I remember being so envious of my Medicine attending Dr. SW when I was a resident at UCLA, way back in the 1990s. She told us that she had become incredibly successful because she only needed 4 hours of sleep a night. We were all so impressed by her, because she was known for having published every article in an entire issue of the prestigious medical journal JAMA (Journal of the American Medical Association) during her maternity leave.
Resisting sleep
Dr. SW convinced me that, in order to be a good doctor, I must train myself to survive on as little sleep as possible. The message was clear: Sleep was a luxury we couldn’t afford, and the not-so-subtle message was that only the weak needed sleep. Our career success was dependent on our ability to build the strength to resist such weakness.
I was secretly ashamed of my own weakness—I had learned during medical school that when it came to taking exams, last-minute cramming never worked as well as a decent night’s sleep. But two years later, I was taking pride in being such a light sleeper that I could awaken fully and quickly to respond to nurse calls in the middle of the night.
I lost the ability to summon sleep to my aid, even when it was a matter of survival
The next year after that, my sleep was further interrupted when I became a mom, and I layered on yet another belief that good moms keep one ear open to their baby’s every whimper and sigh. Frequent interruptions every night were no problem because I was still able to wake up quickly and then fall right back to sleep again in an instant.
And then I went through a period of intense stress with motherhood and a budding academic career. I pushed my body into submission with iron discipline to train for triathlon races, but slept fitfully and ate whatever to cope with the stress. I remember feeling fit, but somehow my body didn’t feel any healthier.
My Chinese medicine doctor at the time diagnosed me as having kidney qi deficiency and dampness—meaning: I had significant underlying health imbalances, despite being in top athletic form. My sleep got even more spotty as I transitioned into perimenopause, and I remember being up in the wee hours with nausea and abdominal pain that turned out to be gallstones.
Unable to sleep
Ironically I didn’t truly learn to value sleep until I was no longer allowed to sleep.
My second internship in Hong Kong was characterized by the same punishing schedule of ten 36-hour shifts per month as my first internship. But I struggled to power through, because good sleep had become such a rare and undervalued occurrence by then. I found myself unable to nap during the rare moments of down time on the wards, and it shook me to realize that I no longer had the ability to summon sleep to my aid, even when it was a matter of survival.
Meditation makes space for my body’s innate healing to take over
I have no doubt that my brain and overall health suffered tremendously during that heinous year. When I finally emerged on the other end, I had come to respect the tremendous importance of sleep and self care in general. I luxuriated in the freedom of being able to sleep when I wanted and promised myself that I would never again take it for granted.
But even so, sleep was an inconstant companion for me. I would listen to my husband’s snoring at night and told myself that some people (like me) just weren't blessed with good sleep genes.
Rebuilding sleep habits
It wasn’t until I started my fellowship in Integrative Medicine that I learned about the possibility of training ourselves to sleep better, as an important way to heal the body and brain. It seemed crazy to be learning for the first time that sleep was a necessity for body and brain health, and not a luxury for the weak and self-indulgent. Wasn’t this the exact opposite of what I had been taught 25 years earlier?
We didn’t know this at the time, but there are actually a handful of very rare genes called DEC2 that run in families of short sleepers. So perhaps Dr. SW was not so much an iron disciplinarian as a scientist who didn’t yet know what she didn’t know. It’s taken more than 20 years for science to catch up to the wisdom of honouring the body’s circadian rhythms and chronotype.
In addition to unlearning my habitual sleep beliefs, I began the process of tackling the sleep habits that were built around those beliefs. It took a surprisingly long time for me to get and stay motivated to change those habits. Turns out that after so many decades of poor sleep, it took more than just telling myself that sleep was the most powerful medicine to change up my sleep hygiene habits.
Sleep is a necessity and not a luxury
Building better sleep wasn’t about tweaking just one habit. My brain was used to scrolling on my phone, binge-watching Netflix or eating snacks before bed. It took a lot of self coaching through journaling for me to see that these behaviours were my default setting—helping me escape my anxiety or overwhelm about work and life. I had to learn that there were other ways to pacify my inner rebel who was constantly striving to free herself from those “good girl” rules that became somehow unbearable at that time of night.
I had to run a series of experiments over months and years to learn what would and wouldn’t work for me. It’s still a work in progress. But through trial and error I’ve discovered a bedtime ritual that works for me. I call it my “landing sequence”—like putting our tray tables up in the upright and locked position as our airplane prepares for landing.
Some elements of my ritual:
Cozy surroundings - I prime my senses for sleep at least 30 minutes before bedtime with dimmed lights and lavender scent. I make sure the bedroom is cool, dark, and quiet.
Clean up routine - a slow warm shower or bathroom time
Story time - By reading or listening to a “guilty pleasure” book, I allow myself to do something fun or indulgent to connect with my inner child
Lights out - I do my qi gong or listen to a yoga nidra guided meditation, focusing my mind on the present moment, and letting go of worries and anxiety about the past or future.
Meditation has proven to be an excellent approach to quieting my mind. When I’m able to create that stillness in my mind, letting go of the chatter, it feels like I’m intentionally making space for my body’s innate healing to take over and perform as designed.
My new beliefs around sleep revolve around the idea that sleep is a performance sport. And I get to keep working on figuring out what habits of thought and action work best for me, as measured by brain functions like energy, focus, speed and emotional regulation.
Dr Em Coaching Tips
As you reflect on your own sleep performance, how would you say you are doing at present? Be sure to take into account not only hours slept, but also energy level when you get up and throughout the day.
Sometimes it’s hard to know if we might be “underslept,” because our brains may have adapted to chronic sleep deprivation over time. Consider how you would rate your cognitive function over the past week, like processing speed, focus/attention and memory (both short- and long-term) are often closely linked to quantity and quality of sleep.
As you read this article, what sounds doable in terms of starting your own experiments and to begin to tweak your personal bedtime “landing sequence”?
What is one thing you can try tonight to help yourself build better sleep? There is no wrong answer here, anything and everything that we do to improve sleep will definitely be a worthwhile investment. Give yourself permission to trust your inner healer to tell you what will give you the biggest bang for your buck.
Resources
Why We Sleep
by Matthew Walker
