Sleep hygiene consists of habits and behaviors that help us to get enough good-quality sleep to leave us refreshed, both physically and mentally. These days, improving sleep hygiene is a priority for many overstressed clients, but adopting new sleep habits can be challenging.
Why do we postpone sleep? Does going to sleep feel like losing control, somewhat similar to death? Or is it simply a motivation issue? Many people know the benefits of sleep but fail to prioritize it. A 2018 study by the National Sleep Foundation polled a sample of 1,010 adults and found that 65% thought sleep contributed to next-day effectiveness. Yet only 10% prioritized sleep over fitness/nutrition, work, hobbies and social life (NSF 2018).
The report found that most Americans don’t take into account how much sleep they’ll need when planning for the next day. Perhaps the issue is as simple as needing, and planning for, an earlier bedtime.
Sleep Hygiene: Enough Sleep, But Not Too Much
In reality, a lot of people oscillate between not enough and too much sleep. The NSF and Sleep Health Foundation both recommend 7–9 hours of sleep for adults (aged 18–64), 7–8 hours for older adults (65+), 8–10 hours for teenagers (14–17) and 9–11 hours for children (6–13) (SHF 2015).
Many people are aware of the numbers, yet more than one-third of American adults don’t get enough sleep on a regular basis (CDC 2016). Perhaps we have the wrong goal in mind.
Following the recommended guidelines for sleep is like counting calories. It’s a good starting point, but ranges can mislead because specific sleep needs vary from person to person. Moreover, getting the bare minimum is not the primary goal, although it’s often the main focus for people. Sleeping too much can also be an issue. Researchers in South Korea found that adults aged 40–69 who slept more than 10 hours a night were more likely to develop metabolic syndrome (Kim et al. 2018). And in adults aged 45–83, Bellavia et al. (2014) found that sleeping more than 8 hours a night increased mortality risk—but only in those with low physical activity levels. Sleep disorders may cause some people to sleep longer to overcome the disruption.
Sleep Hygiene and Fitness
Getting people to embrace sleep hygiene aligns well with the mission of fitness professionals. We know how to plan, motivate and educate. And sleep research covers our core areas of focus: weight loss, performance enhancement and injury prevention, and behavior change.
Sleep may not directly help somebody lose weight, but lack of sleep affects food choices. “On a simplistic level, your appetite changes,” says Charles Samuels, medical director of the Centre for Sleep and Human Performance in Calgary, Alberta, in a report available on Health.com. Lack of sleep alters levels of ghrelin, leptin and endocannabinoids, three appetite hormones (Fields 2016; Hanlon 2016). “We have very substantial research that shows if you shorten or disturb sleep, you increase your appetite for high-calorie-dense foods,” Samuels says (Fields 2016). Moreover, research suggests that sleep restriction can hinder weight management, a risk more people need to know about (St-Onge 2017).
PERFORMANCE ENHANCEMENT AND INJURY PREVENTION
Studies on basketball players have shown that getting enough sleep correlates with improved performance and fewer injuries (Walker 2018). In fact, research has shown that just one night of partial acute sleep loss can lead to elevated levels of cortisol, which can affect the resiliency of the stress response (Leproult et al. 1997).
In his book Self-Reg: How to Help Your Child (and YOU) Break the Stress Cycle and Successfully Engage With Life (Penguin 2016), Stuart Shanker points out that it’s tough to resist temptation when stress load is high. He shares stories about clients who made smoother health-related decisions after reducing stress. We all know it’s hard to sleep when stressed, so paying attention to this relationship is essential.
Meditation, mindfulness practices and even naps are emerging in our culture as ways to counteract the effects of our productivity-driven, overstimulated society. Working downtime and rest into the day is part of the sleep solution (Edlund 2010). We’ve got to stop pushing our way through the day, expecting to crash at night and wake rejuvenated in the morning.
Thankfully, stress reduction is an ongoing conversation in the fitness industry and an outcome of regular exercise. We need rest, sleep and recovery to complement exercise effectively.
Talking to Clients About Sleep Hygiene
Health coaches and personal trainers are in an ideal position to influence sleep habits—especially since sleep needs are individual-specific, just like nutrition and exercise. There are many ways to get the sleep conversation going in the gym. Here are a few ideas:
INTEGRATING FITNESS AND SLEEP
- Include questions about sleep on intake forms.
- Investigate sleep habits during initial interviews.
- Ask about sleep before personal training sessions.
- Share sleep tips in group fitness classes.
- Take polls on sleep with a show of hands in group fitness classes.
- Administer tests like the Epworth Sleepiness Scale (ESS).
- Guide people to complete a sleep journal (download a free journal at BeverlyHosford.com/sleep—toward the bottom of the page).
- Educate people and hold them accountable.
QUESTIONS TO ASK CLIENTS
- How many hours did you sleep last night?
- What time did you get into bed and turn out the lights last night?
- What time did you wake up today?
- Did you wake up at all last night? For how long?
- How rested do you feel on a scale of 1–10?
- What is your stress level on a scale of 1–10?
RESPONDING TO SLEEP DISORDERS
As you investigate clients’ well-being, you may hear about sleep disorders such as snoring, restless legs syndrome, sleepwalking or insomnia. These are reasons to refer to a physician or sleep doctor. Over 100 diagnosable sleep disorders require medical attention.
Sleep doctors need our help. Jerome A. Barrett, former executive director of the American Academy of Sleep Medicine, has highlighted the lack of board-certified sleep medicine physicians and gaps in accredited sleep centers across the country. He recommends that sleep scientists and doctors seek assistance: “Increase the number of those who are qualified to practice sleep medicine by reaching across disciplines to offer an added qualification for other health care providers” (Barrett 2017). Thus, the sleep industry needs the fitness industry.
Addressing the Need for Sleep Hygiene
Thousands of sleep apps have arrived on the market in recent years. Alas, very few meet criteria for functionality, quality and content for sleep management (Choi et al. 2018). Sleep apps can be problematic because evening screen time can inhibit sleep for 60–90 minutes. It’s better to set the smart device to sound an alarm an hour or two before bedtime and then switch the device off in exchange for a relaxing screen-free period.
Doctors are prescribing an evolving array of home sleep tests that measure brain wave activity, leg movements and breathing to diagnose and treat conditions such as sleep apnea, restless legs syndrome and insomnia. Bear in mind that sleep labs still have the best technology. Sleep studies, often covered by insurance, have people sleep overnight while attached to devices that monitor sleep physiology.
NEW TOOLS TO PROMOTE SLEEP HYGIENE
Sleep-related technology is finding its way into home lighting and temperature controls as science discovers more negative impacts of artificial lighting and heating on the body’s internal clocks. The new tools help people acknowledge that the day has come to an end and it’s time to sleep.
Lightbulbs and lighting systems have been built to complement the body’s natural rhythms, though they may not produce results accomplished in controlled studies (McKeough 2018).
Light also affects temperature, so paying attention to both is important (University of Haifa 2017); specifically, exposure to blue light from screens can interfere with the body’s nighttime cooling mechanism, which supports sleep. Gel and water pads on the market account for differing temperature needs of bed partners. Moona is a “smart” pillow that cools the body down and learns the user’s sleep rhythms, adjusting to support the various stages of sleep.
Though these devices show promise, getting outside every day and synchronizing with your environment is still a primary goal when striving for high-quality night sleep.
Building Good Sleep Habits
The consensus of sleep experts and research studies suggests that optimal outcomes depend on these essential sleep habits:
- Use a consistent sleep schedule to set the body’s internal clock. Avoid sleeping in and changing bedtime nightly.
- Establish a soothing pre-sleep routine with reduced stimulation.
- Create a sleep-friendly bedroom environment. Make it dark, cool, quiet, comfortable and gadget-free.
- Dim all house lights before bedtime.
- When truly tired, go to sleep—don’t override sleep cues.
- Expose yourself to natural morning and/or daytime light. Get outside for at least 30 minutes daily.
- Avoid caffeine after 10 a.m.
- Eliminate alcohol, nicotine and other chemicals/herbs before bedtime.
- Avoid medications in the evening (unless required by a prescription).
- Nap early (before 5 p.m.) and for under 30 minutes.
- Eat dinner early. Keep food and beverages light.
- Don’t watch the clock or lie in bed awake. Do something relaxing and screen/light-free.
- Follow through—make sleep a priority and part of your routine.
Insomnia can result from obsessing over lack of sleep. Implement sleep changes gradually, emphasizing the goal of committing to a regular bedtime and a regular rising time. Without this commitment, efforts to achieve the needed 7–9 hours nightly can be frustrating.
Realizing the Power of Sleep
The more we learn about sleep, the clearer it becomes that it’s the third pillar of health—along with diet and exercise. As the author and researcher Matthew Walker notes, the other two pillars crumble without sleep.
Unfortunately, many of us have lost the feeling of being fully awake and alive. We need to be awake in a way that supports sleep, and we need to sleep well enough to maximize our time awake. Sleep and wakefulness are yin and yang, night and day. They operate best when balanced for the individual.
Integrating sleep hygiene within the fitness industry can help people reach all of their health-related goals. We just have to wake up to the possibilities.
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