The basic rules for healthy sleep hygiene

The quality and duration of sleep is often affected by bad habits or states of anxiety and agitation.

From 10 to 15% of the world’s population suffers from a sleep disorder, often for prolonged periods and with significant negative effects on daytime life and on the state of physical and mental well-being.

Epidemiological data indicate an increase in cases of chronic insomnia in the last twenty years, especially in Western industrialized countries.

For this reason, medical and scientific research is dedicating a lot of effort to deepening knowledge on sleep physiology and related disorders, as well as to the development of dedicated diagnostic tools and treatment options as diversified as possible.

The term “insomnia” refers, in fact, to a condition of alteration of the normal physiological process of sleep, with persistent changes in its quantity and / or quality, which can take different forms and have different causes.

To understand what is the best way to prevent sleep disorders in normal conditions or to restore the correct sleep-wake rhythm when suffering from a form of insomnia, it is useful to know its characteristics and functions.

What happens during sleep

Far from being considered, as was believed in the past, a state of inertia of the organism, sleep represents a dynamic phenomenon in which all physiological functions, including psychic ones, remain active, simply undergoing some variations with respect to what happens during wakefulness.

Although during sleep there is a temporary suspension of the function of integration of consciousness with the external environment, brain activity does not undergo any interruption, but, on the contrary, takes place in the period between falling asleep and awakening with typical characteristics.

As is in fact demonstrated by electroencephalographic recordings, the electrical waves of the brain take on particular forms in sleep, configuring a series of stages of varying depth, which take place in succession. On the basis of the structure of brain electrical activity and the associated physiological phenomena, there are essentially two phases of sleep, REM and non-REM, which alternate cyclically throughout its duration.

The triggering of sleep and its exhaustion at the end of the night period are controlled by the physiological processes that define the so-called circadian rhythm, that is, the regular alternation of sleep and wakefulness. These processes consist of the activity of specific nerve centers, which release neurotransmitters, such as adenosine and galanin, and hormones, such as melatonin, with the ability to induce or inhibit sleep.

To keep the functioning of this kind of biological clock constant, in addition to the internal mechanisms of the body, some environmental stimuli, among which the most relevant is represented by light: perceived through the retina, light sends information relating to the course of the day to the nervous structures responsible for modulating sleep and wakefulness.

Although the mechanisms through which the beneficial effects of sleep are realized are not fully known, it is however proven that sleep disorders negatively affect various aspects of psycho-physical health: on cognitive functions, on emotional balance, on the cardiovascular system, on energy metabolism, on the production of various hormones, on cell regeneration processes.

How much you need

Under normal conditions and in the absence of conditioning, an adult tends to sleep about 8 hours per night. However, the amount of sleep perceived as necessary and sufficient to feel rested and feeling good during the day can vary from individual to individual, from 6-7 up to 9-10 hours per night.

In addition,sleep needs change throughout life: 16-18 hours a day for infants, 11-12 hours for children up to 5-6 years and at least 10 hours later and until adolescence.

Similarly, with age, sleep characteristics change, with a gradual decrease in the share of deep sleep.

In all periods of life, however, the lack of sleep or the disorganization of the sleep structure inevitably have negative consequences, to avoid which it is always essential to restore the normal daily sequence of wakefulness and sleep and correct the alterations of night rest. It is in fact to dispel the idea that a systematic sleep debt can be compensated with a few hours recovered occasionally on the weekend or with occasional daytime naps.

Since the need for sleep can be different from person to person, you might think that the concept of insomnia could also be relative. In fact, in the clinical setting insomnia is described by some quantitative criteria: a delay in falling asleep of more than 30 minutes, a number of hours of sleep per night less than 5, a certain number of nocturnal awakenings and the presence of the disorder for several nights a week and for over three months configure a form of chronic insomnia.

The other important parameter to define a sleep disorder as relevant for clinical purposes is its impact on daytime life, daily activities and the general state of health of the subject.

How sleep is preserved and cared for

At the origin of a sleep disorder there can be various pathological conditions that, by their nature or due to current therapies, alter the quality of sleep: cardiovascular, respiratory, musculoskeletal, neurological, psychiatric diseases, metabolic imbalances, endocrine disorders can cause difficulty falling asleep or frequent interruptions of sleep. Medications such as corticosteroids, diuretics, certain antihypertensives, painkillers, respiratory decongestants and hormone therapies can also affect sleep.

Today, to deal with sleep disorders for diagnostic and therapeutic aspects is a specialized clinical sector, that of “sleep medicine”, which operates in dedicated centers where, through sophisticated instrumental investigations, the analysis of the sleep characteristics of individual patients is carried out and on the basis of these the most suitable treatment for each type of insomnia is identified.

However, when you sleep little or badly, specialist visits and examinations are not always necessary: sometimes it is simply a lifestyle that interferes with normal biological cycles that alters sleep.

In any case, considering the essential function of sleep for psycho-physical balance, it is always good not to underestimate the disorder and first of all to check if it can depend on a counterproductive pace of life or improper habits.

Often to get back to sleep well just follow some rules of behavior, following the practical indications defined as “sleep hygiene”.

The principles of sleep hygiene

«Frequently to determine a sleep disorder in the absence of a specific pathology is a psychological state characterized by anxiety, hypervigilance, intrusive thoughts, psycho-physical stress “explains Marco Zucconi, neurologist at the Center for Sleep Medicine of the Department of Neuroscience of the San Raffaele Hospital in Milan and member of the board of directors of the Italian Association of Sleep Medicine.

«These factors can be linked to a contingent life situation and interfere with sleep for a limited period or be part of the character profile of the subject and affect the quality of his sleep almost constantly» explains Zucconi. “However, there are many cases in which the cause of insomnia is only poor sleep hygiene and to solve it some lifestyle adaptations are sufficient”.

The principles of “sleep education” are:

• keep constant during the week the times at which to go to sleep and get up
• create the environmental conditions of suitable brightness (low), temperature (neither too hot nor too cold) and noise (reduced or absent) in the room where you sleep
• provide to make the bed comfortable with suitable mattress and pillow
• Do not place in the room where you sleep objects related to daytime activities (computer, work desk, mobile phone, television, etc.)
• Do not take stimulants in the evening (coffee, tea, chocolate, caffeinated or energizing drinks)
• Do not take alcoholic beverages before bedtime (which initially have a hypno-inducing effect, but alter the structure of sleep)
• abstain from cigarette smoking in the evening hours (as nicotine has a stimulating effect)
• Do not consume high-calorie evening meals and do not eat protein-rich foods, which fatigue digestion
• If possible, avoid taking medications in the evening that may affect sleep
• avoid sleeping during the day, if not taking a nap in the early afternoon (no later than 15.00) lasting a maximum of 30 minutes
• avoid sleeping after dinner before going to bed (for example on the couch in front of the television)
• Before going to bed, engage in some relaxing activity that can become a ritual facilitating sleep (walking, relaxing physical practices, hot bath, reading, listening to music)
• engage in any intense physical activity (such as training in the gym) a few hours before going to bed, in order to let the activating effect of muscle exercise exhaust
• In the evening hours do not stay in too bright environments and avoid exposing yourself to intense light stimulation such as that of digital screens (computers, smartphones, video games, etc.), since light inhibits the secretion of melatonin
• Refrain from activities (recreational or work) that are too stimulating or engaging from an emotional and mental point of view before bedtime.

When to contact your doctor

“If, despite the suggested adjustments, – adds Marco Zucconi – insomnia persists and above all begins to negatively affect daytime life, causing disorders such as fatigue in the early hours of the morning, drowsiness during the day, difficulty in carrying out work or study activities, drops in attention, mood changes, it is certainly advisable to contact your doctor, who, if he deems it appropriate, may refer the patient to a specialised sleep medicine centre.’

The diagnosis of a sleep disorder is made through an accurate description first of the disorder and then of any other diseases of the patient. “In addition, instrumental examinations are used that can be performed at a sleep medicine center or in some cases at home and that serve to characterize the form of insomnia from which the patient suffers – explains the neurologist -. The main tests are polysomnography, which detects a series of parameters during sleep (cardiorespiratory monitoring, muscle activity, eye movements, blood oxygenation, electroencephalogram), and actigraphy, which records continuously, 24 hours a day, the patient’s activity and sleep for prolonged periods, even for one or two weeks.

On the basis of anamnestic data and the results of instrumental investigations it is possible to understand if at the origin of the sleep disorder there are general pathological states or problems that can interfere with its continuity such as restless legs syndrome, sleep apnea syndrome, bruxism . “In these cases – Zucconi clarifies – we must intervene first of all on these disorders. Moreover, thanks to the results of the examinations it is possible to define the type of insomnia of the patient in order to identify the most suitable therapeutic intervention to improve his condition».

What are the therapies?

There are many treatments for insomnia.

“In the case, for example, of primary insomnia, that is, not caused by organic causes, the first approach consists of a psychological intervention, cognitive-behavioral therapy, which has shown to be able to obtain good results, so much so that it is now recommended in all international guidelines,” says Zucconi.

«Pharmacological treatment is to be reserved for cases in which psychological therapy is not feasible or does not work or can be combined with this in the first period, but it must be used with caution, personalized according to the characteristics of the patient (age, physical and mental conditions) and his disorder, monitored by the doctor and above all implemented for a short time.