A very long list of sleep maintenance suggestions

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18 A very long list of sleep maintenance suggestions

15th Oct 2015

16 min read

18

Leading up to this year's Australia megameetup, in the interest of improving people's lives in the most valuable way possible, I was hoping to include a session on sleep, sleep quality and sleep maintenance. With that in mind I put together A very long list of sleep maintenance suggestions.

Some of the most important take-aways:

Do you think you get {good sleep/enough sleep}?
- If no then fix it. This single thing will improve your life drastically. (also don't lie to yourself about this, research shows that people who are sleep deprived are bad at predicting how sleep deprived they are, if you are unsure; probably err on the side of caution. As a measure - if you turned off your alarms - would you be able to get out of bed at the same time every day?)
"I do this weird thing with my sleep but it works well for me, is that a problem?"
- not really. if it works - keep doing it. if it works most of the time but falls apart every Monday, then maybe its time to consider a different plan.
Uberman, and other polyphasic sleep cycles?
- depends if it works for you. Don't force yourself to do it if it, don't expect it to work for you. Feel free to try it; lifestyle is also relevant in considering this sleep implementation, (if you have a 9-5 job you certainly can't make it work, if you have a flexible life then maybe)

Also living a healthy lifestyle will make a big difference.

Some good highlights from the list:

limit caffeine, especially to earlier in the day
avoid using alcohol as a nightcap - it disrupts sleep maintenance
Avoid heavy meals and heavy exercise within 3 hours of bedtime
use bedroom for sleep and sex only
have sleep in your schedule (go to bed and get up at the same time every day, even on weekends)
decrease brightness of home lighting ~1-2 hours before bed
avoid electronics ~1-2 hours before bed
reduce light and noise (via earplugs / white noise) in bedroom as much as possible while sleeping
If you tend to sleep in a lot if you don't set an alarm, you are not getting enough sleep on average - go to bed earlier, consistently.
If your alarm keeps going off in the middle of REM sleep, move your bedtime about 45 minutes in either direction - REM sleep occurrs in 1.5 hour increments.
Use melatonin.
avoid smoking.

The list is best formatted here:

https://docs.google.com/spreadsheets/d/1PbjxWSy77JoaEKj_TEuH025EoIYZBqhjK-yApomJ6go/edit#gid=0

But is also included below for convenience.

A very long list of sleep improving suggestions:	-2 to 2
Area of interest:	Evidence Rating	Explanation by Adam K	Comments by others
Everyday life
eat healthy	1	Being overweight reduces sleep quality and risk of sleep disorder
reduce sugar and refine carb intake	?		These contribute to daytime sleepyness which may result in overnapping - Kat
be a healthy body weight	2	BMI over 30 puts you at risk of sleep apnea, if anything above Normal BMI w/ sleep apnea, losing weight may help reduce apnea symptoms	being overweight can contribute to sleep apnea - Kat
limit caffeine (in chocolate or decaf too)	2	Caffeine response differs significantly in people	Limiting caffeine to earlier in the day may also be of some use - Kat
quit smoking (stimulant and breathing)	2	Less deep sleep, less total sleep, and longer sleep latency
exercise daily (not around your sleep time by at least 2-4 hours)	2	Increased deep sleep, less sleep interruptions	Even a small amount helps - start with 10 minutes of cardio and work your way up if you have to - Kat
reduce anxiety and stress	2	Anxiety increases sleep latency and sleep interruptions
limit irregular work shifts	2	Circadian rhythmicity important for all parts of health
avoid long commutes	1	Rising too early can miss REM, and less total sleep, some confounding factors to consider
Be physically healthy	2	Diseases generally lead to sleep disorder, e.g. diabetes, cancer, etc
Get enough sunlight	2	Light is most important zeitgeiber for circadian rhythmicity

Analysing your sleep setup
use your bed for sleep and sex only	1	Bed restriction in older adults	I don't really know, but older adults who dawdle in bed tend to get better sleep quality if they restrict bed times to reasonable sleep times
sleep in darkness – the more the better; including all LEDs	2	Light is most important zeitgeiber for circadian rhythmicity
Cool room temperature of sleep 15-25c	0	15 may be too cold for people with poor core body temperature control but good for younger healthier more active people. 25 probably too warm for everyone.	In-bed, or rectal measurement are more accurate measures, too complicated for normal people to do
check if you are using comfortable pillows	0	highly subjective, no guarantees, only moderate, weak or no associations with sleep quality and wakings	I guess room temperature is only important if it is to cool down, because if it's too cold you can always pile more blankets on until you are comfortable. Recommended room temperature would be 17-22C then
body pillow, neck pillow, arm pillow, to permit a better body position while asleep	0	highly subjective, no guarantees, only moderate, weak or no associations with sleep quality and wakings
check if your bed is comfortable	0	highly subjective, no guarantees, only moderate, weak or no associations with sleep quality and wakings
evaluate sleep location in bedroom - too close to window, door, other noise / light?	0	highly subjective, no guarantees, only moderate, weak or no associations with sleep quality and wakings
Evaluate sleep distractions in the room	1	distractions, by definition, increase sleep latency
mattress life expectancy check (around 10 years)	0	highly subjective, no guarantees, only moderate, weak or no associations with sleep quality and wakings
pillow life expectancy check (around 2-4 years)	0	highly subjective, no guarantees, only moderate, weak or no associations with sleep quality and wakings
allergens in the bedroom	2	definitely affects sleep quality	Easiest thing to do is buy dust-mite-proof pillow and mattress covers. Wash bedding weekly in hot water and a little bleach (kills mold). Vacuum regularly. Keep windows closed during known allergy seasons. If you have bad allergy symptoms, get tested and get immunotherapy shots if you can afford it. - Kat
limit pets in bed	1	Sharing bed space with anything decreases sleep quality, including sleeping with partners
limit children in bed	1	Sharing bed space with anything decreases sleep quality, including sleeping with partners
make sure there is enough room for those in the bed	1	Sharing bed space with anything decreases sleep quality, including sleeping with partners	and enough sheets and blankets for each - consider separate sheet/blanket for each side of the bed if your sleep partner tugs on the sheets and wakes you - Kat
bedside notepad for anything you might want to write down - if something is keeping you up; you can use this to record things and effectively put them out of your mind so that you can go to sleep.	??	is this a distraction?
Understand approximate sleep hours needed (7-9 in most adults, different summer-winter)	2	Most people underestimate how much they need	physiological 'need' for sleep doesn't decrease with age, only 'feel' for need for sleep does
certain smells can help, certain smells can hinder.	0	highly subjective, no guarantees, only moderate, weak or no associations with sleep quality and wakings
Have sleep in your schedule	2	Regular bed time important for circadian rhythmicity
have a sleep schedule that includes sleep on the weekends (no skipping the weekends)	2	Sleeping in on the weekend can be very good for people who undersleep during the weekdays, but it's not as good as regular sleep of course	ok
Turn your clock so you can't see it while the lights are out / don't check time on your phone	2	If you have a clock, make sure clocks are either dimmed or red LED
what is your bed and blankets made out of? Are these the best materials for you for this bed?	0	highly subjective, no guarantees, only moderate, weak or no associations with sleep quality and wakings
don't have a TV in the bedroom	2	Emits light, is a distraction, etc
Don't have a computer, tablet, or phone in the bedroom	2	Emits light, is a distraction, etc even worse than TV
calming bedroom colour ( need source)	0	Unless referring to red light or candle light use at night, not sure what it's referring to	I suspect this is relating to the 'look' of the bedroom in general, and how you fee when you walk into it. I.e., if you hate mustard yellow, re-paint your room if the walls are mustard yellow - Kat

On the way to sleep

Pre-Bed food		extreme diets (VHC or VLC) can ruin sleep quality, and carbohydrates for dinner can reduce sleep latency
go to bed neither hungry nor stuffed (food)	1	highly subjective, but true
don't eat meals too close to sleep	2	either digestion slows, or sleep is disrupted, one or the other (subjective)
small evening meals	0	highly subjective, no guarantees, only moderate, weak or no associations with sleep quality and wakings
limit late night alcohol	2	alcohol reduces quality of deep sleep	it only reduces sleep quality if it is in your system while you sleep, so you could drink in the afternoon and have it leave your system by the time you sleep and you'd be fine.
limit late night liquid	0	usually true	one thing to note is marijuana, which is commonly consumed, also affects sleep quality, but far less is known about its effects, it seems it is variable
avoid sugar heavy foods	-1	carbs will reduce sleep latency, though I don't recommend sugar for general good health
avoid spicy or greasy meals before bed (or other food you know does not agree with you)	1	high fat meals correlated with poor sleep measure
tryptophan snack – if you are hungry try a light snack before bed	-2	evidence for this actually working is non-existent, a well perpetuated myth	Common suggestions included warm milk, a banana, cheese on crackers, cereal and milk, also turkey - combine carbohydrates and either calcium or a protein that contains the amino acid tryptophan to boost seratonin for calmness.

Things that aren't food
Have set a regular bedtime	2	Circadian Rhythmicity important
have a bedtime routine or ritual which includes relaxation	1	highly subjective, but I guess true
decrease brightness of home lighting ~1-2 hours before bed	2
eliminate blue-spectrum home and screen lighting ~1-2 hours before bed	2	blue light increase heart rate, and wake inducing catacholamines and brain activity, reduces sleep quality	Avoid fluorescent tube lights, compact fluorescent or LED bulbs labeled daylight, cool white, or bright white (instead, use sub-3500K color temps, sometimes called warm white or soft white), and screens without a red-shift application running - Kat
avoid electronics before bed	2	game-like activity increase heart rate, and wake inducing catacholamines and brain activity, reduces sleep quality
keep noise down while heading to bed	0	highly subjective, but may be valuable despite no 'evidence'
organise for tomorrow so you can stop thinking about it	0	highly subjective, but may be valuable despite no 'evidence'	At its simplist, make a todo list for tomorrow. If there's a lot on your mind, try a full-on 'brain dump' on a very large sheet of paper, several hours before bed: write down everything you think is important for the next month or so. Use that to inform your todo lists.
Bedtime media; book; audiobook; calming music (soft),	0	highly subjective, but may be valuable despite no 'evidence'	I guess it's up to the person
stretch (debatable)	0	more likely to be because of exercise
wind down an hour before bed	1	exercise too close to sleep increases heart rate, increases sleep latency
take a warm bath/shower	1	only if you need to lower your core body temperature (see temperature advice above)
before bed – write down what is on your mind and resolve to leave it for tomorrow	0	highly subjective, but may be valuable despite no 'evidence'
read before bed by soft light	0	highly subjective, but may be valuable despite no 'evidence'
don't have a nightcap (alcohol)	2	alcohol reduces quality of deep sleep
neutral neck position in bed and before bed.	0	mostly supported by alternative chiropractic studies, which is poor form of evidence
hot pack on the neck	1	only if you need to lower your core body temperature (see temperature advice above)
do a simple armchair hobby to relax	0	highly subjective, but may be valuable despite no 'evidence'
Go to sleep when you are tired. Don't wait in bed frustrated if you can't fall asleep.	0	highly subjective, but may be valuable despite no 'evidence'
consider wearing socks to bed	0	highly subjective, but may be valuable despite no 'evidence'
sleep diary of if you felt sleepy during the day, things that you think might influence your sleep tonight.	0	highly subjective, but may be valuable despite no 'evidence'	Include food, exercise, sleep details, # of awakenings in the middle of the night and their approx. duration, rate the sleep out of 10, time of last wakeup - naturally or to an alarm? If you were dreaming when your alarm went off, go to bed earlier so that your alarm is not waking you up in the middle of a REM cycle - Kat

Going to bed
Select nightclothes (or none) and bedding to keep yourself heat stable (thermoregulation)	0
If you are having difficulty getting to sleep – try imagine what you would like to dream about	0	only anecdotal evidence, but may be valuable, I personally recommend this technique	If you are an artist or a crafter, imagine the design of a project you would like to do someday - Kat
deep breathing (or other relaxation technique - visualisation breathing, yoga)	2	sufficient evidence to say it works if you have good compliance with the practice

For while you are asleep

Noise / Light
earplugs	0-2	benefits depends on environment, will help (2) in high noise environment
white noise (device, fan, or app, pink noise)	0-2	white noise improves noisy environment, but silence is better
humidifiers for air quality	1	may improve breathing problems, if sleep quality is compromised by breathing problems, cpap etc	Must be cleaned on a regular basis to prevent mold - Kat
air filter	1	may improve breathing problems, asthma and allergies specifically	Tape a 20x20" electrostatic furnace filter to a 20" box fan for a cheap air filter - Kat
fans for air movement+cooling, and/or white noise	0-2	white noise improves noisy environment, but silence is better
eye mask for light	0-2	benefits depends on environment, will help (2) in high light environment
Sleep in the dark - at night if you have a choice; use heavy curtains if streetlights or sunlight present	2

Sleeping positions - get comfortable!
try a leg pillow (pillow between the knees) or holding a pillow	0	highly subjective, but may be valuable despite no 'evidence'
make sure you are sleeping in a neutral neck position	0	mostly supported by alternative chiropractic studies, which is poor form of evidence
try other positions if that one is uncomfortable	0	highly subjective, but may be valuable despite no 'evidence'
try each side, back, front.	-1	I'd say sleeping on back is not good for sleep parameters, higher risk of sleep disorders developing and worse sleep quality

Staying asleep
Body temperature, Room temperature	1	only if you need to lower your core body temperature (see temperature advice above)
noises	0-2	see white noise vs silence, see ear plugs	Ask housemates to avoid low-frequency sounds, like slamming doors, music, etc as these cannot be masked by white noise or earplugs - Kat
smells (i.e. smoke, food)	??	??	Ask housemates to avoid cooking aromatic foods while you are asleep (ex, frying sausage, onions, canned tuna, etc) - Kat

If your sleep is interrupted
small bathroom nightlight (not blue and not bright like normal bathroom lights)	2	try to go to the loo without any lights being turned on, otherwise use red lightbulb
avoid cold floors (rugs/socks)	1	subjective, but warm feed important for getting back to sleep and decreasing sleep latency
get back to sleep: stay in bed	0	subjective
get back to sleep: just try to relax, don't try for sleep	0	subjective	Drowsing in bed is still more restful than being awake and doing something - Kat
get back to sleep: avoid electronics with blue light	2	avoid blue, green, white light
dont use portable electronics in bed	2	avoid blue, green, white light
If wide awake, go do low-key activity for 15m, then back to bed again	1	can stay up for up to an hour and a half

When you wake up
wake up at the same time every day	0	light exposure at same time every day more important, sun lamp or lamp timer
keep a sleep diary of all these possible related factors	0	highly subjective, but may be valuable despite no 'evidence'
increase light levels (just after waking up)	2	lamp and timer or lifx
get up when the alarm goes off – don't snooze button	2	snooze bad, either sleep in or don't, having a string of alarms just compromizes sleep quality even if you think it makes you feel its easier to get up

Naps
One option: nap every single day (siesta style)	2	naps = lots of health benefits
The other: Don't nap	0	no benefits to no naps	No naps was recommended to me by neurologist; helpful if sleep schedule is completely messed up. Otherwise, I would say, don't nap if you're not tired. If you are tired, then nap, and look to how you can add sleep time at night in the future, rather than relying on naps - Kat
If you do; nap for less than 30 minutes		either nap <25 or nap for 70-90min
You can use naps to make up for lost sleep	2	yes, to a degree
avoid naps in the evening	2	leave at least 8h before your bed time else you risk compromising night sleep quality or sleep latency

Medical solutions
see a doctor after symptoms (depression, acid reflux, asthma, medications, headaches)	2
sleeping pills have side effects	2	yes, many are actually bad for sleep quality, and just make you forget you didn't get any sleep (rather than put you to sleep), also dependency and addiction
sleep medications exist	2	yes; more useful for really messed up sleep patterns; see above	Addiction can be avoided by tapering the dose off over the course of several days or weeks when you no longer need it - Kat
check your existing medications for insomnia side effects	2
antihistamine with drowsiness side effects	1	reduces sleep latency but compromizes sleep quality
melatonin but see a doctor before doing anything high dose	2	melatonin + whitenoise/earplugs + sleep mask good combo for bad environments	Melatonin has a fairly short half-life. Best effectiveness may be in taking it right before lights out. Start with small dose (300 micrograms) and slowly increase until most effective dose is found. - Kat
		melatonin also good for everything else, lots of health benefits
Science!		melatonin is a chronobiotic and not a sleeping pill, gotta take it regularly at same time every night even if you don't plan on staying up (if you want to keep your schedule, that is)
test by spending 2 weeks in a row; going to bed at the same time and recording when you wake up without an alarm feeling rested.	??	less valuable than just fixing lighting and taking melatonin for 2 weeks	useful for therapists trying to track someone with a shifting circadian rhythm
consider allowing less sleep time (by trial) (don't expect to sleep for 9 hours or be frustrated if you don't sleep exactly that long)	1	can cut down 1 sleep cycle, and after 2 weeks body adapts (BUT THIS IS FROM HEALTHY 8.5h BASELINE and NOT from "already sleep deprived")	By 'sleep cycle' do you mean REM cycle? - Kat
tracking QS		devices that measure eeg and eye movement most accurate

Misc
polyphasic sleep cycles	?		I have never known anyone to be able to keep those up for very long without exhibiting signs of sleep deprivation. I consider it a 'do it if you have to, but avoid if possible'.
make sleep a priority on weekends (to recover from sleep debt)
check up on your sleep quality over time and re-evaluate these details
waking up groggy? Coffee, look at what point in your sleep cycle you are waking up, try the science suggestion, get more light to your eyes when you wake up.	1	sleep cycle calculations may help, but bright lighting more helpful	If alarm going off during REM, try going to bed 45 minutes earlier. REM cycles every 1.5 hours - Kat
Sleep-walking, sleep-talking?	0	no evidence of treatments for sleep walking :(	See a doctor? - Kat
daytime tiredness? (get more sleep)	2	obviously :) either night sleep or naps	Or lay off the sugar and simple carbs - consuming these and nothing else can cause a blood sugar crash - Kat
afternoon sleepiness? (normal, take a break; get fresh air, eat something, get more light)	1	best to keep moving and on your feet if you want to 'walk off' the midday sleepiness period, keep core body temperature high (cold exposure, body movement)
waking in the night? (can be normal, can be something wrong with your environment, try sleep tracking apps, there is one that records ambient sounds in the room while you are sleeping. Something might be making noise that you were unaware of, rats, possums, cars, devices) How do you feel during the day? If you feel fine then its normal wakeful cycles and don't worry about it	1	evidence says waking in middle of night is, like taking a siesta, just part of natural sleeping pattern for some people, probably depends on genetics, but also depends on circadian rhythmicity, age and environment (like night length, melatonin dose). Obviously could also just be drinking too much water.
grinding teeth or clenching jaw? (reasonably common, reduce stress, use a mouthguard)	1	mouthguard is the main one, also reduce stress, be less hungry (improve diet)
nightmares, strange dreams? (common, reduce stress, check for a dislocated rib or major sleep disturbance, become more busy or occupied during the day – having too much free time can leave your mind to not know what to churn about)	1	usually comes down to brain chemistry (can be related to diet, or medications/drugs, or genetics, or strange lifestyle)
sleeping too much? (normal, reduce exercise if over exerting yourself, improve other health areas, check for depression, check medication, consult medical professionals)	2	more than 10h sleep regularly is either unhealthy in it's own right, or is a sign that you have or are developing a disease that causes sleep abnormality
can't get to sleep? (normal, Check intake of stimulants, alcohol, disagreeable foods etc. check environment, check total sleep time, check if it actually matters, try visualisation or relaxation exercises)		I guess see all of the above	yes, one night of insomnia is not clinical insomnia and nothing to worry about
can't get up at the right time? (get more sleep, get more light at that time, get out of bed really quick, then figure the rest out)
most important question: is this strange seeming sleeping habit actually a problem? Does it bother you or anyone (who matters)? If no; don't change it.			agreed
Changing sleep by changing sleep hygiene takes time - allow ~2 weeks for any change to have an effect			Trying something for one night and then declaring, "this doesn't work!" is counterproductive. Stick with it. Change one thing at a time if an entire list of things seems overwhelming - Kat
If you try most things on this list for >2 weeks and still have daytime tiredness / poor sleep, see primary care doctor or neurologist			Doc will refer you to neurologist for simple testing to determine primary or secondary insomnia. Or you can just say, "I think it's stress (primary insomnia), can I try ambien / lunesta / whatever?" In the US, most docs start PTs on generic ambien - Kat
Get f.lux or redshift for all electronics that emit white light, also "night mode" and "twilight" for android	2	reduces blue and green light emissions
Anyone does nightshift? different rules can apply	2		Reducing light in home before bed, and blocking as much light as possible in bedroom is absolutely necessary - Kat
Sleep posture, babies are different to adults	2	babies sleep on their backs to avoid SIDS, adults sleep on side or front to avoid sleep disorders and get best quality
no midnight snacks	2	metabolizes food differently about 2 hours after dark or after melatonin administration

jetlag	2	fast, and eat a big carb meal first thing in the 'morning' of your destination, can do this several days in preparation take large dose of melatonin at the 'night' time of your destination, can do this several days in preparation
		slow release caffeine on the morning of arrival, can prepare the day beforehand
		light therapy on morning of arrival, can prepare days beforehand
		best thing is to do pre-flight adaptation, but this takes planning and commitment
marijuana	?
other drugs	?
Modaffonil	?
Cool sleeping cap (one study recently)	?

Meta: the original collection of this list took at least 10 hours; plus several other people's time to point out the quality of the suggestions. From deciding to post this to post-ready took 2 hours.

This post was finalised with the assistance of participants on the Slack chat.

My table of contents, includes other posts of mine that might be of value.

Thanks to Kat and AdamK for their help with this post.

As per usual; any suggestions are welcome, and improvements would be appreciated, and I hope this helps you. There will be a poll in the comments.

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