The three pillars of good health are a good diet, a good exercise routine, and good sleep. In my opinion, sleep is far too often sacrificed, but it's much too critical to ignore. That's why I've created this resource: to compile evidence-based recommendations and habits you can use to sleep better and wake up feeling refreshed.
What does the science say? Let's dig in.
Table of Contents
The Risks of Sub-Par Sleep
Most people start their sleep routine 1-2 hours before going to bed and wonder why they don't wake up feeling refreshed. Isn't sleep supposed to be restorative? Well, it is, but there are also a lot of serious health conditions that are linked to a lack of sleep.
According to the CDC, adults who sleep fewer than 7 hours each night are more likely to report health problems ranging from depression to asthma to heart attacks. Common health issues include:
- High blood pressure. When you sleep, your blood pressure naturally decreases. When you have sleep problems, your blood pressure remains at elevated daytime levels for longer. The higher your blood pressure is, and the longer it stays high, the higher your risks are for heart disease and stroke.
- Diabetes. While the link between diabetes and sleep isn't as well-understood as the link between blood pressure and sleep, some studies have shown that getting better sleep can help with blood sugar regulation.
- Obesity. A lack of sleep can lead to weight gain, especially in children and adolescents. Your brain and body handle a lot of blood sugar-related tasks when you're sleeping.
These are just the most prominent issues caused by a lack of high-quality sleep. How do you address these issues? Instead of thinking about sleep just an hour or two before bedtime, start even sooner: from the moment you wake up or even before.
Wake Up at a Consistent Time of Day
One of the most important things you can do to help improve your sleep quality and duration is to make sure you're waking up at the same time every single day. No, not just workdays; you can't take weekends off of your sleep schedule. "Sleeping in" might feel like a luxury, but it hurts you in the long run.
This comes back to our body's natural circadian rhythm, or sleep/wake cycle. Humans naturally love to maintain a regular, consistent sleep/wake cycle. The two are interconnected, as well. When you wake up at a consistent time, you will have an easier time falling asleep at a consistent time as well.
Start the Day Off Right
When you wake up, what is the first thing you do? For some people, it's a shower. For others, it's brewing a pot of coffee and putting together a breakfast.
Most people, however, ignore one critical element of a good morning routine: sunlight.
That's right, sunlight. Sunlight is an essential part of your day, and getting sunlight on your face and skin first thing in the morning helps perk you up by regulating your circadium rhythym (your internal clock). This clock regulates your sleep cycles, so when the morning light shows up, it kicks off important hormonal reactions that help wake you up and get you ready for the day. Remember, our ancestors weren't stuck inside dark rooms. Morning sun is a very natural way to improve mood, alertness, and sleep quality - just remember to wear your sunblock.
Of course, starting your day off with a dose of sunlight can only do so much. Nearly 65% of Americans and a similar percentage of people around the world start their days with a cup or two of coffee. Is that a good thing?
The research is consistent regarding coffee. If we get this right, we can help reduce our cardiovascular disease risks. The trouble is that most people don't get their caffeine intake right. Ideally, we only want to drink caffeine within three hours of waking up.
This is because caffeine has a very long half-life. The half-life of a substance is the length of time it takes for roughly half of a given substance to break down. The mean half-life of caffeine in healthy individuals is about five hours, meaning if you drink a cup of coffee in the morning – which has around 95 mg of caffeine on average – by lunchtime, half of that caffeine is still in your system, and by dinner time, a quarter still lingers. If you're continuing to drink caffeinated beverages (or energy bars or other caffeine supplements) throughout the day, your body is still full of this supplement by the time you go to bed.
What about all of those people who claim that they can still fall asleep after having caffeine? Well, that's true; some people can fall asleep and even fall asleep quickly when there is caffeine in their system. But, the problem is that their sleep quality is likely lower than that of someone who does not have caffeine in their system. They will broadly sleep less soundly, wake up more often throughout the night, and won't be as rested in the morning.
One thing I'd also like to bring up is a viral piece of advice I've seen several times on social media, which is that you should wait at least 90 minutes after waking up before you have any caffeine. I'm not sure where this advice came from, but there's no good human evidence to support the claim.
If you want to brew a cup of joe immediately upon waking up and drink it right away, that's fine. In fact, it's almost potentially better to start sooner: the longer the caffeine is in your system, the more it has time to break down before you go to bed in the evening.
Equally, if you don't like drinking coffee first thing in the morning and you'd rather wait until after breakfast, or after your commute to work, that's fine too.
The important takeaway is that you don't want any caffeine after three hours after waking up. That should be your cutoff point.
Eating a Balanced Breakfast
If you've been raised in the modern era, you've likely been bombarded all your life with advertising for all manner of breakfast foods, from orange juice to cereals to bacon, eggs, and toast, all claiming to be "part of this balanced breakfast." You may even be astonished by how much food seems to be in that spread of a balanced breakfast. Can that really be what you should eat every morning?
Well, one thing is certain: starting your day off right with a meal is absolutely critical. More importantly, numerous studies suggest that if we get most of our calories in the morning rather than in the evening, it seems to improve insulin sensitivity. In other words, a large breakfast and a smaller lunch and dinner will have a more positive impact on blood glucose levels than a smaller breakfast and a larger dinner. Since insulin regulation is a key component of obesity and diabetes, it's very important to get this right.
Keep Dinners Light and Early
When we sleep our bodies are playing catch-up. The brain processes information from the day, our muscles heal and recover from effort expended during the day, and so on. Critically, we don't want our bodies to be spending a lot of effort and energy on digesting a large evening meal, we want them to be able to use that stored energy for more restorative processes.
For an interesting experiment, if you have a smartwatch or fitness monitor, try tracking your difference in heart rate between days where you have a larger, later dinner and days where you have a smaller, earlier dinner. For me, I have a lower heart rate on days when I don't eat as much as late. Anecdotally, I also wake up feeling more refreshed on days with a smaller evening meal.
One possible strategy to help you avoid eating more later in the evening is to wait around 30 minutes after finishing your dinner and then brush your teeth. Many people use tooth brushing as the start of their bedtime routine, and it's a powerful psychosomatic indicator that the day's caloric intake is over. This further reinforces an end to evening eating.
What about beyond the diet?
Don't Avoid Daily Activities
When you wake up tired, there's a significant temptation to avoid the activities you might have otherwise planned. However, it's important not to do this because it can reinforce insomnia. Instead, force yourself to commit to that activity, whether it's a morning run, a session at the gym, or some home-based exercises.
Yes, when you're tired, you won't feel as good, and you won't perform as well. However, daily exercise helps to reinforce the sleep/wake cycle, and exercise is good for you regardless.
Avoid Naps
When you're tired throughout the day, it can be extremely tempting to take a nap. While naps are recommended for certain situations – such as a truck driver who would otherwise put themselves and others in danger – regular naps damage the sleep/wake cycle. Instead, try to go for a walk or other light activity to perk yourself up.
Naps are difficult to generalize. In young, healthy people, naps facilitate executive function, memory consolidation, and emotional processing. However, in older populations, napping has been linked to a variety of negative outcomes. In general, it seems better to avoid naps unless there's an extreme need for them and to definitely avoid making a habit of a midday nap.
Manage Your Anxieties
One of the most common symptoms my patients present when discussing poor sleep quality and continual exhaustion is that they are "tired but wired." They're tired, but they can't help but worry about daily events, finances, relationships, and more. Managing these daily stressors can be difficult, but lying in bed worrying about tomorrow isn't going to help.
Here are a few strategies I've seen be effective for some of my patients:
- Try writing down your anxieties and worries in the evening to set them aside for tomorrow.
- Write down several good things that happened during the day to remind yourself it's not all stress.
- Consider guided meditation. Meditation is a skill and takes time to become beneficial, but the research for its sleep benefits is overwhelmingly positive.
It's also important to avoid alcohol, especially in the evenings. Yes, alcohol is a depressant, which means it can help you fall asleep. However, alcohol is also a toxin, and it dramatically harms your body as you try to sleep. Even those recommendations of a single "healthy glass of wine" have been proven false over the years. Your sleep will be much better with zero alcohol.
Pre-Bedtime Routines
Finally, establishing a good sleep ritual in the 1-2 hours before bed is critical for effective sleep.
Your ritual doesn't need to match mine, but you need to find something that works for you.
- Consider relaxing stretches.
- Try breathing exercises for 15 minutes before bed.
- Take a hot bath or shower, which raises body temperature, which then drops to help you fall asleep.
- Avoid using your phone or watching TV for at least an hour before trying to fall asleep.
- Keep your bedroom cool (around 18-20 degrees C)
- Use blackout curtains or an eye mask to block out light when you're trying to sleep.
- Invest in a good, comfortable mattress. Replace this every 9-10 years.
- Invest in good pillows and replace them every 1-2 years.
- Don't let pets in the bedroom. Both their activities and their dander can cause sleep problems.
- Keep your phone out of the bedroom. Instead of using it as an alarm, buy a cheap alarm clock.
My last tip is to dedicate your bed to sleep and sleep alone. If you're struggling to fall asleep, your body and mind aren't associating the bed with sleep; they're associating it with the struggle to sleep. Instead, get up and do something calming, like read a book (but stay away from screens!). Then, go back and try again later. This helps reinforce that the bed is only for sleep.
A Note on Melatonin
Melatonin is frequently used as a sleep aid, but many people use it incorrectly.
At most, I only recommend a low dose, less than 300 mcg, to help fall asleep. Also, melatonin is meant to be taken at least 1-2 hours before going to bed. Make sure you're using it properly if you've decided to use it at all.
Sources
- About Sleep and Your Heart Health: https://www.cdc.gov/heart-disease/about/sleep-and-heart-health.html
- Effects of light on human circadian rhythms, sleep, and mood: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6751071/
- Pharmacology of Caffeine: https://www.ncbi.nlm.nih.gov/books/NBK223808/
- Association between Frequency of Breakfast Consumption and Insulin Resistance Using Triglyceride-Glucose Index: A Cross-Sectional Study of the Korea National Health and Nutrition Examination Survey: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7246451/
- Exploring the nap paradox: are mid-day sleep bouts a friend or foe?: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5598771/
- The effect of mindfulness meditation on sleep quality: a systematic review and meta-analysis of randomized controlled trials: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6557693/
