How to Sleep Better? Ear Nose Throat Doctor shares expert tips
Doctor Kenny Pang, Ear Nose and Throat (ENT) specialist at Asia Sleep Centre, shares tips
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Sleep is a very basic human need that appears to be a fundamental process. Yet the mechanism and reason why we sleep is extensively researched and still not fully understood
Content
- What is sleep?
- Humans need sleep to live
- Sleep is an active process
- Dream or no dreams better?
- Nose blocked every night
- I don't dream in sleep
- Circadian rhythm
- Light affects sleep
- 5 Sleep cycle stages
- Stressed & can't sleep
- Sleep hygiene checklist
- 8 Bedroom tips for better sleep
What is Sleep?
In order to understand what constitutes quality sleep, we first have to break down the physiology of sleep.
According to the medical profession, sleep can be defined by three key characteristics:
- Sleep is a transient reversible state (the person can be awakened)
- Sleep is a behavioral need (some people require more sleep than others
- Sleep is a perceptual disengagement from the environment (one is not aware of the surrounding)
Woman sleeping in a bed in a dark bedroom (Image 123rf)
Sleep is a habit
Some believe sleep is habitual, as many of us have different sleep requirements and different sleep patterns, sleep habits, or sleep cycles.
Sleep is a state of unconsciousness
Sleep is also seen as a state of unconsciousness in which the brain is relatively more responsive to internal than external stimuli.
The predictable cycling of sleep and the reversal of relative external unresponsiveness are features that assist in distinguishing sleep from other states of unconsciousness. The brain gradually becomes less responsive to visual, auditory, and other environmental stimuli during the transition from wake to sleep.
Humans need sleep to live
It used to be believed that humans need to sleep for the body to get rest; however, we are currently aware that sleep is meant for the brain to get rejuvenation and rest.
Sleep is important for the brain
The average human spends about six to eight hours per day sleeping, for some it can be up to 10 hours per day, while others can do with just four hours per day. Hence, we spend about one third of the day sleeping, and therefore, one-third of our lifetime sleeping, yet so many of us take sleep for granted.
As we spend one-third of our life sleeping, for the average Singaporean who lives up to about 85 years old (current life expectancy, we sleep for a total of 28 years of our life!)
photo KENNY PANG
Sleep is an Active Process
Most of us assume that sleep is a passive event, where we close our eyes and all our bodily functions "turn/switch off".
Is sleep an active or passive process?
Contrary to popular belief, sleep is an active process involving complex interactions with increased metabolic functions and activities within the brain.
Metabolic brain scans have shown that during dream sleep, the brain activity is more intense and active compared to the brain in non-dream sleep and in the awake state hence, during dream sleep the brain is so active, and yet it is important in rejuvenation, repair and memory re-building of the brain.
Which sleep is better - with dreams, or without dreams?
Sleep is divided into two main phases:
- dream sleep (rapid eye movement or REM)
- non-dream sleep (non-REM)
Stage four sleep and dream sleep is also known as slow-wave or delta wave sleep (SWS), when the brain waves slow down to a very slow and coordinated pattern.
Children tend to dream more than adults
On average, dream sleep comprises about 25% to 30% of the entire sleep in an adult. In a child however, dream sleep may be as high as 50% of the entire night’s rest.
Research done on metabolic activity of the brain during different phases of sleep and wake states, demonstrated increased metabolic activity in most parts of the brain during dream sleep compared to nondream sleep and even the wake state.
Is dreaming good or bad?
Most sleep experts believe that dream sleep is crucial for the human.
It is well accepted that dream sleep is the most important element in the sleep process, for well being, memory rebuilding, rejuvenation and mental alertness. Hence, dream sleep is vital to the human mind and body.
Dream sleep is characterised by slow delta waves in the brain, increased metabolic activity in the brain, and rapid eye mocements (REM). Rapid eye movements during dream sleep are a medical phenomenon that helps us identify dreaming events but scientist cannot explain their need.
Dreaming: Active brain, resting body
Simplistically, dream sleep is a highly active brain in a "paralysed" body. This is a natural reaction from our bodies in order to prevent us from acting out our dreams (i.e. if one was dreaming that one was playing soccer, one does not actually kick the bed- partner).
Nose blocked, stuffy every night
This, however, works against the patient with a narrow airway, as the already narrowed airway will lose its tone during dream sleep and collapse, leading to upper airway obstruction, cessation of breathing and lack of oxygen.
Therefore, this can lead to stress on the heart, brain and other organs in the body, a condition known as obstructive sleep apnea (OSA).
Obstructive sleep apnea symptoms
Obstructive sleep apnea (or apnoea) is the most common sleep disorder.
Due to the stoppages in breathing and low oxygen during the night, sleep apnea results in interrupted sleep, sleep fragmentation and poor sleep quality.
During the day, the patient is excessively sleepy, has poor concentration, poor memory and becomes irritable. Long term health consequences include high blood pressure, heart disease, strokes and sudden death during sleep.
Sleeping without dreaming: I don't dream
Non-dream sleep is believed to be a complex interaction between the higher brain centers and the mid-brain. There are four stages of non-dream sleep. They progress from stage I, II, III and IV. stage III and IV are also known as slow wave sleep (SWS).
The exact function of this non-dream sleep (also known as non-REM sleep) is not known, although many sleep scientists postulate that during this decreased metabolic demand state in sleep, the brain can now replenish energy glucose and glycogen stores; perhaps to get ready for the next REM phase.
Circadian Rhythm
The circadian (cyclical) sleep rhythm is one of the several intrinsic body rhythms modulated by the hypothalamus (mid-brain).
The sleep centre sets the body clock to approximately 24 hours, with both light and dark exposure influencing the 24-hour cycle.
Does sleeping in light affect sleep?
The light exposure stimulates the sleep control centre directly and modulates the sleeping pattern as well (blue light stimulates the wakefulness center).
A practical purpose has been proposed for the circadian rhythm, using the analogy of the brain being somewhat like a battery charging during sleep and discharging during the wake period.
4 No-dream stages, 1 Dream stage
The normal human brain goes through a very systematic process every night during sleep. The brain would go through the four stages of non-dream sleep and reach dream sleep in a cyclical fashion.
There are some "rules" that the brain follows:
- Time you take to fall asleep (called sleep latency), and varies from few minutes to half an hour.
- Time you take to have your first dream (called dream sleep latency) ranges from 60 to 90 minutes.
- Babies and children dream most, about 50% of the night, while adults only dream for 25% to 30% of the night.
- Most of your dreams are found in the later half of the night.
Sleep Cycle Stages
One sleep cycle comprises of four stages and last for about 90-120 minutes.
An average sleep period a person will experience four to five complete sleep cycles.
What are the 5 stages of sleep cycle?
The sleep cycle begins systematically from stage I to IV, with four cycles of SWS (Slow-Wave Sleep). Note that after the completion of the fourth cycle, the fifth cycle does not immediately begin; instead, it is followed by a REM period.
The first REM period will occur roughly 60-90 minutes after falling asleep (REM latency) and the first REM period will last only about 10-15 minutes.
The length of the stages is not static, however: as the night proceeds, the length of stage three and four (also called delta or deep sleep) begins to wane, and the length of REM sleep increases.
Therefore, as the night goes on, one tends to dream for longer periods of time.
Read More: 6 Bedroom Accessories for Better Sleep
Stressed, Can't Sleep
The sleep hormone, called melatonin, is sensitive to the dark. It is produced in the pineal gland of the brain and primarily causes drowsiness and enhances deeper and more natural sleep.
Melatonin makes you drowsy for deeper sleep
Melatonin is usually produced about 9-10pm in the evening and peaks at about midnight to 1am and dwindles after that.
Melatonin vs Cortisol
Melatonin is in fine balance (antagonism) with the stress hormone, cortisol.
Cortisol is produced in the adrenal glands and is produced during periods of stress. When the cortisol levels are high, the patient may not be able to have restful sleep, resulting in sleeplessness or insomnia.
Melatonin for jet lag
Oral supplementary melatonin may be used as a sleep enhancer to aid patients with sleeplessness; melatonin is also frequently used in people who cross time zones regularly and suffer from jetlag.
Many studies have showed a variety of features consistent in patients with sleeplessness or insomnia.
If you suffer from long-term insomnia, you're prone to have:
- Depression and anxiety (especially for type A personalities)
- Longer daytime sleep latency (time taken to sleep in the day)
- Increased 24-hour metabolic rate (in easily stressed out personalities)
- More volatile sleep patterns
Managing stress is a very important (and often complex and difficult issue to treat patients with sleeplessness.
Read Also: Your Essential Guide to Quality Sleep
Decrease stress for better sleep
Management of stress can range from ventilation therapy, to counselling, to exercise and to relaxation therapy. Decreasing a patient’s stress would lower the blood levels of cortisol, and hence, allowing the patient to sleep better.
Sleep Hygiene Checklist
Habits to keep sleep hygiene is the practice of following guidelines, usually simple and sensible ones, to ensure more restful, effective sleep which can promote daytime alertness and help treat or avoid certain kinds of sleep disorders.
- Go to bed at the same time each day. This will allow your mind and body a chance to rest regularly, and at a fixed scheduled time.
- Exercise each day, preferably in the morning. There is good evidence that regular exercise (including meditation and yoga) improves restful sleep.
- Go outdoors for sunlight during the day. This allows the mind and body to be aware of the day and night, as melatonin is produced during the night, when exposed to the dark.
- Keep bedroom temperature cool and comfortable, as you would not be able to sleep well if you were sweating. It should not be too cold as well.
- Keep bedroom quiet when asleep, as a noisy environment might keep you awake. The bed partner should preferably not be a snorer, as the spouse of a snorer has been shown to sleep an average of 2 hours less in terms of quantity when compared to a spouse whose bed partner does not snore.
- Bedroom should be dark enough to facilitate sleep. Melatonin levels in the blood start to rise by about 9 to 10 pm and peaks by 1am to 2am.
- Do relaxation exercises before bedtime, for example, muscle relaxation, imagery, massage, warm bath,etc. This might help promote deeper sleep.
- Keep feet and hands warm. Wear warm socks and or mittens or gloves to bed.
Read More: Bedroom Tech Gadgets for Better Sleep
There are, however, some things you shouldn't do before bedtime:
- Don't exercise before bedtime, the heart rate and adrenaline levels in the blood needs some time to slow down. Avoid exercise 3 to 4 hours before bedtime.
- No stimulating activities before bedtime, such as playing a competitive game, watching an exciting program on television or movie, or having an important or heated discussion with a loved one. One should also avoid surfing the internet just before sleeping.
- No caffeine in the evening (coffee, many teas, chocolate, sodas, etc.), as these compounds contain stimulants that might keep you awake at night.
- No reading or television in bed. Using your bed as a workstation or a spot for movie watching confuses your body into staying awake.
- Don't go to bed hungry or too full. You will not be able to sleep when you are hungry, as gastric pain might keep you awake; while a too full stomach will promote reflux disease and cause chest discomfort.
- No daytime naps if you have any form of insomnia or sleeplessness. As the guilt of sleeping in the afternoon will surely keep you thinking and feeling guilty, such that you would surely not sleep at night.
- Don't force your body to sleep. This only makes your mind and body more alert.
Read More: 4 Affordable Hacks for Better Sleep
Young beautiful woman sleeping in her bed and relaxing in the morning (123rf)
8 Bedroom Tips for Better Sleep
The bedroom is one’s personal refuge. While most people can adapt to almost any kind of bedroom environment, it is important to have a good and conducive bedroom for better quality sleep.
1. Better to sleep with no noise
Your bedroom should be as quiet as possible. Many people are very sensitive to the noise in the environment.
Sound in the surroundings should not be rhythmic, like the clock or the sound of dripping water from a leaky tap.
White noise is better, like the sound of your aircon, fan, or noisy radiator. Some sleep specialists recommend the white noise of the FM radio station in between any two stations. Abrupt and intense noise will disrupt your sleep.
Some companies have gadgets that play the soothing sound of the ocean, sea or crickets in the forest to help you sleep.
2. Better to sleep with no light
The use of thick curtains and blocking the rim of doors and windows to reduce the amount of light leaking into the bedroom may help. Eye shades are also useful.
3. Better to sleep in 19 to 23°C
The ideal bedroom temperature should be between 19 degrees Celsius to 23 degrees Celsius (may vary from individual to individual).
As for humidity, about 60 to 80% would be adequate. You may want to buy a humidifier that might keep the environment less dry.
Studies have shown that patients with blocked nose and difficulty breathing through the nose at night would have poorer quality sleep. A HEPA filter in the room might help filter out allergens in the air.
How to Sleep Better? An Ear Nose Throat Doctor Shares Expert Tips
4. Clocks are bad for sleep
If you have a problem falling asleep or maintaining sleep, you should not have any clocks in your bedroom, much less a noisy “ticking” clock.
People who cannot fall asleep would frequently “consult” their clock to see what time it is. The more one looks at the clock, the more anxious one would get, hence, hindering the sleep process.
5. Cotton, silk, linen bedsheets best for sleep
Cotton is popular, as it is soft and comfortable. Silk is also popular but more costly. Linen sheets that are dust mite free and antimicrobial might be useful.
6. Good pillows help with sleep
Orthopedic doctors and chiropractors encourage patients to have good pillows and supports in order to avoid neck and back problems.
7. Good mattress helps with sleep
A good mattress should hug your body snuggly while keeping your spine and back straight.
8. Haze and air pollution is bad for sleep
Close all windows, turn on the air-conditioning and use a HEPA filter throughout the night.