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Sleep

How to Discuss Sleep With Your Patients

Sleep is now an essential ingredient for a healthy heart.

Key points

  • Specialists and primary care providers alike should ask patients about their sleep in the same way they review blood pressure and other vitals.
  • Many people have poor sleep quality due to issues of socioeconomic inequality, such as night shifts, caretaking duties, or a loud environment.
  • It's important to offer patients options for better sleep without medications and supplements, like healthy sleep habits and evidence-based apps.

We already know that getting enough sleep supports our immune systems, memory, and mental health. Sufficient sleep supports healthy weight and blood sugar levels. Now, add another benefit: Sleep is an essential ingredient to heart health, according to updated guidance this summer from the American Heart Association.

AHA updated its previous guidelines, Life’s Essential 7, which outline the seven most important health behaviors and factors for optimal heart and brain health. For years, this list has included things like nicotine exposure, blood pressure, blood sugar, and weight. As of this year, the AHA has updated the list to Life’s Essential 8, which includes a new health behavior: sleep duration.

“Adequate sleep promotes healing, improves brain function, and reduces the risk for chronic diseases,” the AHA states in its new guidelines.

Guideline after guideline and study after study continue to reinforce the importance of sleep to health and wellbeing. Along with clean air, clean water, and nutritious food, sleep is a pillar of good health. Take away any one of these, and good health is impossible.

Why, then, has it taken us so long to recognize the importance of sleep? Why have we relegated a good night’s sleep as a luxury and not an essential life ingredient—essential, like the AHA has written, to the very beating of the heart and functioning of the brain? And, knowing this, how should our healthcare system treat the subject of sleep?

I’ve researched sleep for more than 40 years, seeing the challenges of conveying the importance of sleep to the public—even as I’ve witnessed the tremendous health improvements that people enjoy when they improve their sleep quality and duration. Here are five pieces of important advice for healthcare systems and providers to educate patients on the importance of sleep:

Step 1: Embrace Positive Public Health Messaging

Public health messaging plays a tough role: Too often, public health workers can sound like the Department of No Fun. We tell people what not to do; we urge them to avoid things they enjoy (too much food, alcohol, tobacco, etc. is bad for you) while promising a long-term payoff.

With sleep, however, we have a much more positive story to tell. Sleep offers a next-day return. The rewards are immediate, and the quality of our days depends greatly on the quality of our nights. The long-term effects are obvious, too—from heart, to brain, to mental health—and we can get there one good night and one good day at a time.

Step 2: Make Sleep Part of the Clinical Review Process

For heart health, we see a cardiologist. For brain health, a neurologist. Our bodies, however, aren’t so neatly siloed. Sleep—and lack of it—affects nearly every aspect of our bodies and our minds. Conversely, sleep—and enough of it—can improve nearly every aspect of our bodies and minds.

Sleep habits need to be included as part of the clinical review process. Specialists and primary care providers alike should ask patients how much sleep they get in the same way they measure blood pressure and other vitals. In addition to asking patients about their days—about their nutrition and exercise habits—we should ask them about their nights as well.

Step 3: Connect People to Tools That Promote Healthy Sleep

Even if a provider’s specialty resides beyond sleep medicine, they should have resources to guide patients to for evidence-based techniques to improve sleep. Empower patients to feel a sense of control over their sleep health.

People want and appreciate resources to help them sleep. Guide patients toward evidence-based methods that can improve the quality of their sleep. This may include healthy sleep habits and sleep hygiene, such as a consistent bedtime, keeping phones in a different room, and a quiet sleeping environment. It may include educating patients on the success of cognitive behavioral therapy (CBT) to improve sleep quality and duration, whether through in-person therapy or delivered digitally, such as via a digital therapeutic or evidence-based app.

It’s important to offer ways to improve sleep quality without medication or supplements, as people currently on medication for other illnesses are understandably hesitant to add another— and some of those sleep medications may have side effects that compromise the health benefits that the extra sleep offers. while supplements lack effectiveness.

Step 4: Recognize Healthy Sleep as a Matter of Healthcare Equity

While some people have poor sleep quality due to poor habits, many people have poor sleep quality due to issues of socioeconomic inequality. Just like many people don’t have equal access to quality health care or healthy food, many people don’t have access to enough sleep: They may work night shifts and multiple jobs; they may have caretaking duties that require round-the-clock responsibilities or live somewhere with a loud environment.

Talk to patients about how their lives interfere with sleep quality and work with them to find resources or methods that may help. Ask about their sleep, and then listen carefully. The following discussion should be free of blame and solution-oriented.

Step 5: Reinforce the Concept of Sleep as Fundamental to Good Health

For too long, sleep has been an afterthought, for both patients and providers. When we’re short on time and need a corner to cut, the corner we cut is often sleep. Amid providers’ limited time with patients, it’s understandable that there’s little time to have a meaningful conversation about sleep—if we have it at all. Yet it’s vital to reinforce to patients that adequate sleep is fundamental to good health. They don’t need to feel guilty about not getting enough of it, nor should they boast about how little they need. An open conversation between providers and patients about sleep, along with evidence-based methods that can improve sleep habits, is too crucial to remain a corner that providers cut. The five principles of good sleep health is a free resource that you can share to get your patients started.

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