Nodding off requires us to feel safe, and that it's the right time, to do so. Photo credit: Craig Adderley
Sleep is a vulnerable state. It’s important that we don’t go to sleep if we’re not safe to do so. It’s also important that we don’t waste time better spent elsewhere by sleeping at the wrong time to do so.
In our evolutionary past, daylight was precious to enable necessary work. Therefore, evidence of daytime (light or a call to action) can inhibit our nodding off.
You can tell your body it’s time to sleep by creating the environmental cues of sundown, signals of safety, and an absence of calls to action.
So, imagine you’re in your evolutionary past, living in nature with no electricity or artificial light. How do you know that it’s bedtime?
One of the clues you might notice is that the temperature has dropped.
You can recreate cool conditions by dropping the temperature of your environment (ideally to 18.3°C) by turning down your heating, or opening a window in the hour or so leading up to bed.
You can also drop your body temperature (our core temp drops by 1-2°C at night), which helps support melatonin release. Having a warm bath or shower in the lead up to bedtime can be a good way to do this, after which your core temperature will usually drop. Make sure your hands and feet and head remain warm to enable the peripheral vasodilatation which is the other necessary part of the equation.
Towards the end of the day, the light is dimmer, and more orange in composition. Photo credit: Pixabay
You might notice that, towards sunset, the light is dimmer, of warmer tones, and the sun is lower in the sky.
When you consider light, you can consider both its brightness (measured in ‘lux’), and its spectrometry or colour composition. Brighter, bluer light increases our alertness, while dimmer, warmer-toned light supports sleep through reduced alertness, and melatonin release.[1,2]
To create less bright and warmer-toned conditions towards bedtime, you can:
Dim your lighting (take care to have enough to walk around safely, or consider a motion activated light)
Choose warm tone bulbs rather than cooler ones
Filter out blue light using blue light blocking glasses
Use dimmers, filters, “night mode” and greyscale settings on your devices
A good option is to enact a 'digital sunset' 60 minutes or so before bed, to help you both avoid digital sources of bright or blue light, and associated calls to action.
You can do this by:
Setting an alarm 60 minutes before bedtime to....
Set your morning alarm (consider an old school alarm clock)
Send any last messages and turn off (or put on airplane mode) all electronics – computer, phone*, tablet, TV
Start your bedtime routine.
*Make sure anyone who needs to be able to get hold of you knows how to do so
When you’re actually in bed, you can reduce light by:
Using black out blinds
Putting masking tape over charging lights (or charging your devices in another room) and
Or you might notice that the birds have stopped singing +/- the gentle hubbub of your loved ones gathered around you.
You can recreate quiet conditions by turning down your music, loud noises and silencing notifications.
Gentle background noise can also be useful, to make you less startled by noises, give you something to focus on that isn’t busy thoughts and to replicate the sound of someone keeping watch.[1]
Some people like:
Playing relaxing music, e.g. on Spotify
Sleep-scapes, e.g. on Headspace or Insight Timer
White/pink/brown noise via apps, links or machines (find out the difference between them, here)
Background noise like The Shipping Forecast
Stories, like through Audible or Calm
Having a fan on in the corner of the room.
Finally, when you’re nodding off, if noise keeps you awake, you can try ear plugs.
[1] Frederick Snyder. The sentinel hypothesis. Am. J. Psychiatry 1966;123:121–136.
Reducing calls to action (and introducing a digital sunset)
In our evolutionary past, before artificial lighting, daylight supported action. After all, there were limited activities that could take place in the dark. The night, therefore, was a time for rest, characterised by an absence of calls to action.
Nowadays, our most common source of calls to action, or of threats, tend to be digital:
Stressful work emails or messages
Hectic TV shows or computer games
The news
Social media…
Devices provide both bright/blue light, and alerting signals, around bedtime. Photo credit: Pixabay
Introducing a digital sunset can be a powerful intervention:
Setting an alarm 60 minutes before bedtime to....
Set your morning alarm (consider an old school alarm clock)
Send any last messages and turn off all electronics (or put on airplane mode)*
Start your bedtime routine.
*Make sure anyone who needs to be able to get hold of you knows how to do so, or customise phone alerts to let certain people through
Other things that can help:
Apps, like Freedom
Greyscale settings to make your phone less appealing
Recruiting others in the household to do to do it too.
CBT for insomnia (CBT-i), if it's still tricky to switch off (e.g. The Sleep Project's Retrain your sleep programme.)
Winding down and sending signals of safety to our brains
One of the prerequisites to entering deep, restorative sleep is feeling safe. Many people report first night syndrome, where they’re in a new hotel room or new place, or sleeping with a new person, where they struggle to sleep deeply. This is because we’re not 100% sure that we’re safe and secure.
To feel safe, we need an absence of calls to action or alarms (per previous section) AND signals that it’s time to relax.
We can actively give signals to our body and brain that it can relax. Photo credit: Stefan Stefancik
These include:
Vagal manoevres like slower, deeper breathing.
Connection with others.
Anything that you find relaxing.
The more regularly we repeat these signals, the more conditioned our responses become. It worked for Pavlov’s dogs, and it works for us too! We call them Positive Sleep Associations.
So, set a wind down alarm an hour before bed (or whatever you can manage) and, once it goes off, disconnect from your devices, get into your comfy clothes, and engage in your wind down activity. See the next section for 'low and no' screen ideas.
If you really struggle to wind down, CBT for insomnia (CBTi) can really help.
Many of us rely on screens to wind down. It can induce panic when it’s suggested that we replace our digital devices with something else.
Low and no screen options include: reading a paper book. Photo credit: Thought Catalog
Options for screen-free or screen-reduced options include (but are not limited to):
Having a warm bath or shower
Reading a paper book
Doing a breathing exercise, meditation or yoga Nidra
Spending time talking with your partner or family or friends, in person or on the phone
Our sleep-wake cycle is primarily governed by our circadian rhythm, but another important player is adenosine. This neurotransmitter builds up during our waking hours, creating ‘sleep pressure’, which is then depleted again during sleep.
Caffeine blocks adenosine receptors, reducing our awareness of how sleepy we are. Individual sensitivity to caffeine is highly variable, but if you are caffeine sensitive, avoid having caffeinated drinks or foods within eight hours of bedtime. You can find out more about what contains caffeine here.
Because adenosine is depleted (converted back into ATP) during sleep, naps reduce our adenosine. Some people are excellent nappers, while others they find they then can’t sleep at night if they’ve napped too long or too late.
If you are sensitive to naps, you could skip them, keep them to <30 minutes (the magic length is 26 minutes, according to NASA!), and try not to nap within about eight hours of bedtime (e.g. after 2pm if you tuck up at 10pm).
If you are very sleepy in the day, check in with your doctor, as it may be a sign that you have a sleep disorder, or something else going on.
Managing shifts
Shift workers are particularly prone to insomnia. Photo credit: Jonathan Borba
Shift workers are particularly prone to insomnia. You can find a blog on managing shift work written by Dr Chasser, here. You can also hear more in our Conversation with Experts.
In general, her advice is:
With a one-off missed night, stick to your normal routine, with a 2–3-hour nap as early in the day as possible. Maximise daytime light exposure, exercise and eat as normal, and wind down for bed at the normal time. Having a consistent bedtime routine provides cues to switch off and fall asleep, even after a night shift.
To transition between blocks of nights and days, your circadian rhythm can only shift by 60–90 minutes per day. Support this by recruiting light and dark, the timings of your meals and exercise, and potentially adding exogenous melatonin, with professional advice.
As always, this is not designed to replace advice from a sleep or medical professional. Courses such as Retrain Your Sleep can be very helpful.
This is intended to be a place where busy healthcare professionals can come to find resources to support their fulfilment, productivity, health and performance.
Is there anything missing that you’re looking for? Or anything that has been useful for you that you would like to share? Any niche requests for recommendations? I would love to hear from you.