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13 top sleep questions, answered

I’m a night owl and have trouble going to bed before 4:00 a.m. How does a person change their behavior?

Amanda Clark: The more routine the rest of your day is [in terms of the things you do before bed and upon waking], the easier it will be to adapt a regular bedtime. Expose yourself to light first thing in the morning, and make sure you're getting plenty of natural light throughout the day. That influences the circadian clock, and will help to shift you towards the earlier bedtime.

Am I destined to wake up every night to pee? I've tried not drinking two hours before bed and nothing works. 

Matt Delaney: Look at your total volume of fluid throughout the day. If it is above two and a half liters, drop that down. If that doesn't work, maybe two hours is not enough time for the fluid to get through your system. Try three hours. 

Is it normal? Do most people go to the bathroom every night?

MD: As you age, it gets a little bit more prevalent. It's definitely not something that everybody does every night.

If you have too little sleep, should you avoid working out?

MD: Mechanical stress from a workout is just one type of stress. Then we have sleep deprivation stress. I'm sure we all have nutrition stuff that we're working on. We have work stress and family stress. All this stress goes into a pot, and sleep is your most effective way of diminishing that pot. We have to make sure that we're matching all the demands on our body with the amount of recovery that we're getting. If we're in a place that we're under-recovered to start, we're never going to be able to build on that.

What is REM sleep? 

MD: What happens in REM is that your body goes completely limp. If you’ve woken up with sleep paralysis, that's you waking up in a REM cycle. This is also when you dream. REM is great for creative thinking. It's taking all the information that we have in our head and putting it together in ways that we would never put together when we're awake, and coming up with new ideas. They say when people come up with solutions to their problems is after a really good set of REM sleep, because they're seeing things a little bit differently.

What’s the ideal temperature for sleep?

AC: Generally mid-60s.

If I wake up in the night, I can't get back to sleep. What is the way to deal with that?

MD: First, don’t turn on the lights because the bright lights hit your eyes, and that makes it even harder to go to sleep. I use a breathing technique called 4-7-8 breathing. It’s a breathing sequence that's been clinically proven to induce parasympathetic tones, so when I wake up in the night, I take a deep breath in for a four count, hold it for a seven count, and slowly exhale it for eight. Four to five rounds of that helps. 

AC: Also, if you're somebody who stays up later, your pre-bed routine might need to start two hours beforehand. Journaling, not on a device, but on a regular notebook, can be helpful. Not the type of journaling where you try and actually work through problems, but you're just dumping everything that's in your head to be taken care of tomorrow.

I know you shouldn't do intense exercising too close to bedtime. Well, what about sex? 

MD: It's a similar set of endorphins, so it's a similar response to the body. You definitely would want to have some downtime in between. It depends on the level of activity, but we're talking probably 60 to 90 minutes.

Sometimes after a long trip, I’ll wake up and not know where I am. I don't know if that has to do with exhaustion?

MD: I think it definitely has to do with exhaustion. If you go into the trip well-rested, it will help you acclimate to wherever you're going, and it will help you get back on track when you're coming home. If you're chronically sleep deprived, crossing time zones can be a major stress to the system, so your body might not be recovered. You might go through this period of sleep inertia, and that could be reason why you woke up in that state.

Amanda Clark: Also, sleep deprivation impairs our ability to problem solve, and reduces our reaction time, so that could contribute to being like, ‘Where am I? What's happening?’

What’s the best alarm sound? 

MD: In a perfect world, we would be able to sleep without an alarm clock. If that’s not possible, go with something as minimally startling as possible. There are alarms that use light to wake you up. I would set a second alarm in case the light in the room did not wake you up. 

How many hours before sleep should you eat dinner?

AC: Ninety minutes to two hours. 

MD: Your digestion definitely plays a part, so for some people with a slower system, two hours might not be enough. Also, the type of food you eat has an impact. Foods that are higher in fat content take longer to get broken down in the system, so having a big steak two hours before bed, it might still be sitting in your stomach by the time you're trying to fall asleep. Having a smaller meal with some more digestible protein and some starchy carbs, that might be something that's easier for you to manage.

AC: That goes back to monitoring and making notes, using a tracker or keeping a journal to find out what time works best, what foods in particular interrupt your sleep. You can also track when you start to feel sleepy throughout the day, amount of caffeine, what time you have caffeine, if you have alcohol, what time you have alcohol. The more information you have, the better, to help dictate what kind of habits you want to implement.

How accurate are sleep trackers? 

MD: Most of the trackers now are pretty good at telling you when you fell asleep, when you woke up, and number of disturbances. Some pick up heart rate and other metrics better than others. Devices like Whoop, which sit closer to the skin, get a little bit of a better reading. Do not pay attention to any of the deep sleep, light sleep, REM sleep, any of that, because none of those algorithms have been clinically validated.

AC: Sometimes we outsource too much power to tech to tell us whether or not we're okay. I think most of us are pretty aware of when we did not have a good night's sleep. More than anything, it's keeping the journal that I think is most helpful.

MD: Well, that's the other piece. There's a big difference between education and application. Just because I know about something doesn't mean I'm going to change it. Not a lot of these apps that pair with the devices are great at giving you actual strategies. You have to be able to identify where your challenges are. That takes examining what you've done that night or the nights leading up to that. 

Can you talk about what it would mean to get too much sleep?

MD: People's sleep times are on a bell curve, so the middle of the curve is seven to nine hours. There's six hours over here. There's more than nine hours on this side. If you're somebody who slept nine plus hours a night forever, you might be the person on that end of the bell curve. We did see in a meta-analysis that after about 10 hours there was an increase in mortality, but it wasn't adjusted for the fact that people that were on that side of the spectrum might have had other health issues, like depression. That's why it's important to work with [a sleep coach]. You might not fit into the box that everybody tries to put you in, so we want to get rid of treating the average and actually start treating the individual.

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