Flight #15 - Improving Sleep Quality for Better Mental Health in Pilots

Welcome to The Flight Shrink newsletter! This is Dr. Kevin Heacock.

In this edition, we'll explore a topic that's vital for maintaining mental well-being, not only for aviation professionals but for everyone: sleep quality. We all know the importance of sleep, yet so many struggle with it. Whether it's the demands of a pilot's schedule, stress, or other factors affecting your sleep, we'll discuss practical strategies to enhance the quality of your sleep and, in turn, your mental health.

Understanding Sleep

Before we dive into improving sleep, let's talk about why sleep so crucial. Sleep is when our body and mind rejuvenates. It's not just about how much sleep you get, but also about the quality of that sleep. Poor sleep, whether it be not enough sleep or non-restorative sleep, can lead to irritability, reduced cognitive function, and a negative impact on your overall mental health. In aviation, where alertness is paramount, enough good quality sleep is a must.

The Importance of Sleep Hygiene

When patients ask me what they can do about sleep, I usually don’t have enough time to go into everything, so I tell them to Google the phrase “sleep hygiene” and see what pops up.  Sleep hygiene involves several practices to enhance sleep quality.  The main practice of sleep hygiene involves establishing a bedtime routine that signals to your body that it's time to wind down. You can do this with simple steps like avoiding screens before bedtime, creating a comfortable sleep environment, and keeping a consistent sleep schedule.

Avoiding Screens Before Bedtime

Quality sleep begins with a good wind-down routine, and one of the most effective habits is to avoid screens before bedtime. The cold blue light emitted by iPhones, iPads, MacBooks, and TVs can disrupt your body's production of melatonin, a hormone that regulates sleep. iPhones have a Night Shift setting that decreases the amount of blue light coming from your screen.  You can set it to less warm or more warm and set it to come on at a specific time every night.  I have mine set to maximize the warmth of the light and to come on at 9pm every night (although I should probably set it for 8pm now that the sun is setting earlier).

Many of my patients who are having difficulty falling asleep tell me the only way they can fall asleep is with the TV on in their bedroom.  It makes you wonder that if sleeping with the TV on is working so well, then why are they coming to me asking for help sleeping better?  It can be difficult to convince someone that the way they’ve been doing things for so long and that they think is helpful is actually making things worse for them.  When faced with this, I suggest to them, that if they feel like they’re not sleeping well enough with the TV on, perhaps we should try something different.  The first few nights may be difficult and it can take 2 weeks or more to adjust to a new routine, but if they stick with it, they will eventually fall asleep without the TV and have better quality sleep without the flickering light and sounds throughout the night.

Instead of watching TV or scrolling through your news and social media feeds on your iPhone, consider replacing screen time with a calming activity like reading a book, taking a warm bath, or practicing relaxation techniques. Ten minutes of stretching or gentle yoga can be a great way to wind down before bed.  By allowing your mind and body to relax without the distraction of screens, you set the stage for a restful night's sleep.

What if You Can’t Fall Asleep?

Despite all our best efforts there will still be times when we just won’t fall asleep as quickly as you’d like.  If this happens to you, the typical advice given is that you should NOT just lay in bed staring at the ceiling.  If you don’t fall asleep in the first 15 to 20 minutes of getting in bed, get out of bed and do something dull and boring.  Empty your bladder if you have to or take a sip of water if you need to quench your thirst.  But don’t pick up your iPhone.  Go to another room and read a physical book under a dim warm light.  You want to avoid any stimulating activities like getting involved in an exciting movie, TV show, or story that would engage your mind.  After 5 or 10 mins get back in bed.  And if you don’t fall asleep in the next 15 to 20 minutes, do it again.

If you get in bed and just lay there for hours on end without falling asleep what you’re doing is training your brain that when you get in bed, you just lay there, not sleeping.  So this getting out of bed if you don’t fall asleep in the first 15 to 20 minutes is an attempt to train your brain that when you get in bed, you fall asleep.  It can be really frustrating the first couple of nights.  Some people get up 2 or 3 times an hour for the whole night and never sleep the first night they try this.  And so they think it doesn’t work.  But it will work eventually.  If you go a whole night without sleeping or only get a few hours it’s important to NOT take a nap the next day, stay awake until your normal bedtime, and start the routine over again.  Usually you will be tired enough at this point to fall asleep in the first 15 to 20 minutes and now you’ve established your new routine.  Overtime your brain will learn that when you get in bed, you fall asleep in the first 15 to 20 mins.  Sure you may still have a few nights here and there that you don’t fall asleep right away.  And if that happens, now you know what to do.

Creating a Comfortable Sleeping Environment

Your sleep environment plays a crucial role in the quality of your rest. Start by ensuring your bedroom is dark, quiet, and cool. Invest in blackout curtains if needed. Pay attention to your mattress and pillows; they should provide adequate support and comfort. Most mattress and pillow companies have good return policies so you can try them out for some time to decide if you like them.  My wife and I tried about 5 pillows a few years ago until we each found the one that was right for us.  Once you have the right bedding, be sure to keep your room clutter-free, as a tidy space can promote relaxation. Making your bed every morning can make your bed look more inviting in the evening when it’s time for sleep.  Lastly, while some people sleep naked, if you do wear pajamas, the comfort of your sleepwear matters. Choose materials that feel good against your skin and won’t make you too warm, as physical comfort is key to a good night's sleep.  That may sound like a lot of money for curtains, a mattress and pillow, and comfy sheets or PJs, but for a room where you spend a third of your day and for sleep that makes the rest of your day that much better, it’s worth it.

Keeping a Consistent Sleep Schedule

Consistency is a cornerstone of healthy sleep. Going to bed and waking up at the same time each day helps regulate your body's internal clock, making it easier to fall asleep and wake up naturally. This consistency reinforces your body's sleep-wake cycle, allowing you to optimize the amount and quality of your sleep. Even on weekends or days off, try to stick to your regular sleep schedule as closely as possible.  Sure, occasionally you may have a late night, but try not to sleep in more than an hour later than you usually wake up so you can fall asleep on time the next night. Over time, this habit can lead to more refreshing sleep and improved overall mental health.

Stress and Sleep

Stress is a common companion to those in high-pressure jobs like pilots, and it can severely affect sleep quality. We'll discuss techniques to manage stress effectively, from mindfulness to relaxation exercises, helping you find a peaceful night's sleep even in turbulent times.

Mindfulness for Stress Reduction

Mindfulness is a powerful practice that involves staying fully present and aware in the moment. It can be particularly effective for managing stress before bedtime. By engaging in mindfulness exercises, such as meditation or deep breathing, you can calm racing thoughts and soothe anxious feelings. These practices help you let go of the day's stresses and transition into a more relaxed state, making it easier to fall asleep peacefully.

Progressive Muscle Relaxation (PMR)

I talked about Progressive Muscle Relaxation as a stress management technique last week.  PMR focuses on systematically tensing and then relaxing different muscle groups in your body. This practice helps alleviate physical tension and promotes relaxation. By releasing muscular tension, you signal to your brain that it's time to unwind. This can be especially beneficial for individuals who carry stress in their bodies, such as tension in the neck, shoulders, or back. Incorporating PMR into your bedtime routine can prepare your body for restorative sleep.

Guided Imagery for Relaxation

Guided imagery is a relaxation technique that involves visualizing calming and peaceful scenes. It's an effective way to shift your focus away from stressful thoughts and toward more soothing mental images. Guided imagery exercises can transport you to tranquil settings like a serene beach or a quiet forest, allowing you to mentally escape from the day's worries. By engaging your imagination in this way, you can reduce stress and anxiety, paving the way for a more restful night's sleep.  I have a visualization meditation recording that I have for when I teach mindfulness.  I’ll put this up as a bonus Podcast episode later this week.

Breathing Exercises for Stress Relief

Deep breathing exercises are a simple yet potent tool for reducing stress and promoting relaxation. Techniques like the 4-7-8 breath (inhale for 4 seconds, hold for 7 seconds, exhale for 8 seconds) can activate your body's relaxation response. Deep breaths signal to your nervous system that it's time to calm down, lower your heart rate, and reduce stress hormones. I do this some nights if I don’t all asleep in the first or second attempt at sleeping and it works well for me.  By incorporating these breathing exercises into your bedtime routine, you can transition from a state of tension to one of tranquility, improving your sleep quality.

Yoga and Stretching for Stress Management

I already mentioned how yoga and stretching routines can be beneficial for both the body and the mind. These practices help release physical tension, improve flexibility, and promote relaxation. Yoga, in particular, combines movement with mindfulness, making it a holistic approach to stress reduction. By engaging in gentle yoga or stretching exercises before bedtime, you can alleviate the physical and mental strain accumulated during the day, setting the stage for a more peaceful and restorative sleep.

Journaling and Stress Release

Sometimes, stress accumulates because of unprocessed thoughts or worries. Journaling is a therapeutic practice that allows you to express your feelings, thoughts, and concerns on paper. By transferring your stressors from your mind to the page, you can gain clarity and a sense of relief. So if you struggle with worrisome thoughts keeping you from falling asleep, take a few minutes before getting into bed to write down the things you’re worried about, whether that be things you wish had gone differently during the day, or things you might be worrying about for tomorrow.  This practice can help you let go of those racing thoughts that might keep you awake at night. Consider keeping a bedside journal where you jot down any concerns or reflections before sleep, allowing you to close the mental chapter on the day and embrace restful sleep.

Nutrition and Sleep

The relationship between diet and sleep is intricate, and what you consume throughout the day can profoundly influence the quality of your sleep at night. Both the timing and type of foods and beverages you ingest play key roles in sleep regulation. A well-balanced diet can promote restful sleep, while poor dietary choices can disrupt it.

Some foods can disrupt your sleep if consumed too close to bedtime. High-fat and spicy foods, for example, can lead to indigestion and discomfort, making it difficult to fall asleep or stay asleep throughout the night. Or a big meal of any kind can make it difficult to sleep while your body digests it.

And of course, caffeine and nicotine are stimulants that can interfere with the ability to fall asleep and reduce sleep quality. It's advisable to limit or avoid these substances, especially in the hours leading up to bedtime.  I definitely don’t recommend nicotine of any kind.  And if you’re a coffee or Coke Zero fan, I don’t recommend more than one or two servings a day, and none after noon.  Caffeine has about a 6 hour half life.  So if you if you have 4 cups of coffee at 9am, by 9pm (12 hours later) you still have a cup of coffee in your system.  And be careful of your serving sizes.  When I say a cup of coffee I’m talking about 8 ounces of coffee.  And typical coffee has about 100mg of caffeine per cup, but some Starbucks and other special brews can have double that.  So if you’re struggling to sleep, but you have to have some caffeine, think about cutting back on the number, size, and strength of your coffee.

Alcohol is another type of drink we have to talk about. Some people tell me they just can’t fall asleep unless they have a couple shots of bourbon every night (or whatever their drink of choice is). While it may initially induce drowsiness, alcohol disrupts the later stages of sleep, leading to frequent awakenings and less restorative rest. So sure, it helps you fall asleep, but with alcohol’s short half life, it tends to wear off in the middle of the night, and the withdrawal of the alcohol from your system makes it  difficult to fall back to sleep.  And the sleep you do get is poor quality.  If you have an Apple Watch or some other sleep tracker, I challenge you to compare a sober night to one where you’ve had some drinks. I guarantee you’ll see a noticeable difference.  With that in mind, if you do drink alcohol, do so in moderation and be mindful of its effects on your sleep patterns.

Sleep Disorders and Seeking Help

Sometimes, despite our best efforts, sleep troubles persist. There are many medical conditions which can affect sleep and so if you’ve tried healthy eating, exercise, and good sleep hygiene and are still struggling it may be time to see your doctor to discuss treatment options.  While there are sleeping pills out there, these should rarely be used and if so, never for more than a few days.  If you’re struggling to sleep for medical reasons, the best thing to do is treat the cause.  Depression and Anxiety can make it difficult to fall asleep and stay asleep.  And so treating those conditions with therapy and/or antidepressants like SSRIs would be the way to go.  Chronic pain can make it difficult to sleep and so whatever is causing the pain should be treated.  Sleep apnea, when you stop breathing regularly throughout the night, usually with loud snoring, is another condition that can be treated to improve your sleep.  So if you feel like you’re getting your 8 hours, but not feeling rested and you’ve been told you snore, talk to you doctor and consider a sleep study.  Whatever is making it difficult for you to sleep and/or sleep well, don’t let these issues take a toll on your mental health when effective treatments are available.

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I'm Dr. Kevin Heacock, The Flight Shrink... Keep on flyin'!