Better Sleep 1

This Lazy Old Geek (L.O.G.) has been obsessed with sleep for many years. I’ve done a lot of Internet research on the subject. A lot of people have sleep problems. They’re unique to the individual. What works for me may not work for you and vice versa. I hope to offer a lot of tips and suggestions which may help you to get better sleep.

I have found what I think of as the expert on sleep, Matthew Walker, PhD.

He wrote the best seller book, “Why We Sleep: Unlocking the Power of Sleep and Dreams”. I haven’t read the book but watched a lot of interviews/podcasts with him.

My summary is that he talks a lot about the problems sleep deprivation can cause, how badly sleep deprivation is in the civilized world, the impacts of sleep deprivation on kids, teenagers, adults, seniors, medical workers, shift workers. He also has a lot of suggestions for changes in government, the work place, the medical fields for staff and patients, schools, parenting and individuals. He backs it all up with scientific studies and research.

One of my favorite Interviews:

https://www.youtube.com/watch?v=5j9xCC_VtQA

This covers most of his Ted Talk but is better quality than the one I’ve seen.

Most detailed, but has some rough language and is two hours long.

https://www.youtube.com/watch?v=pwaWilO_Pig

What most interests me:

Reduced Deep Sleep in seniors can lead to Alzheimer’s.

Matthew Walker tips: These are discussed in latter steps

Regularity

Cool Temperature

Dark (no blue)

CBTI

Meditation

Biphasic sleep?

https://www.healthline.com/health/biphasic-sleep#biphasic-vs.-polyphasic

TIP: Matthew Walker did studies on sleeping pills and found that they don't really work. In fact they will set you back further when you stop taking them.

So a couple of things had the most affect on my sleep.

1. CPAP machine. So if you have or suspect a snoring problem or sometimes wake up gasping for breath, I would suggest you see your doctor about Sleep Apnea. I have it. When I started using a CPAP machine, I noticed a big improvement in my being able to sleep longer.

2. CBTI. Well, I stumbled across this on the internet. It stands for Cognitive Behavior Therapy Insomnia.

OK, I know that sounds pretty scary and many people will shy away from even just the name.

BUT, if you do your research, It is one of the most effect methods for treating sleep problems and highly recommended by the VA, Mathew Walker and many other sleep experts.

So there’s an excess amount of internet information about CBTI, most of it by providers wanting to help you through the process (for a fee). Well, I’m a DIYer and would rather do it myself.

Here’s a pretty good overview:

https://www.mayoclinic.org/diseases-conditions/insomnia/in-depth/insomnia-treatment/art-20046677

Here’s my take on some of the rules:

The bed is only for sleep, sex (in my case, stretching exercises)

If you can't go to sleep or stay asleep within 20 minutes, get out of bed and bedroom, only returning when you're sleepy. This is good, though I have hard time doing this when I’m waking up after a good sleep.

Regularity: Set a consistent bedtime and wake time. This means seven days a week, 365 days a year. Weekends/holidays are no exception. This is also recommended by Mathew Walker. This one is easy for me as I’m retired and don’t always know what day it is anyway. Currently I have a snack around 8p.m., stop using computers and TV around 9p.m. read on my Kindle until after 11p.m.

Purists would probably say using a Kindle is bad. So far seems to be okay for me.

Sleep hygiene: No alcohol or caffeine after noon. Also easy for me as I gave up alcohol and most caffeine a long time ago.

Sleep Environment: No TV, smartphone or computer turned on in bedroom. The suggestion is to keep them out of the bedroom. I have a couple of computers in my bedroom but turn them off. As for my smartphone, well, I don't use it and it's in sleep mode. Seems to work for mo.

There’s a lot of information to sift through if you want to research CBTI. I found a program called Path to Better Sleep:

https://www.veterantraining.va.gov/insomnia/

It was designed for Veterans but anyone should be able to use it. What I like about it, is it steps you through the process, has lots of informative videos and comments, let’s you do self assessments.

What CBTI does require is a commitment on your part. You should enter information in your sleep diary every day. And spend some time going through the course videos.

The companion smartphone app is called “CBT-I Coach” but I would suggest using the newer Insomnia Coach (see below). It’s almost the same thing.

After about a week, you will need to do a short assessment and it will give you a Sleep prescription which is basically a suggested bedtime and your desired wake time.

If you’re like me, you will probably not like the prescription bedtime as it’s probably later than you think. Your instinct says you should go to sleep earlier so you get more sleep, but the usual situation is you don’t want more sleep you want better uninterrupted sleep. This is part of the cognitive behavior process.

After several weeks, (months) you’ll probably notice an improvement in how you can fall asleep faster and a reduction in the number and duration of awakenings during the night. I did. Now I typically will fall asleep within 10 minutes, only wake up once a night and for maybe 10 minutes without having to get up and go to the bathroom.

THEORY: See picture. One of the basic concepts is that after a nights sleep, your Sleep Need is low and your Sleep Urge is low. As you go through the day your Sleep Need increases peaking about when you go to sleep. One of the CBTI goals is to train your body to be able to go to sleep at your prescribed bedtime. Sleep Urge is a little different. Many people have a rise in Urge around 2p.m. This "afternoon slump" is part of a person’s circadian rhythm. A process internal to the individual. Studies have shown that this is not tied to what you eat for lunch. (By the way, everyone’s circadian rhythm is different, you might be a night owl, early bird or somewhere in between).

DEVIATION: After several months, I hadn’t been happy with my Prescription and tried going to bed earlier. I’m not satisfied with 5.5 hours sleep a night even though my CBTI efficiency is around 90%. I would rather get closer to recommend 7-8 hours sleep. For a while, I thought I was sleeping longer still remaining efficient. But now, I’m not so sure and moving back to my Prescription.

I recently found another VA CBTI app called Insomnia Coach:

https://www.ptsd.va.gov/appvid/mobile/insomnia_coach.asp#

It looks very similar to CBTI. This simplifies your sleep diary entries and your sleep prescription calculation. It takes me about five minutes a day to complete my sleep diary. I find it best to do it a right after I wake up.

Improvements over CBTI-Coach, it remembers yesterday’s times and it has a lot of coaching built-in.

There is a significant relationship between blue light and sleep. I wrote a couple of Instructables on the subject:

https://www.instructables.com/id/Blue-Light-Project-Part1/

https://www.instructables.com/id/Blue-Light-Project-Part2/

For me the unexpected result from Blue light research is that I learned that blue light during the day is good. So I opened up my blinds and let the sunshine in. And it seems to help me get more energized during the day.

For evening/night, I still have and use a lot of reduced blue light techniques.

Most of my house lights are smartbulbs set to no blue light, others are dimmed or off. My computers use f.lux app to reduce blue light.

I finally got a pair of blue blocker glasses that really work, Uvex Skyper Blue Light Blocking .. (S1933X). I bought mine from Amazon. This is the only one of four pairs of blue blocker glasses I tried that works. Apparently from what I’ve read, the lenses have to be very orange or red to work. These were actually tested and are highly rated:

https://www.consumerreports.org/eyeglass-stores/3-blue-blockers-put-to-the-test/

I like to use these when I watch TV after 8p.m. and if I’m in bright light in the evening, like turning on back porch light. They’re not really comfortable, though.

Yes, I am a Geek and like tech toys. For sleep I own a Fitbit Charge 3 band and a Withings Sleep Mat. Both track sleep, display awake, REM, light and deep sleep. Both have Sleep Scores and resting heart rate.

Naturally, I like to compare results. Well, my non-scientific comparison. Heart rates and total sleep are pretty close. Sleep scores are slightly different, I assume because they use different parameters/algorithms. The biggest difference is in sleep stage times. The Withings seems to have consistently longer REM and Deep sleep times than the Fitbit. Now I’m sure most of that is because they use different sensors and algorithms to calculate. But a lot of Internet comments say none of the commercial devices are very accurate anyway which I agree with.

Personally, I lean towards the Withings as it gives Deep times closer to what I’d like them to be. I think maybe the axiom is to not take seriously any of this sleep data. As is often reported, too much worrying about sleep data adds to stress/anxiety which reduces sleep efficiency.

Resting heart rate: The concept is lower resting heart rate is better for sleep. Activity is a factor in this. While I take a walk in the a.m. with my dog. For various reasons we've dropped from 3.5-4 miles a day to 1.5. One thing, I've been playing with is to do some cardio exercises before 5p.m. What I've learned is I ain't got rhythm and ain't got any coordination but it's just me and Sadie so I go for it. Sometimes while exercising, Sadie will try to go with flow or give me a puzzled look. But it seems like my resting heart rate has dropped from around 60 to below 60.

As to other tech toys, I built my color meter and a no blue light lamp. Also am interested in binaural beats.

I have also been looking into detecting my own sleep stages. The problem with Fitbit and Withings is that you can’t control anything when you’re in a specific sleep stage. So, I’ve been looking into using MindFlex, ECG AD8232, pulse oximeter, pulse sensor to determine my sleep stages. The concern is that if commercial companies, like Fitbit and Withings can’t do it very well, how can a DIYer like myself expect to do it.

Then there’s also the matter of what do I want to control. One thing that some commercial products are trying to do is create a smart alarm clock so that you wake up when you’re in the right sleep stage (usually light sleep). Well, I’m retired and don’t use an alarm clock so I don’t need to do that anyway.

Right now, one of my goals is to lengthen my deep sleep time purportedly to stave off Alzheimer’s.

Mathew Walker is doing some work in that area using electrical stimulation at certain stages of sleep.

WARNING: I would stay away from cheap devices that claim such. Here’s a couple of articles about them:

https://vitals.lifehacker.com/the-truth-about-electrical-brain-stimulation-1822192429

https://www.wired.com/2014/01/read-zapping-brain/

For the time being, I'm going to stay away from this technology.

There are some studies where they use binaural beats during certain sleep stages. This is something I’m interested in, but doubt I will ever get to be able to do it.

Temperature: Matthew Walker talks a lot about temperature. The basic concept is that body temperature drops a bit for sleep.

There’s some disagreement about hot showers. Mathew Walker says a hot shower works as when you get out of the shower, your body tends to cool off.

I think there are a number of variables here, how hot and long the shower is, how soon before bed and your body. I personally like to take hot showers before bed and have had no problem with them.

Now most experts recommend a room temperature of around 65 to 68F. Now I have a problem with that. I seem to feel cold at those temps and have a hard time falling asleep. The other problem is I live in a very hot climate. In the summer I don’t want to have to run the A/C at that temperature through the night.

Having said that, I started looking at reviews of Eight Sleep Pod

https://www.tuck.com/eight-sleep-mattress-review/

It is definitely way more than I would want to spend for a mattress but one thing I like is that you can program different temperatures for different times. I might look into that as a DIY project.

So I almost never have trouble falling asleep. Unfortunately, a lot of the information I've discussed seems to be about helping a person fall asleep rather than stay asleep or increasing Deep sleep. E.g., no blue light, no electronics in the bedroom, bed for sleep only.

Thanks to my CPAP and CBTI my sleep is a lot less interrupted.

My dog, Sadie helps me sleep. Some sleep experts recommend keeping pets out of the bedroom. I disagree. Yes, she can be disruptive. Sometimes she'll all of a sudden start barking at something. Sometimes, she won't come in from outside when I'm ready to sleep. Sometimes she'll need to go outside in the middle of the night. But mostly she's a comfort to me and stress reliever.

Two sleep problems that I still worry about are:

Sleep duration: I’m still averaging around 5-6 hours a night, less than the “recommended” 7-8.

Deep sleep: Unfortunately, I’m not sure how much deep sleep I’m actually getting but I would like to do as much as I can to get more and “prevent Alzheimer’s.”

There are some possible technologies that might track Deep sleep better:

Oura Ring: very expensive and accuracy is questionable.

Whoop: Accuracy is questionable plus yearly fee which I hate.

Eight Sleep Pod: Way too expensive, accuracy is questionable, plus a yearly fee.

As I said before, though, too much sleep information can just add to your stress and make sleep less efficient.

Technologies I’m interested in:

Binaural beats

Meditation

Cooling pads

Biphasic sleep

Like a lot of people, one of the problems I have is that I want instant solutions:

Take a pill (sleeping pill, melatonin, cbd-oil) sleep a solid eight hours. This works for many ailments but not for sleep.

Turn off blue lights, sleep a solid eight hours.

Set night temperature to 68, sleep a solid eight hours.

I would recommend CBTI to everyone if you have the discipline and a ‘normal’ circadian rhythm. Circadian rhythm (I think) is that Sleep Urge cycle in the picture. If your Circadian rhythm is different, I don’t know how well CBTI will work for you. Actually, it might.

TIP: No matter what methods you try, don’t expect instant results. As I keep learning from CBTI it may take weeks.