Why We Sleep: The New Science of Sleep and Dreams

by Matthew Walker

Kripke’s study did a better job in this regard, and included the newer, more relevant sleeping medication Ambien. Individuals taking sleeping pills were 30 to 40 percent more likely to develop cancer within the two-and-a-half-year period of the study than those who were not. The older sleeping medications, such as temazepam (Restoril), had a stronger association, with those on mild to moderate doses suffering more than a 60 percent increased cancer risk. Those taking the highest dose of zolpidem (Ambien) were still vulnerable, suffering almost a 30 percent greater likelihood of developing cancer across the two-and-a-half-year study duration.

The obvious methods involve reducing caffeine and alcohol intake, removing screen technology from the bedroom, and having a cool bedroom. In addition, patients must (1) establish a regular bedtime and wake-up time, even on weekends, (2) go to bed only when sleepy and avoid sleeping on the couch early/mid-evenings, (3) never lie awake in bed for a significant time period; rather, get out of bed and do something quiet and relaxing until the urge to sleep returns, (4) avoid daytime napping if you are having difficulty sleeping at night, (5) reduce anxiety-provoking thoughts and worries by learning to mentally decelerate before bed, and (6) remove visible clockfaces from view in the bedroom, preventing clock-watching anxiety at night.

One of the more paradoxical CBT-I methods used to help insomniacs sleep is to restrict their time spent in bed, perhaps even to just six hours of sleep or less to begin with. By keeping patients awake for longer, we build up a strong sleep pressure—a greater abundance of adenosine. Under this heavier weight of sleep pressure, patients fall asleep faster, and achieve a more stable, solid form of sleep across the night. In this way, a patient can regain their psychological confidence in being able to self-generate and sustain healthy, rapid, and sound sleep, night after night: something that has eluded them for months if not years.

CBT-I consistently helps people fall asleep faster at night, sleep longer, and obtain superior sleep quality by significantly decreasing the amount of time spent awake at night.fn7

All twelve suggestions are superb advice, but if you can only adhere to one of these each and every day, make it: going to bed and waking up at the same time of day no matter what.

Nevertheless, for healthy sleep, the scientific evidence suggests that you should avoid going to bed too full or too hungry, and shy away from diets that are excessively biased toward carbohydrates (greater than 70 percent of all energy intake), especially sugar.

Unfortunately for bosses, a sleep-deprived employee will erroneously perceive a well-rested leader as being significantly less inspiring and charismatic than they truly are. One can imagine the multiplicative consequences to the success of a business if both the leader and the employees are overworked and under-slept.

The answer originates with the esteemed physician William Stewart Halsted, MD, who was also a helpless drug addict. Halsted founded the surgical training program at Johns Hopkins Hospital in Baltimore, Maryland, in May 1889. As chief of the Department of Surgery, his influence was considerable, and his beliefs about how young doctors must apply themselves to medicine, formidable. There was to be a six-year residency, quite literally.

First-year residents would be limited to (1) working no more than an 80-hour week (which still averages out at 11.5 hours per day for 7 days straight), (2) working no more than 24 hours nonstop, and (3) performing one overnight on-call shift every third night. That revised schedule still far exceeds any ability of the brain to perform optimally.

One practice known to convert a healthy new habit into a permanent way of life is exposure to your own data. Research in cardiovascular disease is a good example. If patients are given tools that can be used at home to track their improving physiological health in response to an exercise plan—such as blood pressure monitors during exercise programs, scales that log body mass index during dieting efforts, or spirometry devices that register respiratory lung capacity during attempted smoking cessation—compliance rates with rehabilitation programs increase.

Stick to a sleep schedule. Go to bed and wake up at the same time each day.

Set an alarm for bedtime.

Exercise is great, but not too late in the day. Try to exercise at least thirty minutes on most days but not later than two to three hours before your bedtime.

Avoid caffeine and nicotine.

Avoid alcoholic drinks before bed.

Avoid large meals and beverages late at night.

If possible, avoid medicines that delay or disrupt your sleep.

Don’t take naps after 3 p.m.

Relax before bed. Don’t overschedule your day so that no time is left for unwinding.

Take a hot bath before bed.

Dark bedroom, cool bedroom, gadget-free bedroom.

Have the right sunlight exposure.

Don’t lie in bed awake. If you find yourself still awake after staying in bed for more than twenty minutes or if you are starting to feel anxious or worried, get up and do some relaxing activity until you feel sleepy.