Sleep Improvement for Mental Health

Foreign. I'd like to welcome everybody today's presentation of integrative behavioral health. I am your host, Dr. Donnelly Snipes. Today we are starting a six week limited series to help you achieve the happiest, healthiest you possible. And we're going to start out today by talking about sleep. It's important to recognize that more than 80% of Americans have imbalanced neurotransmitters that are caused by poor health behaviors, HPA axis disregulation, lack of effective distress tolerance and coping strategies, and just unhealthy environments. Life happens, crap happens. But there are many ways that you can bolster your physical and psychological reserves so you can deal with life on life's terms or deal with that inevitable stress a little bit better when it happens. Each day for the each weekday for the next six weeks, I will be discussing strategies and life hacks to help you improve your health and mood. Let's talk about sleep real quick. A good night's sleep equals four to five full sleep cycles, each consisting of periods of deep sleep and rapid eye movement sleep, both of which are critical to the biology of sleep. Different things happen during deep sleep than happen in REM sleep, but they're both essential for health and well being. So briefly, let's just talk about, you know, what are some of the things that adequate sleep can help us with? Well, the first thing is that HPA axis regulation. When we are not getting adequate quality sleep, our body recognizes that as a threat. So it ramps up that HPA axis when it recognizes that we're sleepy, it ramps up that HPA axis to increase the amount of excitatory or awake neurotransmitters that we have. But that is really stressful on the body. That's like the body's way of giving you a little jolt of caffeine without the caffeine. When you get adequate quality sleep, it actually helps reduce the free radicals and slows premature aging. During your sleep time, the body is able to clear out those free radicals. It's able to focus on, you know, cleaning out all the residuals from the day. It's also able to focus on repairing any damage that was done. And we have damage. And it can be stuff you don't even notice, like, you know, cell mutations or something. But the body goes around and it's kind of like the little, the little janitor that goes around and cleans up everything while you're sleeping. The body boosts your immune system when you're sleeping. When we have reduced sleep, it's Important to recognize that it will increase our HPA axis as well as impair our immune system. When the HPA axis is activated, our immune system is suppressed. When you're getting enough sleep, you're going to have less reliance on caffeine, which, which is always a good thing. Reduced blood pressure, improved insulin sensitivity and a better regulated appetite. And throughout the next few weeks, we're going to talk about each one of those things in more depth. Affectively, when you have a good night's sleep, a lot of times you have a better mood. We've seen in research that people who get good sleep have significantly less affective disorder, significantly less depression and anxiety. Now is sleep going to make your depression or anxiety just magically go away? Oh, heck no. But sleep is one of those things, or sleep deprivation is one of those things that does contribute to depression and anxiety. So if we can at least take that contributing factor off the table, we're helping ourselves out. And when you have more energy, you tend to be more curious. You have more energy to look around and pay attention and do things that you enjoy cognitively. In that deep sleep phase, the brain clears out something called adenosine, which is a byproduct of thinking. Basically, you know, it's, that's a little oversimplified. But as we think during the day, as we go through our day and go through our normal processes, adenosine builds up in the brain. It is cleared out overnight and helps us wake up and feel clear headed and energized environmentally. More energy will help you tend to your environment and be more productive at work. And you're more likely to notice the positive things when you're awake and alert and in a good mood. Interpersonally, you're going to have likely improved patience. When you're not exhausted and or hyped up on caffeine, it's a little bit easier to be patient and you're going to have more energy to spend time with friends. You may not have as many hours in the day if you're actually getting those seven to nine hours of sleep that you're supposed to get. But the time that you do have is going to be awake time, quality time. You're not just going to be going through a fog. So how can we do this? Well, let's start out with the physical ways we can improve sleep. Create a sleep routine. It is really important to have the same three to five things that you do every night. I say three because that's, that's an easy one to knock out. In order to cue your body that, hey, it's time to start going to sleep. And there are a lot more things we'll talk about in an environmental. There are a lot more things you can do to cue your body that it's time to sleep. But a sleep routine is especially helpful with kids. We do this, they come home from school, they play, they eat dinner, they take a bath, they read a story, they go to bed. And that helps them develop good sleep habits. Somewhere along the way we stop doing that and that's really detrimental to our sleep. So a sleep routine is helpful. Address sleep apnea and snoring. Sleep apnea has so many negative effects to it. It can increase your blood pressure, it makes your blood sugar harder to control. It actually contributes to a loss of oxygen. You know, when you have apnea, you stop breathing for just a minute and it can contribute to an increased risk of dementia later in life. Addressing apnea and snoring we can do some environmental things, but apnea itself is a medical diagnosis. So if you think you have sleep apnea, it is important to go get evaluated by your physician. Address pain and there are a lot of things that you can do to address pain aside from pharmacological interventions. Sometimes you're going to need pain meds, but most of the time, if you are engaging in proper ergonomics, if you are stretching, if you are taking care of yourself as much as possible, massage, guided imagery, heat and cold, all of those things can help address pain. And it's important to talk with your doctor about non pharmacological interventions that can help because especially the opioids do have a negative impact on our sleep quality. So if we can get away from using opioids to address pain, that's great. But we do need to recognize that if we're in pain, we're probably not going to sleep as well. Address allergies. This can mean taking allergy medication, getting allergy shots, getting a good filter HEPA filter to have in your room to address allergies, whatever it is that you can do in order to minimize how much you are coughing and waking up in the night, or and improve your ability to breathe through your nose so you are not as likely to snore. All of those things are going to help cool down. This is another thing. A lot of people think that they need to, you know, take a hot bath and get warmed up to get ready for sleep. And in actuality, it's just the opposite. When we are going to sleep, our body needs to cool down so it's important to not do too much that's going to get you, you know, super overheated, like take a really long bath or a hot tub or, you know, go out and go on a really long run right before bed. None of those things are going to help you in the short term when you are trying to improve your sleep. The average person sleeps best anywhere between 60 and 72 degrees. And that's. It's going to dep. Vary depending on who you are. I'm down on the lower end, you know, my family tends to be up a little bit higher than I am. Pay attention to set your circadian rhythms. Your circadian rhythms help you fall asleep. And having a sleep routine is one of those things. If you do the same things about the same time every night, it'll start training your brain and training your body that this is when we go to sleep. Set your circadian rhythms by when you wake up, expose yourself to bright light. It doesn't have to be sunlight when we're just talking about setting your circadian rhythms, but bright light can really help to tell your body that, hey, it's, it's time to be awake. It's daytime. During the day, expose yourself to bright light frequently. Even if you work in a place that's dim, it's important to do that to help set your circadian rhythms. If your circadian rhythms are set well, then in the morning when you wake up, your cortisol levels, your stress hormone will actually be highest because it's, that's telling your body, hey, it's time to get up and greet the day. A little bit of cortisol is a good thing. When you go through the day, part of your circadian rhythms is the decline in that cortisol throughout the day. If you're keeping your cortisol levels up because of stress or pain or something else, then it may be harder to get ready to get to sleep. Cortisol works against melatonin. Let's just think about it that way. If you have high cortisol, your melatonin is probably going to be low. And if you vice versa. So if you can naturally increase your melatonin, it'll help suppress, suppress your cortisol. Now, taking melatonin over the counter is not going to do the same thing. So don't think that, oh, hey, I can just take a pill. No, we need to get away from that. We need to start thinking about what can I do to reduce my stress so my stress response system can downregulate, eliminate Stimulants completely if possible, but most people are not willing to do that. So with caffeine, remember that it stays in your body up to 12 hours after you drink it or consume it. So if you're going to consume caffeine, try to do do it no later than 12 hours before you go to bed. And that includes sodas, coffee, and large amounts of chocolate. Small amounts of chocolate, like one Hershey's Kiss or something's probably not going to do have a significant impact on your, on your sleep, but you certainly don't want to be eating a lot of it. Chocolate also has other stimulants in it that can help keep you awake. So avoiding the chocolate right before bed, avoiding caffeine within 12 hours, avoiding nicotine within ideally four hours. But two hours before bed is also important because nicotine does have stimulant properties to it. When you are eliminating stimulants, you're helping your body reduce that cortisol level. When you take stimulants, it increases cortisol. When you back off of the stimulants, it helps decrease the cortisol level, which also helps regulate that HPA axis. Avoid alcohol right before bed. Now, alcohol does help some people drift off to sleep faster. However, it increases sleep apnea symptoms, it increases snoring, and as the alcohol leaves the body, it actually has an excitatory response that impairs sleep the rest of the night. So if you can avoid alcohol before bed, that's good. Hydrate early. There's nothing worse than getting awakened in the middle of the night because you got to get up and go pee. If you hydrate early, then you're going to start eliminating some of that. You definitely want to stay hydrated. But it's important to figure out, you know, when I drink water, how long does it take to kind of go through my system? For some people it's like two hours. For other people it's a little bit longer. Just kind of depending on how fast your body works. But knowing that and then saying, okay, well, I'm going to back off to just sipping on water after, you know, 6pm or something in order to help you sleep through the night. That's really important. As we get older, especially men, as they get older, they may find that they have to go to the bathroom more often. They have to get up in the middle of the night to go potty. It's important for them to talk with their doctors about what they can do to reduce those middle of the night awakenings because those are really hard on the body and really hard on the circadian rhythms. Avoid napping. If you have to take a power nap, keep it under 30 minutes. But when you take a nap during the middle of the day, your body goes, oh, well, maybe it's time to go to sleep. So then you're throwing those circadian rhythms out of balance. Deep breathing before bed can also be super helpful. Whether you're doing it when you stretch or you're just laying down. Breathe in. And at bedtime, if you can, breathe in for eight, hold for eight and exhale for eight. Now, if you feel like you're, you know, can't hold it for that long, you want it to be a relaxing activity. So breathe in for as long as you can, hold for as long as you can, and then exhale for as long as you can. When you slow your breathing, it triggers the rest and digest system, which is the opposite of the HPA axis and helps you start getting ready for relaxation. We need our body and our mind to be relaxed, to help us go to sleep. A lot of people when they lay down, as soon as they, you know, turn off the TV or whatever and they lay down and it's quiet, they start thinking. They get monkey mind and all this stuff that they're worried about starts running through their head. Well, that's going to be a problem. That's going to keep you awake. If you're worried, worry is anxiety. Anxiety is half of fight or flee. So when you're worried, that's telling you that your HPA axis is crank cranked up. Write down your worries and that can be things that you're worried about are going to happen, you know, whatever you can journal about them and things that you need to quote, remember, like if you need to remember to get milk tomorrow when on the way home from work, write it down. Otherwise you're going to be laying there telling yourself, I've got to remember, I can't forget. That keeps your brain, even if you're not actively thinking about it, it does keep your brain a little bit more alert. So keep a notepad by your bed with a red light flashlight. Red light flashlights will help prevent you from destroying your night vision and upsetting your circadian rhythms. Blue light triggers your brain to start waking up. So we want to keep our light at night down around the 2500 Kelvin range, which is really yellow or really red. And that will help you not destroy your, your night vision. I noticed when I was on the way to work this morning that, you know, the, the street lights are actually a very yellow color and I had never really noticed that before, but my guess is they do that to help prevent destroying your night vision when you go from a well lit area to a darker area. I just, I happen to notice that because they replaced one of the street lights with a bright white bulb and it was very startling to the eyes. But anyhow, I digress. Write down your worries. Whenever you can, keep a pad and paper and a red light by your bed or if you put things on your mobile device. If you have a notepad on your mobile device, make sure that you have a blue light filter installed that is on from about two hours before you go to sleep until you wake up in the morning. That way, if you do wake up and turn on your mobile device, it won't disrupt your, your circadian rhythms. Take 10 minutes. When you're laying down or getting ready to lay down, take 10 minutes to focus on the positive or have an attitude of gratitude. That can help get your mind over to something that's more positive and can also help broaden your focus to. Too often we focus our attention on the negative, on our stresses, on our frustrations. It's important to also, you know, take those blinders off so we don't have that tunnel vision on the negative and see the positive. They found that spending 10 to 20 minutes focusing on the positive every day helps improve people's mood. But doing it right before you go to bed can also help trigger some of those relaxation chemicals. And when you're not thinking about stressful things and you're thinking about happier things, meditation is great, as is progressive muscular relaxation. And I have several different videos on the, on the YouTube channel that you can watch that are different examples of meditation, progressive muscular relaxation and guided imagery. A lot of people have other meditations that are on YouTube, so I suggest that you explore different types of meditation, different scripts for guided imagery, or you can even make your own. Environmentally, it is important to have blue light during the day. So light that is 5,000, like daylight bulbs, 5,000 Kelvin or brighter or, you know, or bluer I guess is the better term, and have it as bright as possible. The further away from your head, a light bulb is, the less intense the lighting on you. So you can have a 100 watt bulb, you know, 100 watt equivalent because, you know, ideally use LEDs so it's easier on the environment. If it is, you know, on your desk, you're going to be getting a much more intense dose of bright light than if it is eight feet in the air, in the ceiling. Do consider eliminating blue light two hours before bed. That means either get a blue light filter or turn off your mobile devices and your television. They do have at least a device, if not multiple devices now that you can actually attach to your television that will turn on a blue light filter at a certain time of night. So you just like you have it on your, on your mobile device and on your computer, it can be on your television too. If you feel like you need to watch TV in order to get sleepy. It's also important at night when it is time to sleep, to have it as dark as possible. If you feel comfortable sleeping with a sleep mask, then that's great. If you don't, you know, doing as much as you can to eliminate any sources of light are going to be important. If you feel like you have to have a night light for some reason, having a red nightlight, just like the exit signs and stuff in, in the movie theaters is less problematic than having one that is blue. So do try to do that. So bright light during the day, 5,000 kelvin or above in terms of color temperature at night, have it 2500 kelvin or below. You can find these interestingly enough, the bulbs that they use for outdoor lighting that I guess are supposed to, I don't avoid attracting bugs, tend to be that yellow, really rich yellow color. So you can get them relatively inexpensively if you just get a little creative. You can also put those yellow lights, those yellow bulbs in your lighting, in your room or wherever you spend the last two hours of your night. So when it's time to go to sleep, you have enough light, but so you can function. But it isn't the blue light that is going to keep you awake. Noise, noxious noise. We want to get rid of any noise when we're sleeping is going to potentially wake us up. But having it too quiet can also be a problem because we hear every pin drop. It is recommended by a lot of places, including the Sleep foundation to think about having a white noise machine. But having a, an environment that is not going to startle you, not going to jolt you out of your sleep is really important. Temperature, we already talked about how most people like it somewhere between 60 and 72 degrees. That is really important. So you want to have your body cooled down, but you also want to have a cool room if possible. This is not always possible in the summer, you know, because it can get really expensive to keep your, your house that cold. So thinking about having little, they have little portable swamp cooler things that you can have on your bedside table. Now, I find those are really helpful because it cools the air right around me, but I'm not having to crank up the air conditioning. Smells. Obviously, you don't want to smell something stinky all night long, so get rid of any stinky smells in your room. Try to keep your room as pleasant or neutral smelling as possible and consider aromatherapy. Lavender and chamomile have both been shown to help people fall asleep more quickly. You may find other aromas work better for you. There's also valerian and catnip and patchouli. Do some investigation if you're interested in aromatherapy, into which essential oils work best for you in terms of allergens. Get rid of them. Try to have a filter, a HEPA filter in your room. Even if you don't have really bad allergies, an air filter can usually benefit in reducing even minor allergies. Whether it's dust or pollen or something like that, allergens will keep you up even if they don't actually wake you up. If you are coughing or you're getting stiff stuffy during the night, which in the nose, which causes you to open your mouth, you may start snoring and it's kind of a, a downward spiral from there. So address allergens as much as possible. Which takes us to critters. You want to try to keep. Ideally keep the animals out of the bedroom when they move at night. Even if you're not really noticing it, they're not waking you up enough to notice it when they move. They're probably waking you up and they do contribute to allergies for a lot of people. So the recommendation is to keep animals out of the bedroom. I, I violate that one every single night. But we've got to pick and choose our battles, don't we? Ergonomics are really important. Make sure that you have a pillow that is ergonomically sound for how you are built. Your neck, your spine should stay in alignment when you are sleeping. So think about if you sleep on your side or if you sleep on your back. The best height of pillow to keep your neck in alignment so you are as relaxed as humanly possible. Make sure that you have a good bed, a good mattress. We all have experiences probably where we've slept on a mattress, where you know it's, it's got divots in it because people have been sleeping in the same place in the same position for so many years on that mattress. And that is going to throw off your ergonomics The Sleep foundation recommends replacing your mattress every five to 10 years. But definitely consider rotating your mattress or flipping your mattress periodically to avoid getting those, you know, impermanent imprints there that may contribute to poor ergonomics. If you sleep with a partner in your bed, consider having separate blankets and make sure that when you're choosing your mattress, you try to choose a mattress that you're not going to feel feel every time that person turns over or moves. Because again, just like when the animals move, when your partner moves, that can wake you up. Separate blankets, same thing when they turn over. You know, one partner often is the blanket hog and the other one ends up cold. That neither one is getting the best quality sleep. So it is important to consider using separate blankets at night. Weighted blankets are also super helpful. They've done a lot of research on weighted blankets and they found that the pressure from the weighted blanket actually triggers the release of oxytocin, which is our bonding hormone. And that can help people feel more relaxed, more calm, and get better quality sleep. Try to keep the bedroom for sleep and sex only. Don't do your bills there, don't do your homework there. Don't definitely try not to argue in the bedroom because the residual reminders of negative things that happen in the bedroom can make it a stressful place to be. Your bedroom should be an oasis, somewhere where you can go and relax and kind of get away from the world. And interpersonally, oxytocin, as I just mentioned, does help us relax and get to sleep more easily. Consider using the loving kindness meditation. And I've talked about that in other videos, particularly the one on meditation. You can also look online and you can find other scripts for the loving kindness meditation. But a lot of times we harbor resentment, frustration, irritation, suspicion, you know, negative feelings about other people or the world. And using the loving kindness meditation can really help us get into a very positive mental space where we are attracting positive energy and we are trying to relax and develop hope. And finally, sexual sex has been shown to help people relax. Yes, you know, if it can also cause you to heat up a little bit, but it is counterbalanced by the release of dopamine and oxytocin that help you get to sleep a little bit faster. So those are, I believe those are 29 different strategies that you can try to start improving your sleep. When people start using sleeping pills, a lot of times their body becomes dependent on that because the sleeping pill becomes part of their sleep routine. But a lot of times, not always, but most of the time, when people are having difficulty getting to sleep, there is an underlying issue that's preventing that. It can be anxiety, it can be depression, it can be physical pain or just dysregulation of the HPA axis and the circadian rhythms. So it's important to really examine. Talk to a your physician or a counselor to examine what's going on and what might be preventing sleep. Now, some people have there are some sleep disorders that are biological, but by and large the majority of people have difficulty sleeping because of HPA axis and circadian rhythm dysregulation. Remember, when you're thinking about the environment, it's important to address noise as much as you can. White noise can be helpful. Noise blocking headphones can be helpful, and earplugs, if you're willing to do it, can be helpful. Now, I don't like to not hear. I like to be able to hear. So I would rather have white noise that kind of drowns out everything else than not be able to hear. But that's me. Are there any other questions? I appreciate everybody being with me for this first episode of the six Weeks to a Happier, healthier you, and I look forward to seeing you tomorrow. It.