Sleep: the ten commandments

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Adapted from a presentation by Dr Anna Borowska, sleep specialist at the Centre for Sleep Disorders at the University of British Columbia, given at the Foundation for Medical Excellences 34th Annual Chronic Pain Management Conference, September 2021.

1. Avoid substances

Avoid caffeine, including caffeine-containing pain medications such as Tylenol #3, for at least eight hours before bed.

Avoid nicotine. Smoking worsens sleep. Nicotine is a stimulant, and withdrawal in the night wakes you up.

Avoid alcohol: it does help people fall asleep but then disrupts the sleep, and suppresses vital REM sleep.

Avoid decongestants: these are stimulants and interfere with sleep.

2. Wind down for at least an hour before bed

Have the lighting low. A warm bath can help but finish it at least an hour before bed.

3. Wait until you’re sleepy before going to bed

Advice to have a fixed bedtime isn’t right. Instead, have an earliest bedtime (e.g. 10 pm) but stay up until you feel sleepy.

4. Have a sleepy bedroom environment

A comfortable bed, darkness, a cool temperature, and quiet (consider earplugs). People sleep better on their own, unfortunately: consider it.

5. Create a sanctuary

Have a comfortable chair for rest and leisure activities. Don’t use your bed for these.

6. Bed for sleep or sex only

Don’t use your bed for reading, watching TV, using electronic devices, or anything else: only sleep and sex.

If you’re lying awake for more than fifteen minutes, get up, go to your sanctuary (point 5 above), and do something boring until you feel sleepy. Then go back to bed.

7. Don’t check the time at all during the night

8. Get up at the same time every day, even at the weekends

Use an alarm clock (turned around so you can’t see the time) and get up. Snoozing in the morning disrupts your future sleep.

9. No napping

Napping reduces your sleep inertia’ and worsens your night-time sleep.

10. No horizontal rests during the day

… unless you’re so sleepy you can’t resist it, or if needed for safety. In those cases, maximum twenty minutes: set an alarm.

Good night!