Episode 193: In part two of his series on sleep, I explore all the different ways we can get better sleep - including optimising your light exposure, energy intake, pre-bedtime routine, bedroom setup, and more.
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Chris Sandel: Welcome to Episode 193 of Real Health Radio. You can find the links talked about as part of this episode at the show notes, which is seven-health.com/193.
Seven Health is currently taking on new clients, and there are a handful of reasons that clients commonly come and see us. Hypothalamic amenorrhea is one of them, and that’s the fancy name for not getting a period. This is often the result of undereating and over-exercising for what the body needs, irrespective of your actual weight, and it’s almost always coupled with body dissatisfaction and a fear of gaining weight.
We work with clients along the disordered eating and eating disorder spectrum. Sometimes clients wouldn’t think to use the term disordered eating to describe themselves, but they see that they’re overly restrictive with their eating, they fear certain foods, whether that be breads or carbs or processed foods or fats, they feel compelled to exercise excessively, and/or they find themselves binging or feeling out of control around food.
Moving on from dieting is another one. Clients have been dieting for years and decades and just realize that it’s not working for them and it’s this failed endeavor, but they’re struggling to figure out how to do food without dieting. What should they eat? How do they listen to their body? They’re confused and overwhelmed.
Then body dissatisfaction and negative body image is the final main reason. Many of our clients experience feelings of body shame and hatred, and they find themselves fixated on weight and determined to be a particular size and frustrated when they look in the mirror. They may even avoid social events or opt out of photographs or put off appointments with doctors as a result of negative body thoughts.
In all of these areas, we’re able to help, and do so through a mix of understanding physiology and psychology, so understanding how to support the physical body and how it works, but also being compassionate and uncovering the whys behind clients’ behavior and figuring out how to change this.
If any of these are areas you want help with, then please get in contact. You can head over to seven-health.com/help, and there you can read about how we work with clients and apply for a free initial chat. The address, again, is seven-health.com/help, and I will also include that in the show notes.
Hey, everyone. Welcome back to another episode of Real Health Radio. I’m your host, Chris Sandel. Let me start the show, as I’ve been doing recently, with the book giveaway. We’re now giving a book away with every new episode of the podcast, and you can find the list of books that we have on our Resources page.
This week, the winner is Ruth N. Ruth, thank you so much for your review. We will be in contact with you shortly to send you a book of your choosing.
Reviews really help the podcast. They help with visibility, they help with us reaching more people, and ultimately our goal is to help as many people as possible. They also give you a chance to win a book. All you need to do is leave a review on iTunes, then take a screenshot of it, and then email it to info@seven-health.com, and then you’ll be permanently entered into the drawing.
I’m back today with another solo episode, and it’s actually Part 2 of my podcast on sleep. I released Part 1 of this last week, and this is the second edition, so an update of my sleep podcast. I think this would probably hold up as a solo episode where you could listen to this even if you haven’t listened to Part 1, but it’s going to make a whole lot more sense if you have listened to the previous episode, where you get an understanding of the mechanics of sleep and why it works and how it works and why it’s important. It will just give you a better context to the ideas discussed today. My suggestion is, if you haven’t listened to Part 1, to stop this and go and listen to Part 1 first.
Interestingly, in the week between recording Part 1 and then recording this Part 2, I was going back through all my past clients over the last 4 years, looking at the symptoms that each of them came to me with at the beginning, and sleep is far and away the most prevalent. Nothing else comes close. So I’m well aware that this is a big issue for the clients that I work with, but I’m also aware that this isn’t specific just to my niche and the people I work with. Sleep is a ubiquitous issue, and I’m hoping through these episodes that it’s providing some insights and some answers to help the situation.
I should mention as well, this two-part episode has been no small feat. It’s taken somewhere between 60 to 80 hours to put all this together, but I know this is something that is always going to be relevant and always going to be helpful, so I think – or at least, I hope – it has been time well spent.
On today’s episode, I’m really going to focus on all of the suggestions for how you can improve your sleep, and as part of this as well, highlighting the many obstacles that can get in the way of proper sleep. While sleep is something that is typically happening at nighttime, many of these suggestions will be focusing on things that you can do during the daytime to support sleep. This is because it connects to circadian rhythm and the concept of zeitgebers that I mentioned in the last show. As a reminder, “zeitgeber” comes from the German and means synchronizer or time giver. There are many things that can occur during the daytime – and also the nighttime – that attempt to tell the body what time of day it is, and therefore can either help or hinder sleep.
As I mentioned in the intro to the previous podcast, I want to make this episode particularly relevant to the demographic that mostly makes up my practice, because while there can be universality in sleep issues and reasons for sleep issues, for clients who are struggling with disordered eating and eating disorders or chronic dieters, some of the reasons are going to be more specific to that situation.
I am going to touch on ideas that won’t be relevant for someone with an eating disorder or disordered eating, but I will flag that up when that’s the case, and it’s going to be obvious. There’s a couple of reasons for this. One, I do have a varied audience, and it’s not just those with disordered eating or eating disorders who listen. But also, when someone recovers and are in a better place, there are ideas that then do become relevant. Even though that’s not where they are now, it’s so that later on, there is some understanding of what those other things could be.
So this is my attempt to make this well-rounded and touch on things from many angles, even though it will be focused through the lens of what I’m mostly seeing in practice.
00:07:25
I want to start this by outlining some of the issues I see related to the sleep issues that clients are experiencing when they come to me. The number one most common issue with clients I see is waking in the night and then being awake for extended periods or not falling asleep again at all – often, being awake for an hour or a couple of hours, or where they wake up for 20 or 30 minutes, but they’re doing this multiple times a night. This can be surprising for clients because they go to bed exhausted, they wake up tired, they generally feel low in energy, but they just can’t stay asleep.
These wake-ups that can occur in the night often can be rather startling, like they’re being given an adrenaline shot, like this bolt upright feeling and immediately awake and feeling stressed. It’s obviously not always like that, but that does happen.
The next most common issue is difficulty falling asleep, so taking an hour or many hours to actually fall asleep. Again, this can happen when someone goes to bed feeling exhausted, but they just can’t manage to switch off and fall asleep.
If I was to compare the problem of waking in the night versus difficulty falling asleep, it’s much more common for the clients that I see to have issues with waking in the night. They actually can fall asleep pretty easily, but staying asleep is their problem.
Other common issues are waking in the night to urinate, or often waking multiple times in the night to urinate, which can sometimes start in the evening time. Clients comment that they’re urinating three or four times in the last hour before going to sleep, and that then continues through the night, where they’re waking up multiple times.
Waking hungry in the night. Sometimes this is super obvious, where clients wake up with this really obvious hunger, and then other times it’s less obvious, but if they have something to eat, they’re back asleep within 15 to 20 minutes, and if they don’t eat, they’re awake for hours.
They can be spending the night tossing and turning and being restless, having night sweats. This is particularly common in the early stages of recovery or during times of extreme hunger or when calorie intake is increased.
Having nightmares or intense dreams. Again, this is often in the early stages of recovery, but nightmares or dreams where clients feel like they’re having to do something and are really active as part of their dream, and then they wake up and it feels like they haven’t had a proper break.
Then the final one is clients who feel like they’ve slept fine but are waking up exhausted. It’s not like they had trouble falling asleep or were awake in the night, but they just feel unrefreshed upon waking.
Those are by far the most common issues that I see with clients, and often it’s having a combination of many of them – trouble falling asleep and waking in the night multiple times, needing to urinate, having difficulty falling back to sleep, waking hungry at some point during the night, having intense dreams at the point of actually being asleep, and then waking up exhausted. That combination is pretty commonplace.
00:11:00
Why is this occurring? Based on the clients I’m seeing, there are a number of reasons, but they pretty much always come back to the same thing, which is an imbalance between the calories coming in versus the amount of calories that are needed – namely, not enough energy coming in. Clients are in energy deficiency. They aren’t taking in enough for what is being asked by the body. Or even if they are in energy balance for today, because there is so much debt from so many years of restriction, even if they supposedly met today’s needs, the sleep is still going to be poor because there’s that debt to pay.
Why does energy deficiency lead to sleep problems? During Part 1, I went through all of the functions that are taking place during the sleep process – while you’re lying on your back and feel like you aren’t doing much at all, there’s still a huge amount of important functions occurring. Yes, your basal metabolic rate does slow down and lower while you’re sleeping, but it by no means goes to zero. Sleep is still a metabolically taxing process, and this takes energy to run.
Sleep is also meant to be a time of low stress. If you look at the circadian rhythm of cortisol, which is something I mentioned in the last episode, during the evening time through the night, it’s at its lowest points. It does start to increase as you get closer to wake-up time, but during the night it should be low.
The same thing with adrenaline and noradrenaline. Adrenaline seems to follow a circadian pattern where it is lower in the evening and the nighttime. Noradrenaline, while not following a circadian pattern or rhythm per se, is reduced by the act of sleeping. So whether you are sleeping during the daytime or sleeping at nighttime, this should reduce noradrenaline.
Cortisol, adrenaline, noradrenaline all fall under the umbrella of stress hormones. They aren’t exclusively stress hormones, especially cortisol; they have functions outside of the stress response. But let’s just focus on them as stress hormones for the moment.
Stress hormones are released for a number of reasons, and one of these reasons is to mobilize energy in the body. If you’re running low in energy, your body turns on the stress response to try and find more energy. As I mentioned a moment ago, sleep is meant to be a team of low stress, but if you’re running out of energy, your body isn’t able to do the repair work that should be occurring.
When the energy is low, the stress response is then turned on, and as stress hormones increase, this pulls you out of your sleep, or it prevents you from getting to sleep in the first place. Or maybe you sleep through, but there’s lots of tossing and turning and the repair processes aren’t occurring in the way they should, or the higher stress hormones leads to nightmares. The need to urinate in the night can also be connected to low energy and increased stress hormones, and this is something I cover in much more detail in Episode 56 of the podcast called “Understanding Fluid Intake and Urination.”
00:14:20
Under the umbrella of insufficient energy, there’s a number of ways that clients can get there. The first and most obvious is undereating. The amount of food taken across a day is just not enough for what the body needs. Often, this is obvious; clients and I are both aware that they’re not eating enough.
But undereating for others can feel like it doesn’t fit the bill. They can’t get their head around why they could be possibly undereating. For some, this is because they are eating a lot of food, but this food is high volume and low calorie – lots of steamed vegetables, lots of rice cakes or corn thins, lots of salad. They can be finishing meals where they are feeling full or they oftentimes feel overfull or bloated, but actually, what they’ve taken in isn’t very high from a calories perspective, and lower than what their body needs.
Sometimes clients can be eating a mixture of foods, so it’s not just this high volume, low calorie food, but their estimation of what they actually need is way off. They’re simply eating meals that aren’t enough for their requirements.
Again, sometimes this is obvious, as the clients are always hungry, or when they start eating, they feel this wave of hunger, or they finish eating and they know that they aren’t full, but they decide they’ve had enough or that’s the amount that they’re giving themselves.
But other times, clients genuinely don’t feel hunger. It’s a matter of eating even while not hungry, and if they do this enough, then hunger starts to return again. It takes energy to make you hungry, and if the body is used to this message being ignored because that’s what’s happened for years or decades, it can stop sending those signals. So clients don’t feel hungry even though they aren’t meeting their energy needs.
Eating too infrequently can also be a problem and be the reason for not enough calories coming in. This could be someone eating three meals a day and not snacking, but where each of those meals simply isn’t large enough.
But often what I see – and this is most common – is clients who save up their eating for the evening time or for later in the day, where they either eat no food except for in the evening time, or they do eat other snacks and meals, but actually the bulk of what they eat (say 60% or 70% of calories) is coming in in the evening or starting in the late afternoon. If the majority of eating is happening later in the evening, even if your dinner is leaving you at a point of fullness or over-fullness, this still doesn’t guarantee that you’ve covered your energy demands for the day.
Or even if you have, by the time you actually go to sleep, you aren’t going to be able to have digested all those calories. If you’ve had breakfast and a snack and lunch, etc., then those meals would’ve been available as energy throughout the day. But just one large meal in the evening or a lot of food coming in later in the day, that energy takes more time to become available.
This isn’t to say that you can’t have a large dinner or large amounts of food in the evening time. You can. But if your food intake is skewed so that little is coming in during the day and large amounts are coming in later in the day, especially if this is then combined where total calories is lower than what the body needs, then sleep is likely to be negatively impacted upon.
The solution here isn’t to suddenly start reducing eating at night and hope that you eat more in the daytime; it’s eating more in the daytime, and then with time, the desire to eat more at night will change. But the idea around this could fill a whole separate podcast episode, so I’ll just leave it with that.
Over-exercise is another factor that impacts on calorie needs. Over-exercise here is context specific. Someone could be exercising three times a week and it’s over-exercise, or they could be doing nothing more strenuous than walking and it’s over-exercise. For this to be over-exercise, it’s simply that the amount of energy that is coming in doesn’t match up to the demands that are created by the exercise that’s being done in combination with all the other demands that are being asked by the body.
This is actually a topic I talked about with Charlotte Gibbs when we covered RED-S, which is relative energy deficiency in sports, which is Episode 160 of the podcast, which I will link to in the show notes.
This can be hard for clients to get their head around, especially if they used to be doing so much more and now they’ve reduced what they’re doing. For them, it now feels like they’re doing so much less – which can be true, but in relation to the energy requirement of their body, this reduced amount of exercise is still creating a situation where there is not enough energy coming in each day.
Again, this often comes back to the energy debt that has accrued through years or decades of overtraining and under-fueling. Yes, you can be consuming large amounts of calories – amounts that you are certain easily surpass what you’ve used on that day – but with the debt outstanding, sleep can still be negatively affected.
From working with clients for over a decade now, I’ve noticed that sleep can take a long time to improve, especially if this is recovery from a longstanding disorder. It can be months and months, sometimes over a year, of consistent eating and prioritizing rest for sleep to get back into a really solid place. Thinking that you’ve been eating for a couple of weeks or even a couple of months and everything should be fine – this just often isn’t the case.
Now, if it’s been a much shorter time or the energy deficiency or deficit has been less extreme, then sleep can bounce back pretty quickly. If it’s a short term thing, once eating reverts back to providing the calories that are needed and the debt is paid, then sleep improves fairly quickly. But with the types of clients I’m regularly seeing these days, these kinds of quick changes are less common.
Another phenomenon that is common and worth mentioning is that when clients do finally start to eat more and/or exercise less, sleep in the beginning can get worse. Sleep can be more broken. They can have more instances of waking in the night feeling hungry. They can start getting night sweats. It’s like the body finally senses that food has become available again, and in that scenario, food is more important than sleep.
So just because sleep gets worse, doesn’t necessarily mean that there is an issue. It could be a sign that things are improving as long as this is happening alongside the changes that would be supporting recovery.
All of these difficulties that I’m talking about here with sleep that are created by a deficiency of energy don’t only happen to those who look thin or visibly emaciated. Undereating can occur at any size. I’ve had many clients who are living in larger bodies who were not taking in enough, and that impacted on their sleep. This is important to remember, too, if you’re gaining weight as part of recovery. Just because your body is bigger now or just because you think your body is bigger than you would like it to be, doesn’t mean that enough energy has come in to cover your daily needs or to pay off the outstanding debt.
Insufficient energy is by no means the only cause of sleep issues, and I want to go through many of the ideas and recommendations in a moment to assist sleep, but if energy deficiency is a problem, so many of the other suggestions are going to pale in comparison. Yes, they can be helpful, but without enough energy as a foundation, they’ll be much less useful in moving the needle. These things need to be done alongside dealing with the energy debt.
00:22:35
Before I start going through the recommendations, let me just make the same comment I made in the first show in relation to healthism. Healthism is the belief system that sees health as the property and the responsibility of the individual and ranks the personal pursuit of health above everything else. It ignores the plethora of factors that can be outside someone’s control that can impact on their ability to make healthful choices or why a healthful choice might not be someone’s first priority.
Some of the items that I’m going to mention are going to be nonstarters for you for various reasons. Others might be doable, but are going to be a real challenge. Others might feel like an easy change to make. Do what you can, and see what difference you notice with your sleep. These suggestions are based on what research suggests, but that doesn’t mean they will all benefit you equally. Some will work more and matter more to you than others.
I also know that children can really mess up your best laid plans around sleep, so if you have kids that wake you up throughout the night or some of the nights, then just do the best you can. The same can be said for any other factor, especially if it’s something that is unchangeable.
On to the recommendations. The first one is actually one I’ve already mentioned, which is taking in enough food. I’m going to just repeat it here because for the clients I see, this is by far the most important idea.
For the rest of the recommendations, what I’ve done is broken them down into different categories so that common ideas can then be clumped together.
00:24:20
The first area I’m naming “structure of sleep,” and the first idea here is aim for 7 to 9 hours of sleep a night. This is the number that is recommended by the National Sleep Foundation for Adults, and where you fall on that spectrum in terms of your needs – whether that be closer to 7 hours or whether that be closer to 9 hours – is likely connected to many factors, some of which are genetic in nature, many of which I chatted about in Part 1.
There are a couple things to note with this. One is that the recommendation for an individual with this 7 to 9 hours is for someone who doesn’t have any sleep debt to make up. If you are sleeping less than this and have been sleeping less than this for a long time, for whatever the reason is, your sleep needs are going to be increased.
For example, it’s common for clients in recovery, once they are eating enough and can make it through the night, that they’re getting 10 or 11 or 12 hours of sleep a night. I know there can be some concerns that sleeping more than 9 hours is a problem and that research shows poor health outcomes can be correlated with sleeping more than 9 hours, but this is correlation, not causation.
Many illnesses cause increased sleep time. As I talked about in the previous podcast, sleep is when your immune system is at its highest and when repair is happening, so if you are ill, it makes sense for your body to push you to sleep more, but it’s not that more sleep is causing the problem. Fears around sleeping too much and this being a problem are really unfounded, and during recovery or where you are paying off sleep debt, increased sleep is a temporary situation that will self-resolve as health improves.
The second thing to note is that the recommendation for 7 to 9 hours is actual sleep time. Because it takes time for you to fall asleep and there may be time that you’re awake in the night, this needs to be taken into consideration. If you’re only giving yourself an opportunity for 7 hours, the reality is you’re going to get a lot less than this.
There’s a concept known as sleep efficiency, and this looks at the percentage of time in bed compared to the percentage of time actually asleep, and this is especially important not just in recovery, but can be for as people get older or if there are other issues that are impairing sleep.
One remedy for this is increasing your sleep opportunity so that even if you are struggling to fall asleep or you are awake for some of the time in the night, it gives you a better chance of getting sufficient sleep because you’ve given yourself a longer time.
The third thing to note is there are outliers who can get by on less than 7 hours, but they are exceptionally rare. Most people who do think that they are fine, the reality is something very different. So don’t let your wish to be able to function on less sleep blur the reality of the situation. If you actually need 8 hours a night, there’s no amount of getting 7 hours a night or 6 hours a night that is going to change this. All that is going to happen is you build up sleep debt. Accept how much sleep you actually need instead of fighting it.
There is a rare genetic condition that affects 1 in 12,000 that can mean a person can get by on much less sleep – as little as 5 hours a night – but to quote Thomas Roth, “The number of people who can survive on 5 hours’ sleep or less without any impairment, expressed as a percentage of the population and rounded to a whole number, is 0.”
The next idea is follow the same sleeping routine, whether it’s weekend or weekday. No matter whether it’s a weekday or a weekend, your sleep should roughly look the same. Your body should be in a natural rhythm with when it wakes up. On the weekend, you should be naturally waking around the same time as you do during the week. So comparing your weekday waking time versus your weekend waking time can be a good indicator for how well you’re doing on the sleep front.
I know that people have a tendency to go to bed later on a Friday night or a Saturday night, but if we remove this variable, is your wake-up time similar during the week as on the weekend? It’s not uncommon for people to normally get up at say 6:30 or 7 a.m. during the week, but then on the weekend, they sleep in till 10 a.m. or 11 a.m. or they feel like spending all day in bed.
If this is the case and there’s this big discrepancy between the weekdays and the weekends, it can really demonstrate that you have lots of sleep debt that the body is trying to catch up on. This should then be a fair indicator that you need to be getting more sleep during the week and/or not going to bed so late on the weekend.
In an ideal world, if the sole goal was to maximize the efficiency of sleep, your sleep duration and the wake and bedtime would be the same with the week and the weekend, but this isn’t practical and realistic because people like going out late or they like seeing friends or they like staying up later and watching a movie, or for a whole multitude of reasons.
Really, the goal here should be about consistency, and as much as possible keeping a consistent bedtime. A big part of this is to do with circadian rhythm and the entrainment that goes with keeping a regular pattern, and then that helping to increase sleep efficiency. If you have a routine of going to bed at, say, 11 p.m., then your body gets used to doing this, and it should start to feel tired before this so that then when you go to bed, you’re more likely to fall asleep more easily.
There are plenty of things that can interfere with this, which I’ll touch on as we go through these ideas, but keeping a regular structure is going to help your ability to fall asleep and increase sleep quality.
The next suggestion is follow your chronotype for sleeping patterns. Connected to this idea of structure and consistency is following the chronotype that you are predisposed to. I spoke about this last time in Part 1. You have early-to-bed chronotype, you have later-to-bed chronotype, and you should be using this as a bit of a guide with when you should be going to bed.
In the last podcast, I talked about a number of online tests that you can do to determine what your chronotype is and that these are fallible, because habits can have a way of making you enter things in a certain way even if you are different genetically to what you’ve been keeping up to.
But I would say if you are unsure, I would suggest incorporating some of the first suggestions that I’m going to go through and see if it becomes more apparent. Basically, if you’re not doing the things in the evening time that are artificially keeping you awake longer, will you start to notice that you are wanting to go to bed earlier, or are you becoming tired earlier?
I would also note that for some clients, they are waiting until they feel absolutely exhausted before taking themselves to bed. You want to be tired when you go to bed, but this can be more subtle than falling asleep on the sofa and that being your indication that it’s time to go to bed.
00:32:15
The next section is light exposure during the evening. Light is one of the biggest factors that can impact on circadian rhythm and our sleep. In this section, I want to focus on light exposure in the evening time, but later on I’m going to talk about light during the daytime.
It’s only been in the last hundred-odd years that we’ve had widespread use of lightbulbs, and a much shorter time for devices like televisions and computers and phones. Never before in our evolutionary history have we had access to 24-hour light in the way that we do now. Yes, for a long time we had a fire and campfires at night, but this is very different from being in a room in a house that is brightly lit by lights on the ceiling, with a glowing TV screen on the wall and a bright phone in our hand.
Light is one of the zeitgebers that tells our body what time of day it is, and for the body that has evolved in the way that it has, this used to be solely dependent on the sun being the light. While we are now getting all these lights coming from our homes and our devices at nighttime, our body really assumes that this light is coming from the sun, and that it must be daytime.
We can’t see all the light on the electromagnetic spectrum. The visible spectrum is the portion that the human eye can see. At the low end of this spectrum is violets and blues and greens, and then at the higher end of the visible spectrum is yellows and oranges and reds. Lights at different points on this spectrum – whether you’re talking about blue light or red light – will have differing effects on the body.
I’ve actually covered this topic in more detail in Episode 52 of the show, called “How Light Affects Health.” It was recorded a long time ago and needs an update, but I touch on this topic around light in much more detail than I go into here.
But part of the reason why light can be problematic in the evening time is because of the blue end of the spectrum. It’s a frequency that the brain and the various body clocks that we have in different organs associate with daytime. Part of this is related to melatonin, which I talked about in Part 1. Melatonin is a hormone that is associated with sleep. The best analogy for it is it’s like the starter gun for a race. It’s not involved in the race, but it gets all the various processes to the start line and then gets them to commence.
The problem with bright light, especially blue light, is its suppression of melatonin, meaning that light in the evening can then impact on our ability to get to sleep. It can also interfere with our perception of how tired we are, or you can get into this “tired but wired” place where you’re just pushing back your bedtime, or when you go to bed, you have a really difficult time getting to sleep.
On to the suggestions. Number one is minimize your exposure to bright lights in the evening. The way you can do this is dim your lights where possible, use lamps instead of stronger overhead lights. If you want, you can use candles, as quaint as that may be.
The older style incandescent lightbulbs in comparison to the new energy-saving ones actually produce a lot less blue light and more light in the orange and red range. While the world is trying to phase them out because they are less energy-efficient, from a blue light perspective, they can be a better alternative.
The next suggestion is avoid or limit TV, computer, phones, and tablets before bed. All of these devices produce huge amounts of blue light, and this is especially the case now because the average TV screen is getting bigger and bigger, and we typically have phones and tablets very close to our faces that are pouring out this light. Sometimes it can be hard to notice this, but if you turn off the lights and then turn on a screen, you can see how much it glows and the light lights up your face and your body.
This light can suppress melatonin and can interfere with restorative sleep. This particularly can affect non-REM sleep or deep sleep, as this is the sleep that’s mostly happening in the early part of the night.
As someone who runs their own business, I know that this isn’t the easiest rule to keep. There are times when I won’t finish up recording a podcast or finish on a client call until 9 p.m. at night. With those, I’m staring at a laptop screen until this time. As someone who usually goes to bed between 9:00 and 10:00, this isn’t leaving much break between stopping looking at a screen and then actually going to sleep.
I also, like many people, enjoy TV and movies. I have Netflix, I have Amazon Prime. I find watching things to be relaxing and interesting and a hobby. Prior to being a parent, I used to watch a lot more stuff during the daytime, mostly on weekends, but now with a small child, this isn’t an option, so the only time that I can watch something is in the evening time.
I know that the reality of the situation isn’t as simple as just saying “Don’t use screens in the evening time,” so there’s a couple of ideas.
Where possible, don’t be watching a screen right until the point of going got sleep. If you can create some cutoff point, whether that’s for the last hour or the last two hours before going to sleep you’re not looking at a screen, that’s great. Or maybe you set a limit on the number of times you do this each week. So every week, there are three nights or four nights or five nights a week where you don’t look at a screen in the evening. Instead, you read a book or you chat with your housemates or partner or you call a friend or you listen to a podcast or audiobook.
This avoiding of screens also includes phones and tablets, too. Not watching TV but then being on your phone the whole evening is going to have basically the same effect from a blue light perspective as if you’d just watched TV.
Reducing the screen brightness in the evening can help a little, but if possible, being off screens altogether is going to make the biggest difference.
Personally, if I go to sleep directly after watching TV or being on a screen, I notice how much it affects my sleep. My mind is just churning away, and I struggle to be able to turn off, just feeling lost in thought. These thoughts typically have little to do with what I just watched, but are rather about anything and everything. It will take me much longer to fall asleep as my mind continues to race.
The overall advice is to minimize screen time as much as possible, within reason, and if you are using them, to try and have a gap between when you stop and when you actually go to bed – which shouldn’t then turn into you going to bed much, much later just so you can have this break, but rather, you finishing up watching screens earlier.
00:39:50
The next suggestion connected to this is using blue blocking features. This can be either apps or programs or real physical products. If you do need to use a laptop or a device in the evening, then start using blue blocking features. By blue blocking, I mean features that then take out the blue light.
I highly recommend downloading a program called F.lux, and I’ll put it in the show notes. It used to be just Mac specific but is now also on PC. F.lux runs in the background while you’re using your computer and makes adjustments to the color on the screen based on the time of day and the amount of brightness in the room. During the daytime, you won’t notice any difference, but as the sun starts to set and the light gets darker outside, the color temperature of the screen adapts and it takes out the blue light.
There are many other similar programs to F.lux; there’s Iris, there’s Redshift, and I will link to them all in the show notes. I know that most phones now have nighttime modes on them that can actually do this, although they don’t seem to be anywhere near as effective as something like F.lux, but they can make a difference.
The one caveat with this is if you are a designer, don’t use F.lux in the evening while designing. Otherwise, in the morning time, when you look at what you’ve done, it will look very different to how it did at nighttime because of the way the colors are affected.
You can also get glasses that you wear that block the blue light from entering into your eyes. While light does penetrate the skin, the eyes appear to be the most important when it comes to blue light and its effect on the brain and what times it believes it to be, so wearing glasses that block out the light in the evening time can be helpful, especially if you’re going to be watching screens right up to the point of bed.
I know some people wear them in the evening irrespective of screen time; the lights in the house are emitting enough blue light to disrupt sleep quality, and by wearing the glasses, they notice that their sleep improves.
If you go on the market looking for these kind of glasses, there are two main options: one, where the glasses are clear and make fairly minimal changes to your color vision, and then two, where the lenses are orange and when you wear them, your vision is much more impacted upon, where things appear more orange and reddish when you’re wearing them.
By far the most effective glasses are the ones that are orange and change the color vision. Yes, they can be more annoying in terms of impacting what you’re seeing on a screen, but the other options are just not nearly as helpful.
There are plenty of options on Amazon if you simply search for blue blocking glasses. The best version – and this was recommended by Ari Whitten, who’s done a ton of research around this – is by a company called Safety Blue Blockers. They have a pair called Sleep Superior Ultra. Again, I’ll link to that in the show notes.
Part of the reason these can be useful is they also block out green light, not just blue light, and the green light can be problematic and is often in high amounts from certain lights and screens. Also, with the glasses, they have things that then shield the side of the eyes so that you’re not getting light coming in the side of the glasses.
A word of warning: I think they look incredibly ugly. Think Bono in Zooropa, but where the lenses are orange. So they are by no means a fashion accessory – or maybe you think they’re fashionable and we have very different aesthetic tastes. But I’ve had many clients where wearing blue blocking glasses has greatly helped their sleep.
Once you do get used to it, it simply becomes a habit. I remember the first week that I used F.lux, and all I could see was how red my screen was at nighttime. Now, I don’t even notice it. Occasionally I’ll turn it off just for a moment, just to see if it’s still working, and when it goes off, I then instantly notice what it’s been doing.
I know at the beginning of the podcast, I stressed how much having enough energy coming in was the most important thing above all else. Well, I would say that these suggestions around lights and screens in the evening time are probably the next thing that makes the biggest difference for clients.
Part of this is because by making this one change, other changes start to follow. So they’re now reading more in the evening time, or they start noticing that they’re tired earlier because they’re not looking at a screen, so they’re getting to bed earlier. This one habit seems to create a snowball effect.
But I think this habit in and of itself is helpful just because we’ve as a society gotten into such a habit of being on screens so much of the day, and then so much into the evening time, and this light has such a profound effect in terms of melatonin and where the body thinks it is in terms of daytime or nighttime.
Up until this point when talking about light at night, I’ve been focusing on all the things you should be avoiding. But one type of light that can be helpful in the evening time is red light. When I mentioned earlier about the visible light spectrum, I said that blue light was at one end and then red was at the other. Red light has different functions on the body, and one of the benefits is that it helps to increase melatonin production and its release, so helping to organize and then start the processes that are going to help to get you to sleep quicker and deeper.
The easiest way to get red light in the evening is changing the lightbulbs that you have in your lamps so that these are in the right light range, and then you can simply use these lamps in the evening time and limit the use of the other lights.
I will link to a number of different options in the show notes that you can check out. Some of them are more orange than red in appearance, but they’re putting out a spectrum of light with more of it being orange and red and near infrared end of the spectrum as opposed to the blue/green end of the spectrum.
If you’re awake at night or you’re waking up in the night, if possible, avoid turning on the lights. This is one where I didn’t really know where else to talk about it, but if you’re awake at night, you are best to avoid turning on a light unless it is going to be a red light. This is especially true if you are waking up simply to go to the bathroom and then to get back to bed. Turning on a light in the middle of the night is likely to wake you up more and make it more difficult for you to fall asleep.
There are times when clients are waking in the night and having to eat, which is rather common in recovery. In this scenario, I’ll typically suggest clients leave food next to their bed or on their bedside table so when they have to eat in the night, they can do so without having to get up and go to the kitchen and turn on a light or be exposed to light by opening the fridge door.
The caveat to this suggestion of not turning on a light is around preventing injury. Say you have poor night vision and making your way to the bathroom without a light on feels dangerous, or if you’re unsteady on your feet and have to make it downstairs to get to the toilet safely – turn on a light. Safety first here. There’s no point injuring yourself in an attempt to limit light exposure at night. But if it is possible to do this without turning on a light, then I would suggest doing so.
00:48:15
The next section I want to focus on is on bedroom setup, or the adjustment that you can make to your bedroom that will help get better quality sleep.
One is sleep in complete darkness, or as close as possible. For deep sleep, you want to be sleeping in as close to darkness as possible, and depending on where you live, this can be more or less of an issue. When I lived in London, there were always lights outside that would come in through the windows at night, and now, living in the country, things are very different and we have very minimal light coming in because we don’t have streetlights and we don’t have lights from other properties that are making it through our bedroom windows. If it’s lighter in my room at nighttime and all the lights are off, it’s because it’s a full moon.
There are two solutions for helping you sleep in darkness. The simplest and most basic is wearing an eye mask. You want one that is comfortable and you keep on all night long. I know sometimes people put them on just to help themselves fall asleep, but you’re really wanting to get the maximum benefit. You’re wanting to have something that stays on all night long. I will link to one option in the show notes, but really, this is going to be down to personal preference of what feels good on your head.
The second option is using blackout blinds or curtains – curtains or blinds made from material that are thick enough so that light doesn’t penetrate through.
I remember one of the places that I previously lived in London had VELUX blackout blinds all through the house and in the bedroom, and when I would close them, it would be pitch black. Even when my eyes had time to adjust, I still could not see the hand in front of my face. I remember sleeping so well in this place. In the place that I lived prior to that, there was huge amounts of light that would come into the room, so I got blackout blinds for the room and I noticed a real improvement in my sleep when I made this change.
It’s interesting when I go to places like France or Italy how much more common this kind of thing is with blackout blinds in the house or the little doors on the outside of windows that you can close that block out the light. Maybe this is because these places, as well as other places around the world, have a history of sleeps during the day or siestas, so when trying to sleep in the middle of the day, you want to be able to block out the light. They are also places that get much hotter, so having a way of preventing light getting into the building through the window will keep the house cooler.
But for whatever reason, having blackout blinds or some way of preventing the light coming into the room can help you to sleep better if you can get it so you’re sleeping in complete darkness, or close enough to.
The next suggestion in terms of things to do in your room is remove electronics or devices from your room. There’s two reasons for this. One obvious one is that many of the electronics and the devices that you have in your room are going to emit bright lights. If you have a TV in your bedroom, you’re more likely to watch TV just before going to sleep, or if you have an iPad or a phone in your room, you’re more likely to check it in bed. Removing these items from the room can then help prevent this.
The other reason, and maybe the less obvious reason, is that for some people, having electrical devices in the room can impact on their sleep even if they aren’t emitting bright light. This is getting into the realm of EMFs and Wi-Fi. I know there’s a lot of controversy and conspiracy theories around all this and this is not an area where I’m an expert, so I’m definitely not going to weigh in to any side of the debate here; all I know is that for some clients, when they have removed electronic devices from the room, it helped them sleep better, and this was even the ones that weren’t emitting bright light. It can be worth trying to see if it makes a difference for you.
The next suggestion is removing your clock from view. Even if you aren’t going to remove electrical devices, for many it can be useful to remove the clock so they can’t see it when they’re in bed. Part of this is you don’t want to have a glowing light next to your face as you’re trying to fall asleep, but mostly it’s because a clock can be maddening if you struggle to fall asleep or stay asleep.
Seeing the time go by and adding up all the missed sleep or doing the math in your head where it’s like, “If I fall asleep now, I’ll get 6 hours” and then “If I fall asleep now, I’ll get 5 hours” – it’s adding psychological torture to a situation that can already be stressful and anxious. So removing the clock from view, even if this is simply turning it around so it’s not facing the bed, can be helpful.
The next suggestion is using temperature to regulate circadian rhythm. Temperature is another one of the zeitgebers that nudges the body clock and lets it know where it is. Throughout our evolutionary history, typically it was warmer during the daytime and cooler during the evening time. If we can mimic this by changing the temperature in the bedroom, it can support better quality sleep.
In Matthew Walker’s Why We Sleep, he recommends setting the thermostat so the bedroom is at 65 degrees Fahrenheit, or 18.3 degrees Celsius, which is significantly cooler than most people have their heating set to in the wintertime. Or if you are in a hot climate, this would potentially mean using a fan or air conditioning to reduce the temperature to this amount.
The next idea is correcting for outside noise. You want to sleep in silence – or if silence is an impossibility because of living in a city, you want to block out the sounds that can interfere with sleep. If noise is a problem, use something to produce white noise or pink noise that can then run in the background while you sleep.
I will link to a couple of different apps in the show notes. One is called Sleep Bug; one is called Lightning Bug. But there are lots of apps that are available that do this, which is making sounds that sound like the ocean or just a humming sound that is enough to block out background noise, but is rhythmical and can then help you to sleep.
The other alternative is using earplugs as a way of blocking out noise. Personally, the times I’ve tried to sleep with earplugs, I’ve found them really annoying, and they kept falling out and felt weird with the pressure of them. But I think the times that I have tried them have been on flights, where I was using the free ones that I’d been given. I know there are lots of different options on the market with different sized and shaped earplugs for sleeping. So with the right ones, undoubtedly I would’ve been fine. If you are going to try the earplug option, I would say that there are many different alternatives you can try.
00:55:50
This next section that I want to go through is about fluid intake. There are three ideas as part of this one.
The first one is avoid caffeine after lunchtime. Caffeine has a long half-life in the body and can block proper restorative sleep. I would say this is the case whether you really feel it or not. I know plenty of people who can have a coffee and go straight to sleep, and while they may not notice it, this will still likely be impacting on quality of sleep and the repair work that is being done.
Walker’s advice is to avoid caffeine after lunchtime, and this means tea and coffee. Yes, tea has less caffeine than coffee, but it can still impact on sleep. Especially in the UK, it’s amazing how many clients I’ve had see real improvements in their sleep by just being aware of their caffeine intake, including teas, and limiting this to the earlier part of the day.
The next idea is limiting alcohol intake. Alcohol prevents you from falling into deeper sleep, and while it makes you drowsy and you fall asleep easily, it may prevent a restful and repairing sleep. Walker is actually pretty draconian in his recommendations here and really recommends no alcohol in the evening. In the same way as caffeine, alcohol can take a long time to break down. Having alcohol in the daytime, as long as it’s not in excess, will have time to be broken down before bedtime, not interfering with sleep, but not alcohol in the evening.
But as someone who lives in the real world, telling someone no alcohol in the evening can feel rather impossible. Having alcohol at lunchtime may be fine if you’re on the weekend or you’re having a long lunch followed by a siesta and then you’re back to work, but if you’re grabbing a short lunch break before returning to work, alcohol isn’t so appealing. But in the evening time, when work is finished for the day and people are relaxing, this is when they feel like having a drink.
Everyone has a different tolerance, and a small glass of wine in the evening with dinner for a lot of people will have minimal impact on sleep or no impact on sleep. This will be especially true if you eat dinner earlier and have some time before going to bed rather than finishing dinner and going straight to bed. Large amounts of alcohol are where problems start to arise and will definitely be impairing restorative sleep.
This is true with really all health outcomes connected to alcohol consumption. The health benefits of abstainers compared to those who have one alcoholic drink a day, the difference on average is fairly marginal, and so small to potentially be chance rather than being statistically significant. But as levels increase, it becomes more and more obvious in terms of the impact to health.
So where possible, avoid alcohol in the evening time. If this isn’t the case, limit yourself to one drink and it will have a negligible impact on sleep. And on the occasions that you have more than this, which is likely to happen, know that this will have an impact on your sleep.
The next one is be aware of hydration and how this affects your sleep. Dehydration and overhydration can both impact on sleep quality. Waking in the night to urinate, while common, shouldn’t really be happening. Your body produces a hormone called antidiuretic hormone, and like many other hormones, this follows a circadian rhythm and should be highest in the nighttime so you can make it through the night without waking to use the bathroom.
I see nighttime urination most commonly in clients while they’re struggling with an eating disorder or disordered eating and whilst in the early stages of recovery from these. Very often this is frequent urination during the daytime as well that then just seems to continue throughout the evening.
Sometimes this is connected to fluid intake, where these individuals are drinking excessive amounts of water and herbal teas and other fluids, whether this is all throughout the daytime or particularly in the evening time. If this is the case, we reduce fluid intake and we see what happens. Sometimes this is all the change that is needed, and other times it’s only a partial resolution.
But often excessive intake isn’t the case, and despite drinking what should be a reasonable amount, clients are still waking in the night to urinate, often multiple times. I typically see this connected to overall energy deficiency and the debt that someone is in, meaning that there is no quick fix for this in many cases. If this is happening outside of excessive fluid intake, it’s often a matter of recovery and repair getting further along and energy debt being paid off, and then this will correct itself.
Outside of this, I would say that things that support circadian rhythm more generally will help in this regard. Because antidiuretic hormone is meant to follow a circadian rhythm, and if other things are out in this realm, this could be part of the problem. This would be about implementing many of the ideas that I’ve talked about already as part of this episode – light exposure and caffeine intake and then other things that I haven’t gotten to yet – and just seeing if that helps.
One thing I should note here is if something is waking you in the night, it’s then common to need to urinate. For example, when my son Ramsay was still a baby, he would obviously wake in the night and Ali would feed him, and I would change his nappy. When this would happen, I would always end up having to pee in the night. I would often also get hungry, and we would have food in our bedroom during this time because we would need it to help us get back to sleep.
I just want to mention this because the need to urinate at night is not always going to be because of low energy. If something else is waking you, there may be a need to urinate that follows simply because you are now awake.
In the scenario of a crying baby, there is no way around this. But in other scenarios, there may be a solution. Say, for example, you awake in the night due to a noise. Could you be using earplugs or white noise to block this out? But I just thought it was important to say this because nighttime urination isn’t always connected to low energy or circadian rhythm.
At the other end of the fluid intake spectrum, dehydration is also an issue. You don’t want to be waking in the night feeling parched and having to guzzle a big glass of water. Sometimes I see this happening alongside restless legs. This is the feeling when you’re trying to lay still and fall asleep that your legs just start moving. There’s many reasons for restless legs, but one of them is dehydration and the subsequent buildup of sodium in the blood. So if you are someone who is prone to forget to drink fluids, you have darker urine, maybe you’re getting frequent headaches and feel dehydrated, then focus on upping your fluid during the day and see if that helps with sleep.
01:03:40
The next section of suggestions is looking at activities that can be done during the daytime to better support sleep. Most of these are connected to circadian rhythm and circadian rhythm entrainment, so doing things that let the body know that it is clearly daytime.
The first idea is get sunshine during the day. As I mentioned in the first episode, our circadian rhythm is strongly influenced by light and dark, and the light side of the equation is hugely important. We evolved when we were spending all our time outdoors. For hours and hours a day, we would have sunlight hitting our body. Even if we were in a hot climate and we were escaping the heat of the sun into the shade, we were still being exposed to high amounts of light from the sun.
So getting sunshine throughout the day is incredibly important, and this is especially true in the early morning. Getting in bright light or bright sunshine within the first hour of waking can be incredibly powerful to support circadian rhythm and help the body move more into being awake, in that awake mode.
There are going to be times of the year when being outside doesn’t provide much sunlight, or the conditions are so bad that even if there is some light, you just don’t want to be out there. Let me first focus on situations when the weather is decent, and then we can look at what to do in the darker and not so nice months.
As I said, you want to be getting bright sunshine within the first hour of waking if possible, and then throughout the day, have other periods of getting sunshine, but without getting burnt. Getting adequate amounts can be challenging if you have an office jobs, and especially if you commute to work in a car or on the tube and then you’re in an office all day, and then you travel home again.
But see if you can have a couple of times where you’re outside during the daytime. Go outside for your lunch break and eat on a bench or in a park. If you have a snack in the morning or the afternoon, if possible, go outside to do this. If you can do calls or meetings outside, do so. Then on weekends or times when you can be outside more than just these short times, do so. As long as you aren’t burning, I’m up for spending large chunks of the day outside if you can.
There’s a few things I want to say about this. The first is I remember reading an article – and I think it was in Wired – that on average, we spent less than 5% of our day outside. That’s just over an hour outside. Now, I’m always suspect of articles like this, so I wanted to look and see if I could find studies looking into this. I could find lots of articles online talking about this topic, but more difficult to find original studies.
It was also difficult because many studies that I could find would ask people about “How much time do you spend in nature each week?” or “How much time do you spend playing outside each week?” Because of the way these questions are farmed, this isn’t telling us about total outdoor time.
I did find one metanalysis called “An Overview Analysis of the Time People Spend Outdoors.” Annoyingly, I couldn’t find the full study, just the scaled down summary on PubMed – which sucks, because I really would like to dig into this more. But from what I could see, as part of the study the estimation was that on average, people spend just over an hour outdoors during the week and nearly 1 hour 40 minutes on the weekend – although on holidays, the average time was between 5 and 6 hours outdoors.
So the 5% estimate outside of holidays wasn’t far off. In other articles online, I found estimates of between 6-8% of the day. This means that in the whole scheme of things, on average, we spend a pretty tiny amount of time outside, being exposed to sunlight.
The second thing with this is it can be easy to think we’re getting decent amounts of light because we are indoors, but we have these windows and light is coming in. One way of measuring light is lux. This is the measure of the intensity of light as perceived by the human eye as it passes through or hits a surface. While lux is about the eye’s perception, it is connected to the intensity of the light that is then hitting surfaces and the skin.
You can actually get a lux app for your phone, and it then uses the camera on the phone to tell you how many lux it is picking up. The one that I use is called Lux Camera, and I will link to it in the show notes. I work out of an office in my garden, and I face a set of floor-to-ceiling glass doors and windows that are 4 meters wide. I’m about 3 meters back from these windows, so my office feels incredibly bright and light-filled, and I’m looking out to nature. It feels like I’m getting a huge amount of light each day.
In February time, I tested the lux in the office while facing the windows, and it was a fairly cloudy day, but it was by no means as bad as it gets in winter. While sitting down at my desk, it was at 400 lux. If I stood up with the phone camera, stood up from my desk and then looked out, it was 2,000 lux. But when I went outside, it was 12,000 lux. That’s a big difference from 400 to 12,000. That’s 30 times more light being outside.
I then tested this a couple of days ago. The weather is much nicer now, with clear blue skies. It’s still in the mid teens temperature-wise, so it’s not the middle of summer. (For those that work in Fahrenheit, that’s roughly around 60 degrees.) When I check it sitting down, it’s 1,200 lux; when I do it standing up, it’s 4,500 lux. When I step outside and look at the sky, but I’m looking away from the sun, it’s 20,000. If I look more directly into the sun, it’s 120,000. A bright blue sky in the middle of summer, you’re talking 150,000 lux.
Here, the difference is going from 1,200 lux when sitting down to 120,000 lux when going outside, so 100 times more light. Even though my office can feel sunny and bright, the difference between being inside and outside is enormous. Getting sunlight on our skin has a wide range of benefits, but from the perspective of this podcast, the light will be assisting in entraining circadian rhythm, meaning that more light in the day can then help you sleep better at night.
The third thing I want to say connected to this is that being outside doesn’t have to mean movement. As I talked about earlier in this episode, often the biggest hurdle that I’m seeing within my client population is energy deficiency preventing restorative sleep. Often, a big part of this is over-exercise or even walking for long periods each day, because often clients don’t think to put walking into the bracket of exercise. So even if they’re doing 3 hours of walking a day or 5 hours of walking a day, they discount this as not exercise.
So just because I’m talking about the benefits of sunlight and outdoor time, doesn’t mean this has to be paired with movement. I’ll often suggest that clients go outside and sit down. They can read a book. They can listen to a podcast. They can do a meditation. However they want to spend their time, do so outside.
This can often be challenging for them to be still and not moving, but I think it’s important to flag this up because I don’t want you to think that just because I’m suggesting being outside more, this then gives you license to be walking for hours on end each day. Invariably, this won’t help your sleep, at least within the population I’m typically working with.
01:12:35
I’ve talked about what to do during the better times of the year, when it’s nicer to be outside and the sun is providing decent amounts of light, but what about in the wintertime?
In the wintertime, using light therapy can be a great strategy to help up the deficit in natural light, which involves using lightboxes or satellites to provide you with bright light that you aren’t receiving from the sun. Typically, these products will provide around 10,000 lux or higher, which is significantly higher than you’re going to get looking out of a window on a grey, wintery day. I’m going to link to a couple of options in the show notes.
As I said earlier, getting bright light in the morning can be hugely beneficial, so this kind of lightbox can be put on first thing in the morning, maybe while you’re in the kitchen prepping breakfast or while eating breakfast, so you’re getting that strong light early on, reinforcing that it is daytime even if it’s still dark outside. Then you can use it throughout the daytime. If you have a desk job, you can put the light on your desk or next to your desk and have it on while you work.
I would say, though, you are best to avoid this in the evening time. This is the time when things should be getting darker and you’re wanting to avoid bright lights, especially those that have strong blue and green fields – which most light therapy lights have. Save these lights for the daytime to use them, and then use the red lights in the evening time.
Another alternative, and maybe something that is worth having in addition, is a light therapy light that doubles as a dawn simulator. A dawn simulator is a lamp that you can program to slowly turn on, which you’ll ideally use in the morning to mimic a rising sun. Waking up in total darkness, it is rather tempting to hit the snooze button, but when a dawn simulator is used, you get this slowly increasing brightness of light which mimics an accelerated sunrise, helping you to gently wake up so when the alarm finally goes off, you’re already much more awake – or maybe you don’t even need an alarm and the dawn simulator is enough on its own to wake you up.
This means that before getting up, you’re already getting decent amounts of light or a dose of light that’s helping to reinforce to your body that it’s morning time.
So those are some of the ways that you can be upping the light to support circadian rhythm and assist better sleep, and also just feeling better when you are awake.
Still in this same section of things you can do during the daytime to support better sleep is something that’s connected to what I just talked about: waking up without an alarm. An alarm is hard on the nervous system and the cardiovascular system, increasing both stress hormones and blood pressure. This is multiplied if you keep hitting snooze, where you fall back into sleep and then the alarm goes off again, giving you another shock to the system.
In an ideal world, you are going to bed early enough so that you naturally wake up before you need to get up. The next best option is using something like a dawn simulator that naturally wakes you up through the use of light – or if you do need to set an alarm, make it something gentle and at a lower volume that wakes you up without startling you and when this goes off, you get up without snoozing.
Obviously, to make all of these things work, you need to be getting enough sleep and going to bed early enough for this to happen so that you’re then waking up where you’re feeling refreshed and are able to naturally wake up. Being woken up in the middle of a sleep cycle by a bleeping alarm doesn’t set you up well for the day ahead.
I know this can be difficult for many reasons. Often clients would love to be sleeping better. It’s not that they aren’t trying to; it’s just that because of where they are in the recovery process or because of where their body is, it’s just messing with their sleep, and they’re often in a deep sleep at the time they need to get up. Or life is incredibly busy, and getting enough sleep is just difficult, or you have to wake at a time for work that is outside when you would otherwise get up, so you aren’t naturally waking at this time.
This one might be one of the ideas that feels completely outside of your control, but if you can find a way to wake up without an alarm, then go for it.
01:17:30
The next suggestion is around eating and doing so in a consistent manner. The body thrives on regularity, and part of this is because regularity reinforces circadian rhythm and tells your body what time it is. In an ideal world, eating meals at a consistent time each day will support the body. So having breakfast at a similar time, lunch at a similar time, snacks at a similar time.
In recovery, this may mean eating many meals throughout the day, and if you’re doing this on a consistent basis, this is great and it will be helping you. But I should add here that this shouldn’t be an excuse to put off eating and to restrict. In recovery, eating can be more messy than at other times. You may finish a meal and then an hour later be hungry. If this is the case, then eat. Hunger trumps any ideas here around consistency. Don’t be hungry for 2 hours simply to try and eat at consistent times. This should be one that comes later on if, in the beginning, things are all over the place.
Connected to this idea of eating more consistently is having more food come in during daylight hours and the daytime. This is when you are most active, whether that’s physically or mentally, and when we need more energy. If eating can be skewed towards this time, then great.
But again, don’t let this idea lead to more disordered eating. If you are hungry in the evening and find yourself wanting to have more, then go for it. If you finish dinner and you feel like a snack, have a snack. This isn’t a suggestion to restrict or to say that you can’t eat food after X time of the day.
Use your own intuition with this as well. I know personally, I eat a large dinner. It is often my biggest meal of the day – although none of my main meals would be described as small. I will also often have something to eat after dinner, and this is because I do better eating this amount. If I try to have a smaller dinner or eat less in the evening time, I don’t sleep well. It’s a much lighter sleep for me. I’m more likely to be restless, and it can take me much longer to get to sleep. Whilst most of my food intake does come in during the daytime, I by no means have a light dinner or no food come in in the evening time.
But equally, I have clients where eating less at nighttime does really help with sleep and it makes a noticeable difference basically as soon as they start to make the change – to the point that if they do have a poor night’s sleep, nearly every time it was down to eating later.
This is one that you’ll need to play around with, but on average, if you can be consistent with eating and have more of your food come in during the daytime, it will support circadian rhythm and sleep quality, as long as this message isn’t leading to more disordered eating or restriction or following advice blindly and not checking in with how it works for you.
01:20:55
The next suggestion is movement or exercise during the daytime, and this again is going to come with lots of caveats. Typically, movement and/or exercise during the day supports circadian rhythm. From an evolutionary perspective, daytime was when we moved and nighttime was when we were more still because once the sun sets, yes, you may have a campfire, but typically you are staying put.
Doing movement or exercise during the daytime can be helpful with sleep, but obviously the big caveat with this one is about where your current health is at. If you’re in recovery, then this suggestion really doesn’t apply. Whatever potential circadian benefit there could be gained from daytime movement, it’s going to be wiped out by the energy that is used for that movement that could otherwise be used for repair. Again, don’t use this as a way to support disordered behaviors.
But if health is good or you are not in recovery or dealing with energy deficiency, then daytime movement should be supportive to better sleep. And this can be low intensity movement, or NEAT. Something as simple as walking or gardening can be helpful, and part of this will be because you are outside and getting the benefits that this offers, but the other part is from the movement per se and the impacts that this has on circadian rhythm and other systems in the body.
If you are going to do something more intense, this typically is better to be done earlier in the day, or at least avoiding doing it in the evening time – at least from a sleep perspective. Doing intense exercise is a stress on the body. This doesn’t make it inherently bad. It’s actually good. The stress is what leads to the adaptions and the benefits from the exercise. But it can take time to wind down, and if you’re doing this in the evening time, it can be impacting on your quality of sleep.
I know that everyone has different time pressures, and the evening may be the only time you have a chance to exercise, but just be conscious of how this affects your sleep. Pay attention to your sleep on exercise days versus non-exercise days and compare what happens.
Connected to this and in the same vein is standing more during the daytime can also entrain circadian rhythm. Historically, we would’ve spent more of our daytime moving and standing, while we sit down and sleep more in the evening time or as the sun went down and the day came to a close.
Now, this also comes with the exact same caveats as the last one. For many people, this isn’t appropriate. Energy deficiency means that the most important thing for you is sleep, and health is going to be greatly improved by you sitting or lying down and resting as much as possible. This is the advice, and this trumps anything else that could be potentially beneficial.
But if you are in better health and are not in recovery or in energy deficiency, finding ways to stand more during the daytime could be helpful. If you have an office job, could you set a timer to go off every hour so that you get up and stand and move when this happens? This can be helpful for lots of reasons outside of simply sleeping. It can be helping with concentration to have mini-breaks. It can help in terms of your eyes, to give it a break from staring at a screen for long stretches of time.
At the more elaborate end of the spectrum – and this is clearly not going to be an option for everyone – is to have a sit/stand desk, which is a desk that can be adjusted so that you can spend some of your time sitting and some of your time standing while working. This is something that I got when I moved into this new office about 9 months ago. A couple of hours a day, I will be standing while I work.
But I want to highlight that, one, I’m in good health. I’m not in energy deficiency, so doing this does genuinely benefit me. And two, I’m in a privileged position that I get to pick my own office furniture and am my own boss, which is not most people’s experience. So this is a suggestion that is going to be relevant to a lot less people, but I did still want to mention it because depending on your situation, it could be helpful.
01:25:30
The final thing I want to mention in this section of daytime activities is to do with naps. In Walker’s book, he is rather supportive of the idea of naps during daytime, which is common in many cultures – although it’s sadly dying out. He talked about when these countries do shift to stopping napping during the day, many health problems start to increase.
Some of this may simply be to do with these people getting less total sleep overall than previously, so no longer napping, but they haven’t increased their nighttime sleep. Some may potentially be genetic and specific to those particular areas. If you and many of your generations of ancestors has naps during the daytime, maybe there’s some changes that have occurred that somewhat anticipate this nap and make it necessary or need it. When this is then removed, it’s felt much more than someone who never had a history of naps during the daytime.
But whatever the reason, naps during the daytime can be supportive for health. For many clients during recovery, daytime naps are something that occur for some time. Obviously, if there is an office job, this is more challenging so it can only happen on weekends. But in recovery, the need for sleep drastically increases, and often this can’t be achieved all in one go, so having a nap after a meal can really help.
The suggestion here is if you are going to have a nap, avoid doing it after 3 p.m. If you’re napping after 3 p.m., it’s much more likely that this is going to interfere with nighttime sleep. This time is not set in stone; maybe you can nap after this point because you are so tired and in need of repair, and this doesn’t impact on your nighttime. If this is so, then keep doing what you’re doing. But on average, it’s best to avoid having naps after this, and if you’re going to do it, do it before 3 p.m.
01:27:40
The next section is going to be ideas around pre-bedtime and the things you can be doing in the hours before bed to support sleep. I know I talked a bit about this already in the section around light at nighttime in terms of avoiding screens and encouraging red light, but I want to add in some more suggestions.
The first idea is to have a consistent pre-bed routine. I commented that the body thrives on regularity, and this is definitely true with the pre-bedtime routine as well. This doesn’t mean that every night is going to be an exact carbon copy of one another, but it’s more about finding different things that you can do to support yourself in getting in a more relaxed state that can assist in helping you fall asleep easily and then stay asleep.
Some of these are connected to polyvagal theory and stimulating the ventral vagal nerve, which is part of the nervous system that is associated with being in a relaxed state.
Let me share some ideas. You can do many of these things at night; it’s not just about doing one of them. Some of these ideas could be expanded upon in much more detail, but for the scope of this episode, I’m just going to list some of them.
In the hours leading up to bedtime, you can read a book. If you are reading on a device, have it be one like the e-ink Kindles so it’s not giving you the bright light. You could listen to relaxing music. You could do some journaling or some writing, whether that be a plan or reminders for what to do tomorrow, whether that be a gratitude journal or doing some form of freeform writing or creative writing. You could have a hot drink or a snack.
You can meditate. In terms of apps, I really like Waking Up, Headspace, and Calm. They’re the three that come to mind. Doing breathing exercises or guided imagery can also be helpful. Stretching or restorative yoga or foam rolling can be helpful with this. You can chat with your partner or friends or family. Singing or gargling.
I know I mentioned earlier about using temperature to assist sleep and having the room be a cooler temperature. To actually accentuate this temperature change, having a warm bath or a shower before bed can really assist this. Epsom salt baths can be especially helpful. The magnesium from the Epsom salts can help with relaxation and the nervous system, and if you have aches or pains or swelling, this can be supportive as well.
One thing I would say is that if you do have a hot bath before bed, it can take a while to cool down, and you might find yourself sweating after you’ve just gotten out of the bath for a while. So either avoid making the bath really hot, or if you want to have a really hot bath, do so, but do it earlier so that you’re leaving extra time for yourself to cool down so you aren’t trying to sleep as your body is pouring out sweat.
Another option for helping with temperature regulation and something that can be done before bed is a thing called the Cryohelmet. This was originally used for migraines and tension headaches, but can be a way to cool the body. It kind of looks like the scrum caps that some rugby players wear or one of those old leather caps that pilots would wear. I’ll link to it in the show notes.
Basically, you put the cap in the freezer during the daytime, and before bed you pull it out and put it on and you wear it for 30 to 40 minutes, and it helps to bring down body temperature and head and neck temperature in particular. Anecdotally, it can be especially useful if you have lots of racing thoughts when trying to sleep and have a hard time switching off. It’s definitely not for everybody; it wouldn’t be the first thing I’d suggest, but it is an option.
01:32:25
The final section here is around medication and sleep. The first idea is to review your medications. If you are on medication, check these medications to see if there are any potential impacts or side effects that it can be having on your sleep.
Just so we’re all clear here, I’m not a doctor. I’m not saying you should come off your medication. It is not my job to tell anyone to come off their medication, and many medications people cannot come off. But if you are having sleep issues and you are on medication, one of the side effects of this could be the sleep issues. If this is the case, speak to your doctor. Maybe there is an alternative that doesn’t impact on your sleep – or maybe there isn’t, but you now know that some of your sleep issues may be unavoidable because of this medication.
Yes, I think you will benefit from all the various suggestions that I’ve made throughout this podcast, but just knowing about this other variable can stop some of that maddening of not understanding why something is going on.
The next suggestion is to avoid sleep medications. Again, this isn’t me saying you need to come off sleep medications. If you’re on sleep medication, this is something you need to speak to your doctor about. Depending on your situation, you may be able to come off them; you may not. That’s not for me to tell you.
But in Walker’s book, he is rather damning of sleep medications and how frequently they’re recommended, mostly because of the poor health outcomes that they are connected with. He states that there is no sleep medication that induces natural sleep. This means that you’re not getting all the repair benefits of sleep, so the function of sleep is really blunted. They’re also highly addictive and make it difficult for people to sleep without them, which then becomes a vicious cycle.
01:34:30
Walker, instead of sleep medications, recommends CBTI as the first line of treatment. That stands for cognitive behavioral therapy for insomnia. It’s hard to describe CBTI in a simple sentence or two because it’s not one simple technique that you do and then sleep improves. While insomnia is in the name, there are many things it can be used for, some of which people aren’t going to use the word insomnia to describe. It’s used for trouble falling asleep, waking through the night, early morning waking, feeling unrefreshed during the day, anxiety around sleep, and general anxiety and stress management.
The way that CBTI works is you work with a trained practitioner and you have weekly or fortnightly sessions. They take your case history to understand what your issues are, and then they get you to keep a sleep diary. They use this as a basis for making recommendations and a way of measuring improvements.
Depending on your situation, different methods will then be implemented. Let me run through some of them, because some of this stuff is going to be useful. Even if you aren’t going to go and see someone for CBTI formally, you can try some of these ideas to sort out your own sleep issues.
Part of the CBTI is looking at things like sleep hygiene, sleep environment, relaxation training, and other lifestyle habits that can impact on sleep, which is basically everything I’ve covered as part of this podcast. So, what are the things someone is doing that are potentially negatively impacting sleep, and what happens when these are removed? That’s a really big part of the CBTI process.
But there’s a couple of ideas that I haven’t touched on. The first thing is intentional sleep restriction. For example, if someone is used to going to bed at 10 p.m. but they struggle to fall asleep or they’re waking in the night, they will be instructed to stay awake for much longer. If they are also in the habit of napping during the day, they’ll be instructed to cease doing this. So they switch from say going to bed at 10 p.m., and now they’re told to go to bed at midnight or 1 a.m.
This is then paired with the other sleep-promoting strategies that I went through. It’s not getting someone to stare at a screen until midnight and then go to sleep; it’s getting someone to do all the things that promote sleep, but then resisting the urge to actually sleep, meaning that when they do finally sleep, they are really exhausted.
Paired with this, they are suggested to get up at the same usual time, which then causes partial sleep restriction and increases tiredness. This is then kept up for a decent amount of time – often many weeks. This can be really difficult and can be a really tough time for someone, but the goal with this is to get to a point where someone is so tired that they’re then able to fall asleep really easily and they’re able to make it through the night.
When this then becomes consistent, they start to slowly increase the bedtime so that they start to go to bed earlier and earlier, but they’re still able to then maintain the ability to fall asleep easily and sleep throughout the night – again, while still continuing to work on sleep hygiene and sleep environment and sleep relation techniques.
I know Ari Whitten has talked about studies that take this sleep restriction further, where people will stay awake for a full night or even two nights or three nights so that they’re absolutely exhausted when they finally are allowed to sleep. When they do finally go to sleep, this can then reset the system. Then if the other helpful sleep practices are in place, it can be a quicker way of getting back to sleeping well.
The big caveat with this method is that if you are doing this for more than a single night, then you definitely should be doing this under the care of a sleep specialist or a sleep doctor, and you should definitely not be driving even if it’s just one night of total sleep deprivation, given the damning statistics I talked about in the previous episode connected to sleep deprivation and car accidents.
So some form of sleep restriction is often used as part of CBTI, or that method, and then another component is remaining passively awake, or paradoxical intention. Most people who struggle with falling asleep or waking in the night and not getting back to sleep get into this mental place where they’re trying to will themselves to sleep, where there is this force that they’re trying to impose to push themselves to sleep. This obviously causes lots of stress and anxiety and rumination and has the opposite of the desired effect.
With this, they teach you to be okay with just lying there and being awake. Stop trying to force yourself – or even, counterintuitively, lie in bed closing your eyes, but with the intention of not falling asleep. See if you can try and keep yourself awake. This paradoxical change can then lead to getting to sleep easier and can change beliefs and feelings around sleep.
Those are some of the components of CBTI. Depending on the situation, there can be other things included, but this would depend on your practitioner and what they notice as part of the situation. I’m not trained in CBTI, but improving sleep is often a large part of what I do with clients, so looking at the situation and figuring out what are the likely blocks for them sleeping well and then testing them out and seeing how things improve.
One other idea that I’ve come across before for helping persistent sleep issues is going camping – and not just for a night, but doing it for say a week. Often with camping, the first night or two, sleep is pretty poor. It’s not as comfortable as your usual bed. It can be really cold or really hot in the tent. So doing it for more than a couple of days and more like a week is where you’ll really notice the difference.
A big part of this is that it forces you to change many of your habits. You’re going to bed much earlier because once the sun goes down, the darkness makes you more tired. Even if there is a campfire, this is different to sitting in a fully lit-up household room. If you do this time to disconnect from your phone, you’re then not going to be looking at a screen at nighttime. During the daytime, you’re getting plenty of natural sunlight as you’re spending time outdoors basically all day as part of the camping. You’re getting the natural changes in temperature as the sun goes down and the nighttime is cooler than the daytime.
Really, so many of the suggestions that I’ve made throughout this podcast get made for you because now you are at the mercy of nature deciding. Obviously, this isn’t an easy option for many people, but if sleep is an issue and if camping is an option, it can be another way to reset the system and get back into a better sleep rhythm and follow certain habits.
But obviously this will only last for so long if you come back and keep up the same habits that were happening before. This is almost like a startup or a refresh, and then the other things that I’ve talked about as part of this episode need to be coming in.
That is it on the recommendations front. If you are someone who deals with sleep issues, I hope that this has given you many insights and ideas of things to potentially try.
Like is suggested with CBTI, keep a sleep log for a couple of weeks. Keep track of the many things that I’ve talked about in this episode, like what time are you going to bed? What time are you waking? Are you noticing that this is consistent? How are you spending your time in the evening before bed? Are there differences that you notice on the days that you do X in the evening versus doing Y in the evening? What is happening during the daytime? When are you eating? How much are you eating? How much time are you spending outside?
Really get a sense of what your baseline is, and then figure out what you want to experiment with changing to see how it helps with your sleep.
And just a note on making changes: habits are hard to break. Even when you’re doing things that you realize aren’t supporting you, you will still often continue to do them. Very often, our right-now self is enjoying doing something even when we know that our future self will pay for it later on.
I’ve previously done a podcast called “Setting Goals and Achieving Them,” which is Episode 72 of the podcast. Basically it looks at how to go about making changes that actually stick, with the short summary being that you focus on one thing at a time and figure out how to make that a habit, and then you move on to the next one and then you move on to the next one and so on, which is how I work with clients.
On the surface, it may appear slower to do it this way, but the reality is that in 6 months’ time, people are in a hugely different space than they were because of all the changes they made. For those that try and change everything at once, mostly they do it for a couple of days or for a week and then they quickly revert back to old habits because it just feels overwhelming.
But anyway, the podcast goes into a lot more detail about habit change and could be worth a listen if you do want to implement any of the ideas shared in this episode.
That is it. This was a rather monumental two-part episode. If you know other people who would benefit, then please share it with them. Sleep is a huge trouble for so many people, even outside of the niche of eating disorders and disordered eaten that I work in. So please share this message far and wide if you found it beneficial.
As I mentioned at the top, Seven Health is currently taking on clients. If you are struggling with dieting or disordered eating or recovery or body image issues or sleep or any of the topics that we cover as part of this show, then please get in contact. You can go to seven-health.com/help.
Next week, I will be back with another guest interview, but until then, take care, stay safe, and I will catch you next time.
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