University HealthCare Alliance

July 12, 2018

Wellness Wednesdays, presented by Stanford Health Care

(Image Credit to: Maddie Meyer/NBAE/Getty Images)

Throughout the 2017-18 NBA season, the Official Team Physicians of the Golden State Warriors, along with Chelsea Lane – the Warriors’ Head of Physical Performance & Sports Medicine – and various Physicians at Stanford Medicine provided input and suggestions on some of the most common health problems facing everyday people today. The season may be over with, but the NBA calendar stops for no one, so we continue with that series today.

Last time, we covered stress management, and the steps by which we can diminish or even eliminate stress. In this installment of Wellness Wednesdays, Lane and Drs. Fiona Barwick, Scott Kutscher and Clete Kushida tackle the subject of sleep.

For the Warriors and their fans, the last four years may feel like one super long, extended season, given that they’ve made four consecutive trips to the Finals and won three Championships in that span, including each of the last two. While thoroughly enjoyable and well worth the effort, the arduous journey the Warriors have been on over the last several years has been an exhausting one, and just like the rest of us, they require a certain amount of recuperation in order to operate at their best. Sleep is an essential part of that recuperation process, and equally important whether you’re an NBA player or an everyday Joe.

“Sleeplessness can elevate anxiety, reduce motivation and impact our tolerance for stressful situations,” says Lane. “Poor sleep can impair our attention, concentration and problem solving abilities. It also impacts on the ability to retain or remember what is learned through the day.”

There are numerous methods by which we can all improve our sleep, or at least create a situation in which we’re more likely to experience restful sleep. But before addressing those solutions, it’s important first to understand the biological process of sleep and the phases that comprise it.

Sleep is divided into two distinct phases, being Rapid Eye Movement (REM) sleep and Non-REM (NREM) sleep. The majority of sleep is comprised of NREM sleep, which is further broken down into three stages: N1, N2 and N3. During NREM sleep, our heart rate, blood pressure and metabolism are at their lowest levels, while the brain and body recover. During REM sleep, otherwise known as ‘dream sleep’, those levels increase, which aids in learning and memory.

“A healthy adult will cycle through sleep stages throughout the night, starting in light sleep, going through moderate and deeper NREM sleep, and lightening again before entering REM for the first time, about 90 minutes after sleep onset,” says Dr. Kutscher. “The process continues, with 4-5 cycles on average during a single night. Deeper N3 sleep, or slow wave sleep, occurs predominantly in the first half of the night, with progressively longer periods of REM sleep toward early morning.”

Now that we have a basic understanding of the sleep process, let’s discuss the various methods by which we can help ensure restful sleep. Just like an NBA player repeating the same motion to perfect their jump shot, the people that get the best sleep tend to be creatures of habit.

“There a lot of good habits you can adopt to help facilitate a good night’s sleep,” says Lane. “Some will have more impact than others, some will be more possible than others depending on your lifestyle. Incorporating as many as you realistically can will add up to more rest than not trying at all, so you’ve nothing to lose by giving some or all of them a go.”

For starters, identify your ‘sleep window’, and do your best to keep a consistent sleeping schedule.

While most of us naturally feel sleepy and wakeful at specific times throughout the day, those times aren’t consistent from person to person.

“Morning larks feel sleepy early in the evening (7:00-8:00pm) and wakeful early in the morning (3:00-4:00am),” says Dr. Barwick. “Hummingbirds feel sleepy later in the evening (10:00-11:00pm) and wakeful later in the morning (6:00-7:00am). Night owls typically do not feel sleepy until after midnight, often between 1:00-4:00am, and do not feel wakeful until 9:00am or later.”

Once you identify your best sleep window, do your best to adhere to it.

“Going to bed at roughly the same time every night – with no more than a one-hour difference – and getting up at the same time every morning helps to set our ‘internal clock’, or the master pacemaker in our brain,” says Dr. Barwick. “Once that master pacemaker understands our typical sleep-wake pattern, it can help us feel sleepy as bedtime approaches and wakeful as rise time arrives.”

If you have trouble falling asleep, often it helps to develop a relaxing ‘wind down’ ritual that you can repeat each night. “It helps your mind recognize that sleep is on the way and also helps stick to your bedtime,” says Lane.

Additionally, limiting your alcohol and caffeine consumption, as well as screen time before bedtime, are easy steps we can take to help prepare our bodies and minds for a good night’s sleep.

“The blue light emitted from electronic devices can throw your biological clock, and your sleep out of whack,” says Lane. “If you just can’t find a way to cut out the screen time, consider wearing glasses that filter your exposure to blue light.”

If you find that you’re having trouble staying asleep, consider altering your environment to make it more conducive to sleep.

“Sleep leaves us vulnerable,” says Dr. Barwick. “It is risky to be unaware of what is going on around us for hours at a time. That is why our sleep environment must feel safe and comfortable. If possible, banish any sources of stress from the bedroom. Keep only things that you find soothing close by, whether music, pictures, games, or anything else that is relaxing and not too stimulating.”

In general, an environment conducive to sleeping often features any combination of factors, including comfortable mattresses and pillows, the absence of light and noise, and a cool temperature. This is particularly relevant to NBA players, who spend a considerable amount of the season on the road, traveling from hotel room to hotel room.

“I also like to encourage people to turn their clocks away,” says Lane. “Knowing how many hours you have left until you wake up will not make you feel any more rested in the morning. Clock watching will only induce anxiety and frustration and worsen your chances of sleep.”

With the advances of modern technology, we have options at our disposal that can aid in tracking our sleep patterns. Wearable devices such as a Fitbit or Apple Watch are helpful for setting goals and tracking progress, but their applicable use remains somewhat limited.

“These devices are convenient to use because simply wearing them allows you to track a behavior of interest,” says Dr. Kutscher. “However, these devices at the present time are not able to accurately measure sleep since they do not monitor brain activity.”

In some cases, over the counter and prescription sleep aides may be useful, but they are not intended for long-term use, and your best sleep will always be that which comes naturally. In general, if you have concerns or questions about sleep, raise them with a qualified health care professional.

Despite all these recommendations and more, the reality is that even with them, there will be occasions in which we get poor sleep. That will happen to even the healthiest of sleepers, and it’s important to not dwell on that ‘failure’, but rather, learn from it and adapt.

“Just as a professional athlete needs to shake off a loss or poor performance and focus on the next game, it’s best not to dwell on one bad night,” says Dr. Kutscher. “If you listen to your body and trust the process, you can achieve better sleep health.”