Habits for Healthy Sleep

Importance of Sleep

Beginning In the late 1990s, Holiday Inn Express had an ad campaign that featured ordinary people performing over-the-top endeavors because of the healthy sleep habits they had while staying at the hotel. One commercial portrayed a surgeon performing surgery and when discovered as an imposter, he replied, “No, I am not (Dr. Stuart), but I did stay in a Holiday Express last night.” The exaggerated situation portrayed in the commercial rings true to how we feel after a sound, quality sleep…on top of the world!

Healthy sleep is the anchor for a healthy life. We can not survive without it, yet our modern lifestyles seem to trivialize it, even compete with it. We don’t get enough sleep or often practice healthy sleep habits and we are experiencing the consequences. Insufficient sleep and sleep disorders are on the rise, contributing to various problems, including cardiovascular disease, diabetes, accidents and injuries, stress, pain, neurocognitive dysfunction, anxiety, depression, and mortality. Add MS to the equation and the prevalence of sleep disorders increases, compounding the potential problems mentioned with worsening MS symptoms and quality of life. Sleep is important. Sleep, for a significant number of people with MS, is a problem. Symptoms of MS can impair sleep, and poor sleep can worsen MS symptoms (see CAN DO article, Sleep & MS: Strategies for Improving Your ZZZs). If you are reading this article, perhaps you already know this; you live it.

The encouraging news is that there are many evidence-based, supportive ways to get a better night’s sleep. Developing new healthy sleep habits can be simple, low-cost, safe, and effective. This article concentrates on what can be done to improve your sleep to create your own “Holiday Express” sleeping experience. Take a deep breath (more about breathing later), relax, and focus your attention on what you want to change to become the sleeper you desire to be to improve your health and quality of life.

Setting Up Your Sleep Space for Success

Environment

Tap into what your senses need to sleep well.

DARKNESS

Make your room like a cave. Darkness is essential for melatonin to be released to promote sleep anticipation. Blackout curtains and blinds can be helpful to eliminate light sources. A common interference with darkness is the light emitted from electronics (blue wavelengths emitted from electronics block melatonin release). A 2023 National Sleep Foundation poll found that 76% of the respondents earned a letter grade of “F” because of using electronics before bedtime. A part of your sleep routine should include turning off electronics at least one hour before sleep.

QUIET

Your environment needs to be very quiet which may mean the need to use white noise or earplugs for possible noise interruptions.

SCENTS

Our sense of smell is closely connected to our memories, emotions, and feelings. Aromatherapy, the use of essential oils from plants, promotes a sense of relaxation and helps with sleep. Essential oils can be inhaled through diffusers or sprays, or topically applied.  Lavender, sandalwood, cedarwood, or rose are calming oils that can help with inducing and maintaining sleep. Essential oils can be purchased online or in health stores.

TEMPERATURE

Heat sensitivity is a common symptom of MS and can negatively impact sleep quality. For good sleep, a drop in our core body temperature is needed to signal our bodies for sleep. Room temperature should be between 60°-70° Fahrenheit, depending on individual preference. The
use of a cooling pack behind the neck or upper back can enhance a cooling effect, induce relaxation, and promote sleep.  Some people have the opposite problem at night and experience cold extremities during colder months of the year. A small recent study showed that wearing socks at night to warm feet while sleeping in a cool environment had positive effects on sleep quality that included falling asleep faster, increasing sleep time, and lessening the amount of waking during the night.

Products to Keep You Cool

CLOTHING

Moisture-wicking material is helpful if you are prone to night-time sweats. Light, loosely fitting clothing made with breathable cotton fabric is best.

BEDDING

*Information gathered through the Sleep Foundation website. All products can be purchased through many sources. Intent is to give examples and reviews of products only)

• Sheets: The materials used should be durable, breathable, lightweight, and easy to
  move around in. Look for a lower thread count which will allow more airflow. The most
  effective materials include bamboo, cotton, and linen.
• Pillows: The materials used in the exterior/cover should be breathable and lightweight, such as cotton or bamboo; the interior should have shredded materials to allow airflow. Avoid memory foam (in pillows and mattress toppers) because it traps heat by conforming to your head and body, and also can make movement difficult.
• Covers: Look for lightweight or all-season covers. Outside materials should be moisture-wicking and breathable. For inside, down alternatives are more breathable materials. Organic cotton or bamboo materials are recommended.

Helpful Equipment for Building Healthy Sleep Habits

We sleep better when we are comfortable and can move around with ease in bed. Adaptive products improve safety and independence and save energy. Some products to be aware of that may help you sleep better.

• Bed Rails– to assist with turning in bed; with standing and sitting.
• Bed Straps– to assist with sitting up in bed.
• Blanket Lift Bar– may help those who are sensitive to the feel of bedding over their feet and/or for those whose feet overheat easily at night.
• Bedside Commode– to have close accessibility when needed, to reduce awake time and energy expelled.

Embrace Healthy Lifestyle Habits

What we do, eat, and think in our daily lives impacts our sleep.

EXPOSURE TO LIGHT

Exposure to sunlight, at least 30 minutes a day, preferably in the morning hours, suppresses melatonin and promotes wakefulness. Natural light helps keep our circadian rhythm or sleep-wake cycle in balance.

EXERCISE

Exercise is incredibly important for sleep! Exercise helps induce sleep and helps achieve deeper sleep states. To receive the bounty of benefits it offers to our whole health, follow the physical activity guidelines specifically for people with MS of at least 2 to 3 days a week of 10 to 30 minutes of aerobic exercise at moderate intensity, and 2 to 3 days a week of resistance training that includes 1-3 sets of 8-15 repetitions each. The time of day you exercise is important. Do not exercise within four hours of going to sleep.

NUTRITION

The Mediterranean-style dietary pattern is associated with adequate sleep duration and fewer insomnia symptoms. This way of eating emphasizes plant-based foods and healthy fats. It includes eating a variety of fresh fruits, vegetables, whole grains, beans, lentils, nuts, and fish rich in mega-3 fatty acids. Lean meats are consumed minimally. The Cleveland Clinic or The Harvard T.H. Chen School of Public Health are good website resources for learning more about this way of eating.
Additional tidbits from research about how and what we eat include:

• Skipping breakfast and eating at irregular times during the day negatively affect sleep quality.
• High fat and simple carbohydrate intake interfere with sleep quality. Limit intake of sugary and processed foods.
• Some foods have sleep-promoting effects such as milk, fatty fish, and fruits such as cherries, bananas, and kiwifruit, but more research is needed.
• Caffeine interferes with our brain’s signal to sleep. Although everyone has a different metabolism rate, caffeine can stay in our systems for 4-12 hours. Limit caffeine intake to earlier in the day.
• Alcohol may help you fall asleep but it interrupts sleep. Drinking alcohol before bed is linked to frequent awakenings, less restful sleep, headaches, night sweats, and nightmares. Avoid drinking alcohol 4-6 hours before bedtime.
• Nicotine, although not a food, is a stimulant and has similar effects to caffeine, often disturbing sleep. Avoid smoking in the evening and in the middle of the night if you wake up.
• Eating big meals before bedtime interferes with falling and staying asleep. Protein-rich and high-fat foods are hard to digest. Avoid eating after 8 p.m.
• Drinking water and staying hydrated throughout the day is very important but drinking within an hour of bedtime can interrupt sleep with the need for frequent bathroom breaks.

NAPS

Naps can be restorative or a hindrance to restful sleep. Naps 20-30 minutes long can be rejuvenating and helpful if not taken too close to the evening. Longer naps can interrupt your circadian rhythm, confusing your natural wake/sleep cycle. Understanding that fatigue is a common symptom of MS, energy management tools are of utmost importance. The same length of time for a nap is recommended if you experience MS fatigue. Remember, relaxing activities such as reading, listening to music, engaging in meditation exercises, or closing your eyes for a
few moments, can conserve and lengthen your daily energy levels without hindering your sleep.

MINDSET

Develop healthy thinking about sleep. A challenge with sleep is that we can’t force ourselves to fall asleep. Experiencing poor sleep can ignite fear and worry that the next night will be the same, and these negative thought patterns combined with attempts to try harder to fall asleep or
return to sleep make it worse. Instead of agonizing or worrying, switch your perspective to positive emotions to break this negative thought loop. When you are preparing for sleep, think of three things that happened in your day, or anything in your life, that you are grateful for. Help
your mind relax by changing your emotional reaction to sleep with confidence, not dread. Positive thinking generates the relaxation response while worry and fear generate the stress response. It takes practice and a lot of repetition.

Still having anxious or racing thoughts? Keep a notebook next to your bed and write down a “worry” list or tomorrow’s “to-do” list that you can address in the morning when you are rested. Cognitive behavioral therapy for insomnia (C.B.T.-I), is an evidence-based treatment for insomnia proven to be more effective than sleep medications in the long term. It consists of a four to eight-session program, virtual or in-person, that teaches people different ways to relax and to create realistic expectations about their sleep habits. Your primary physician should be able to refer you to a program.

Creating Rituals & Soothing Habits

Train your brain to prepare for sleep, fall into sleep, and stay asleep by embracing a nightly
routine.

HAVE A CONSISTENT SLEEP SCHEDULE

Go to bed and wake at the same time every day of the week. Adults need between 7-9 hours of nightly sleep. As mentioned earlier, we can not necessarily force ourselves to sleep, however, we can control when we awake each morning. If falling asleep (and/or staying asleep) is challenging, focus on the time you can get up each morning. Arising within an hour of this time every day will help you fall asleep more easily and naturally at night.

SELF-CARE ROUTINE

Reserve an hour before bedtime to wind down. This time is for you! Engage in relaxing and pleasurable activities such as reading, talking to a loved one, listening to a podcast, performing gentle yoga stretches, meditating, bathing, or drinking herbal tea or warm milk. Remember, this is the time at night to turn off electronics (and turn off your brain) so melatonin is released to become sleepy.

CREATE POSITIVE ASSOCIATIONS WITH BEDTIME

Be in your bedroom environment only for sleep and intimacy. Lie down to go to sleep when you feel sleepy. If you have difficulty falling asleep after 15-30 minutes, leave your bedroom if you are able, and engage in a relaxing activity until you feel sleepy enough to return to bed.

MINDFULNESS MEDITATION

Mindfulness meditation can be very helpful to develop a positive mindset and promote relaxation. The most convenient way to learn and participate in meditation is through apps or YouTube. There are many apps that have specific meditations and breathing exercises to help
with sleep. The apps offer guided meditations, stories, soothing music, and breathing techniques to help fall asleep faster and stay asleep for longer. There is usually a free trial period for apps, however, a subscription charge will occur after a certain amount of time. There
are many free meditations for sleep on YouTube. The attached link reviews and recommends the “top apps for sleep meditations of 2023.” It is challenging to measure the effectiveness & quality of apps due to the rapid growth & changes that are constantly occurring in this area of technology. Find an app that appeals to you and meets your authentic needs.

A small, recent study demonstrated the effectiveness of mindfulness-based stress reduction techniques (MSBR) in people with MS to help reduce insomnia and improve sleep quality and quality of life. MSBR is an evidence-based, experiential program developed by Dr. Jon
Kabat-Zinn. It includes eight weekly sessions that can be attended online or in-person. A cost is involved but generally, scholarships are available.

BREATHING TECHNIQUES

Breathing done with awareness has an impact on changing our moods and overcoming anxiety and sleeplessness. Breathing techniques help connect our minds and bodies. One deep breath allows space to respond instead of react; relax instead of stress; and quiet instead of stimulate. Breathing techniques can be performed anywhere and anytime and the more practiced, the more automatic they will become to help diminish stress and promote relaxation. Belly breathing and “4-7-8” breathing are excellent first techniques to learn that will help promote sleep.

Healthy Habits = Healthy Sleep

Creating a supportive environment, integrating healthy lifestyle behaviors, and embracing soothing bedtime routines all make for great habits for healthy sleep. They can make a significant impact on your quality of sleep and your quality of life. Create your “Holiday Express” experience by prioritizing what lifestyle
area stands out the most in need of improvement. Start small. Create weekly goals, such as turning off electronics one hour before sleep, eating more fruits and vegetables daily, or getting up at 8 a.m. daily. If it feels overwhelming to know where to begin, begin with keeping a sleep log for one week. Record bedtime, wake-up time, what you do before bed each evening, what you eat/drink each night, and how rested you feel the next day. Look for patterns. These are the priority areas to change first.

Sleep disorders are complicated and can occur for a variety of reasons. It is important to discuss any issue you are experiencing with your doctor or MS health care team. Additional treatment may be needed.