This article is part of PAR’s Mental Health Awareness Month series, in which we will be focusing on the multifaceted issue of mental health in the U.S. 

“Waking up on the wrong side of the bed” is more than just a saying—we all have experienced the impact of a poor night’s sleep on our daily activities. Quality sleep is an essential component to good mental health, and there is a significant body of research showing the impact of sleep on anxiety, depression, suicide risk, PTSD, addiction, and much more. 

In support of Mental Health Awareness Month, we sat down with Melissa Milanak, PhD, Clinical Assessment Advisor at PAR and sleep expert, to get some tips on how to get a more restful night’s sleep and debunk some of the common misperceptions of sleep. 

Dr. Milanak, what do you think people need to know about the importance of sleep? 

People have come to believe the myth that the body can get used to less sleep. We have such busy days that we cheat our sleep to try to fit more in but fail to realize that on too little sleep, we are less productive and less efficient. This means it can actually take us longer to do things than if we had gotten more sleep! Research finds that both short- and long-term sleep deprivation can have significant negative effects on your body and your brain, proving that your body doesn't adapt to lack of sleep. 

We have to make sure that we're giving ourselves the opportunity to have quality restorative sleep without it being fragmented. It’s important for us to prioritize sleeping straight through the night and get the full amount of sleep that our bodies need. 

From a short-term standpoint, if you don’t have a good night’s rest, you may have some difficulties concentrating, some decline in mood or memory, or even feel fatigued. But longer term, we can see a significant negative impact on work performance or cognitive functioning. Lack of sleep can even increase the risk for dementia. 

Does everyone need the same amount of sleep? 

The standard of 8 hours of sleep is not actually a one-size-fits-all number. Eight hours is only an average. We are all unique and our needs vary. Some individuals require a shorter amount of time to be fully rested, while others need more. Also, this changes throughout our lives based upon many factors such as age and physical activity. 

As we sleep, we go through a process of cycles of sleep made up of stages of sleep. So much of this is dependent on how quickly we cycle through the different stages of sleep. Over the course of the night, the percentage of time spent in each stage of sleep changes, so we have to build up enough sleepiness to sleep all the way through the night to complete the process. We need to make sure we are getting to spend enough time in the stages of sleep that occur more frequently later in the process, in the early morning hours. 

This is also why we need to reduce the number of times we wake up. Each time we wake up, the process has to start over, so we can end up cheating ourselves out of those later stages of sleep that are responsible for cognitive processing and emotional wellbeing. 

Also, the older we get, typically the less sleep we need. If you think of it logically, sleep is designed for repair, rejuvenation, and growth. As we age, our cells are changing at a much slower pace. Think of how much sleep a newborn needs versus a baby or an adolescent. 

How do you know what your ideal amount of sleep is? 

When you have achieved your ideal amount of sleep, you will fall asleep within 10–15 minutes, sleep straight through the night (minus a possible bathroom break) and wake up feeling rested without daytime fatigue. 

Can I catch up on sleep if I take a nap or sleep late on the weekends? 

Catching up on sleep is something that people are constantly talking about trying to do. But research shows us that if you are not getting the adequate amount of sleep that your body needs, it can take at least four days for the body to make up for one hour less sleep. 

If you're trying to make up that sleep debt and you take that nap and go to bed earlier, you may wake up the next day and not feel as tired, but it doesn't mean that your body made up for the lost sleep the night before. 

Additionally, research has shown catching up on sleep doesn't immediately right the impact lack of sleep can have on our metabolism. We want to get ourselves right back on track to get to a place where we're getting the adequate amount that our bodies need. It's not as simple as just taking our weekends to try and “catch up” on sleep. It's going to be a much longer process to get back to what our bodies need. 

When you go to bed at different times, it can confuse your brain and make it harder to fall asleep over time. Your brain doesn't know when to feel tired. Think of it just like if you eat dinner at the same time every night, your brain knows to get hungry at the same time. 

What should I do if I can’t fall asleep? 

If you are trying to get to sleep and are awake for more than 15 minutes, get out of bed and do something boring in low light until you are sleepy enough to return to bed. 

The longer you spend in bed when you are not sleepy or are worrying, the more you will associate your bed with fear, worry, anxiety, and frustration. You want your body to associate your bed with sleep and not those feelings. 

Any tips for waking up in the middle of the night? 

If you wake in the night, do not check the clock! This adds to your stress as you begin calculating how much more sleep you might get. If your alarm has not gone off, then it does not matter what time it is. All that matters is that it is not time to be awake yet. 

If you truly cannot fall back to sleep, get out of bed. You can also do things to trigger sleep like redoing your wind-down routine to help your body and brain know it's time to sleep. 

What is the most important thing people should focus on to improve their sleep? 

One of the most important things we can do to improve our sleep is to have a consistent sleep and wake time seven days a week. If you go to sleep one night past your bedtime, it is very important to still wake up the next day at your regular wake up time. Although you will feel sleepier throughout the day, it is important to stay awake until your normal bedtime. Consistency with your sleep schedule is key. 

If you have a night where you did not sleep well, do not go to bed earlier the next night trying to catch up on sleep. When you try to force yourself to spend more time in bed than your body needs, you will wake up more often and get less quality, sustained sleep. 

And finally, make sure you reserve your bed for sleep—not reading, watching TV, or eating. Otherwise, your brain gets confused as to whether it should be asleep or awake when in bed.

Dreams have long been the subject of intense scrutiny, and the subject of lucid dreams even more so. Lucid dreams can be defined as any experience within the dream in which you become aware you are dreaming. If we are asleep and become aware we are dreaming, what good does it do? Well, psychologists have conducted studies that have shown multiple benefits to lucid dreaming.

Ward Off Nightmares – Thanks to lucid dreaming, nightmares don’t have to be traumatic, dreaded experiences. Those who know they are dreaming can see threats for what they are—nonexistent. In the face of perceived danger, the knowledge that one is dreaming automatically relieves anxiety because the individual knows events aren’t really taking place and no harm can occur.

Enhance Creativity – Because the brain is very active and unconstrained during lucid dreaming cycles, it is more creative than at other times. This creativity carries over into the dreamer’s waking life, allowing for greater problem-solving ability and artistic expression.

Embrace Adventure – Dreams offer a level of adventure that often isn’t possible in real life. Due to the realization that one is in a dream, anything can occur. The traditional limits of time or laws of nature no longer need apply. Whatever can be imagined can be fulfilled, and the experience can be very freeing.

Learn or Practice Skills – Thinking about or visualizing a task enhances the ability to perform that task. Mental imagination uses the same muscles that would be used if the action were actually performed. A study on the effect of imagery revealed that imagined exercise produced significant elevations in systolic blood pressure, heart rate, and oxygen consumption.

Alleviate Depression – A study by the Department of Human Development at Cornell University revealed that the frequency of lucid dreaming is directly tied to depression. There is a positive link between lucid dreaming and how much control people feel they have over their lives. Because lucid dreaming gives one a sense of control while asleep, that same feeling of control can be felt while awake.

Lucid dreaming, like any skill, can be nurtured and developed. There are many techniques available for those who would like to learn or perfect the art of lucid dreaming. Lucid dreaming is a natural state when the conscious brain awakens during sleep, turning dreams into an alternate reality where all senses come to life, enabling one to do things limited only by their imagination.

Share your thoughts on lucid dreaming. PAR wants to hear from you, so leave a comment and join the conversation!

 

In a technical report issued by the American Academy of Pediatrics (AAP) last month, chronic sleep loss among middle and high school students was cited as a “serious threat to academic success.” There are many contributing factors to a generation of sleepyheads—among them increased caffeine consumption and the use of electronic devices, whose low-intensity light can disrupt circadian rhythms and suppress melatonin production. The AAP study outlines that one key contributor could be best manipulated to help alleviate this problem: later school start times.

Beside extending sleep duration, this delay would have significant positive effects on self-reported sleepiness and academic achievement, says the Academy. But according to a U.S. Department of Education 2011-12 survey, of the 18,000 high schools in America, less than 15% start at 8:30 a.m. or later, and more than 40% start before 8 a.m.

Dr. Bob Weintraub, headmaster of Brookline High School in Massachusetts from 1992 to 2011 and now professor of educational leadership at Boston University, says that during his tenure the high school moved start times for most students to 8:30 a.m. But he also points out that these shifts raise concerns like how to have maximum participation in after-school activities like athletics, drama, and music when later start times means later end times (which means in the dark during winter months in the Northeast).

Despite these challenges, the AAP argues that communities nationwide have been creative in coming up with solutions to this challenge, including providing free periods and study halls at the end of the day, exempting student athletes from PE, and installing lights for athletic fields.

In sum, the Academy “strongly supports the efforts of school districts to optimize sleep in students and urges high schools and middle schools to aim for start times that allow students the opportunity to achieve optimal levels of sleep and to improve physical and mental health, safety, academic performance, and quality of life.”

While every baby is different, the sleepless nights are something that most parents of infants can’t escape.

Sleepless nights don’t just equal tired parents, though. Sleep deprivation can double mom’s risk of suffering from depression and can lead to marital strife. But how should tired parents teach their babies to sleep?

While some parents believe letting their child “cry it out” will teach self-soothing behaviors, other parents believe that letting their child cry will cause their little one to feel insecure and abandoned. However, exhausted moms and dads have some new research on their side that can (hopefully) afford them a little shut eye.

A new study released in the journal Pediatrics followed 225 babies from seven months old until age 6 to compare the difference between parents who were trained in sleep intervention techniques and those who were not. The sleep intervention group was told to select either “controlled crying,” which had them respond to their infant’s cries at increasing time intervals, or  “camping out,” which asked them to sit with their child until he or she fell asleep, removing themselves earlier each night over a three-week period.

Families in the sleep training group reported improved sleep. Mothers were also less likely to experience depression and emotional problems. Furthermore, it was determined that those children in the sleep training group were not harmed by letting them cry it out. Researchers found no differences between these children and the children in the control group in matters of mental and behavioral health, sleep quality, stress, or relationship with their parents at age six. Allowing babies to cry for limited periods of time was found to help the entire family sleep better without causing psychological damage. Furthermore, an earlier study found that sleep training does work – babies learn to go to sleep easier and stay asleep longer than their counterparts.

No matter which method parents choose, they can feel better knowing that while it may seem that their infant is stressed when he or she is crying, researchers believe that it is good stress and it will have no lasting impact on the parent-child bond.

You don’t have to be Hamlet to wax poetic on the wonders of sleep, but several new studies are giving us more insight into your nightly snooze. Although you may think sleep is just a way for your body to rest and recharge, the following researchers are showing that there is so much more to it.

Sleep deprivation may increase hunger

According to a presentation given at the American Heart Association’s annual conference, people tend to consume more calories on the day after they’ve had less sleep. Researcher Marie-Pierre St-Onge, PhD, found that women consumed, on average, 329 more calories when sleep deprived; men consumed 263 more. In addition to eating more calories, individuals also tended to consume foods with a higher fat and protein content than they did when they had adequate amounts of sleep. Though it may seem that participants were looking for quick sources of energy, if could also be that sleep impairs one’s ability to make healthy food choices.

Dreaming about a task may be beneficial to learning

Scientists are finding more evidence that dreaming about a particular task may be associated with better performance in that particular activity. Researchers are finding that dreaming is an essential part of understanding, organizing, and retaining the information we learn during the day. Harvard researchers found that college students who dreamt about a computer maze task they encountered during the day showed a tenfold improvement in their ability to navigate the maze than did those who did not dream about the maze.

Your social life may have an impact on your sleep schedule

Information collected at the University of Chicago found that people who report higher levels of loneliness also tend to report more sleep fragmentation. Those who feel more connected to others tend to get a better night’s sleep.

 

Sleep seems to have a positive impact on so many aspects of life. In what other settings have you noticed sleep’s influence on an individual’s functioning?

Getting a good night’s sleep is a typical recommendation during times of stress, especially after a unsettling or traumatic experience. A new study, published in the Journal of Neuroscience, questions this standard thinking. Researchers at the University of Massachusetts at Amherst showed 106 participants unsettling images, then showed them again 12 hours later. Subjects who stayed awake during those 12 hours had less emotional reactivity to the same stimuli than did subjects who went to sleep—particularly those who had more time in REM sleep. The same pattern was noted for recognition accuracy 12 hours later—it was better in participants who slept than in those who didn’t.  The study concludes that “sleep enhances emotional memory while preserving emotional reactivity.”

“It is common to be sleep-deprived after witnessing a traumatic scene, almost as if your brain doesn't want to sleep on it," said Rebecca Spencer, one of the authors of the study. In fact, going to sleep may “lock in” the negative emotions associated with the traumatic event.

Have you found this to be true in your practice? Do patients who get more rest after a negative event have a harder time recovering than those who get little sleep? Could insomnia be considered as a recommended treatment for people with PTSD?

The recent electronic release of Adam Mansbach’s “Go the F--- to Sleep” has taken the Web by storm. The book, which features as narrator a tired parent attempting to put his child to sleep for the night, combines mock-sweet prose with bursts of exasperation and annoyance. If you’re a parent, and you remember the sleepless nights—and you have a sense of humor—this amalgamation of genuine parental love with the eye-rolling that goes along with nighttime routines will probably strike a chord with you.

The book and its release bring up several interesting issues, including the frustration experienced by all parents of young children. Ranging from mild annoyance to real anger, the feeling can be surprisingly overwhelming. Parenthood is generally advertised as a joyous walk through a meadow, and, for some, discovering that the meadow is filled with divots, bumblebees, and sharp branches is a shock. Though it could be said that the book uses strong language for shock value, for most readers, the use of expletives serves to highlight just how intense the aggravation can be.

The book’s message goes a little deeper, though, as it effectuates a collective sigh of relief in its readers who are parents. Many parents inherently feel guilty about having negative feelings about parenthood. It may be psychologically reassuring for a young parent to know not only that many—okay, most— children have trouble going to sleep at night, but also that he or she is not the only one who finds the bedtime routine—and, for that matter, any routine that requires the parent to coerce the child—a vexing experience.

So, what do you think of the book? Do you think it’s vulgar and/or inappropriate? Do you think it serves a purpose in letting parents know they’re not alone? Are you willing to admit that it could have been written from your very own thoughts? Most important, do you have any tips for those of us who are trying to put little ones to sleep every night?