Advice from one very tired person to another

By Nicola

Oh, sleep… that really great thing we all wish we got more of! This week’s topic is all about sleep, it’s function, and some tips to help get more of it. We’re going to get educational here, so buckle in for some good ol’ VIA revision that will hopefully convince you to stop studying/watching Netflix/playing LoL and get some shut eye.

Sleep has three main important functions. One, NREM (non-REM) sleep is for restoration and repair, it allows for tissue repair and energy recovery. Two, REM sleep has a big role in memory consolidation* (*pro-tip: study something really important just before bed!). Three, sleep overall is a method to conserve energy and hence is a protective mechanism, something we can observe in hibernating animals.

When we don’t get enough sleep (which, mind you, is so often with all of us…), there are a plethora of consequences that accumulate. We have the real obvious one – we don’t perform as well the next day, yawning through a 8-10 hour day of placement and lectures, and making more errors in seemingly easy tasks. There is an increase in our sympathetic nervous system drive, which over time predisposes us to hypertension. A change in dietary and hunger hormones causes a higher appetite and probable weight gain. Lastly there is higher levels of nocturnal cortisol secretion which can lead to insulin resistance.

Have I convinced you to go to sleep yet?

The balance between our sleep drive and our wake drive (i.e. the Circadian rhythm), plus the role of melatonin, promote sleepiness when we need sleep and will wake us up when we need to get up. Things like, having varying sleeping and waking times make it difficult for this homeostatic mechanism to work effectively, explaining partially why sometimes we wake up feeling absolutely awful (some of it might also be because it’s 5:30am and we need to be on ward rounds by 7am). This kind of imbalance is seen with shift workers or in jet lag, and have been demonstrated in a multitude of studies to be associated with impaired attention, poor decision making, mood alterations, and even higher incidences of cancer long-term.

How about now? Are you feeling sleepy?

One of the biggest contributor to our poor sleep patterns, other than staying up to all hours studying, is being on our screens too late. The effect of blue light on our Circadian rhythm and melatonin secretion has been researched by Harvard University, and even dim light can mess it up. Blue light isn’t all bad though, during the day it’s awesome – boosting attention, improving reaction times, and mood. With blue light in our faces all night, our poor brain thinks it’s still daytime.

But just filtering out our blue light emitting screens isn’t going to solve all of our sleep issues, it helps a lot though. The best thing to do is have great sleep hygiene. This is defined as “recommended behavioural and environmental practice that is intended to promote better quality sleep”.

Here’s a (not exhaustive) list of things which are associated with a better night’s sleep:

  • Sleep scheduling, this is having a set time to fall asleep and wake up every day. This is difficult with the changing schedule of clinical placements and classes, but I found that at least trying to get to sleep at the same time every night helps!
  • Aim for that 20-30 minutes of exercise every day, but no later than a few hours before bed. You get all the fun, no-metabolic-syndrome-benefits of exercise but it’ll also tire you out enough to sleep.
  • Meditate! (I am so so so sorry that pre-clin ruined it for you, I promise it’s good). Apps like “Calm” or “Headspace” have specific guided sleep meditations.
  • Read a book before bed (and I mean a paper back one, e-books have no place here).
  • Avoid caffeine later in the day. Say… no later than 3pm… I know, shocking right, but that stuff hangs around in your system for ages! That includes caffeinated teas too! It’s suggested to not have any caffeination 6 to 8 hours before bed.
  • Try and have your bedroom for sleepy times and sexy times only, no study times. Again this is super difficult if you’re in student accommodation (read: a shoebox), but maybe try studying at the library or in the lounge room.
  • Don’t lie in bed awake, get up and do something else and come back to bed once you’re tired.
  • Listen to a sleep podcast, this is a really good one – Sleep Restore.

Good things come to those who wait – change isn’t going to happen overnight. Sleep hygiene and consequently improved sleep is a habit you need to work on. Did you know it takes approx. 4-6 weeks for form a habit? Good luck, and enjoy your new-found good nights of sleep 💤

 

P.S. in all seriousness, if you’re having trouble with getting to sleep, staying asleep, or having daytime sleepiness, especially after trying the above tips, please see your doctor 🙂

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