I’m Dr. Naina Limbekar, board certified neurologist. Ask me anything about how to develop healthy sleep habits and the relationship between health, wellness and sleep.

Are there any good tactics on how to fall asleep fast? What should I think about? Years ago I found that counting really helps, anything similiar? Relaxing muscles, breathing correctly, etc? I really struggle sometimes falling asleep, do you fall asleep faster in a cold room?

Yes there are some techniques you can try to help fall asleep quicker! You mentioned some of them. The key to help promoting sleep is to relax your mind and your brain! You can do this by deep breathing exercises, taking a hot shower before bedtime, distracting your mind with some relaxing sounds or audio book, progressive muscle relaxation, and avoiding dinner or eating heavily too close to bedtime. If your anxious or worry about things, you can try journaling before bedtime to get all of those thoughts out before you hit the sack!

Usually it is a drop in temperature that helps promote sleep. Make sure your bedroom is cool and dark which can help promote sleep. You can check out my podcast below for more tips and tricks!

https://podcasts.apple.com/us/podcast/sleep-on-it/id1515992116

I'm in a bad pattern of what I've seen called: revenge bedtime procrastination. Where I don't get time to do what I want during the day so I sacrifice sleep to get that time. How do I get out of that rut? I can see it affecting my next day and it builds up an awful sleep debt throughout the week.

Try not to compromise your sleep even though it is tempting in today's demanding and fast paced world! Not getting enough sleep can impair your daytime functioning and research has shown that it can affect your short term memory, focus, attention, and recall! So getting that good night of sleep is actually an investment into having a more productive and fruitful day!

Are there any long term consequences of using melatonin and/or Benadryl regularly to sleep through the night? What other sleep aids might be worth exploring when it feels like all non-medicinal interventions (regular sleep patterns, avoiding screens, cool showers, etc.) have been exhausted. Are there any healthy sleep habits that you would recommend that are not common knowledge, that maybe wouldn’t occur to someone who has explored this subject?

I generally do not recommend the long term use of any pharmacological agent including melatonin or benadryl to treat insomnia. Melatonin is a an agent that can be helpful in treating circadian disorders (advanced or delayed sleepers) but it is not recommended by the American Academy of Sleep Medicine to use in people with insomnia.

There are ways we can train our brain to fall asleep faster. One of the less known ways is use to light as important gatekeeper of sleep. By getting plenty of sunlight exposure throughout the day, we are priming our brains to fall asleep faster at night! In the same way we want lots of daytime light exposure, we want to strategically avoid bright lights before bedtime that can have an arousing or alerting effect on the brain instead.

Additionally, the timing of meals and exercise is also important. Avoiding eating anything to spicy or heavy before bedtime which can trigger insomnia, and also dinner should be at least 2 hours before bedtime. Avoiding exercising late into the evening is also important as it can have an alerting effect on the mind and body.

Is there any point in "catching up" on sleep e.g. at weekends if you got an inadequate amount during the week?

Excellent question! "Catching up" on sleep is real and important way you can pay off your " sleep debt". Research suggests that you can make up for sleep time lost during the weekdays over the weekends and this can have a positive impact on your overall health. However, ideally, try to optimize a consistent sleep routine where you can get between 6-8 hours of sleep a night!

I've been wondering about this literally my whole life but maybe you can answer! I am the only person I know who absolutely hates napping. I have a hard time falling asleep during the day even if I'm tired, and when I do nap I wake up feeling horrible, usually really groggy and agitated and my heart is pounding. I remember feeling like this as far back as elementary school. What might be going on that makes it so difficult/unpleasant for me to sleep during the daytime?

Great question! If you are getting adequate sleep at night which usually is between 6-8 hours of sleep for most people, I generally recommend avoiding naps throughout the day. Taking naps throughout the day can steal from our sleep drive at night and make it more difficult to fall asleep in a timely manner at night. In addition, you are not alone in feeling groggy after taking a daytime nap! If you feel sleepy during the day and must take a nap, research has suggested that the optimal time for nap is less than 30 minutes long and sometime in the early afternoon period. Taking a longer nap or taking one close to the evening hours can cause you to fall into deeper stages of sleep, which upon abruptly waking up from may cause you to feel "drowsy or hungover".

For more info on napping check out my podcast episode "All About Napping-the Pro's and the Con's":

https://podcasts.apple.com/us/podcast/ep-8-all-about-napping-the-pros-the-cons/id1515992116?i=1000488723699

Do you have any tips for avoiding screen usage in the hours before bed? What would be on your list of recommended activities to do in the hours before going to bed to help fall asleep more quickly? Thank you for your time!

I generally recommend trying to avoid bright light exposure from screens or other technological devices ideally for 2 hours before bedtime. If you do like watching tv to wind down, I would make sure that the screen is at least 5 feet away from where you are sitting. Otherwise, although they are not 100 percent effective in filtering out all the bright rays, utilizing the "night shift" mode commonly found on many screens can help dampen some of those harsh rays.

Listening to relaxing audio music or audio books can be a great way to wind down. Also taking a hot bath or shower can often help alleviate muscle tension and promote sleep before bedtime as well!

How does alcohol affect sleep? Would sleep disturbance be part of what causes anxiety that can sometimes accompany a hangover?

Great question. Although many notice that drinking alcohol can help you fall asleep faster, it does have a few negative impacts on sleep. Alcohol causes greater awakenings throughout the night and can also suppress REM stage of sleep which is important to feel refreshed. A poor night of sleep can definitely cause some symptoms of anxiety so best to avoid alcohol close to bed time.

Sometimes I wake up in the morning and feel energetic but fall right back to sleep, only to wake up shortly after (an hour or less) feeling very groggy/tired. Any thoughts?

Once your up in the morning, as long as you've gotten a sufficient night of sleep which for most people is around 7-8 hours, I would say just push yourself to get up and get some morning light exposure. Morning bright light exposure can help alert your brain that its awake time, so that you feel more energized and refreshed!

what are some of the best ways to lead myself to sleep?
-I worked, went to the gym, and had a social life while obtaining my graduate degree. Not stressed, just couldn't sleep well

It's great you go to the gym! Exercising regularly can definitely help promote a better night of sleep. However, the timing of when you to go the gym does matter. If you are going to the gym too late it in the evening, it can prevent your body from being able to wind down enough before bedtime. Going to the gym in the morning or early afternoon is optimal timing for a better night of sleep.

Could a continuous lack of sleep during the arguably most important developmental years (early-mid childhood and adolescence) have an impact on the progression/development of mental illness when you're older?

Yes, there is some research to suggest that sleep deprivation can further worsen symptoms of mood disorders such as anxiety and depression, especially in those that are more prone to having pre-existing anxiety or depression (family history, etc).

It is important for children and adolescents to obtain adequate sleep ( and often they require more sleep than adults) to help promote brain maturation and development. Children and adolescents may require up to 10 hours of sleep to feel rested.

I've been diagnosed with REM behavior disorder. It's not a regular thing, but a couple times a week I will violently kick, usually upward, while acting out in a dream. I'm able to manage that and protect my wife, but I am constantly living in fear that I will develop Parkinson's down the road, since it's one of the early indicators of the disease. What do you know about the link between REM behavior disorder and Parkinson's, and should I genuinely be concerned about this? If so, is there anything I can do besides excercise and a healthy diet to prevent Parkinson's?

Thanks for sharing! Often patient's with REMBD can get down on themselves because of their episodes at night which can be frightening to both yourself and your bed partner. However, I want to just emphasize, that you have no control over these events and they are not occurring consciously! Making sure to get sufficient sleep with a consistent sleep routine can help minimize events. As well as avoiding caffeine and alcohol close to bed time.

Research has suggested that there is a long term correlation of developing PD down the line if you have REMBD. However, not all patients develop Parkinson's Disease. I would advise you see a sleep neurologist who can help clarify some more questions for you and recommend potential treatment options to minimize the episodes. Make sure you have a safe sleeping environment!

Healthy lifestyle habits can only help, including healthy plenty of vegetables and fruits, lean proteins, drinking plenty of water, and getting exercise!

What is the biggest tip you can give us regarding sleep?

Keeping a consistent sleep routine, avoiding caffeine after early morning hours , avoiding alcohol before bedtime, getting plenty of day light exposure in the morning and afternoon, avoiding bright light at night, and exercising routinely ideally in the morning!

How does smoking cannabis before sleeping affect the sleep cycle?

We still do not know the exact effects of cannabis on sleep since research has been limited due to federal regulations!

I currently work split shifts so I dont get a full night sleep, rather 5 or 6 hours then a 1 or 2 hour top up nap in the afternoon.

What's your thoughts on splitting your sleep like this? Is it any more detrimental to ones health if this sleep pattern continues for months?

Excellent question! Research has suggested that long term shift work which requires splitting sleep into nonoptimal times can cause what is called "circadian misalignment" and put some at risk for adverse health outcomes in the long term. However, its important to make sure that even though your sleep may be split between different periods, that overall you are getting between 6-8 hours of sleep a day. Quantity of sleep does matter ,even if it is split!

For instance, if you work nights and need to sleep in the day, you can make sure to avoid bright sun light on your drive or walk home the following morning. Wearing sunglasses can help ensure that the bright sun light doesn't promote further wakefulness when you are trying to achieve sleep during the daytime hours. In addition, try something to wind down when you get home in the morning, rather than just hopping into the bed immediately.

Can you outline the steps that a healthy normal person should follow during the day to ensure they fall asleep? And what is the true recommendation on the amount of sleep a healthy adult needs.

My wife can easily sleep for 9-11 hours a night, whereas I usually find it difficult to sleep more than 7.

Thanks!

That's a great question. Research suggests that the optimal duration for most people is around 7-8 hours. However, there are definitely interpersonal differences with this and some require less while others require more. It's more important to also be mindful of how you feel when you wake up. As long as you feel rested and energized , then stick with that number of sleep! If your wife still feels groggy after 9-11 hours of sleep, then I would say it may be helpful to look for an underlying sleep disorder such as obstructive sleep apnea which could be impacting her quality of sleep.

i'm a night owl is there anything i can do to change that? what would happen if i didn't follow my night owl sleep patterns which feel natural? are night owls born that way?

Great question. Firstly, its a great observation to know when you are naturally sleep and when you are the most awake. Everyone has an "optimal sleep time" which refers to your unique "circadian fingerprint" which is genetically determined and inherited so yes it is possible you were born this way with a lifetime tendency of falling asleep later. There is nothing wrong with being a night owl or what we called a "delayed sleeper" The only time this is a problem is when your unable to sleep at your natural time due to morning or daytime obligations or commitments which would preclude you from doing so. If you have such commitments, you can see a sleep doctor who can advise treatment options which can shift you timing of sleep to a more desired time for work or school. However, when you sleep outside of this optimal sleep period, even if it is the same duration, can cause you to feel unrested due to "circadian misalignment". Listening to your body's clues about when it is telling you are sleepy ( i.e head nodding off, or eyelids feeling droopy) can help you understand what time this occurs and when it is time to initiate sleep. When we try to go to sleep when we are not sleepy, it can create a negative impact and make it harder to fall asleep. For more information about circadian rhythms, you can refer to my podcast episode on "Circadian Rhythm".

https://podcasts.apple.com/us/podcast/bonus-ep-circadian-rhythm/id1515992116?i=1000476194604

Not too long ago I learned about how sleep helps the brain to “clean itself” of stuff that accumulates during waking hours. If this indeed sounds approximately right, can you help explain what that “stuff” is and why it needs to be cleared out?

That's a great question. The "stuff" you mention is referring to the proteins which are the the byproducts of the brain. There is some research in mice and humans suggesting that sleep help promotes the clearance of these by-products via the glymphatic system. Some research suggests that if one does not sleep, then enough of these by products are not being cleared out in a healthy fashion. Instead these by products may remain in the brain in sleep deprived individuals, and then pose a risk for memory problems or neurodegenerative processes in the future. This is a complicated field with rapidly evolving research so I help this answers your question!

Hi, how do I setup a healthy sleep environment? I always wake up feeling very tense on my neck and shoulders. Tried different pillows/ergonomic pillows and mattresses in the last 2 years but it didn't work. Thanks!!!

Tense neck and shoulders can be a sign of stress! Try taking a hot shower at night to relax those muscles, or doing light stretching before bedtime which can loosen up some tension. Additionally, you can try the technique of "progressive muscle relaxation" which can help promote relaxation and sleep at once! You can refer to my podcast to learn more on this technique:

https://podcasts.apple.com/us/podcast/sleep-on-it/id1515992116

Hello Dr. Limbekar! Wearable sleep trackers have been increasing in popularity in recent years. Do you see this as a positive trend or do you think there is a better approach to improving sleep for people on a large scale? Considering there are a variety of sleep tracking devices and applications, what would you consider the most important features for a sleep tracker to have to increase the quality of a person's sleep? Thank you for the AMA!

Hello! I think it's great that technology is growing in the sleep field and we can definitely continue to use this as an asset both in research, clinical settings, and the real world! However, we are still not a hundred percent certain on how accurate they are in measuring sleep. That being said, I often tell my patients not to worry or fixate too much on what they see in their wearable device, but to focus more on how they are feeling when they wake up!

I think it is great that technology is growing in the sleep field! We can definitely use these wearables an as asset in advancing research as well as both the clinical and real world setting! However, we are not 100 percent regarding how accurate the devices are in measuring quality of sleep. That being said, I often advise my patients not to worry too much or fixate on what they see on their device in the morning, but rather, to focus on how they are feeling!

Is not having dreams normal?

It is possible that you may be dreaming but not remember them. It is also possible you may not be dreaming at all. Most dreaming occurs in REM stage of sleep which can be suppressed by common sleep disorders such as obstructive sleep apnea, or by some common antidepressant medications. Good to review this with your sleep doctor!

How do I get more sleep? I've just started going to bed an hour earlier to try to get more sleep, but have ended up waking up an hour earlier, still feeling tired.

Everyone has an "optimal sleep time" which refers to your unique "circadian fingerprint" which is genetically determined and inherited. It is important to determine what your optimal sleep time is, because sleeping outside of this time even if it is the same duration, can cause you to feel unrested due to "circadian misalignment". Listening to your body's clues about when it is telling you are sleepy ( i.e head nodding off, or eyelids feeling droopy) can help you understand what time this occurs and when it is time to initiate sleep. When we try to go to sleep when we are not sleepy, it can create a negative impact and make it harder to fall asleep. For more information about circadian rhythms, you can refer to my podcast:

https://podcasts.apple.com/us/podcast/sleep-on-it/id1515992116

I generally get 8-9 hours of sleep per night, but regardless of the amount, I wake up groggy and exhausted. I haven't felt well rested for years. I don't have sleep apnea (or so the doctor said) but I snore a lot. I don't wake up at night, either. What are some of the possibilities you can think of?

Snoring can be a common symptom or sign of obstructive sleep apnea (OSA), but not everyone who snores has OSA. It would be important to assess for other disorders of sleep with an in lab sleep study to ensure that your sleep is of good quality. Medications, mood state, exercise level, daylight exposure, and nutrition can definitely impact energy levels throughout the day so those are important to evaluate and consider as well.

Check out my podcast episode on "Much to Do About Snoring" to learn more:

https://podcasts.apple.com/us/podcast/ep-11-much-to-do-about-snoring/id1515992116?i=1000502815233

Hi Dr. Limbekar,

How much can sleep quality be effected by ENT problems? I know 'ENT problems' sounds vague, but I imagine that those with clear nasal passageways and the ability to breath through their nose the entire night will experience better sleep and feel more rested.

Second question, is it better to go to sleep slightly hungry than it is to go to sleep just after eating? I never snack before bed but I always wake up starving to the point where it's slightly painful due to the acid like feeling in my stomach. Drinking water helps, but I'm still confused as to why my metabolism or stomach don't slow down while I sleep.

Thank you for your time!

Hello, thanks for your questions!

Firstly, if you have obstruction of your airway including nasal passages or enlarged tonsils for example this can definitely impact the quality of your sleep. Making sure you have good breathing and oxygen at night can sure that you will wake up feeling more rested and energized. Having a sleep study to asses for breathing disorder at night may be helpful.

For your second question, I generally recommend eating anything too heavy (especially fatty or spicy) too close to bedtime and advise eating at least 2 hours before your bedtime. Making sure that your dinner is energy dense with good proteins and good quality fats can ensure that you will feel satiated throughout the whole night. But keep in mind everyone's different and some people swear by that cup of milk before bedtime so keep listening to your body!

should people with sleep issues look at cannabis as something that might help them sleep with more ease and/or fall asleep quicker?

We still do not know how cannabis effects sleep quality due to lack of research on this topic given federal regulations regarding use. Hopefully we will know more in the future!

Hi, i have my sleep disorder since the past 6-7 years it's become intolerable. Because i live on a very frequent location I am hardly ever woken by myself it's always some hard noise or continuous hunk and i get easily woken and even sometimes i get scared right away from my dream. It's affecting every relation from work, friends, girlfriend and family. I am constantly nervous from constant waking up negatively. I try sleeping pills but they don't always help. It didn't bother me before, but now i can't live without earphones and music. My question is, can i ever make up the lost sleep during all these years?! Thank you for reading and your time and effort <3

Thanks for sharing! Poor sleep can definitely impact mood and energy levels throughout the day, so your not alone! Certain sounds can be sleep promoting, so if listening to certain music or sounds help you fall asleep and stay asleep then I say go for it! You can always make up for lost sleep time or pay back your "sleep debt" and its never too late!

Good afternoon! I have narcolepsy/cataplexy. In the past I’ve done a low carb / ketogenic diet, and every time it had a dramatic impact on my excessive daytime sleepiness. My energy levels were even better if I did intermittent fasting as well. Seems like glucose levels might impact the hypocretin/orexin system but there’s not a ton of research yet. Have you heard anything like that before?

Hello! Thanks for the question. There has been some research suggesting that low carb diets can help improve daytime energy levels, however like you said this is lacking specifically in narcolepsy at the moment to be able to provide definitive guidance. You know your body and mind well, and if it is working for you then that is great! However, we do not know the long term effects of ketogenic diet so I would definitely refer to your doctor about this.

Even if you sleep early and a decent amount of hours, can chronic pain (including during the sleep) make a person permanently fatigued?

The good news is that research has shown that a good night of sleep can improve your pain tolerance, so keep up the good work in optimizing and prioritizing your sleep! Pain is complex and can certainly contribute to fatigue, but making sure you sleep can improve how you perceive pain and improve your mood!

Why do I want to sleep for 11 hours, and then still nap during the day. I got blood tests, everything is fine. Do some people just need more sleep to function?

There are some people who require more sleep than others and can be classified commonly as "long duration sleepers". However, I would recommend exploring a sleep study to make sure the quality of your sleep is good and to determine whether you are having the correct proportion of stages of sleep we generally see in the general population . If too much REM stage of sleep, then this could be concerning for a type of hypersomnia disorder. Please see a sleep doctor for further evaluation!

Hi Doctor, does working night shifts (working through the night and sleeping through the day) really have a major impact on overall health?

Hello! Chronic shift work has been shown in research studies to adversely impact overall health by causing something called "circadian misalignment". However, you can mitigate some of these effects by making sure that you still get adequate amount of sleep (6-8 hours) on a 24 hour period even if it is split in two different sleep periods!

Does the actual hour of the day you go to sleep/ wake up matter?

I mean is a 8 hours sleep session between 11 pm and 7 am better than one from 2 am to 10 am?

Everyone has an "optimal sleep time" which refers to your unique "circadian fingerprint" which is genetically determined and inherited . The way to determine your optima sleep time is to understand and observe when your body feels sleep, i.e. when your head feels heavy or your eyelids start drooping. The best sleep is usually obtained when you feel sleepy during your natural circadian rhythm. However, when you sleep outside of this optimal sleep period, even if it is the same duration, can cause you to feel unrested due to "circadian misalignment". Listening to your body's clues about when it is telling you are sleepy ( i.e head nodding off, or eyelids feeling droopy) can help you understand what time this occurs and when it is time to initiate sleep. When we try to go to sleep when we are not sleepy, it can create a negative impact and make it harder to fall asleep. For more information about circadian rhythms, you can refer to my podcast episode on "Circadian Rhythm".

https://podcasts.apple.com/us/podcast/bonus-ep-circadian-rhythm/id1515992116?i=1000476194604

Hi Dr. Naina,

I've never had any issues falling asleep at night, but in the last two weeks I have developed insomnia out of nowhere. I either wake up at 2AM and can't fall back asleep until 8AM or I can't fall asleep at all until 8AM.

This started out of nowhere and I think it might be stress related, but how common is it for insomnia to start so quickly? Can I consider this to be a short bought with it? Do you have any solutions?

Acute insomnia is not uncommon, and about 1 out 3 adults experience this in their lifetime so you are not alone! Stress is usually the most common trigger for insomnia. Being mindful of our emotional state can go a long way. Try incorporating relaxing techniques before bedtime including deep breathing, night time yoga, meditation, audio-books or relaxing audio-music. Remember the longer we remain in bed when we are not sleeping can create a negative vicious cycle of insomnia and further frustration around not being able to fall asleep. If you find yourself awake for long periods in your bed, try getting out of bed and trying one of the relaxation techniques I just mentioned. When you feel sleepy like your head is nodding off, then you'll know its time to head back to bed!

I wonder how I became so sensitive to lack of sleep. If I sleep 8,5 hours instead of 9, whole day I feel sleepy. I regularly exercise, sleep and wake up at same hours, eat well and try to be careful about sleeping hygiene. Can it be related to insulin resistance or histamine intolerance?

Great question! When we think about sleep we think about both sleep QUANTITY as well as sleep QUALITY. Sometimes even though you are getting the right QAUNTITY of sleep, it may not always reflect good sleep quality which can cause you to still feel tired or sleepy throughout the day. Sleep disorders such as obstructive sleep apnea (snore, gasping/choking for air) can definitely disturb sleep quality and cause excessive daytime sleepiness. Additionally, some medications, and eating heavy meals throughout the day can cause excessive daytime sleepiness. Also, mood can impact energy levels, so always be mindful of your emotional state!

What sleep advice do you have for people that regularly work overnight and sleep during the days?

If you work nights and need to sleep in the day, you can make sure to avoid bright sun light on your drive or walk home the following morning. Wearing sunglasses can help ensure that the bright sun light doesn't promote further wakefulness when you are trying to achieve sleep during the daytime hours. In addition, try something to wind down when you get home in the morning, rather than just hopping into the bed immediately.

I have chronic migraines, about one a day, and while I'm not taking blockers at the moment I take Excedrin pm. I would rather not go back on blockers but I've been having a worse time falling asleep and staying asleep. Would you be able to recommend something different I could do to help? Or maybe a different over-the-counter pain/sleep aid?

Migraines and sleep are a complexly related. Research has suggested that prioritizing sleep and getting and adequate quantity of sleep 7-8 hours can reduce migraine frequency- more evidence to the mind and body connection! In terms of medications, I would refer to your sleep doctor or neurologist for specifics to make sure that your overall health is considered in selecting an appropriate agent to prevent migraines.

Hello! My sleep schedule has been severely messed up for months and I’ve been trying to get it back into place. Nothing I’ve tried so far has helped so I recently resulted to melatonin. I’ve found that this doesn’t seem to help either, I never even feel slightly drowsy when taking up to 20mg of melatonin. I’ve tried all different sizes of doses. Is it possible to have some sort of “immunity” if you will to a naturally occurring hormone? Is this possibly a reason why I almost never feel tired at night?

The current best evidence and guidelines from the American Academy of Sleep Medicine do not recommend taking melatonin for insomnia as it is not effective in promoting sleep for most people. I would avoid it if it is not helping you or adversely affecting your sleep or daytime energy levels. Your body naturally produces melatonin. However, melatonin production does decrease as people age normally. I would say avoid bright lights before bedtime which may suppress your body's natural secretion of melatonin at night.

If you make sure to keep a consistent routine and sleep hygiene and still having trouble, it is possible that you may have an underlying sleep disorder that is preventing you from falling asleep and may need further evaluation with a sleep study.

For more information about melatonin, check out my podcast where I talk about "All About Melatonin" episode.

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https://podcasts.apple.com/us/podcast/ep-9-debunking-common-misconceptions-about-melatonin/id1515992116?i=1000489364558