Well hello! It’s been a busy time getting ready for the first-ever Mastermind Retreat for Women in Male-Dominated Fields, but I’m back on the blog with an exciting guest post. This week’s blog comes from Dr. Carol Yuan-Dulair, a board-certified physician in pulmonary critical care, internal medicine, and sleep medicine. She started a sleep service for women that helps them get better sleep and live better lives. She even named the program after her daughter, so sweet! I hope this post from Dr. Yuan-Dulair helps you consider any hang-ups you may have regarding your sleep so that you can secure a better snooze!

– TiredSuperheroine

The Rules Were Not Created for You

I’m a rule follower. Maybe it’s a means of survival in the world of medicine. But for women in male-dominated fields like medicine, often, the only rules you find are those created by men for men.  

To give you an example, I returned to my work as a pulmonary intensivist after just five weeks. This amount of maternity leave is inhumanely insufficient, and I do not recommend it. This ‘choice’ came from a combination of my naivete and the pressure I felt as the only female in my group. For context, when I first told the partners I was pregnant and requested time off in advance, one of them responded coldly, “I wish I could be pregnant.” 

As soon as I got back to work following maternity leave, I realized the inherent conflict between following the rules of a man’s world and being a “good mom.” Heeding guidelines and recommendations, I was determined to provide my child with exclusive breastfeeding for 6 months. The only problem was that the ICU rounding schedule didn’t seem to respect my lactation needs. There was always another procedure, STAT situation, or family meeting before I could sneak away with my heavy, conspicuous pump bag to the lactation room, which was located on the other side of the building. 

Trying to meet a woman’s needs in a male environment

Usually, by the time I got to the bare, windowless room, milk-soaked through my undershirt. There, like Diana Prince transforming into Wonder Woman, I unleashed the biological power of my womanhood. With the pump’s mechanical hum echoing off the walls, I finally caught the glorious sight of filling milk collection containers, which hung off my topless body. As I pumped, I worked, of course, a phone wedged between my ear and shoulder, as ten fingers typed furiously on the keyboard.  

Meanwhile, my male colleagues seemed blissfully ignorant of these challenges. One time, a colleague called to discuss a patient while I was pumping. The pump made a cyclical alternating groan in the background. Hearing the noise, he asked what I was doing. I thought he would realize, not just from the noise over the phone, but because he was a new parent himself.

“I’m pumping,” I answered.

“Where? I’ll come too,”  he said.  

I was shocked.  Not sure what he had in mind, I stuttered, “Why?”  

“I haven’t worked out in a while. I can do some weights too,” he replied. He didn’t have a clue about my challenges as a breastfeeding mom, and unfortunately, some male-centric sleep guidance is similarly inadequate when it comes to addressing women’s unique needs and challenges.

Some Sleep Rules that Could Thwart Your Sleep

There are many sleep “rules” we’re told to follow in order to secure a better snooze. Take them with a grain of salt.  

“Sleep hygiene” consists of a popular set of sleep rules, with a peculiar name, in my opinion. What does sleep have to do with cleanliness? While clean bedding and good air quality are certainly key to a comfortable night’s rest, sleep hygiene as a set of behavioral rules first appeared in the book Current Concepts: The Sleep Disorders, by Dr. Peter Hauri. 

The original version of these rules came out in 1977:

• Sleep as much as needed to feel refreshed and healthy during the following day but not more. 
• A regular arousal time in the morning strengthens circadian cycling and finally leads to regular times of sleep onset.
• A steady, daily amount of exercise probably deepens sleep; occasional exercise does not necessarily improve sleep the following night.
• Occasional loud noises (e.g. aircraft flyovers) disturb sleep even in people who are not awakened by noises and cannot remember them in the morning. Sound attenuated bedrooms may help those who must sleep close to noise.
• Although excessively warm rooms disturb sleep, there is no evidence that an excessively cold room solidifies sleep.
• Hunger may disturb sleep; a light snack may help sleep.
• An occasional sleeping pill may be of some benefit but their chronic use is ineffective in most insomniacs.
• Caffeine in the evening disturbs sleep, even in those who feel it does not.
• Alcohol helps tense people fall asleep more easily but the ensuing sleep is then fragmented.
• People who feel angry and frustrated that they cannot sleep should not try harder and harder to fall asleep but turn on the light and do something different.

Today, if you Google “sleep hygiene”, 175 million results come up. The advice ranges from intuitive: “Get into your favorite sleeping position,” to questionable– “Use your bed only for sleep and sex.” Why is sex okay, but not reading? Isn’t exercise supposed to be bad at night? There’s also a range of caffeine and alcohol advice. But is the cut-off at 2, 4, or 6 hours before bed? It can be confusing and even anxiety-provoking to follow all these rules, which can of course be counterproductive.

Sleep rules don’t guarantee a better snooze

Earlier this year, when the American Academy of Sleep Medicine published the latest clinical practice guidelines, there was a collective sigh of relief over their recommendation against the use of sleep hygiene for chronic insomnia.  The opinion agreed with what most sleep clinicians have observed– that sleep hygiene alone doesn’t work. The academy added: “Clinical care devoted to sleep hygiene as a single-component approach may impact the availability of clinical care devoted to more effective…treatments.”

Here are a couple of my personal observations to add: 

Rules can add to a feeling of frustration.  

It’s frustrating when you’ve done all you’re supposed to do, but you still can’t sleep. My neighbor, Diana, is a successful entrepreneur who owns and operates a medical spa while holding a corporate position as well. Her regimented bedtime routine included getting off all electronic devices one hour before bed and donning blue-light-blocking shades to eliminate a potentially sleep-disrupting exposure. She goes to bed at the same time every night, following a half-hour of yoga and meditation. Once in bed, she tries to fall asleep under an expensive weighted blanket, a Christmas gift from her sympathetic husband. Her routine made her feel frustrated. Not only was she still bone-tired from not sleeping, she felt she had done all there was she could to combat her insomnia. She came to me at the end of her rope.   

Rules foster competition

Recently after watching the movie Space Jam, my son became interested in basketball. Obligingly, I enrolled him in a basketball class. On the first day, the coach gave him A Beginner’s Guide to Getting Started in Basketball. I found it surprisingly similar to the advice I give my patients.

1. Get into the correct gear (I.e., wear comfortable night clothes)

2. Warm up the correct way (Wind down before bed) 

3. Start jogging, cycling, or walking everyday (Daily physical activity helps better sleep)

4. Make sure to have fun (Try not to stress over a bad night) 

Sports statistics depict a measure of performance. Similarly, today’s technology has turned sleep, once intangible and mysterious, into a measurable behavior for individuals. Smartphones and watches measure sleep stats, like sleep time and deep sleep percentages from detected body movements. The data is crunched through proprietary algorithms, and flashes on the screen as sleep scores are plotted into charts and graphs, just like sports statistics. Could this be counterproductive?   

Potential competitors in the sport of sleep include bed partners, social media personalities, and purported averages presented as what’s “normal.” Sleep rules, like a playbook, are followed to a tee, as nightly success is attributed to effort or lack thereof. Competitive sleep is a slippery slope with insomnia waiting at the bottom.  

It’s true that restful sleep is the key to your competitiveness. But fundamentally, sleep is as natural as night following day. It’s as biological as the exhale following the inhale, and as necessary as the breathing that sustains life from the first cry to the last breath. Sleep is intrinsically unique from one person to the next.

Discover your sleep identity to secure a better snooze

Your best sleep is anchored in the knowledge of your own sleep identity. As Lao Tzu, the ancient Chinese philosopher and the founder of philosophical Taoism said:

“Knowing others is wisdom; knowing yourself is enlightenment.” 

Lao tzu

If you don’t know your sleep, then all the sleep rules, sleep hygiene and sleep statistics will be interpreted improperly. Without knowledge of your unique sleep personality, your sleep plan will be distorted, and likely ineffective, putting you at a disadvantage as each night begins.  

“What is your name?” and “Where are you from?” are two questions we commonly ask when meeting someone new.  We have come to understand the answers contain important pieces of information about our identity. We all know there is more to each of us than our names and where we live, but these facts offer a frame on which to hang our stories. Two equivalent questions to ask about your sleep personality are your circadian rhythm and your sleep hours.  

Circadian rhythm

Circadian rhythm is the natural rhythm of sleep in relation to the 24 hour day and night cycle and societal norms. One’s circadian rhythms can roughly be categorized as a tendency toward “early” or “late.” You may be familiar with the cliche of the early bird, or for those who favor later hours, the evening lark.  

Perhaps you know your circadian rhythm already or have a gut feeling about it. If you’re unsure, think back to the last time you were on vacation. What time did you go to bed, and when did you wake up? Being away from noise, stress, and the day-to-day grind, sleep on vacation can present in its most natural form. 

Sleep hours

The amount of sleep your body needs nightly should fall somewhere between 7 and 9 hours. Numbers outside that range can still be normal but may warrant a medical evaluation to rule out potential sleep disorders.  

If you want to be more precise, You can do an experiment called a “sleep vacation”. During a two week period, when you have a flexible schedule, pick a consistent bedtime, and don’t use an alarm to get up. For the first few days, sleep may vary as your body tries to adjust. Keep going to bed at the same time, and you’ll eventually establish a pattern that tells you the number of hours of sleep you truly need.  

In my experience, most people are familiar with their sleep identity. With varying degrees of success, we’ve been at it every night for our whole lives, after all. The problem arises when we get our sleep identity mixed up with various rules and expectations. Untangling this mess requires reinforcement of what truly matters, often with my help.  

When you know your sleep identity, the goal becomes matching your real-life sleep schedule as closely as possible. Execution can be tricky.  

What do I have to give up to secure a better snooze?

Sometimes, you need to be honest about whether you’re prioritizing ample sleep.

“I just want to have more energy to do the things I need to do,” Tiffany told me one day in between patients. A nurse practitioner with an affable bedside manner, Tiffany is a mom of three with a history of gestational diabetes. She is also a talented baker. Earlier that day, I nearly drooled on her phone when she showed me pictures of the Frozen-themed cake she made for her daughter’s first birthday.  

I immediately knew what she needed to get her energy back. I suspected she knew it too. She told me about her guilty pleasure going home to a quiet household after a long workday. It was just before the older ones got home and while her toddler took a 4-hour afternoon nap. In that time for herself, she loses track of the hours, as she researches cake recipes and responds to inquiries. Then, Baby, their youngest, wakes up.  

Will she ever get enough Zzz’s?

As it turns out, after her refreshing nap, Baby doesn’t go to bed until after 11 pm. And Tiffany forces herself to stay up late, crashing as soon as Baby goes down for the night. Then, in less than 6 hours, she drags herself out of bed at the sound of her 5 a.m. alarm.  

Tiffany knew she needed more sleep. At least an hour if not two. She used to have a lot more energy when she could sleep 7 to 8 hours before having kids, or even just before Baby came along. Yet with the knowledge and insight, she was not about to give up her “me time.”  She didn’t want to wake Baby up from her nap either, in order to get Baby to bed earlier at night. She was also hesitant to delegate Baby’s nighttime routine to her husband because she thought it was important that he had his alone time as well.  

Are you serious about securing a better snooze?

In pursuit of our best sleep, there may be sacrifices. It might be our control, beliefs, independence, me-time, or just plain time– there is no silver bullet. There’s also no right or wrong answer. Your choices will determine the best path at the time and in any given circumstances. The secret to securing a better snooze lies in following the unique blueprint that fits your goals and priorities.    

Because Tiffany chose not to give up her me-time and independence, she continued to “run on fumes” as she called it, for months after we spoke. Gradually, Baby grew out of the daily long afternoon naps. In the meantime, Tiffany, alarmed by her weight gain and mounting glucose levels, started heading to the gym after work. These changes led to an earlier bedtime and more regular sleep for the family. Tiffany’s energy level improved. 

“What about the me-time after work?”  I asked her one day. 

“Arghh…..” Tiffany expressed displeasure with the trade-off she’d made. “To make it up to myself, I stay up later on weekends and bake after Baby goes to bed,” she explained.   

The rule-follower in me was dying to bring up issues of social jet lag and total sleep deficit, but I stopped myself and nodded knowingly. Then cheekily I asked, “Got any pictures?”  

This post was brought to you by Dr. Carol Yuan-Dulair, critical care and sleep expert. Please check out her tips and program at https://www.bhaisleephealth.com/ !