Surgeon Sleep Secrets – How to Master Sleep

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If you’re anything like me, you probably have a love-hate relationship with sleep. You love the way it makes you feel, but you hate that it seems to waste so much time, or maybe it just doesn’t come easily to you. As someone who has struggled with and ultimately conquered severe sleep-onset insomnia, here are the lessons I’ve learned.

New research has illustrated just how important sleep is. *This is the part where you moan in annoyance as you’ve been told this time and time again.* I won’t belabor the point, but I do want to leave you with three facts about the importance of sleep that are too interesting to omit. First, drowsy driving accounts for more accidents than drunk driving or driving under the influence of other substances, combined. Second, you can function well without food for several weeks, without water for several days, but you experience the most rapid decline in function without sleep. And third, despite millions of years of evolution, we still spend 1/3 of our lives asleep, despite it being extremely costly. Think about it, it must be necessary if evolution hasn’t prioritized finding food, or finding a mate, or simply not being vulnerable to predation.

Now let’s address your difficulty with getting good quality sleep or getting enough sleep – and don’t tell me you are too busy to prioritize your sleep. As someone who is actively growing two YouTube channels and growing three separate businesses while still getting 7-8 hours of sleep, I’ll be the first to say that it’s less about you being busy and more about you being inefficient with your time.

 

The Chronotype – Fact or Fiction?

The discussion on sleep optimization has recently focused heavily on one’s chronotype. As humans, or rather organisms on planet Earth, we run on a circadian rhythm. This 24-hour internal clock coordinates various physiologic functions related to sleep and wakefulness, from hormone levels to body temperature, and much more. Approximately 40% of people have an advanced sleep chronotype, meaning they are “morning people” or “early risers”. Approximately 30% of the population has a delayed sleep chronotype, meaning they are “night owls”. The other 30% fall somewhere in the middle.

As Dr. Walker writes in his book, Why We Sleep, “Night owls are not owls by choice. They are bound to a delayed schedule by unavoidable DNA hard wiring. It is not their conscious fault, but rather their genetic fate.” Chronotypes actually change over the course of your life. Infants are predisposed to early chronotypes, teenagers are delayed chronotypes, and once you pass the age of 50 or 60, you trend towards early again.

A greater understanding of chronotypes is awesome, but it comes with good and bad news. The good news is that it’s backed by science, and we understand that being a night owl doesn’t mean you’re lazy, it just means you have a delayed sleep chronotype. If you have a delayed sleep chronotype, there are even data suggesting your prefrontal cortex, the part most important of the brain for higher-level cognition, won’t function optimally when you’re forced to wake up early.

But here’s the bad news. The world doesn’t care about your chronotype. I don’t consider myself an early bird, but I still had to wake up at 3:30AM hundreds of days in a row while doing plastic surgery. The hospital and operating room didn’t slow down just because I’m not a morning person.

That being said, all hope is not lost. In my first post about sleep optimization, I explained how I grew to love waking up early despite not being a morning person. And in this post, I’ll teach you the techniques to help you sleep like a pro, regardless of your chronotype.

 

The Four Pillars of Sleep

When we speak about optimizing sleep, we don’t simply mean getting more shut-eye. Surely, you’ve experienced nights where you slept for 8 hours and felt great in the morning, and other nights where you slept 8 hours but somehow felt terrible. The reason is that there are four pillars of sleep, and sleep duration is only one of them.

 

The four pillars are:

  1. Sleep depth/quality: reflected in the quality of the sleep waves, meaning alpha, beta, delta, and theta waves, sleep spindles, K complexes, etc. These are measured on an EEG.
  2. Sleep duration: how long you’re sleeping. For most adults, this should be 7-9 hours.
  3. Continuity: is your sleep continuous or interrupted?
  4. Regularity: falling asleep and waking up at the same time each day.

 

Falling short in any one of these four pillars will result in suboptimal sleep and negative effects on your restfulness and overall health. For example, say you have two scenarios where you sleep 8 hours each night. On one night, you sleep 8 hours continuously without interruption. On the other night, you sleep the same amount of time but over a longer 9 hours with multiple small interruptions. The continuous sleep will result in far better restfulness.

 

5 Steps to Sleep Serenity

Keep these four pillars in mind as we work through the five steps in optimizing your sleep. But, also remember that there’s no one single magic bullet, and only you can decide how much you’re willing to prioritize your sleep. Some of these changes will come easier than others. That being said, if you follow these instructions, you should experience a drastic improvement in how rested you feel.

 

Step 1. Laying the Foundation

First, determine what time you have to wake up in order to get to work or school on time. Work backward from there, accounting for how long it takes to commute and get ready in the morning. You should plan for 7-9 hours of sleep each night. By doing this exercise, you will set up your target bedtime and wake time. This may not be optimized for your chronotype, but setting these times will still be highly beneficial in improving the quality of your sleep.

As tempting as it is, do not deprive yourself of sleep during the week only to binge and “catch up” on the weekends. This behavior throws off your circadian rhythm, resulting in reduced sleep debt or sleep pressure, meaning it’s harder for you to fall asleep and stick to your schedule come Monday.

There’s a reason this is step one. This is arguably the most difficult step to implement, but I have personally found it the most powerful.

If there are days you can go in to work or school later, I still suggest you sleep and wake up at your scheduled times. Use that extra time in the morning to get studying or work done. This benefits your sleep schedule, and you might as well start the day with a win.

It’s not uncommon to stay up late on Fridays and Saturdays for social events, throwing off your sleep schedule. I’ve done that too from time to time. However, during particularly stressful periods, like when I was doing plastic surgery residency plus growing Med School Insiders plus building and running a biomedical incubator, I prioritized sleep over social events. I wasn’t writing off socializing and partying forever. I simply was in a season of my life where I needed to grind hard. What season are you in?

 

Step 2. Bedroom Optimization

If you’re serious about not feeling tired all the time, optimizing your bedroom should not be taken lightly. Let’s talk about lighting, sound, and temperature.

In terms of lighting, you want your bedroom as dark as possible at night. I bought blackout curtains in college mostly because my apartment was poorly insulated, but I soon realized the benefits of sleeping in complete darkness. This also means turning off any lights from electronics that illuminate your room. I placed electrical tape on various battery chargers and electronics in my bedroom that give off even dim light. The results were surprisingly drastic.

For temperature, understand that your hypothalamus reduces your core body temperature by approximately 2°F for sleep. Ever notice how it’s terribly difficult to fall asleep in a hot room? To help your body get into a more conducive state for sleep, it helps to keep the room cool, with most experts agreeing that the mid-60s are a good temperature to aim for. Or you can do what I do, which is to wear very little when going to sleep and use light bedding. This means I can keep the room in the low 70s and still sleep like a baby.

With regard to noise, most people don’t realize that noises that don’t wake them up consciously still affect their sleep quality. Remember continuity and depth from the four sleep pillars? I like to use a fan as white noise in my room, but you can also buy a white noise generator, which is what my housemate does. If it’s still noisy, I recommend using earplugs. Some people complain that earplugs poke them in the ears if they lay on their sides, but that’s usually due to them not inserting the earplugs deep enough. If earplugs still bother you, you can try using putty earplugs instead.

 

Step 3. Pre-Bedtime Routine

If your mind is racing while you lay in bed trying to sleep, I feel you. I’ve found pre-bedtime routines to be the most effective antidote. A good routine not only relaxes you and activates your parasympathetic nervous system, preparing you for rest, but it also acts as a classical conditioning stimulus to signal to your subconscious that it’s time to sleep. Substitute Pavlov ringing the bell and the dog salivating with you doing your bedtime routine and getting sleepy.

My personal bedtime routine is to set my bedroom lights to a dim red color, take a warm shower, and practice mindfulness meditation for 10 minutes. Meditation has been demonstrated in clinical studies to reduce sleep latency and also improve the continuity of sleep. I also keep a notebook and pen by my bedside so I can write down any lingering thoughts that may come up. I find that by writing them down and “trapping” them on paper, it’s easier for me to let go of the thought.

If you’re wondering why I set my bedroom to red, it isn’t for the mood lighting. Blue light stimulates photoreceptors in your eyes that inhibit the release of melatonin from your pineal gland. In short, using screens like your smartphone, tablet, computer, or TV makes it harder for you to fall asleep.

You can adjust the color temperature on your screens. On Apple devices, this is called Night Shift, analogous to Night Mode on Android devices, or f.lux on your computer. These work by turning your screen more yellow, to warmer colors, thus reducing the amount of blue light emitted in the evening. While they are helpful, a recent study has demonstrated that screens with night shift still suppress melatonin. The best way around this is to simply stop using devices at least 60 minutes, but ideally 120 minutes before bed. I know that’s a long shot, so the next best thing is to wear blue light blocking glasses, which make everything appear super orange. Be sure to also reduce the brightness on your devices, as bright screens, regardless of light color, will also suppress that sweet sweet melatonin.

I take this last rule so seriously that I auto-schedule Do Not Disturb mode on my phone every night after 9PM. That means no notifications, messages, or phone calls. I also charge my phone far away from my bed, so I’m never tempted to pick it up. I don’t even set my alarm by looking at my phone. I always do it hands-free by activating Siri or Alexa through voice activation alone.

You may be wondering whether or not you should read in bed. Here are the general guidelines: If you have sleep-onset insomnia, meaning you have difficulty falling asleep, then avoid reading in bed. You want to associate your bed only with sleep and sex. If you read in bed, you’ll associate it with wakefulness. If you don’t have sleep-onset insomnia, or you have issues with sleep maintenance insomnia, then you should be fine to read. That being said, remember to use a dim light and definitely do not read on an iPad or other backlit screens.

 

Step 4. Wake Up Routine

Now for the fun part – setting your wake routine. I’ve used Spin Alarm Clock, which forces you to get up and spin in circles to turn off, and Sleep Cycle in the past. Nowadays, I use the regular built-in alarm function of my phone with two big caveats.

First, I put my phone across the room, so I’m forced to get up to turn it off. Simple and effective.

Second, I have Philips Hue smart lights integrated across my room, and actually across my entire apartment. Thirty minutes prior to waking up, my lights gradually increase in brightness, simulating sunrise. This results in a much softer and less violently jolting way of waking up. Dare I say waking up is even… pleasant. If you don’t want to go all out with smart lights or if you’re on a tighter budget, you can also go with a Wake-Up Light, which is essentially a standalone alarm clock that gradually illuminates your whole room.

 

Step 5. Daily Habits to Improve Sleep

This is going to be your least favorite part but one of the most important for you to hear.

You need sleep pressure, or sleep debt, to fall asleep at night. Adenosine is a compound that builds up in your brain during the day and is cleared at night. It’s one of the factors responsible for why we feel tired or sleepy as the day progresses. For this reason, if you struggle with sleep onset insomnia, avoid taking naps, particularly later in the day, as this reduces sleep pressure. Caffeine, which blocks adenosine from acting on brain receptors, should also be used carefully.

Caffeine has a half-life of 6-8 hours. We know you can sleep with blood concentrations of approximately half of your caffeine intake of the day, otherwise, your sleep will be disrupted. Therefore, stop drinking any coffee or tea 8 hours prior to bedtime. If you sleep at 10PM, that means stop at 2PM. Caffeine should not be a crutch you rely on, but rather a tool you use when necessary. I got through medical school and was in surgical residency drinking coffee only a couple times per year. You can do it too.

Alcohol and sleep also don’t mix. While it may reduce latency to sleep, the quality of your sleep is compromised. Remember the pillars. Alcohol inhibits REM sleep and also increases your body temperature, the opposite of what we want.

Is marijuana the wonder sleep drug we’ve always wanted? Not quite. THC is certainly not a good compound for sleep, but the verdict on CBD is still up in the air. THC decreases sleep latency, but it also inhibits REM sleep. There’s also a dependency component regarding the latency, meaning that when you stop using marijuana, you’ll have rebound insomnia. CBD, on the other hand, decreases latency without inhibiting REM. It also helps to reduce body temperature and may contribute to restfulness through its anxiolytic, meaning anxiety-reducing, effects. That being said, more research is needed prior to being able to provide guidelines on whether CBD use is beneficial or not with regards to sleep.

 

If you found this post helpful, please let us know with a comment below and send this to others to benefit! Let me know what you want me to cover in future posts in the comments.

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