# RKS: 💤 SLEEP (III) - Promote Healthy Sleep - Drive Away Insomnia

     

# RKS: 💤 SLEEP (III)

PROMOTE HEALTHY SLEEP - DRIVE AWAY INSOMNIA

RKS / 2025-2026 / Ser 7 / Blog 3

1st June 2025

ENSURING OPTIMAL SLEEP

... NATURALLY

Dear Reader,

In yesteryears sleep therapy was pharmacologically defined as successful inducing sleep for 20 hours in a day for an extended period, say 2 weeks. But in today's context the same is neither acceptable nor practical. Various drugs are available which claim to mimic the physiological sleep pattern. But since drugs are besieged with their own shortcomings in terms of side effects, alternative sleep aids have become very popular and widely accepted.

Fig: Worldwide usage of sleeping aids.

In the context of usage of aids for sleeping disturbances the top 10 countries by rank include:

1. Sweden
2. Norway
3. Denmark
4. Singapore
5. New Zealand
6. United States of America (USA)
7. France
8. Canada
9. United Kingdom (UK)
10. Czechia

This last blog of a series of 3 pertaining to sleep and its disturbances claims to unfold various options available besides the doctor-prescribed drugs.

OPTIONS FOR INSOMNIA

• Sleep education

• Relaxation and Meditation techniques

• Cognitive Behavioral Therapy for Insomnia (CBT-I)

• Drugs 

• Nutraceuticals and Supplements

SLEEP EDUCATION

10-3-2-1-0 SLEEP RULE

• 10 hours before bed = no more caffeine
• 3 hours before bed = no more food or drink
• 2 hours before bed = no more work
• 1 hour before bed = no more screen time
• 0 = number of times one should hit the snooze button

80/20 SLEEP RULE

The “80/20 Rule” of sleep entails sticking to regular routine and schedule 80% of the time while allowing 20% flexibility. This flexibility allows the occasional late night or shifted nap timings without impacting the overall sleep habits or throwing one’s circadian rhythm out of whack.

20-20-20 SLEEP RULE

Set your phone timer to remind looking away every 20 minutes at an object that is about 20 feet away for a full 20 seconds. This prevents sleep disruption as well as digital eye strain which otherwise is a reality since seeing the mobile phone when one occasionally gets up at night for urination has become a norm.

30-90 NAP RULE

Scientists found that people who napped for 30 to 90 minutes had better word recall – which is a sign of good memory – than people who did not nap or who napped for longer than 90 minutes. People who nap for that golden 30 to 90 minutes are also better at figure drawing - another sign of good cognition.

RELAXING AND MEDITATION TECHNIQUES

SLEEP TIPS

• A warm shower before sleep is relaxing and the drop in body temperature, as one cools down afterward, precipitates drowsiness.
• Listening to soothing music or reading a book creates a relaxing bedtime habit which could be inculcated.
• Use warm-light spectrum lightbulbs in the bedroom before falling asleep.
• The optimal bedroom temperature between 60 and 67°F (15.6 and 19.4°C) was earlier recommended whilst sleeping. However, at present, between 68 and 77°F (20.0 and 25.0°C) is the sweet spot for ensuring optimal sleep efficiency. 
• Sleeping nude can help the core temperature cool faster and lead to better sleep.
• Sleeping on the floor can make it easier to keep the spine straight during sleep, since there is no worry about sinking too deeply into a mattress. However, there may be a need to use pillows to decrease pressure on spine, such as placing a thin pillow beneath the lower back.
• The best pillow position for sleeping on back is to have head and neck fully on the pillow (but not the shoulders). The cervical spine should be resting parallel to the mattress and head gently cradled in a relaxed position. However, if one doesn't use pillows, the head rests in a natural position.
• Positioning on the side or stomach can help the airways stay open to reduce snoring and alleviate mild apnea.
• If possible, one should wake up around the same time each day.
• Bedroom is to be used only for sleep and sex.

RECOMMENDED LIGHT INTENSITY AT NIGHT

LUX (symbol: lx) (one lux is equal to one lumen per square meter) is the unit of measurement for the amount of light that falls on a surface. The sleep environment should be as dark as possible. The recommended maximum ambient light is 1 lux measured at the eye.

Watts was an indicator of how bright the light was in earlier days. However, lights have gotten much more energy efficient with the introduction of LEDs (light-emitting dioides) and CFL’s (compact fluorescent lamp), so now one cannot tell how bright a light is based on watts alone.

Since buying a light based on brightness, using lumens proves a better guide the bedroom light source should ideally be:

• Incandescent source: 5-10 watt 
• CFL bulb: 1-2 watt 
• LED light: 0.5-1 watt

RELAXING TECHNIQUES

Relaxing techniques which could be employed to induce sleep include:

• Autogenic relaxation: One needs to repeat words or suggestions in the mind that may help relax and lessen muscle tension. For example, one can imagine a peaceful setting.

• Progressive muscle relaxation: In one type of progressive muscle relaxation, one can start to tense and relax the muscles of toes. One then gradually works the way up to the neck and head.

• Visualization: One can form mental pictures to take a visual journey to a peaceful, calming place or situation.

• Deep breathing: Inhaling, holding breath and exhaling for a count of 4, 7 and 8, respectively, is the 4‐7‐8 method of breathing control. The 4‐7‐8 breathing control, which is based on an ancient yogic technique called pranayama, aims at reducing anxiety and facilitating easier sleep if done for 5-10 minutes everyday.

• Massage: For better sleep, consider evening massage (at least an hour before bedtime) focusing on areas like shoulders and neck, and try gentle techniques like Swedish massage or foot reflexology. An hour-long massage is about the equivalent of 7–8 hours of sleep.

• Meditation: 20 minutes of meditation is equivalent to 4-5 hours of deep sleep.

• Tai Chi: 5 minute Tai Chi exercise increases total sleep time, prolongs duration of N2 sleep stage and reduces sleep latency.

• Yoga: Yoga nidra is a type of guided meditation that improves sleep quality, reduces stress, and encourages a deep state of relaxation. The practice involves lying down, breathing deeply, and following the verbal cues that work to calm the mind and melt away tension.

• Biofeedback: This technique teaches users how to calm the body and mind before sleep, leading to a deep and restorative sleep, provided it occurs under the right conditions. During biofeedback, a therapist connects electrical pads or sensors to different parts of the body. These pads might be used to: monitor brain waves to check the temperature of skin, measure muscle tightness, etc.

• Music and art therapy: Music therapy significantly improves subjective sleep quality by calming the autonomic nervous system (ANS) leading to slower breathing, lower heart rate and reduced blood pressure.

• Aromatherapy: For a night of deep and restful sleep, the use of Lavender oil, Cedarwood oils or Bergamont oil can increase the amount of slow- and deep-wave (N3) sleep.

• Hydrotherapy: Balneotherapy (mineral water body immersion such as in the Dead Sea in Israel, the Kangal hot spring in Turkey and the Blue Lagoon in Iceland) and spa therapy, similar to hydrotherapy, can affect some hormones such as histamine and serotonin to thereby influence sympathetic nerves and thereby regulate body temperature leading, in turn, to improved quality and increased quantity of sleep. 

CBT-I

CBT-I is a short, structured and evidence-based approach to combating the frustrating symptom of insomnia. CBT-I can effectively address insomnia by modifying thought patterns and behaviors that hinder sleep, often leading to better sleep quality and reduced reliance on medication.

DRUGS

Hypnotics and sedatives are both central nervous system (CNS) depressants that can cause drowsiness and help people sleep. The main difference between the two is their intended use. Hypnotics are used to help people fall and stay asleep, while sedatives are used to calm people and reduce anxiety.

Benzodiazepines (BZD) receptor agonists (BzRAs) (alprazolam, diazepam, lorazepam amongst others), melatonin receptor agonists, selective histamine H1 antagonists and non-selective antihistamines, antidepressants, antipsychotics as well as anticonvulsants have been traditionally considered for insomnia management. 

In addition to abuse and dependence, other major risks associated with BzRAs use include the following: cognitive impairment, daytime drowsiness, increased reaction time, ataxia (unsteadiness whilst walking) and anterograde amnesia (inability to form memories from a new event). Even non-BzRAs (zolpidem) do not appear to consistently alter the disturbed sleep stages.

NUTRACEUTICALS & SUPPLEMENTS

Most of insomniacs do not prefer a pharmacological approach for insomnia treatment and often switch to alternative treatments such as nutritional supplements. If insomnia is to be comprehensively benefitted the following should be facilitated by the nutraceutical / nutrient:

• Non-Rapid Eye Movement (NREM) Sleep: shorten N1 as well as lengthen N2 & N3 stages.
• Rapid Eye Movement (REM) sleep requires to be normalized.
• Electroencephalogram (EEG) recording of brain waves: increase K-complexes and sleep spindles.
• Ultradian sleep / wake cycle to be restored.
• Circadian hormonal clock to be reset.
• Synaptic plasticity to be enhanced.
• Stress relief is invariably sleep-inducing.
• Anxiety and depression concomitantly present need to be tackled.

The 4 best natural herbal sleep aids include: 

1. Chamomile
2. Hops
3. Tart cherries (Prunus cerasus)
4. Valerian

These can be supplemented by magnesium, L-tryptophan (an amino acid) and αS1‐casein (a protein component in milk) for enhancing the effect of ingredients being consumed for managing insomnia. For the stubborn insomniacs, the intake of melatonin can spell magic.

CONCLUSIONS

The perks of good sleep are:

• Reduce stress: cope better with life’s ups and downs.
• Improve mood: get along well with people.
• Think more clearly: increase in attention span.
• Form long-term memories: and do better in school and at work. 
• Make good decisions: avoid injuries — for example, drowsy drivers cause thousands of car accidents every year.
• Get sick less often: boosting of immunity.

Improving sleep quality can boost cognitive performance, promote sharper thinking and may reduce the likelihood of aging-related cognitive decline. Memory, an essential component of cognition, can be segregated as:

1. Conscious (declarative / explicit) which is the memory of facts, data and events; and
2. Unconscious (nondeclarative / implicit) is the memory of how to do things.

Declarative memory consolidation requires to ensure adequate N2 and N3 NREM sleep stages. However, for non-declarative memory consolidation, REM sleep adequacy is necessary. The unconscious is a long-term memory subtype which aids the performance of particular types of tasks without having conscious awareness of these previous experiences. Like for example whilst driving one does not need to concentrate but always subconsciously remembers the coordination required for accelerating, braking, changing gears, etc.

Summing up, for sharper thinking, better memory, and longer living sleep for an optimal of 7 hours each day. It doesn't matter if the sleep is not in one stroke at night - even multiple times sleeping (polyphasic sleep) during the day totalling to 7 hours will do. 

Will sleep credit build up benefit longevity? The data is skewed and indeed interesting to note.

There is credit / debit account of sleep maintained in the SCN of the brain hypothalamus:

Sleep debit / credit = Recommended amount of sleep (week) - Hours slept (week)

That's why the idiom: 'Eat, Drink and Be Merry' could now rightly re-phrased as be - 'Eat, Sleep and Be Merry'!

DR R K SANGHAVI

Prophesied Enabler

Experience & Expertise: Clinician & Healthcare Industry Adviser

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