Everyone Does It. Everyone Needs It. But Not Enough of Us Get It. Sleep.

June 09, 2022

Written by Justin Johnson, MD, Director of Veteran Services 

Recommended Hours of Sleep

Despite the importance of sleep, studies estimate that 30-40% of Americans don’t get enough of it. The American Academy of Sleep Medicine and the Sleep Research Society recommend adults ages 18 to 60 sleep at least 7 hours per night for optimal mental and physical health.

Effects of Sleep Deprivation

Poor sleep correlates with a host of medical and psychiatric disorders such as high blood pressure, obesity, heart disease, depression, mania in Bipolar Disorder, post-traumatic stress disorder (PTSD), and anxiety. A major study in the journal “Sleep” showed that too little sleep correlates with an increased risk of death over one’s lifetime.

Sleep and Mental Health

Poor sleep – particularly poor sleep from nightmares, insomnia, or sleep apnea – represents a risk factor for suicidal thoughts and behaviors, which if addressed, can reduce a person’s overall risk for suicide. From clinical experience, we know that helping patients sleep usually boosts their mood and motivation, which leads to improved overall physical and mental health. Americans who sleep well lead more productive, healthier, and happier lives.

Causes of Lack of Sleep

So why don’t Americans sleep better? A variety of answers exist, everything from the “workaholic” nature of the American lifestyle to recent stressors from the Covid-19 pandemic. Cultural causes of poor sleep were even addressed by Congress in the proposed changes to Daylight Savings Time, with representatives suggesting time changes to improve sleep for Americans. The reality is the cause of poor sleep remains an individual assessment, unique to the person not sleeping well, and can result from that person’s insufficient emphasis on sleep, medical factors, poor nutrition or too much caffeine, psychiatric disorders, or other causes including poor sleep hygiene.

If you sleep poorly, evaluation for solutions should always begin with your physician. Many medical issues such as restless leg syndrome, heart disease, or sleep apnea can drive poor sleep and can be fixed with treatment. Use of stimulants like caffeine or nicotine may also need to end, especially after 4pm.

Similarly, psychiatric disorders such as anxiety or PTSD often cause insomnia, and sleep likely will not improve until these disorders are addressed by a professional. If these conditions have been addressed and sleep remains a problem, medications or behavioral interventions can help. Medications may be used to address straightforward insomnia but must be overseen and prescribed by a medical professional.

CBT for Insomnia

Perhaps the best overall treatment for insomnia, though, and the number one recommended treatment by the American Academy of Sleep Medicine, remains Cognitive Behavioral Therapy for Insomnia, also known as “CBT-I”. Its principles can help us all improve our sleep.

CBT-I 

CBT-I, the primary first-line treatment for insomnia, has been shown to improve sleep problems in the long run better than medications, as it fully changes your disrupted sleep habits to fix them for good. Many principles of CBT-I may be common sense, but others run counter to prevailing wisdom. For example, people with disrupted sleep often assume they should remain in bed longer to ‘make up’ for sleep deficits. CBT-I reveals this as incorrect, and actually recommends to limit folks’ time in bed to boost overall sleep efficiency. CBT-I makes you a more efficient, better sleeper through behavioral changes over time. Another counterintuitive idea is that if you do not fall asleep within 15 minutes, you should get out of bed to change scenery and distract yourself, so as not to associate the bed with poor sleep. CBT-I helps you associate your bed with sleep through a variety of behavioral changes. The full breadth of CBT-I is beyond the scope of this article, but many of its principles are listed below, as tips for improved sleep hygiene.

For anyone interested in pursuing CBT-I, Dr. Jason Peck, a sleep specialist double-board certified in General Psychiatry and Sleep Medicine serves clients at HopeWay Psychiatry & Associates. You can also visit psychologytoday.com and search for therapists in your area with expertise in CBT-I or you can download an app or buy one of the many books focused on CBT-I. Some helpful apps are the VA’s “Insomnia Coach” or “CBT-I Coach”, as well as non-VA “Shut-Eye” or “Sleepio” apps. For more detailed books, you can search online or go to your local bookstore and ask for self-help books focused on CBT-I.

Feel like you are being impacted by poor sleep? By incorporating some of these suggestions into your sleep hygiene and routine, all of us can improve our sleep, which in turn improves our daily life.

Sleep Hygiene Tips 

1.Sleep only as much as you need to feel refreshed the next day. Limiting your time in bed helps deepen your sleep. Excessively long times in bed leads to broken, shallow sleep.

2.Get up at the same time every day, 7 days a week. A regular wake time in the morning leads to regular times of sleep onset and helps set your ‘biological clock’.

3.Don’t take your problems or work to bed. Plan a set time earlier in the evening for working on the next day’s activities or for working on problems. 

4.Do not try to fall asleep. This only makes sleep worse. Instead, if you are trying to fall asleep and can’t, leave the bedroom, turn off the light, and do something non-stimulating like read a book or listen to calm music.

5.Use the bed for sleep only. Try to limit ANY other activities besides sleep. You want your body to automatically associate bed with one thing – SLEEP! 

6.Put the clock under the bed or turn it so you can’t see it. Clock watching leads to frustration, anger, worry, and interferes with sleep.

Clinical trials have studied and proven all of these tips to improve sleep. Use them to your benefit!

Justin Johnson, MD

Dr. Justin Johnson, Director of Veteran Services, is a board-certified psychiatrist with expertise in mood and anxiety disorders, PTSD and TBI, men’s mental health, military and Veteran mental health, and psychotherapy. He is one of a limited number of psychiatrists trained in an evidence-based psychotherapy for PTSD. Before HopeWay, he treated patients at the Durham VA’s Iraq/Afghanistan Veteran clinic. He is an Assistant Consulting Professor of Psychiatry at Duke University School of Medicine and currently serves in the U.S. Army Reserve. Dr. Johnson attended UNC Chapel Hill, followed by medical school at Johns Hopkins. He completed his psychiatry residency at the Massachusetts General Hospital and McLean Hospital combined program at Harvard Medical School, where he served as the Chief Resident. He went on to complete an additional fellowship in Psychosomatic Medicine at UNC Hospitals, where he developed his expertise in treating patients with complex medical-psychiatric disorders such as TBI. He has also trained in psychodynamic psychotherapy at the Psychoanalytic Center of the Carolinas.