Robert A. Lebby, M.D.
The crossroads of lifestyle and current age range of Millennials present significant sleep challenges to this important population. For Millennials are essentially guinea pigs, the first generation raised entirely on portable technology and social networks, where a 24 hr lifestyle is now the norm. This new lifestyle collides with the normal physiologic changes which affect individuals in the Millennial age range, and together these factors can wreak havoc on one’s sleep.
Whereas “Baby Boomers” are a very well defined population segment (1946 – 1964), other generations such as “Generation X”, “Generation Y”, and “Millennials” are less well defined. These terms are probably most relevant to marketers and students of group behavior who try to define large groups based on purchasing habits, job habits, or voting habits. Millennials in my mind though (those born roughly from 1982 – 2004) are actually REALLY different. They are the very first generation to have ever been entirely raised on personal portable technology, social networks, immersive media, and a true 24 hr lifestyle. No prior generation has ever been completely exposed to these factors. I am sorry Millennials, but you truly are lab rats.
Millennials include individuals with ages in the teens and 20’s, with a few early 30 somethings. We now know that after puberty during adolescence and young adulthood there are real physiologic changes which occur in the still evolving brain. These changes are part of normal development and due to hormonal changes and other factors. In relation to sleep, they affect the timing of the body’s underlying Circadian Rhythm. This rhythm guides several processes in the body including hormone secretion, level of alertness, and the sleep / wake cycle. During this developmental period there is a natural desire to go to sleep about 2 hours later than usual, and then wake up about 2 hours later than usual. This is called a “Sleep Phase Delay” with a shift in the entire sleep period to a later time. This is why it is harder for people in this age range to get to sleep at a “normal” time and then wake up at a “normal” time. This is also why there has been a push recently to have schools start classes later in the morning.
On top of this underlying propensity to go to sleep later, there are also many new pressures on adolescents and young adults which can add to sleep initiation insomnia and sleep maintenance insomnia. There is more anxiety and competition now surrounding school, college application, and job performance. The economy has clearly been more challenging for young people recently. During school there is more pressure to engage in after school sports and other activities, with a natural push to do an even larger amount of homework later in the evening. There is no time now for a “wind down period” and it is more difficult therefore to relax and fall into sleep. Once in bed Millennials also tend to bring their portable electronics to bed with them, surfing the internet or interacting on social networks. There is now essentially a 24 hour cycle of peer pressure. Watching TV or playing video games is also common into the wee hours of the night. Use of caffeine from Starbucks or Energy drinks is also common at a younger age now and this alone may greatly disrupt sleep. Thus young people today begin with a physiologic desire to go to bed later, actually go to bed later due to societal pressures, then once in bed remain active on electronic networks. They often do not get to sleep until well after midnight. These factors then result in great difficulty getting up in the morning at the usual time that society begins, at 8:00 am. Unfortunately this group of people because of physiologic factors and poor sleep habits are really set up for severe problems related to poor sleep.
WHAT CAN WE DO?
First and foremost, it is important to UNDERSTAND AND ACCEPT that a good night’s sleep is IMPORTANT for good physical health, good mental health, and good daytime performance. Sleep is not simply a waste of time. Several very important physiologic changes occur during sleep, it is actually a very active time for the brain, not a passive dormant state that many believe it is. One must accept that sleep is a very important part of your life and important to your health, just like eating, breathing, exercising. Try to enjoy the notion of sleep, look forward to it, embrace it, and savor it. A warm comfortable bed is truly one of the great joys in life.
TAKE CHARGE OF YOUR SLEEP! You can actually control many factors surrounding your sleep if you try. YOU CAN CONTROL YOUR SLEEP HABITS (or SLEEP HYGIENE as it is called).
First off several factors may help strengthen your underlying Circadian Rhythm. Try to keep a regular bedtime and even more importantly a regular wake up time. Try to stick to these every day if possible. Next use the natural light / dark cycle to help tell your brain where your cycle should be. Avoid bright lights in the evening and at night. Dim overhead lights, sit further away from TV screens, computer monitors, and phone / i-pad screens. If possible dim these screens as well. Some screens now have a night time setting to change the characteristics of the light and help with night time light exposure. Conversely, get as much light as possible right when you wake up, during the morning, and throughout the day. Natural sunlight is always best. Open your blinds, sit near a window, take breaks outside, do whatever it takes to get your light. Sometimes a sleep doctor will even prescribe a special Light Box to use at home or work if you cannot get enough natural sunlight. Regular exercise (though not too close to bedtime) and keeping regular meals will also help strengthen your Circadian Rhythm. A large meal too close to bedtime is not recommended but a bedtime snack is fine. Short naps can be helpful to combat daytime sleepiness yet extensive daytime naps may reduce night time sleep drive and worsen insomnia.
Millennials, if you can, try to schedule your start of classes or work to a time later in the morning. This can help greatly with your underlying Sleep Phase Delay and physiologic need to sleep later. You will be a more efficient learner and a more productive worker.
Next try to avoid caffeine in the afternoon or evening (or at any time if you are very sensitive). Also avoid heavy alcohol intake close to bedtime. Drug use and certain medications may also disrupt sleep if used close to bedtime.
Next make sure the bedroom environment is conducive to sleep. It should be quiet, free of distractions such as phones, noise, pets, or other factors. It is OK if you need earplugs or eye shades. Having a sleep partner is usually comforting, unless their nighttime behaviors are disrupting to you. If this is the case, help them address their sleep issues to help you with your sleep. The room should be dark, cool, and the bed should be reasonably firm and comfortable. The optimal sleep position will vary for each individual. Sheets and comforter should not be confining. Your pillow should be comfortable yet not too thick. Wear as little clothing as you are comfortable. There is actually new data that sleeping naked may result in the best sleep. And finally be on the lookout for allergens or irritants in your sleep environment, especially if you have underlying Asthma or reactive airways.
Aside from the Circadian Rhythm driver for sleep, there is another important driver for sleep called the Homeostatic Sleep Drive. This is just a fancy name for the process in which your sleep drive increases the longer you stay awake. Your pressure to go to sleep increases the longer you stay awake. This Homeostatic driver is usually what gets you to sleep initially in the evening and then your Circadian Rhythm driver takes over later in the night. It is important to understand that you can always arouse yourself (or wake up) during the night if necessary, even if you are very sleepy. Certainly if there is an earthquake, or a bear enters your bedroom you need to wake up and be alert. So you can see that we need to reduce our cognitive arousal level to below that at which our sleep drive can take over, to allow ourselves to get to sleep and stay asleep. This is how anxiety and ruminating thoughts can keep us awake, by not letting us relax to a level below our underlying sleep drive.
Now considering these factors, several important behaviors that may help improve sleep can be recommended:
Take a wind down period prior to going to sleep, so your mind is at peace before going to bed.
If you have a lot of things on your mind, try to write them down and organize your next day activities on paper before you go to bed, that way you know they are settled before you go to bed.
A bedtime ritual may be helpful if that is relaxing, like a bedtime snack, etc.
A hot shower or bath before bed may also help you get to sleep.
If your mind is active in bed, then a white noise generator, soft music, or a distant TV may distract you from your thoughts.
Other relaxation techniques such as biofeedback or behavioral medicine techniques may also be helpful. Some behavioral medicine programs are now available on line.
Avoid anxiety provoking behaviors during the night such as watching the clock. Turn your clock away from you. Very sensitive individuals should turn off or cover even very small charging lights.
Avoid other arousing activities in bed which will keep you from relaxing and getting to sleep. For you Millennials, this means avoid all electronics and media in bed once you are going to sleep. These activities will keep your brain active and prohibit sleep. Set an ELECTRONICS / MEDIA CURFEW. You should not have a laptop or phone in bed where you are tempted to use them. They should be in silent mode, charging away from your bed. Remember: SLEEP IS IMPORTANT. Sleep is not something that you can do concurrently with entertainment.
It is generally best to not be using your bed for any other activities other than sleep and intimacy. Subconsciously you need to only associate being in bed with SLEEP. Doing frequent other activities in bed such as eating, watching TV, or using electronics disrupts this subconscious association of being in bed with relaxation and sleep. This is also the reason why it is suggested that if you cannot get to sleep within 30 minutes at any time, it is best to get out of bed and do something relaxing, and then return to bed again only when you get sleepy again.
Even with all these behavioral suggestions, getting good sleep may still be very difficult in certain people in specific situations, such as:
Shift workers (especially if rotating shifts)
Frequent travel across time zones
Have other underlying medical problems s/a Asthma, lung disease, heart disease, epilepsy, chronic pain.
Have underlying psychiatric problems s/a Depression, Anxiety, Bipolar disease.
You require medications which disrupt your sleep
For people with any of these associated problems, you should get some guidance from your health care provider or seek out a Sleep Physician.
For Millennials who also have other underlying primary sleep disorders, these should also be addressed to promote health sleep. These may include Obstructive Sleep Apnea, snoring related issues, Narcolepsy, night time movement disorders, or other primary insomnia’s. A Sleep Physician or other sleep trained professional can help advise you about the best treatment.
Several phone and pad Apps are available to help you monitor your sleep. Most of these actually monitor your activity / movement at night and use this movement as an estimate of wake, while using lack of movement as an estimate for sleep. While this is not entirely accurate it certainly can give a reasonable estimate of sleep and overall they can certainly provide you with useful information regarding your sleep. These programs may be improved if other parameters are also measured such as heart rate. FITBIT and other sleep trackers may be quite helpful in monitoring one’s sleep, especially if used in conjunction with an overall SLEEP DIARY.
For people concerned about snoring and breathing difficulties during sleep, there are some new excellent screening applications such as SnoreReport which monitors and assesses night time breathing noises. This data can also be synchronized with Fitbit data to give a much broader overview of your sleep. This information can then be used to monitor your sleep or can be brought along with you to your healthcare provider where the information can be used to help guide decisions about your care.
Sleep Medicine is now a separate bonafide medical specialty. If you have concerns about your sleep that are not being addressed by your primary care provider, it may be reasonable to seek the advice of a Board Certified Sleep Specialist.
Doctor Lebby is a board certified Sleep Physician in Laguna Beach, CA. He evaluates patients also in Huntington Beach, Brea, and Yorba Linda. He can be reached by email at robert.lebby@drlebby.com or drlebbysleep@yahoo.com.
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