Summary: The Sleep Prescription By Aric A. Prather, PhD
Summary: The Sleep Prescription By Aric A. Prather, PhD

Summary: The Sleep Prescription By Aric A. Prather, PhD

Become Your Own Sleep Scientist to Unlock the Secret to Your Sleep

As a human being, you are biologically built to sleep. But the obstacles are real. Digital distractions, stress, the environments where you live and sleep, and even larger systemic issues like race and class put pressures on our biology . . . and it bleeds into sleep. Many of us have been steeped in a culture that devalues sleep: ever heard the expression “You can sleep when you’re dead”? We all have responsibilities, big goals, big pressures. You’re here on this planet for a purpose. But you can’t do any of what you really want to do if you can’t sleep.

Maybe your challenge is figuring out how to prioritize sleep when the rest of life encroaches. Or maybe you’ve been prioritizing it, and still struggling. Maybe your sleep isn’t bad, but you’re an optimizer, a hacker who wants to maximize the restoration you can get each day.

No matter your starting point, the strategies here, spread out over the next week, are the tried-and-true tools that we know improve sleep, and in doing so, improve well-being and joy. So for the next seven days, we’re going to tackle one tiny habit per day.


Less Chaos, More Calm

We don’t make sleep happen; sleep comes to us. So, we can’t choose a time to fall asleep, and it’s essential that we don’t put that kind of pressure on ourselves at night when trying to improve our sleep. But we can powerfully influence when we fall asleep through when we wake up. And when we wake is absolutely within our control. So starting today, we’re going to begin stabilizing and regulating our circadian rhythm and homeostatic sleep drive.

Pick your time! Choose a wake-up time you can consistently maintain every day of the week, including the weekend You’ll want to choose a time that suits your life, and if possible, your preprogrammed preference.

Set your alarm! Program your alarm or phone for your chosen time now—for every day this week. Some people don’t want to use an alarm; they prefer to wake up naturally. That’s great, if you’re in the habit of waking up at a particular time and you don’t need to adjust.

Get some light! As soon as you wake up, get up and open the blinds. If it’s feasible (and not too cold!), go right outside. If you’re trying to shift your wake-up time, light exposure is a powerful zeitgeber that can jump-start your system.

Reward yourself for waking up. Make a nice cup of coffee. Read a book. Take a walk. Put on some music. Take a long hot shower. Pick something that you can look forward to, that you may not always be able to find time for in a typical hectic morning.

And finally . . . Take a moment to fill out your sleep diary! It will take less than a minute of your time this morning, and we’ll need the data later this week.


Fixing Your Daytime Problem

Today, take the long view about the day . . . and the week ahead. Look at the week as a whole. Think about how you might space out your responsibilities so that everything’s not loaded into one time frame. And remember that one of your responsibilities is to yourself: to make time for sleep, and for breaks. This can help you plan and set doable expectations around deadlines and other big to-do’s for yourself and others.

To prepare: make a quick list of what you’ll do on your breaks. Suggestions from the author are:

A five-minute meditation (download an app like Headspace if you want some guidance). A ten-minute walk. Listening to fifteen minutes of your favorite podcast. Put on a favorite playlist and walk around the block; go outside and pull weeds in your garden in the sunshine, if that’s something you find relaxing and satisfying. You choose: this is for you.

Choose one of these two ways of holding yourself accountable to your breaks:

Set a timer. Program five alarms into your phone to go off at times of your choosing. When the alarm goes off—to the extent that you can—drop what you’re doing and do one of your break activities.

“Anchor” your break to an existing staple in your routine. Behavior scientists suggest this tactic as a quick and effective way to add a new element to your routine. Tether your break to something you do routinely. So, you might say, every time I go to the bathroom, I’m going to take a break right after. Or every time I answer an email (this depends on how many emails you get!).

Commit to doing this every day this week! Do this today—but do it tomorrow, and the next day, too.


Boosting Yourself Over the Afternoon Dip . . . Without Sabotaging Tonight

Stick your head in the freezer: it’s science.

A mild physical shock to the system might be exactly what you need today at 3 p.m. to beat that circadian dip you’re feeling. We’re not talking about anything extreme here—the author’s not going to tell you to go take a cold shower or a polar bear swim. But the principle is the same: cold impacts the nervous system. If it’s tamped down to a low idle and your energy has tanked, a brief cold exposure can act on you like jumper cables on a car battery.

When that afternoon slump hits, go stick your head in the freezer! And hang out there for as long as you can. (Or, if you can, fill the kitchen sink with cold water—as cold as you can make it—and immerse your forearms to recreate our “cold pressor” task in your own home.)

While you’re experiencing the blast of cold, notice if it feels uncomfortable. But bear with it. Try to relax into it. Just try to exist with the intense sensation of cold. When you’re done, your system will be revved up: heart rate a little higher, nervous system engaged, alertness up.

Going forward: This is a small “stressor” to your system, not a big one. But as your day goes on, if you catch yourself experiencing a stress response to something that happens, try to reframe it as exciting instead of threatening. Stress researcher Dr. Elissa Epel suggests that positive stress, like exercise, cold exposure, or a feeling of “challenge” stress that you can quickly recover from (rather than “threat” stress, which tends to linger) can trigger hormesis, a cellular cleanup process that promotes healing and longevity. Its not only good for your sleep tonight, it’s good for your cells, too.


When Your Own Mind Is the Problem

The best time to get ahead of worry and rumination is during the day, before the sun even starts to set. There’s no magical switch to completely turn off rumination—you have a human brain, and part of its job is to consolidate information and build new synapses by dredging up moments from your day, memories from the past, stuff that upset you, and so forth. Your brain has a pretty good reason for doing most of what it does—it just gets off track.

Today, and for the rest of this week, set aside a specific chunk of time for something very important to your well-being. It’s not a massage or a hot bath. It’s not me-time—though if you’re following yesterday’s instruction to take a break, you hopefully got some of that as well! This is time exclusively for worrying. Yes: today, you’re going to worry on purpose.

The author recommends choosing a time during the mid- to late-afternoon because it’s early enough that it won’t impact your ability to go to sleep later, but it’s not so early that you still have a big chunk of your day left to go to produce rumination-creating foibles.

Set a timer for fifteen minutes. This is your daily, intentional worry time. Don’t do anything else while you do this—it defeats the purpose. If possible, go someplace where you can be uninterrupted. Some of my patients have locked themselves in the bathroom to avoid being disturbed. Some people take a walk. Do what you need to do!

Once that timer starts, you are going to give yourself the freedom to worry. Worry about one topic at a time. Think of it like a to-do list that you go through one by one, except what you’re checking off are the topics you feel the most anxiety about during the day (and then night), the ones your mind returns to over and over, the topics that occupy all your mental space. You may spend a lot of time trying to stop yourself from thinking about this stuff too much—in this fifteen-minute window, just let yourself go. One important caveat: this is not problem-solving time. The expectation is not that you come out of this with everything solved. Your entire goal is just to worry, fruitlessly, obsessively.

Two hours before bedtime (or as close as you can manage), switch to wind-down mode. It’s easy to get caught up in stuff and let the cutoff time blow right past. Tell Siri or Alexa to alert you. If you happen to have smart lighting in your home, program the lights to dim down around this time. Not only will it cue the transition, but it will also limit light exposure, allowing your melatonin system to get working. When you get the cue that it’s time to wind down from whatever type of alert or alarm you choose, there are a few big-ticket items that you really do have to stop pretty immediately. Stop Doing Work. Stop Social Media. Stop Drinking.

The point in stopping all of the above is that you unplug from the day, to give yourself the opportunity to let cognitive arousal dissipate. It’s not really something you can rush—you have to allow it to happen.

Again, this is an individual process, and you’ll pick what works for you. But there are a few heavy-hitter wind-down activities that tend to work for people across the board. In brief: Dim the lights. Nightly meditation. A gratitude journal. Watch a show or a movie. Read. Take bath or shower. Sit outside and look at the stars. Listen to a podcast. Anything that makes you feel positive.


Stimulus Control: The Key Piece of the Sleep Puzzle

Rule #1: Do Not Get into Your Bed Until You’re Sleepy

Remember, you’re starting your wind down roughly two hours before bedtime. But be aware of your own body. You don’t need to be rigid about this. If two hours is up and you’re still wide awake, keep on winding down! Remember, as much as we’d love to have more control, we don’t get to decide when we fall asleep. Sleep comes to you. So, downshift into something even less stimulating. For example, if you’ve been reading, maybe relax with your eyes closed and listen to music.

Rule #2: Don’t Do Other Things in Your Bed

No phone, no laptop, no book. Bed is for sleep and sex only. (Caveat: it won’t always be this way. You aren’t doomed to never-Netflix in your comfy bed for the rest of your days. But when you’re trying to fix this, be as clear to your body as you possibly can. No mixed messages.)

Rule #3: Give It a Shot

You get in bed, you feel sleepy, but you’re not falling asleep yet. That’s OK. Give it a chance! Let’s say, fifteen minutes. It often takes people between fifteen and twenty minutes to fall asleep—this is completely normal.

Rule #4: If You’re Up, Get Up!

If you’ve followed rule #3 above and hit the twenty- to thirty-minute mark of lying in bed, it is time to get out of bed. Get up and transition back to wind-down mode. Go read your book. Listen to smooth jazz. Smell some candles. Drink some tea. When you feel that sweet sleepy feeling again, get back in bed.

Rule #5: Stick with It!

Do this practice not just tonight, but tomorrow, and the next night. This isn’t going to work overnight. It works over time.


There’s No Such Thing as Perfect Sleep

Fixing people’s sleep, as much as it is important for health, immune system, cognition, and more, is really all about improving their waking function. And there are other ways to improve our days. For instance, we can build naps into our days. One of the ways that the “two sleeps” idea persists into the present day is with cultures that practice the siesta, having a culturally sanctioned afternoon break for rest and napping might decrease total sleep time at night, but is also associated with improved cognition and alertness, as well as reduced risk of heart disease. In Japan, a country known for its intense work culture, people practice something called “inemuri,” which might look like napping at your desk or on the subway, but which roughly translates to “sleeping while present.” There, a quick nap in public isn’t viewed as slothful or lazy, but a sign of dedication and hard work.

While our culture might need a little more prodding to get more comfortable with the midday nap, there’s nothing inherently wrong about napping, if nights are persistently hard for you and you can work it into your schedule. But this is sometimes a scenario where medications are particularly appropriate and helpful. There’s a new class of medications that are particularly effective with what the author calls “sleep maintenance”: falling asleep and staying asleep. When people are waking in the middle of the night or early in the wee hours of the morning, it can be really challenging or impossible to get back to sleep—you’ve already drained out too much sleep pressure and even if you still feel tired, there’s just not enough juice left in your homeostatic sleep drive to get you there.

If you’re awake, and nothing’s working, try acceptance. Trust your body: you’ll make up for it tomorrow. Remember that any sleep debt you build up, you can use to help yourself fall asleep with more ease the next night. You have this awake time now, in the middle of the night—that’s not your choice, but you can choose what to do with it. So do something that makes you happy; something you don’t always have time for during a typical busy day. This is “bonus time.” Read a book. Watch reruns of Friends or The Real Housewives of Whatever—nobody’s judging. And remember that even the “best” sleepers have bad nights: perfection is not the goal, nor is it possible. Your nights, like your days, will always have a degree of unpredictability. Part of the project of improving our sleep is being OK with that, and knowing that our bodies are resilient and will recover—if we continue to prioritize sleep, realize its value, and live our days according to that knowledge.