I am pretty far removed from being a clinician these days. That being said, the skills stick with you as do the memories. When I was in Louisville, I remember working at a primary care practice that was just starting out bringing mental health onsite. The physician there agreed with me that one of the best uses of my time was to go into the exam room first and go through a set of questions with the patient to assess how they were doing so that when he came in, he had a better understanding of where they were with their mental health. For me, it was pretty easy to decide where to start. “Hi, Mrs. Smith, my name is Ben and I am working with your primary care doc as an expert in mental health. We are bringing these services to all the patients in this practice, and I wanted to ask you how you are doing? Let’s start with your sleep - how are your sleeping?” It’s a deceptively simple question, many patients saw no correlation between their sleep and their mood or broader health issues. But I found in my experience that understanding an individual’s sleep habits was a key to better understand them (and sometimes give insight into any potential problems).
As children and teens, many of us were told a good night’s sleep is just as essential for our bodies as proper food and nutrition. As adults, we often neglect to practice what we preach (case and point, think about the last time you woke up feeling rested!?). Leaders applaud those who can survive on just a few hours of sleep a night (which is foolish). Our society’s addiction to coffee and energy drinks drives maximum productivity in the workplace (or does it?). Our entire society largely ignores symptoms of exhausted minds and bodies, glamorizing the “push through” mentality. Work more! Do more! Sleep becomes a victim to our drive to do more.
Over 35% of American adults report sleeping less than the recommended minimum of seven hours per night and almost half of all Americans say they feel sleepy during the day between three and seven days per week. Sleep is one of our bodies’ primary defense mechanisms to combat everyday stressors, and people who don’t get a sufficient amount of sleep are more than twice as likely to experience frequent mental distress than people who regularly get the recommended amount.
Sleep and mental health have a bidirectional relationship, meaning that poor mental health often means poor sleep, and poor sleep often exacerbates mental health problems. The connection between everyday stressors and our overall well-being are uniquely tied. People who experience high levels of stress daily tend to sleep poorly and those who sleep poorly or not enough, are often more anxious and depressed. It’s a vicious cycle that can be hard to disrupt.
Maintaining healthy sleep patterns is an integral part of managing both physical and mental health. Our nation needs to start actively promoting a culture of sleep health and focus on improving sleep quality across all segments of the population – however contrary to our culture this may be. We can do this for ourselves and our neighbors in a few ways.
Evaluate your own sleep.
As I’ve asked hundreds of people before, how is your sleep? Taking note of your own sleep habits is akin to flight attendants directing you to put on your oxygen mask before assisting others in the event of an emergency. Are you tired during the day? Is a big project at work or familial tiff or how to pay rent next month adding stress to your life? Do you sleep with the TV on in your bedroom all night? For those who are fortunate enough to be able to fall asleep easily - and stay asleep - this may be a good moment to reevaluate bad habits. Yet, many may find that there are larger issues which need to be addressed, from anxiety to insomnia. When asked how to help with sleep, few people would refer to the most evidence based of strategies – sleep hygiene (your environmental set up, your own behavior, etc.).
Educate yourself.
Societal factors also play a role in how much sleep a person gets. Much like there are egregious disparities between Americans’ social and economic standings, the CDC recently identified a “sleep gap” that shows that wealthy White Americans sleep far better, on average, than poorer Americans of any other race. The light and noise pollution that are common in urban environments adversely impact the sleep patterns compared to residents who live in quieter, more suburban locations.
Those who have always had a safe, warm bed to come home to often take sleep for granted. After all, we spend about a third of our lives sleeping or attempting to fall asleep. While awareness alone won’t solve this problem, it will help us all respond to others with more empathy and challenge leaders to take action.
Help others sleep better.
While sleep is deeply personal, there are still countless things we can do to help others in our communities get a good night’s rest. Donate bedsheets, blankets, and pillows to homeless shelters to make someone’s stay a little warmer – or better yet, ask lawmakers to implement policies to help them find permanent housing. Talk to your city council about ordinances to reduce noise and light pollution (when was the last time you went to a city council meeting?!). Financially support domestic violence shelters to help women and children leave unsafe home environments. Volunteer at a food bank to ensure no one goes to bed hungry.
If there is one thing that I hope you would take away from this Substack it would be this: do not ignore or write off a lack of sleep. Restless nights and tired eyes are one of the many ways that our bodies ask for help, and issues are likely to only exacerbate without effective solutions to the root cause. Pay attention to these signs – listen to your body – it may be trying to point out larger issues that need to be addressed.
This week’s Substack is dedicated to Maddy and his mom Jordana, who recommended this important topic. Jordana @CoJordana, thank you for entrusting me with a small piece of your family’s story and for encouraging us all to better support those who are struggling with their mental health. I think of Maddy daily.
Thank you for helping me think of ways I can help others be able to sleep more and better! I feel like our “always available“ work culture also must change for everyone’s health. For myself I know I have to sleep or everything else goes haywire. I don’t take it for granted at all.
Dr. Miller sleep, mental health, and sleep empathy just jumped into my world with both feet splashing knowledge, insight, and personal reflection all over my new health fetish, better sleep. Of course I will basically recap your brilliant zzzz post here.
Trying to solve my sleep conundrum or better said responding to all the data about how sleep and the lack there of can harm our mental and physical health has become my personal quest and clinical trial. What I've learned which mimics what you've shared.
Donna hated me because back in the day I could fall asleep faster than you can say Jimmy Cricket. I'd sleep until the dawn which, depending on the time I fell out would be x number of hours. Waking at the same time every day and unable to sleep in was a bit of an issue. I think it was dad and his military training getting up for morning drills. Early to bed early to rise stuff.
Sleeping alone after Donna's death became a bit more problematic and aging didn't help. Interrupted patterns of age, arrgh. Once up from mid sleep, falling back was an endless loop of trying to put the roiling thoughts at bay. A tick I learned that worked was, if you awake and were dreaming when you try to sleep again go back to the dream and pick it up from where you left off. It works at about a 74% success rate. Also, reading something on paper not digital helps.
January 2022 I moved my crisis counseling shift to 4am. Trying to crash at 10pm so I had six hours. Meh. The truth is the day is ruined when I get up at 4am. Productivity falls, creativity fails, and my mental health suffers. (Indeed all you shared is spot on). I've limited my 4am shifts to 2x a week or 3x because those in crisis are worthy of help even at the expense of my being grumpy for a day.
In the end from this personal sleep trial and as I say to those I am counseling when we talk about sleep. Sleep is a magical elixir to help us refresh, reflect, and reload. Yes sir it does. I know that when I get a fair nights sleep the day is okay. I may not be a paradigm of mental health. Even on days of feels a good nights sleep allows me to productively participate with life no matter what is going on.
I never considered donating blankets and linens thank you.