This week, March 6 – 13, is National Sleep Awareness Week, so it’s a good time to review healthy sleep habits. I see a lot of adults and teens in my clinic who are chronically tired and have troubles sleeping — both falling asleep and staying asleep.

How Much is Enough?

According to the National Sleep Foundation’s research, here’s the amount of sleep we need:

• Newborn (0-3 months): 14-17 hours
• Infant (3-12 months): 12-15 hours
• Toddler (1-2 years): 11-14 hours
• Preschool (3-5 years): 10-13 hours
• School age (6-13 years): 9-11 hours
• Teenager (14-17 years): 8-10 hours
• Adult (18-64 years): 7-9 hours
• Older adult (>65 years): 7-8 hours

One of the main problems with insufficient sleep is the daytime sleepiness, an obvious consequence of not sleeping enough. A fascinating series of tests in children showed that insufficient sleep and daytime sleepiness both lead to worse school performance. Most of these children went to bed at 9-9:30 am and almost all got up at 7 am, causing a daily sleep debt of 1/2-1 hour for many children. While that may seem like a small amount, like any debt, it must be paid back, and most children cannot recover all of this lost time by sleeping late on weekends.

One good bit of news from the same study describes how delaying school start times even by just a half hour can significantly improve sleep duration and daytime sleepiness. In their interventional study with six primary schools in Shanghai, delaying school openings from 7:30 to 8 or 8:30 gave the children almost an hour of extra sleep — and more importantly, less complaints of daytime sleepiness. This fits with studies in other parts of the world and supports the growing movement, led by pediatricians, to delay school opening times to 8:30 am. Just doing this could allow better sleep and improved test scores for all students!

Besides school performance, poor sleep also leads to an increased risk of overweight and obesity in children (as well as adults). A 2007 meta-analysis of 36 studies across the world showed a strong, independent association between short sleep duration and weight gain in children, which continues into adulthood.

For adults,  poor sleep can cause long-term problems with high blood pressure, depression, diabetes and obesity. It can also cause dangers such as sleeping behind the wheel or more errors at work (medical training and internships are notorious for this, as are night shift workers driving home).

My tips for sleeping well

Get all screens out of the bedroom. Technology is changing so quickly that it’s difficult for research to keep up. But it’s clear that many people are having a lot more sleeping troubles when using their iPads and cell phones at bedtime. It’s partly because their backlight alters our sleep hormones, but also it’s distracting us with answering text messages even after lights out. I think a great general rule, for adults and kids, is no screen time two hours before bedtime (that includes TV), and definitely get all screens out of your bedroom while you sleep.

Exercise often — but early. Exercise has been shown to improve sleep habits, but only if done at least four hours before bedtime. Otherwise, you still may have too much metabolic energy and will have trouble falling asleep. This is also a good tip for kids who are having sports practices late into the night.

Avoid alcohol and smoking before sleeping. Alcohol is a major cause of insomnia for many. Drinks will certainly make you sleepy, but your body will rebound and wake you up in the middle of the night. It’s far better to have only a drink or two, at least 2 hours before bedtime. Smoking causes the same problems; that initial relaxation quickly wears off and the nicotine stays in your system for hours.

Caffeine is another major cause of poor sleep. As we get older, we cannot handle the triple-shot cappuccinos which we had in college, and it’s very common to have poor sleep with any caffeine drinking after lunchtime. So if you’re having light sleep, definitely take a look at your caffeine habits first; any tea, sodas or coffee after lunch may be keeping you awake. If you must have your afternoon coffee, at least try to switch to decaf.

Other tips include not staying in bed if you can’t sleep. If you can’t fall asleep, after 20 minutes of trying you should get up and try to relax in another room. Staying longer in bed generally makes you more anxious, making it even harder to fall back asleep.

Take a nap. Napping, even if only 20-30 minutes when needed, has been shown to have great benefit for short term memory and concentration. As I get older, I definitely lag more in the afternoon, and a 15 minute power nap at lunch really helps me get through a busy clinic afternoon (as does a lighter lunch).

What about natural medicines and non-prescription pills? Many people use over the counter pills such as Tylenol PM. It does work well, in the short term, for many people — but I strongly advise not taking it regularly, as the Tylenol component is totally unnecessary and can cause liver problems if taken chronically. If you must use this medicine, please buy only the active ingredient, diphenhydramine (Benadryl) separately and only use that. As for natural medicines, melatonin works for some types of insomnia but is rarely very effective. Others may consider an herbal capsule with valerian and other compounds such as passionflower, hops or lemon balm.