July 12, 2023

Good Sleep Hygiene: More Than Just a Bedtime Routine

By Clara Schlemeyer, RLS Foundation Program Coordinator

Sleep hygiene is always a sensitive subject when you have an underlying sleep condition that stops your sleep in its tracks. Sleep hygiene is not simply about crafting and sticking to a bedtime routine; sleep hygiene encompasses your daytime habits, in addition to your evening and nighttime habits. In this article, you will learn the science of how sleep works, the effects of poor sleep on overall health, how your internal circadian clock works and some helpful tips on how to achieve better sleep. This will give you some insight into the importance of maintaining and implementing a healthy sleep-wake schedule.

Studies have shown the tremendous complexity that is “sleep” and how it affects virtually all body systems. Lack of sleep in adults has been correlated to a broad range of negative health consequences that include cardiovascular problems, compromised immune function, insulin resistance, higher risk of obesity, cognitive dysfunction and mental health problems. Sleep is an essential biological function, and it is a time for your brain to restore and heal after a long day.

SLEEP ARCHITECTURE

When you first drift off to sleep, there are almost immediate changes in both the brain and the body. Your body temperature drops, brain activity goes down, your heart starts beating slower and your respiration slows.

There are four different sleep stages that you experience each night. The first three are categorized as non-rapid eye movement (non-REM) sleep, and the final stage is REM sleep. Stage one occurs just as we fall asleep. It is very light sleep and when woken up during this stage, most people will not be sure that they were actually asleep. Stage one sleep is what allows people with sleep apnea to take a breath again. When someone stays in stage one sleep, which is non-restorative sleep, they are often very sleepy in the daytime. This does not happen to people who have lots of stage two sleep.

When you transition into stage three, you experience some of your deepest sleep as your muscles relax and your brain activity slows. Researchers believe the recuperation of the body and brain happens at this time. Stage three sleep varies dramatically with age. Children may spend 30% of their sleep in stage three, while seniors may have little or no stage three sleep.

REM sleep is the fourth stage of sleep, lasting about 10–60 minutes in short episodes that increase in duration towards wake time. In REM sleep, activity in the brain and most of the body pick up significantly. The skeletal muscles experience temporary paralysis. The REM sleep stage is often believed to be critical for the brain, enabling important functions like learning and memory.

Sleep architecture is the structure of a person’s stages of sleep and cycles throughout a night. Each stage is essential to a person’s overall sleep architecture, which affects sleep quality.

THE MASTER CLOCK IN THE BRAIN: BREAKING DOWN CIRCADIAN RHYTHMS

Circadian rhythms are 24-hour cycles that coincide with the body’s internal clock, which executes essential functions and processes throughout the body. The most commonly known and important circadian rhythm is the sleep-wake cycle. The body’s master clock is directly impacted by the surrounding environment. This is why circadian rhythms are tied to the cycle of day and night.

The hypothalamus, a part of the brain, is home to the suprachiasmatic nucleus (SCN), which is highly sensitive to light and acts as a cue for brain signals to coordinate the internal clocks in the body. There are other cues that can affect the master clock, but light is the most powerful stimulus. During the daytime, exposure to light causes the master clock to send signals that generate alertness. As the day winds down, the master clock initiates the natural production in the brain of the hormone melatonin, which promotes sleep.

START SMALL AND WORK YOUR WAY UP

There are many ways to improve your sleep hygiene and cultivate healthier sleep. There is no one-size-fits-all approach. It is important to determine what works for you and implement tactics that fit your lifestyle. The Sleep Foundation has broken down sleep hygiene tips into four categories to make them more approachable.

1. Transform your bedroom environment:
• Choose a mattress and pillow that ensure your comfort and promote relaxation. Find a favorite pillow and comfortable mattress that will ensure a good night’s sleep.
• Get good quality bedding that is comfortable to the touch and will help you maintain a temperature comfortable to you throughout the night. Bedding such as a new mattress or pillow is key to promoting sleep. There are sheets and mattresses that have a cooling or warming effect.
• Reduce light disruption. A cool, dark, quiet environment is conducive to sleep. Blackout curtains can help achieve a darker environment. Earplugs and a sleep mask are other items that can help to limit light and sound in the bedroom.
• Keep noise to a minimum to elevate your sleeping. Try noise-canceling headphones, ear plugs, or machines or phone apps that create ambient noise (white, purple, rain, etc.).
• Decide an ideal room temperature, since being too hot or cold can distract you from a good night’s rest although it is known that people tend to sleep better in cooler environments.
2. Improve your sleep schedule:
• Try to go to sleep and wake up at the same time every day, even on weekends. It is nearly impossible to get accustomed to a sleep routine when you are waking up at different times. Consistency is vital to maintain healthy sleep and the wake time consistency is much more important than bedtime.
• Be wary of naps. If you nap for too long or too late in the day, there is a risk of disruption to your sleep schedule. If you enjoy a nap during the day, no worries! Try to nap after lunch in the early afternoon; it’s proven that a 20-minute nap is ideal. However, for patients with significant bedtime insomnia, napping should be discouraged.
3. Cultivate a bedtime routine:
• Don’t just jump into bed. Winding down for approximately 30 minutes can help you drift off to sleep with ease. Reading, stretching, listening to soothing music or doing relaxation exercises can help put your mind and body in the mood for a great night’s rest.
• Follow a set bedtime routine. Habitual actions are correlated to specific cues that tell your brain that you are almost ready for sleep.
• Turn down the lights. Bright lights can affect the production of melatonin in the body.
• Adjust devices, tablets, cell phones and laptops. These light- emitting devices can keep your brain awake. The more interactive the device, the bigger the impact on falling asleep. Keep the blue light down and change to orange/red light for 3 or more hours before bedtime. Most LCD screens (cell phones, computers) have a setting option to turn the light red and lower in the evening. It is recommended to disconnect at least 30 minutes prior to climbing in bed.
4. Create healthy habits during the day:
• Get daylight exposure. Natural light in the morning and early afternoon supports consistent and high-quality sleep by driving your circadian rhythm and aligning your sleep-wake pattern. For those unable to get outdoors, there is a bright light therapy box to simulate natural light.
• Try to incorporate movement into your daily routine. Activity promotes health across the board and can help make it easier to sleep at night. A short 20-minute walk can transform your day and help you get to sleep at night but don’t exercise too close to bedtime as that can hype your brain up.
• Reduce the amount of caffeine you consume after lunchtime. Caffeine can take up to seven hours to be fully out of your system.
• Plan mealtimes. It is best to avoid heavy meals two to three hours before bedtime to avoid still digesting when getting ready for bed.
• Reduce alcohol consumption in the evening. Alcohol can make it easier to fall asleep but has been shown to disrupt sleep later in the night when you are in the important stages of REM sleep. Also, avoid caffeinated beverages too close to bedtime.
• To cultivate a healthy relationship with sleep, try to limit the activities in bed to sleeping and sex only.

TIPS FOR WHEN YOU CAN’T FALL ASLEEP

Whether you have just crawled into bed or woken up in the middle of the night, here are some tips to help you fall asleep: 1. Don’t toss and turn in bed in the hopes of getting to sleep. This can create a connection in your brain between frustration and your bed. Try walking around for a couple of minutes, reading in low light, or doing something relaxing or very boring before returning to bed when you feel sleepy. 2. Avoid checking the time. Constantly checking the time can increase anxiety about sleeping and in turn make it harder to fall back asleep. 3. Record your sleep. A sleep log or journal can help identify patterns that may be hindering your sleep. If you are implementing new sleep hygiene tactics, track the changes and see how well they are working for you. A sleep diary may help your doctor get a better idea of your day-to-day habits and a clearer picture of your sleep.

To benefit from these sleep tips, it is essential to incorporate them into your daily life. It can be overwhelming to completely restructure your relationship with sleep. Start small and work your way up. Stick with your changes. You may not see the benefits right away, and that’s okay. Maintaining your plan may very well pay off over time.

Life happens, so you may not be able to follow your curated routine every single day. Give yourself some grace and set realistic expectations that are attainable for you!

Sweet dreams.

May 4, 2022

The Sleep Community Rallied

The RLS community responded quickly to a recent Action Alert to request our Representatives to sign on to a bipartisan letter in support of sleep disorders and sleep health disparities. On April 25, 2022, an amazing total of 36 U.S. Representatives signed that letter, which is very impressive by Congressional appropriations letter standards.

Meet the 36 Co-Signers

Please join us in thanking the bipartisan group of 36 Representatives who joined the letter including:

What If Your Representative Didn’t Sign On?

If your Representative did not sign on, it does NOT mean they didn’t support your request. All have the option to put in their requests using a confidential process rather than this public process. Also, if your Representative serves on the subcommittee that the letter is addressed to, they would not need to sign on. Securing these 36 co-signers could not have happened without all of the great efforts from this RLS community!

Thank You!

We extend a special thanks to Congressman Adam Schiff and his office for championing this letter once again this year. Thanks to all the Congressional Offices who responded to their constituents’ requests and signed on.

Thank you to all in the RLS community who reached out, shared their RLS story, and made their representative aware of the needs of their constituents: increased funding and more awareness for sleep disorders.

March 30, 2021

"Congressional Sign On Letter" for Sleep Disorder Research, Education and Awareness

Background

For the third year in a row, an official Congressional Sign On Letter will be sent to the Appropriations Committee asking them to prioritize support for sleep and sleep disorders research and awareness. To be effective, we need your member of the U.S. House of Representatives to "sign on."

Urgent Deadline Approaching

Your Congress Person will only join if YOU (the constituent) ask, and the final deadline is April 8. Take action TODAY, it is imperative! Here’s how:

1. Provide us with your name, address and email here. Include your Representative's name - go to www.house.gov and enter your zip code in "Lookup" to confirm your current member of House of Representatives.
2. Within 24 hours we will return text that you can copy and paste into an email (sample below) along with the email address for the staffer that handles healthcare for your district.
3. Insert staffer's email, cc: clara@rls.org and Press SEND!

Thank you for joining our RLS advocacy efforts by raising your voice for RLS, sleep and sleep disorders!

-----*SAMPLE PERSONALIZED REQUEST EMAIL*-----

To: [first.last]@mail.house.gov
Cc: clara@rls.org
Subject: Sign On Letter – Sleep Community

Dear [Staffer],

My name is [Your Name] and I am a constituent from [City, State]. I am also an advocate for the RLS and sleep disorders patient community. I hope your office will join the attached sign on letter, which supports the community’s appropriations recommendations for FY 2022. To join this letter, please contact Heather Connelly at heather.connelly@mail.house.gov by April 8.

Thank you for your time and for considering this request.

Sincerely,
[Your Name]
[Your Address]
[City, State Zip]

ATTACHMENT: FY22 Sleep Disorders DC and Sign on Letter

Act NOW! Send us your request by April 5!

Please submit your information now, you will receive a personalized email to send to the appropriate health staffer within 24 hours. All requests must arrive before April 5 to meet the email deadline of April 8.

Help Us Keep Sleep Disorders in Department of Defense Medical Research Program

Action Alert: Residents of Alabama, Alaska, California, Hawaii, Illinois, Kansas, Kentucky, Maine, Mississippi, Missouri, Montana, New Mexico, Rhode Island, South Carolina, Tennessee, Vermont, Washington, and Wisconsin

The Department of Defense (DOD) is finalizing the list of conditions eligible for funding through their Medical Research Program, and we need your help to ensure that sleep disorders like RLS stay on that list! Send us your RLS story about why more research is needed and we will deliver the letter to your legislator.

With your help, we will contact all Senators serving on the Defense Appropriations Subcommittee and ask that they continue to support the inclusion of "sleep disorders" as conditions eligible for study through the Department of Defense Peer-Reviewed Medical Research Program during the Fiscal Year (FY) 2019 appropriations process. 

Background

Each year, the United States Senate crafts an annual DOD appropriations bill, which includes a list of conditions that are deemed “eligible for study” through the Peer-Reviewed Medical Research Program (PRMRP). In order for a condition to be included, Senators need to support the condition and officially ask for its inclusion. Senators have many competing appropriations priorities and in order for them to support a condition-specific request, they need to be educated and asked to do so by their constituents (You).

As a result of grassroots outreach, the Senate has recognized sleep disorders as a condition eligible for study annually for a number of years. This support allows RLS medical researchers to compete for nearly $300 million in federal research funding each year.

Senators are currently working on the FY 2019 DOD appropriations bill and deciding which conditions will be included on the next PRMRP eligible conditions list. Being included on the list one year is no guarantee of being included again in the next year. At this critical juncture, please reach out to the offices of your Senators and ask that they once again support the inclusion of “sleep disorders” in the DOD PRMRP’s eligible conditions list in FY 2019.

Take Action

1. Please consult the list below and see if one of the Senators from your state serves on the Defense Appropriations Subcommittee.

Senate Defense Appropriations Subcommittee Members

Thad Cochran, Mississippi
Dick Durbin, Illinois
Mitch McConnell, Kentucky
Patrick Leahy, Vermont
Richard Shelby, Alabama
Diane Feinstein, California
Lamar Alexander, Tennessee
Patty Murray, Washington
Susan Collins, Maine
Jack Reed, Rhode Island
Lisa Murkowski, Alaska
John Tester, Montana
Lindsay Graham, South Carolina
Tom Udall, New Mexico
Roy Blunt, Missouri
Brian Schatz, Hawaii
Steve Daines, Montana
Tammy Baldwin, Wisconsin
Jerry Moran, Kansas


2. Send us your RLS story via SurveyMonkey!
3. The RLS Foundation will complete the letter template with your story and deliver it to your Senator's office.

Your support is invaluable to the Foundation's advocacy efforts, and we will continue to fight for more funding for research that will help us identify better treatments and a find cure for RLS. You can help make a difference in the lives of thousands living with RLS. Send us your story today!

Don't live in these key states? Your US senators and representatives still want to hear from you – their constituent. It is straightforward and simply a matter of telling your story, sharing your experience and asking them to take your needs into consideration. Want to get involved? Visit the advocacy page of the RLS Foundation website to find out how you can take action now!

Promoting Awareness – One Gift Membership at a Time

By Barbara Faraone

When long-time RLS Foundation member Barbara Faraone sees the need for education, she takes action! In the past several years, Barbara has purchased over 25 RLS Foundation gift memberships for physicians, nurses, pharmacists, hospital administrators and others to promote education and awareness about RLS. At the RLS Foundation, we are extremely grateful to individuals like Barbara who use whatever creative means they have to raise awareness for RLS. Barbara, thank you for making a difference – you are truly an RLS hero!

I’m a 79-year-old grandmother who has suffered with restless legs since at least 18 years old, although I suffered from leg pains (or as the doctors used to say, “growing pains”) from a very young age. I remember going to high school and being so glad that classes were only 45 minutes long. I would always try to sit in the back of the room, as I was always moving about. I was often asked why I never sat still. I never really had an answer for people, but thought it was just me.

Even going to college, my place was always in the back of the room; it was just plain uncomfortable to sit, and I preferred to stand. Thus, standing in the back of the room was enjoyable for me.

I became a teacher of third grade, and that suited me just fine. I never sat at my desk. I was always about the room with my children, working on projects or just tutoring one-to-one, thus walking a lot. With age came marriage and two children. This, too, was always an active time for me. It was during this time that I began to notice that sleeping with covers over my legs was not good for me. The pressure of blankets just made my kicking in bed worse. I was never one to cuddle in bed, as the legs would not stay still. I did not know what to do to stop this kicking, and it was not welcome to my husband, as you can imagine.

As years followed, I found myself being awake for many nights and often going from bed to couch to floor. I tried sleeping with my back on the floor and legs up on the wall or the back of the sofa. I tried hot baths, warm milk, Bengay, soap under the mattress, and any other odd suggested thing to try, of which there were many. I must say that a scotch and water would often calm them during the evening, but it did not last through the night.

I soon learned to exist on three to four hours of sleep and sometimes an afternoon nap. I just figured it was something I had to live with. I might add that I had all the muscle and nerve tests done over a period of years, but nothing seemed to show up wrong.

Doctors were of no help until my general practitioner went to a lecture about RLS at the local hospital. When he came back from this, we started in on the approved medicines available at the time. That was some 20 years ago. Since then, I have tried them all in many combinations. They would seem to work, but within a short time I was right back to my old self of discomfort most of the night. When the discomfort turned to pain, I began the treatment of painkillers. Yes, they worked, but got to be an all-day thing. And oh my, what it did to my system and mind. This was awful. I had to come off them.

I went to an RLS meeting in San Antonio and met the folks there. With their help, I made contact with a specialist at an institution that is now a certified RLS Quality Care Center. I call him my “savior,” as with his help and methadone, I do sleep, and my life is somewhat normal – or what I think of as normal. My legs are not really still during the day, but my friends have gotten used to me always moving. Thank goodness for friends.

My legs hurt most of the day, but during the night they are quiet enough that wherever I fall asleep, I sleep – whether it be in bed or on the couch.

Now, I have asked for years, what can I do for others who have RLS? Yes, I can contribute to the RLS Foundation, and it does help, especially in research. But I feel that I need to do something more to help educate medical providers.

So … I have been buying RLS Foundation memberships for all the doctors I meet in the hopes they will read NightWalkers and maybe learn something. Maybe they will believe what I say to them.

For example, I found a local hospital was advertising that they treated RLS. I went to see the doctor, only to find out he knew nothing of RLS. In fact, he called my druggist, as he thought I was addicted and needed help, and had no idea the uses for methadone. My druggist, who has a subscription to NightWalkers, gave him a 15-minute lecture as to the uses of methadone. I had the RLS Foundation send the doctor and hospital administrator a gift membership with information about RLS and a copy of NightWalkers.

I think my count of current gift memberships is up to something like 12 doctors and hospital administrators, and then I add friends or nurses or whomever needs an education about RLS. Has it made a difference? I don’t know, but I do know they are getting the correct information, and this can only help in the future.

An excerpt from the Summer 2016 edition of NightWalkers, the Foundation's quarterly magazine. Become a member today to receive this and other member benefits!

Helpful Links for RLS Sufferers who Want to Learn More

Below is a presentation from the Foundation's 2016 educational webinar series, "Coping with RLS and What Sleep Deprivation Does to You." This webinar is presented by Dr. Jeffery Durmer, CMO of FusionHealth and member of the RLS Foundation Scientific and Medical Advisory Board. Visit www.rls.org for more information about our webinar series and other Foundation programs!



Additionally, this Buzzfeed article has some great infographics about tips for getting a good night's sleep!

Important Tips to Help with Your Sleep Cycle

For RLS sufferers, it is oftentimes nearly impossible to fall and stay asleep. Many have reported to the Foundation that they get as little as 2-4 hours of sleep per night. When the recommended amount of sleep is 7-9 hours each night, such little sleep can have debilitating effects on waking life.

However, it is recommended for those with RLS to get at least 30 minutes of exercise a day, as regular exercise can significantly improve and stabilize the sleep cycle. Studies from the National Sleep Foundation have continuously shown us that:

1. Exercise reduces stress and tires us out, allowing us to have a longer and better quality sleep
2. Sleep disorders like insomnia, sleep apnea, restless legs syndrome, and narcolepsy cost millions in medical costs and disrupt work and social lives
3. Those that exercise report getting a better quality of sleep than those who do not, and are less likely to have sleep issues

Exercise in the early hours of the morning or afternoon can have a positive effect on the natural circadian rhythm, or "sleep-wake cycle." Exercise raises the body's temperature for roughly four to five hours before gradually falling, thus helping one feel sleepy in the evening around bedtime. However, it is important to note that especially for RLS sufferers, rigorous exercise before bed should be avoided, since it can stimulate the brain and prevent one from falling asleep.

Meditation, yoga or light stretching are great options for easing RLS symptoms before bed, as they can help settle both the mind and body. Additionally, the Foundation's Sleep Diary is a great resources to help find sleep cycle patterns and potential RLS triggers.

Other suggestions for getting a good night's sleep include avoiding technology before bed, sticking to a consistent schedule and cultivating a relaxing evening ritual for yourself. Remember to refrain from any activity that your doctor has specifically told you to avoid. Read more about healthy lifestyle habits for RLS sufferers on our website.

Check out the original article about sleep and exercise and its great infographics at CapeCod.com.

Both Conditions Have Serious Consequences on Sleep Cycles

Like restless legs syndrome, migraines can be horribly debilitating. According to the Mayo Clinic , "a migraine can cause severe throbbing pain or a pulsing sensation, usually on just one side of the head. It's often accompanied by nausea, vomiting, and extreme sensitivity to light and sound."

In fact, two-thirds of individuals that participated in the Migraine in America 2016 survey , reported that their symptoms lasted five days or more. That's more than five days of excruciating pain, sometimes enough to be disabling.

To make matters worse, one in six reported that they also experience restless legs syndrome during a migraine attack. These are two serious conditions that interfere with sleep, potentially resulting in a decreased quality of life.

In fact, 66 percent of survey respondents said that lack of sleep could bring on a migraine. The irony is that migraines make it nearly impossible to fall into a restful sleep, yet sleep is one of the best tactics at soothing a migraine.

Read more about migraines and their adverse affects on various aspects of life in Reader's Digest.

Insufficient Sleep Cited as Public Health Problem

According to the Centers for Disease Control and Prevention (CDC), more than one third of adults in the United States fail to get a sufficient amount of sleep on a regular basis. In fact, many of these people are actually suffering from sleep disorders.

A sleep disorder is defined by any change in the way you normally sleep. Some of the more common examples include insomnia, sleep apnea, narcolepsy and restless legs syndrome (RLS) .

Symptoms of a sleep disorder involve irritability upon awakening and problems concentrating, and can lead to an overall decreased quality of life. Specifically, restless legs syndrome can prevent falling and staying asleep, resulting in unrefreshed sleep cycles and serious daytime fatigue.

Read the full article from Oklahoma Magazine here .

The Link Between Sleep Disorders and Cardiovascular Health

On Sept. 19, the American Heart Association released a scientific statement confirming that sleep disorders, like obstructive sleep apnea and insomnia, are associated with negative cardiovascular health.

The American Academy of Sleep Medicine and the Sleep Research Society recommend that adults get in at least seven hours of sleep every night. However, this is rarely the case. In fact, according to the National Heart, Lung and Blood Institute, roughly 50 - 70 million adults in the U.S. each year report insufficient sleep or suffer from a sleep disorder.

With these new findings in mind, it was suggested that the AHA focus on sleep behavior through a public health campaign concerning proper sleep habits, as well as educating clinicians on how to screen for sleep disorders. Additionally, it was recommended that the impact of other sleep disorders, like restless legs syndrome and periodic limb movement , be tested for their relation with cardiometabolic risk.

To read more about the AHA's statement, check out this article featured on Cardiovascular Business.