As answered by Issue Reviewers
Q: Any tips on making time for sleep in a busy life?
Dr. Thomas
The key is to consider good and adequate sleep as necessary for health, just like optimal food, exercise, relationships and so on. Time will have to be made. If sleep is considered a nuisance and somewhat optional, it will be so denigrated. Some examples of making best use of time are to read work material while on an exercise machine, minimize meetings and keep them short/targeted, make trade-offs for a shorter commute, work from home, and yes, take vacations and intermittent off-days to keep fresh.
Dr. Lipford
It seems the busier we get, the more tempting it is to shift our bedtime later to get those extra things done. However, this strategy just doesn’t pay off. Staying up late and working when we are sleepy leads to inefficiency and making mistakes. By prioritizing adequate sleep, we can get more done in less time, our performance and accuracy improve, and we are more prone to reflect the best version of ourselves in our work and home relationships. One of the best ways to prioritize sleep is to set a consistent bedtime and rise time. As bedtime approaches, that is your cue to stop working, put away the screens, and have a few moments of quiet time to relax. This will help you fall asleep faster and get better quality sleep. Waking up at the same time every day also helps to preserve good sleep patterns. Adults should aim for 7-8 hours of sleep nightly. Getting adequate sleep fills your tank so you are ready to attack the busy day ahead.
Dr. Zak
Making sleep a priority is a challenge in our 24-7 culture that has been exacerbated by the ability to interact anytime and anywhere. Thus, it takes creativity and discipline. To the extent possible, it is best to block out the time on your calendar—the same way you would as for a meeting—for the 1.5 to 2 hours prior to bedtime to be reserved for you to have a “wind down routine” just as we do for our children. I have not truly answered the question because I think there is no answer—we cannot both work and wind-down at the same time—but having awareness and thinking about ways to carve out the time to allow for a winddown period will help with sleep. Until we can create a 27-hour day, I think we can only do the best we can.
Dr. DelRosso
Remember that sleep is important for mental, physical and emotional wellbeing. Some tips would be to engage your family in prioritizing sleep with you. Take simple actions to protect your sleep (i.e. avoid caffeine in the late afternoon, evening), reassess the demands of new projects before you decide to accept them and avoid unnecessary activities that may steal sleep hours (such as late night movies).
Q: Are over-the-counter sleeping pills okay to take?
Dr. DelRosso
I do not recommend to take over-the-counter (OTC) sleeping pills before checking with your doctor. I recommend taking a picture of the label of the product you are planning to take and bringing it to your doctor for discussion. There are a couple of concerning issues with OTC medications/supplements:
• They are not free from side effects or interactions
with other medications
• They can have unwanted substances (contaminants)
• They can cause sedation during the day
Dr. Thomas
There are two types of OTC sleeping aids—one type based on antihistamines and the other on various combinations of melatonin and herbs with sedative components like valerian. OTC antihistamines are potent, long-acting and often block a neurochemical called acetylcholine, which is important for memory. Any effective sleeping aid is a potent drug and so, should only be used with care, occasionally, and not when driving the next day. If you find yourself reaching for an OTC sleeping aid frequently or continuously, a trip to see your physician is probably necessary. For jet-lag, a prescription sedative is better, as the duration of action is shorter, while antihistamines can keep you groggy for several hours after awakening.
Dr. Zak
The question should be extended to over-the-counter substances globally, including herbal supplements. This is a complicated question that has no global answer. Just be aware that herbal supplements have properties similar to prescription medications (for example, St. John’s Wort has properties similar to Prozac and valerian has properties similar to Ativan) and, therefore, taking OTC substances is akin to taking prescription medications. Therefore, it is important to discuss any and all of these with your clinician.
Q: How long should it take to fall asleep?
Dr. Thomas
These days, that is not a simple answer, as a phone/tablet are frequent bed companions, never mind the television. However, more than 30 minutes after shutdown of distractors can be considered abnormal; 60 minutes is definitely abnormal. It is important not to get into bed and try to sleep if feeling wide awake or after substantial late bright light exposure– a long time to fall asleep is virtually guaranteed in those instances.
Dr. Zak
This is an individual question and the same amount of time may feel normal to one person and an eternity to another. We generally consider 20 minutes or so as normal, such that more than 30 minutes is generally considered long and less than 8 minutes is considered short. That stated, normal sleep latency is almost as much a function of how one feels as opposed to an absolute number. In fact, some patients who feel they have a long sleep latency (too much time to fall asleep) get relief by just by going to bed closer to their natural bedtime as that decreases time in bed awake even though there is no change in the clock time at which sleep occurs.
Q: How many nights of insomnia should I endure before calling my doctor?
Dr. Thomas
Insomnia for more than two nights a week is worrisome. Progressive worsening of insomnia usually needs evaluation. Persistence of insomnia for several weeks after a transient trigger requires evaluation. Cycles of insomnia are also a red flag and could be an early feature of depression. Rare and intermittent insomnia that has a logical trigger (obvious stressors, travel, exams, etc.) is best tolerated, but if a person has high sleep reactivity to stress, a prescription sleeping aid can be a useful preemptive strategy used occasionally if behavioral strategies fail.
Dr. DelRosso
You should not endure insomnia. In fact, insomnia is diagnosed when sleep symptoms are present for at least three times a week and for a duration of at least three months. Many things can affect your sleep temporarily. Stress, diet, medications, pain or social situations can hinder our ability to fall asleep at a reasonable time for a few days. But if the problem persists and interferes with your activities during the day, you should let your doctor know.
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