in Healthy Individuals: Developing Normative Sleep Values Across the Human Lifespan | SLEEP | Oxford Academic (oup.com) + Normal polysomnography parameters in healthy adults: a systematic review and meta-analysis - The Lancet Respiratory Medicine
Quick tips for common concerns
What do you do if you cannot sleep for 15- 30 minutes after trying.
Get out of bed and do something else relaxing outside of the bedroom until feeling sleepy again then return to bed. Similar to feeling hunger without eating, sleep inertia (like hunger signals) can fluctuate up and down so “missing” falling asleep can happen. Staying in bed and being anxious about not sleeping will not help you fall asleep.
“What should I do if I just broke my sleeping routine?” “I just had a routine, but I went out into the town last night and disrupted my usual sleeping routine.”
Don’t be too concerned. Being anxious about sleep loss is not helpful.
Embrace being a resilient human while being more tired the next day. Sleep pressure from the change in the schedule should build to make getting back into your routine and falling asleep easier the next night.
If you’ve had a routine before, you can likely establish another one.
What do I do if I have had a bad night's sleep?
It is likely that the next day, you will have higher sleep pressure to start the day, so falling asleep that night will be easier if you keep the rest of your routine similar. All you need to do is not deplete your sleep pressure, so avoid napping and avoid creating negative expectations for future sleep quality. If you feel tired and might have previously napped, do something active or get out of your current calming environment instead until the sleep inertia decreases.
Monitor food cravings and intake during the next day, as sleep deprivation impacts these negatively.
How do I know my sleep is high quality?
Many might think perceived “energy” or mood upon waking is a good indicator of sleep quality. Actually though, your levels of perceived alertness in the later parts of the day, nutritional cravings, and exercise performance are better indicators of whether that previous nights’ sleep was high quality.
Myths
“Sleep Trackers are accurate.” Gold standard sleep assessment is completed in a sleep laboratory with polysomnography, which includes technology that measures brain, eye, and face muscle tone. Measurement of each of these accurately determines the type of sleep and quantity of sleep you achieve throughout the night. No wrist-worn or phone device can assess all these factors, so be sceptical of sleeping quality and length estimates. Sleep trackers can also create negative thoughts, such as too much attention to a sleeping quality “number,” which might create false expectations of health and performance for that day. An example might be if sleep records that night were poor, you might expect to perform worse, which won't help performance. If you feel your sleep tracker is not helping you, have a sleep tracker “holiday” Apps and fitness trackers that measure sleep: Are they useful? | Cleveland Clinic Journal of Medicine (ccjm.org) + Performance of seven consumer sleep-tracking devices compared with polysomnography - PMC (nih.gov) + Manipulating sleep duration perception changes cognitive performance – an exploratory analysis - PMC (nih.gov) + Orthosomnia: Are Some Patients Taking the Quantified Self Too Far? - PMC (nih.gov) + Sham sleep feedback delivered via actigraphy biases daytime symptom reports in people with insomnia: Implications for insomnia disorder and wearable devices - PubMed (nih.gov)
“Alcohol….” or “cannabis help me fall asleep.”
Pharmaceutical cannabis and alcohol might help initially with falling asleep, but reduces sleep quality Polysomnographic sleep disturbances in nicotine, caffeine, alcohol, cocaine, opioid, and cannabis use: A focused review - PubMed (nih.gov) + The Effects of Cannabinoids on Sleep - PMC (nih.gov).
As well as waking feeling tired, alcohol drinkers often wake several times during the night during that 1-3am period due to the effects alcohol has on sleep quality interruptions The association between alcohol consumption and sleep disorders among older people in the general population | Scientific Reports (nature.com)
“Coffee does not affect my sleep.”
Many guidelines say to avoid caffeine at least 8-12 hours before bedtime to improve sleep quality. We used to recommend 6 hours prior but further research shows caffeine hangs around longer than we used to think The effect of caffeine on subsequent sleep: A systematic review and meta-analysis - PubMed (nih.gov) You might be used to drinking coffee at night and not having any trouble falling asleep. This would be fine if sleep onset was the only measure of good sleep health. However, sleep quality is still affected by caffeine, so you will still benefit from not consuming caffeinated beverages within 8 hours for overall sleep. Try decaffeinated coffee or informing yourself of the long-term benefits of good quality sleep Coffee, caffeine, and sleep: A systematic review of epidemiological studies and randomized controlled trials - PubMed (nih.gov)
Variable amounts of coffee are found in many caffeinated products so assume your intake is a range rather then an exact amount Caffeine content of Nespresso® pod coffee -2019 (sagepub.com) + Beverages | Free Full-Text | Caffeine Consumption through Coffee: Content in the Beverage, Metabolism, Health Benefits and Risks (mdpi.com)
“I'm a person who doesn't need lots of sleep,” or “I need more than 9 hours sleep each night,” or “Extra sleep above 10 hours per 24 hours has extra benefits.”
1) There are individual sleep differences between people, and this need varies across your life, but it is very unlikely you will “need” and ensure optimal health with less than 7 hours or more than 10 hours as an adult The influence of heredity on self-reported sleep patterns in free-living humans - PubMed (nih.gov). Those who don’t fear monger themselves when they have less than suitable sleep duration might feel tolerant of less sleep but still should aim to sleep for at least 7-9 hours each night.
2) Don’t confuse less need for sleep then your preferred wake up time. We know 10-20% of the population do well waking earlier in the day or going to sleep later and waking later, and this habit might not be adjustable. “Early to bed, early to rise”: Diffusion tensor imaging identifies chronotype-specificity - ScienceDirect + AutoMEQ - Your circadian rhythm type (chronotype-self-test.info) Don’t let known social stigma (“waking up later means you're lazy”) affect when you choose to sleep as long as you feel you are meeting sleep duration and quality recommendations Implicit and Explicit Stigma of Chronotype in Emerging Adults - PubMed (nih.gov).
3) Consistently sleeping shorter or longer than recommended times across one's lifespan is linked to increased risk of many diseases, such as cardiovascular disease, obesity, depression, diabetes, dementia and an earlier death Short sleep duration and health outcomes: a systematic review, meta-analysis, and meta-regression - PubMed (nih.gov) + Long sleep duration and health outcomes: A systematic review, meta-analysis and meta-regression - PubMed (nih.gov) + Age estimation from sleep studies using deep learning predicts life expectancy - PubMed (nih.gov) + Examining sleep deficiency and disturbance and their risk for incident dementia and all-cause mortality in older adults across 5 years in the United States - PubMed (nih.gov) + Midlife Sleep Characteristics Associated with Late Life Cognitive Function - PMC (nih.gov) + Short and long sleep are positively associated with obesity, diabetes, hypertension, and cardiovascular disease among adults in the United States - PubMed (nih.gov) + Sleep duration as a risk factor for the development of type 2 diabetes - PubMed (nih.gov) + Is poor self-rated sleep quality associated with elevated systemic inflammation in healthy older adults? - PubMed (nih.gov) Short-term sleep deprivation is also linked to worsening job performance and reduced job satisfaction Why Sleep Matters-The Economic Costs of Insufficient Sleep: A Cross-Country Comparative Analysis - PubMed (nih.gov)
“Waking up early to exercise won’t affect my health and performance.” Lower than recommended sleep duration reduces performance and recovery from exercise or sport. Remember sleep is by far the best “recovery tool” to improve adaptation from exercise or sport. Ensuring high sleep quality should be the highest priority over any other “recovery tool.” Sleep and the athlete: narrative review and 2021 expert consensus recommendations - PubMed (nih.gov) This is a plug for the parents who have children who wake early for sports. Organise a time for training (afternoon training, shorter morning sessions that start later before school) that your child is physically ready to train rather being counterproductive and disturbing their best recovery strategy for more sports training. Advocate for good quality sleep for your childs health and this will ensure higher performance in sports directly anyways.
“There is an optimal sleep position.” Nope. You are not a machine that can’t adapt to your preferred sleeping positions. If sleeping position was dangerous, the forces exposed to the body when awake and moving would be much more harmful and we all know exercise is healthy. Healthy sleep involves multiple movement position changes each hour of sleep. If there is a position you sleep in that isn't comfortable or that you believe causes pain later, you should be asking yourself why am I not adapting to that position? or why can’t I tolerate this position? and seek lifestyle actions to improve your tolerance (building optimism in your bodies resilience, exercise, stress reductions, more sleep) Sleep positions and position shifts in five age groups: an ontogenetic picture - PubMed (nih.gov) + Sleep positions and nocturnal body movements based on free-living accelerometer recordings: association with demographics, lifestyle, and insomnia symptoms - PubMed (nih.gov) Unless you are in hospital and sleeping position is being adjusted and restricted for a reason, don’t try and maintain one sleeping position. Even in pregnancy, the sleeping position for your unborn childs’ safety is still being debated.
Although instruction to sleep in a certain position might translate to your sleeping position, sleeping quality is worsened when position is instructed rather then left to be free The effects of instruction regarding sleep posture on the postural changes and sleep quality among middle-aged and elderly men: a preliminary study - PubMed (nih.gov) Fear of future pain is a risk factor for future pain.
Can you sit in the same position for 7-9 hours. No. Your body makes you wriggle and move to reduce the sense of discomfort. This you also do in your sleep, moving into 100’s of possible and healthy positions.
Yes, you can wake up with pain and think sleeping position is the cause. Spontaneous pain occurs very commonly though so be careful quickly blaming your sleeping position Inciting Events Associated with Lumbar Disk Herniation - PMC (nih.gov)
More resources on sleep myths:
Sleep myths: An expert-led study to identify false beliefs about sleep that impinge upon population sleep health practices - PMC (nih.gov)
Examining understandability, information quality, and presence of misinformation in popular YouTube videos on sleep compared to expert-led videos - PubMed (nih.gov)
False beliefs about sleep and their associations with sleep-related behavior - PubMed (nih.gov)
If you have insomnia or sleep apnea that objectively stops you from being able to sleep well, a more nuanced approach will be more helpful. See the following resources for a start:
Insomnia
Insomnia and Sleep Disorders: Understanding and Managing These As We Age (youtube.com)
Patient-Friendly Guides - American Academy of Sleep Medicine (aasm.org)
Insomnia and Sleep Disorders: Understanding and Managing These As We Age (youtube.com)
National Sleep Foundation’s sleep time duration recommendations: methodology and results summary - Sleep Health: Journal of the National Sleep Foundation (sleephealthjournal.org)
Be careful of Matthew Walker's "Why We Sleep" book as it is “riddled with scientific and factual errors” https://guzey.com/books/why-we-sleep/
Sleepwell | It's no dream. Sleep well without sleeping pills. (mysleepwell.ca)
The hyperarousal model of insomnia: a review of the concept and its evidence - PubMed (nih.gov)
Insomnia: prevalence, consequences and effective treatment | The Medical Journal of Australia (mja.com.au)
Brain Sciences | Free Full-Text | Acute and Chronic Insomnia: What Has Time and/or Hyperarousal Got to Do with It? (mdpi.com)
(Mis)Perception of Sleep in Insomnia: A puzzle and a resolution - PMC (nih.gov)
Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline | Journal of Clinical Sleep Medicine (aasm.org)
Sleep Apps
Sleep help for children
Obstructive sleep apnoea management
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