Sleep Is Critical for Good Health: Here’s What We Should Do — and Should Not — to Get Better at It

Not getting enough or getting poor-quality sleep has been associated with many health issues, from dementia and depression to impaired immune response and sexual dysfunction. Photo: JGI/Tom Grill/Getty Images

Study after study, research continues to reinforce the importance of sleep. Not getting enough or getting poor-quality sleep has been associated with many health issues, from dementia and depression to impaired immune response and sexual dysfunction.

And just last month the American Heart Association added healthy sleep — seven to nine hours a night for adults — to its list of eight essential lifestyle factors for “optimal cardiovascular health,” with AHA president Donald M. Lloyd-Jones saying, “sleep impacts overall health, and people who have healthier sleep patterns manage health factors such as weight, blood pressure or risk for Type 2 diabetes more effectively.”

So the stakes are high when it comes to getting a good night’s rest.

But what if — like almost half of Canadians, according to a 2017 Statistics Canada report — you have trouble falling or staying asleep at least some of the time. And what if it’s more than some of the time? (A third of us also reported getting less than seven hours of shut eye a night.)

For advice, we asked neuropsychologist Maude Bouchard, a lecturer at the University of Montreal who has been researching sleep for more than a decade and, in 2015, co-founded a virtual clinic to treat insomnia and poor sleep called Haleo.

So many of us report having trouble falling or staying asleep at least some of the time. How do we know if it’s insomnia?

You mentioned it, insomnia is defined as having difficulty falling asleep, staying asleep or waking up too early in the morning, that affects your daily functioning. But for it to be considered chronic, it needs to happen at least three times per week for at least three months.

Screening for sleep disorders is particularly important since some people might think they suffer from insomnia, but in reality they may have a phase delay, i.e., they have problems falling asleep, not because of insomnia, but because they are trying to sleep at a circadian timing that is not optimal for them (for example, too early when they are night owls). A telehealth clinic, like Haleo, can help distinguish between the different sleep problems and their causes in order to treat them.

Aging is considered a risk factor for insomnia. Why is that?

Sleep is a dynamic process that keeps changing as we age. When we are getting older, we spend less time in deeper sleep stages, more time in lighter sleep stages and we tend to wake up more often during the night. This doesn’t mean that we will all have insomnia when we become older. It mostly means that our sleep will become more fragile to disruptions.

Moreover, different life events can impact sleep as we age, such as changes in our level of daily activity, retirement, health problems, pain, medication, grief, mental health problems, etc.

Is there a frequency of waking up at night at which we should be concerned?

It is very normal to wake up during the night for short periods of time. It is, however, less normal to always need a long time (30-plus minutes) to fall back asleep. I would say that the number doesn’t matter that much, except if the awakenings are linked with something else, like sleep apnea (to stop breathing for a few seconds many times during the night).

One good question you can ask yourself regarding your night awakenings is: Am I feeling drowsy/sleepy during the day? If the answer is yes, that could mean that you need more sleep or maybe better quality sleep or even that there is an underlying sleep disorder that prevents you from sleeping well.

Among other poor health outcomes, too little — and too much — and poor-quality sleep has been linked to brain diseases, including Alzheimer’s. Why is sleep so important for brain health?

This is such a good question. Many physiological processes crucial to our physical and mental well-being happen during sleep.

For instance, it is now known that during sleep there are processes that help get rid of waste accumulating in between neurons that are produced by our normal brain activations during the day. This specific process can help clean the brain, and is therefore really important for our cognitive health. In order for it to happen, we need to sleep!

What’s a common behaviour that negatively impacts our sleep? And what’s one that can help us sleep better?

One thing that we don’t talk about a lot is how people tend to compensate for their bad nights of sleep. For example, someone might decide to sleep in, take a longer nap or go to bed earlier the day after a bad night of sleep. Unfortunately, while this can help them get more sleep on a shorter term, all these behaviours can exacerbate an insomnia problem and make it actually more difficult to fall sleep at night.

And one thing we teach through cognitive behavioural therapy for insomnia (CBTi) is how not to compensate after those bad nights.

We ask people to keep a really strict sleep schedule — even if they had a bad night. This way, it allows them to have a better sleep the following night as their sleep drive (which accumulates during the day the longer we are awake) will be higher. This will result in what we call a sleep rebound: which is generally a deeper sleep that will help to recover from previous sleep debt.

To some people therapy may seem drastic to address trouble sleeping. What would you say to them?

Sleep is such a pillar of our health that taking care of it can have tremendous positive outcomes in our daily lives.

CBTi is a behavioral approach and a way to target behaviours and thoughts that are implicated in, and perpetuate insomnia. It allows people to modify their behaviors and thoughts steadily over a few weeks while they learn about sleep physiology and get tools to better manage their sleep. Therapy is a way to be accompanied while you learn how sleep works and what works for you. The fact that licensed therapists are implicated and that this type of therapy has been widely studied by the scientific community can also be reassuring for the public.

This Q&A has been edited for length and clarity.