Sleep Hygiene

Sleep gets a fraction of the attention we give diet and exercise, and it should not. Research from Dr. Ari Shechter at Columbia University has shown that poor sleep feeds obesity, diabetes, hypertension, and heart disease. It costs people their daily functioning, and underneath that it is quietly setting long-term disease risk. It is not a secondary problem.

When I ask patients about sleep, I keep it practical. When did this start, and is it new or has it always been like this? What is the bedroom like, too warm or too bright or too loud? Do they snore, gasp, or stop breathing, which points toward apnea? Any crawling or tingling in the legs, which points toward restless legs? I ask about weekdays versus weekends, because an irregular schedule can look exactly like insomnia. And I ask about caffeine, alcohol, nicotine, and medications, which patients rarely volunteer.

Formal tools give the conversation structure. The Epworth Sleepiness Scale is quick for daytime sleepiness. The Pittsburgh Sleep Quality Index is broader. STOP-Bang and the Berlin questionnaire flag possible apnea. The Insomnia Severity Index tracks both severity and how much it is costing someone functionally.

For objective data, in-lab polysomnography remains the standard for apnea, limb movement disorders, narcolepsy, and REM sleep behavior disorder. Wrist actigraphy at home gives a more practical picture of sleep and wake patterns over time, which is often what I actually need.

Adults should target 7 to 9 hours, and children and teenagers need more. Hours alone do not settle it. Timing, efficiency, and how someone feels the next day all matter. Patients tell me constantly that they are in bed for eight hours and wake up unrested. That is the point where efficiency and awakenings become the more useful thing to look at.

The consequences of chronic short sleep are well documented. It shifts ghrelin and leptin in the direction of more hunger and weight gain (Spiegel et al., 2004). It degrades glucose control and raises diabetes risk (Tasali et al., 2022). Hypertension, coronary disease, and stroke all track with insufficient sleep, and long-standing sleep problems are associated with cognitive decline and dementia risk (Vorster et al., 2024).

Causes are usually layered. Behavior contributes: irregular schedules, screens late, heavy meals and alcohol close to bed. So do physiologic and psychological factors: apnea, restless legs, anxiety, chronic pain.

Practical work starts with sleep hygiene. A consistent schedule resets circadian rhythm. Bedrooms should be cool, dark, and quiet. Bright light late interferes with sleep onset. Evening caffeine and alcohol come down. A wind-down routine, reading or stretching or a warm shower, makes the transition easier.

Daytime habits matter more than patients expect. Morning light anchors circadian rhythm. Even ten minutes of aerobic activity improves sleep depth. And for anyone waking in the night, what they do next shapes the rest of it: awake more than twenty minutes, get up and do something quiet in dim light rather than lie there getting frustrated.

The behavioral approach I use most is stimulus control. The principle is simple, which is rebuilding the association between the bed and sleep. Go to bed only when sleepy. Use the bed for sleep. Leave it if sleep is not coming. I have watched patients with years of insomnia retrain themselves this way. One had been scrolling his phone in bed for hours every night; once he started leaving the room when sleep would not come and only returning when he felt drowsy, his sleep onset shortened within a few weeks and the nightly frustration went with it.

Sleep is a medical necessity, and it belongs in routine care alongside everything else we screen for. Taking it seriously improves rest, and it also improves cardiometabolic health, mental health, and how people feel about their days.

Scott Rennie, D.O.

References

Shechter A. Improving Sleep in Your Patients. Columbia Cornell Obesity Medicine Course, 2024.

Spiegel K et al. Ann Intern Med. 2004.

Tasali E et al. JAMA Intern Med. 2022.

Markwald RR et al. PNAS. 2013.

Vorster A et al. Clin Transl Neurosci. 2024.

Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Insomnia is one of the most common problems I deal with. A few bad nights bleed into everything: work, mood, patience, appetite. Patients usually open the visit asking about pills or supplements, and I understand why. Sleep feels like something that should have a switch. Most of the time the answer is duller than a prescription and works better, which is a hard sell at nine at night when someone has been staring at the ceiling for a week.

How Much Sleep Do We Need

Seven to nine hours suits most adults. Under six on a regular basis carries real risk, and routinely running past nine is its own signal that something else is going on. The exact number moves from person to person, and I put more weight on how someone functions at four in the afternoon than on the number they report.

What Sleep Actually Does

Sleep is repair time. It consolidates memory, sharpens focus, and steadies the emotional baseline, which is why a rested person absorbs a bad day and a chronically tired one doesn’t. It supports immune function, cardiovascular health, and metabolic balance. The long-run associations with longevity and lower rates of chronic disease are consistent enough that I treat sleep as a vital sign rather than a lifestyle detail.

The Cost of Short Nights

Chronic sleep loss shows up in obvious ways and quiet ones. Fatigue, irritability, work that slips. Those are the complaints people bring. What they usually do not connect to sleep are the things that accumulate over years: hypertension, diabetes, heart disease, obesity. Immunity weakens, which is why the poor sleepers in a household tend to be the ones who catch everything going around. Anxiety and depression travel with chronic insomnia in both directions, each making the other worse. Cognitive decline is the long-horizon concern, and it is the one patients ask about most once they hear it.

Medications for Insomnia

Short-term use can help. None of these drugs are free of risk, and I’d rather say so plainly than bury it at the end of a list.

Zolpidem (Ambien) helps with both falling asleep and staying asleep, though daytime drowsiness and the odd nighttime behaviors are well documented. Zaleplon (Sonata) is shorter acting and suits the patient whose whole problem is sleep onset. Eszopiclone (Lunesta) covers onset and maintenance, and the metallic taste is a common enough complaint that I mention it before someone calls about it. Temazepam (Restoril) is a benzodiazepine, still prescribed, and carries the most dependence risk of the group.

Shortest effective course, every time. These work best as a bridge while the behavioral changes take hold, not as the plan itself.

Supplements

Melatonin is the one everybody has already tried. It earns its place in circadian problems, delayed sleep phase and jet lag especially, and sometimes in mild insomnia. One to five milligrams is the usual range, and timing matters more than dose, which is the part most people get wrong. Magnesium is worth considering in patients who are actually deficient. Leafy greens and nuts are good sources. Supplements are gentler than prescription hypnotics, and they won’t touch the underlying driver of chronic insomnia.

In my opinion, the most effective and lasting treatment is better sleep hygiene. Patients who hold a consistent schedule, same bedtime and same wake time seven days a week, often notice a difference within a few weeks. Cool, dark, quiet. Screens and blue light in the last hour before bed work against the transition.

Routine matters more than people expect. Reading, stretching, meditation, anything repeated nightly trains the body to wind down on cue. Caffeine, nicotine, and alcohol all interfere and are best kept well away from evening. Daylight exercise helps; a hard workout an hour before bed usually doesn’t.

One small change that pays out more than it should: turn the clock away from the bed. Patients who wake at three and check the time start doing arithmetic about how much sleep is left, and the arithmetic keeps them up longer than the original waking would have.

Keeping a Sleep Diary

When insomnia persists, a diary earns its keep. Bedtimes, wake times, awakenings, caffeine, stress, exercise. Two weeks of honest entries usually surfaces a pattern nobody had noticed, and reviewing it together tends to point at a small, specific change rather than a large vague one.

When to Seek Help

If the problem holds after the schedule and the environment have genuinely been addressed, it needs a proper evaluation. Sleep apnea, restless leg syndrome, anxiety, and depression all hide behind a complaint of insomnia. Treating the thing underneath is what fixes the sleep.

Scott Rennie, D.O.

Sources

National Institutes of Health Office of Dietary Supplements. Magnesium Fact Sheet for Health Professionals. https://ods.od.nih.gov/factsheets/Magnesium

National Sleep Foundation. How Much Sleep Do We Really Need? https://www.thensf.org

Centers for Disease Control and Prevention. Sleep and Sleep Disorders. https://www.cdc.gov/sleep

American Academy of Sleep Medicine. Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults. J Clin Sleep Med. 2017;13(2):307-349.