Healthy Sleep Habits for Adults

By Dr Lim Li Ling | Consultant Neurologist, Singapore Neurology & Sleep Centre, Gleneagles Medical Centre | Director, Sleep Disorders Unit, Singapore General Hospital

1. Sleep-wake Schedule
   Go to bed and get up at about the same time every night and morning respectively, including weekends. Try to have a regular schedule of going to bed and waking up. This will help you to anchor your circadian ("biological") clock and establish a consistent rhythm of sleep.
2. Stimulus Control
   Go to bed only when you are feeling sleepy. If you are not asleep after 20 minutes, then get out of the bed and engage in a relaxing activity like light reading or watching a non-stimulating (short) television show. Go back to bed only when you feel sleepy again.
3. Food & Drink
   Avoid heavy meals within two hours of bedtime. Try not to go to bed hungry either. Avoid fluids close to bedtime to prevent awakening to go to the toilet. Avoid caffeine after lunch and using alcohol as a sleep aid. Limit caffeine use to one or two beverages a day, no less than four hours before bedtime.
4. Bedtime Routine
   Establish a relaxing pre-sleep routine while getting ready to go to bed, e.g. reading, watching TV, listening to music. Set time aside to relax and practise natural relaxation techniques, e.g. Deep breathing, progressive muscle relaxation.
5. Napping
   Avoid taking long daytime naps unless you are sleep deprived. Afternoon naps, if taken, should not exceed 20 to 30 minutes.
6. Exercise
   Regular physical exercise is encouraged but vigorous physical activity should be avoided too close to bedtime. Do not engage in vigorous exercise four hours before sleep.

The above mentioned are good sleep habits to follow daily. Environmental enhancements which create a more restful atmosphere conducive to sleep, such as comfortable pillows and ambient temperature, quiet surroundings or calming music or aromas can all contribute to improved sleep. Conversely, any form of discomfort (e.g. physical pain, shortness of breath) or environmental disturbance (e.g. loud noise, bright lights, too hot or too cold temperature, unpleasant smells) will certainly make it difficult to have a good night's sleep.

Healthy Sleep Habits for Children

By Dr Jenny Tang | KK Women’s & Children’s Hospital

1. Consistent sleep schedule
   Regular nap times, bedtime and wake times to accommodate children’s natural preferences, activity and family lifestyle. Avoid discrepant weekday and weekend schedules.
2. Consistent bedtime routine
   A consistent but enjoyable bedtime routine is important to help transit children from a high level of daytime activity to bedtime. It should be pleasant, so that the child looks forward to bedtime. The routine can include changing into pyjamas, brushing of teeth, bedtime stories etc. A regular daytime schedule (e.g. mealtimes and playtimes) also helps to stabilize the sleep wake schedule.
3. Avoid sleep onset associations
   Always put the child to bed awake but drowsy, so that they can learn to settle themselves and fall asleep both at bedtime and at night waking. Avoid sleep associations e.g. breast-feeding, bottle-feeding. Transitional objects e.g. a blanket, stuffed animals, dolls, may assist independent settling and self-soothing.
4. Avoid night feedings after age 6 months
   Night feedings are not physiologically necessary in most cases after the age of 6 months and do not improve the quality or quantity of sleep. A persistent requirement for night feedings may be related to sleep onset associations or conditioned hunger. Unnecessary night feeds also increase wetting and more disturbed sleep.
5. Avoid co-sleeping
   Co-sleeping increases the risk of Sudden Infant Death Syndrome under certain conditions, such as parental smoking, drug or alcohol use. The practice has also been implicated in suffocation deaths, but is controversial in its impact on psychological and developmental effects. Co-sleeping infancies have less SWS and more frequent night-time arousals and may result in difficulty in transiting the child to their own bed or room when appropriate and necessary.
6. Ideal bedroom
   The bedroom should be at a comfortable temperature, quiet, and dark. A night-light is acceptable if preferred by the child. Avoid using the bedroom for time-out or punishment, and the bed for activities other than sleeping i.e. do not play, study, read or listen to music on the bed. Keep the television set out of the bedroom.
7. Appropriate naps
   Naps should be geared towards child’s age and developmental need. Avoid long naps or naps too close to bedtime.
8. Encourage adequate Sleep

Insomnia

10 Fun Facts on insomnia
By Dr Ng Beng Yeong, Dr Victor Kwok | Singapore General Hospital

1. It takes approximately 5 hour to remove half the amount of caffeine in the coffee you just took.
2. Exercising (e.g. jogging) just before sleep may make you tired, but it actually makes it harder to fall asleep because of the adrenaline released.
3. It is not only excessive napping in the daytime which can make it harder to sleep at night, spending too much time in the daytime doing other activities in bed eg. surfing the net or reading can also interfere with our ability to fall asleep at bedtime.
4. Insomnia often plagues people with shift work.
5. Using alcohol or sleeping pills to sleep can result in addiction.
6. Sleep deprivation is a more common problem than insomnia.
7. Prolonged sleep deprivation can worsen your alertness and brain function. A person with sleep deprivation may perform even worse than someone who is drunk.
8. A "tryptophan snack" like a banana or milk has not been shown to induce sleep.
9. Women tend to be more prone to insomnia.
10. As sleep is a time when memories get consolidated, people with poor sleep tend to be more forgetful.

Sleep Facts | Sleep Deprivation

By Prof Michael Chee | Cognitive Neuroscience Laboratory, Neuroscience and Behavioral Disorders Program | Duke-NUS Graduate Medical School

1. People who live in cities are getting less sleep. For example, from 2001 to 2009 an annual sleep survey showed a decrease in self-reported average hours of sleep from 7.0 to 6.7 hours.
2. People who sleep less than they need are less likely to take part in activities that improve health. They tend not to exercise, eat unhealthy foods and engage in less leisure activities.
3. Some people need less sleep than others and in some cases this may be genetically determined.
4. Sleep deprivation impairs attention, leading to a higher risk of accidents.
5. Memory (important for students) benefits from sleep.
6. Sleep results in the clearance of amyloid – a substance that can contribute to Alzheimer’s disease.
7. Lack of sleep affects the body's metabolism, increasing the chance of becoming obese.
8. People who chronically lose sleep are not able to tell how badly their cognitive brain functions are affected by the lack of sleep.
9. The use of sleep medications or medications to increase alertness is on the rise globally.
10. Sleep deprivation can dangerously affect decision making under risky situations (eg. when driving).

Sleep Facts | Paediatric

By Dr Jenny Tang | KK Women’s & Children’s Hospital

1. A child spends 40% of his childhood sleeping
   Sleep is the primary activity of the brain during early development. Sleep is very important in childhood and directly impacts mental and physical development.
2. A newborn infant has 50% of Rapid Eye Movement (REM) sleep (Dream sleep)
   The proportion of REM sleep decreases over time to 25% in adulthood. REM sleep has been shown to help developing brains mature, and is also important for memory and consolidation of learning. Disorders that reduce REM sleep e.g. sleep apnoea, may result in cognitive dysfunction.
3. Teenagers need as much sleep as young children i.e. about 9.5 hours
   Studies have shown that teenagers need about 9.5 hours of sleep but most get 7 to 7.5 hours. This is due to a variety of factors, such as shift in the internal clock, early school start times, social and school obligations. Chronic sleep deprivation will result in impaired mood, behaviours and cognitive function.
4. 30 – 50% of children have some form of sleep problems in childhood
   These include very common problems like behavioural insomnia e.g. sleep association disorder, recurrent night awakenings, limit setting disorder; chronic sleep deprivation and parasomnias e.g. sleepwalking, night terrors; to the less common like sleep apnoea, narcolepsy, restless legs syndrome and periodic limb movement disorder. It is therefore important to actively screen for and manage sleep problems in children.
5. Most children do not need a night feed by 4-6 months of age and sleep through the night by 9 months of age
   Studies suggest that 70-80% of infants sleep though the night by 9 months.
   Physiologically, infants 4-6 months do need a night feed. Frequent feeding though the night may result in a persistent requirement for night feeds with conditioned hunger, increased wetting and recurrent nighttime awakenings.
6. Rocking and nursing / bottling your child to sleep may result in recurrent night time awakenings
   Allowing your child to fall asleep in a ‘sarong’, rocker or while nursing, feeding from the bottle may result in a sleep onset association disorder, where the child is a ‘signaler’ vs. a ‘self soother’. The child having learnt to fall asleep only with the required intervention (e.g. rocking or nursing), will cry during a normal nighttime arousal until original sleep onset conditions are re-established. Putting the child in bed drowsy but awake allows the child to learn to fall sleep on her own.
7. Nightmares are common in children
   Studies have shown that approximately 75% of children report experiencing at least one nightmare. It is virtually universal and is part of normal cognitive development, peaking at 3-6 years of age. Reducing anxiety, stress, sleep deprivation and exposure to frightening or over stimulating images, especially before bedtime, can reduce incidence of nightmares.
8. Sleepwalking and sleep terrors are a neurodevelopmental phenomenon
   Parasomnias e.g. sleepwalking and sleep terrors are common. Up to 15-40% report experiencing sleepwalking and or sleep terrors during childhood. This arises out of slow wave sleep and in most children spontaneously resolves following puberty. This is a result of a dramatic decrease in slow wave sleep at puberty. Sleepwalking and sleep terrors are neither indicative of a psychological issue nor result in psychological harm.
9. Habitual snoring in children may indicate the presence of sleep apnoea
   Habitual snoring - i.e. snoring on most days of the week- is uncommon in children, occurring in 6-10% of children of which up to 30% may have sleep apnoea. All children with habitual snoring should be evaluated for possible sleep apnoea.
10. Prevention is better then ‘cure’
    Studies have shown that increasing parental knowledge, and awareness of childhood sleep and sleep problems, is effective in reducing the prevalence and impact of sleep problems in early childhood. This can be done by parental education in antenatal or early postnatal classes.