Sleep: effective ways to improve it
Introduction
Our research found that melatonin supplementation, cognitive behavioural therapy for insomnia (CBT-I), light regulation, mindfulness-based stress reduction (MBSR), and improved night-time air circulation could all be effective ways for you to increase the quality and quantity of your sleep.
This is a summary of research conducted into the most worthwhile practices for sleeping better. The post is the first in a series looking into the most effective ways people can improve their wellbeing, aiming to present this information as simply and practically as possible.
Thank you to the EA Infrastructure Fund for financing this project. If you find this information useful and/ or take up any of the suggestions, please get in touch and let us know!
Important note: None of the following constitutes professional medical advice. Some of the interventions suggested have risks of negative side effects that are discussed below. We encourage you to experiment with these practices but please be cautious in doing so and take any risks seriously.
Top takeaways
Our principal recommendations for improving sleep quality are (in order):
- Melatonin supplements: 0.3mg (300mcg) daily taken two hours before bed.
- CBT-I: a six-to-seven-week, self-guided course in cognitive behavioural therapy for insomnia, accessed through an app.
- Light therapy: greatly increasing exposure to bright light during the day, either through building a lumenator or purchasing a SAD lamp.
- Improved night-time air circulation: opening a window to reduce overnight CO2 accumulation.
- Mindfulness-based stress reduction: mindfulness training through an app with a focus on sleep.
Key findings
Following a broad search of possible interventions, this review evaluated the effectiveness of 11 practices for improving sleep quality and quantity using an adapted weighted factor model.
The five most promising interventions are listed below along with a brief explanation. More detailed assessments of all 11 practices are provided further down.
This research compared interventions across six criteria: strength of evidence, quality of evidence, ease of implementation, risk, externalities, and novelty. Full results from the model, along with reasoning for the metrics used and their respective weightings, can be found here.
Melatonin
Ranking: 1st
Intervention: 0.3mg daily supplementation (e.g. Options A, B and C)
Summary: Melatonin is a natural sleep hormone that can improve sleep quality and quantity when taken in small, daily doses. Melatonin supplementation appears highly practical, with a low risk of notable side effects as well as possible spillover benefits for other conditions.
CBT-I
Ranking: 2nd
Intervention: Completion of an app-based CBT-I course (e.g. Dozy; CBT-I Coach)
Summary: Cognitive Behavioural Therapy for Insomnia (CBT-I) involves a combination of reframing negative thoughts around sleep, improving sleep hygiene, and implementing sleep restriction. We found good evidence that completing a self-guided CBT-I course via an app can be an effective way to sleep better.
Light therapy
Ranking: 3rd
Intervention: Increasing indoor lighting brightness, preferably up to 10,000 lux or more (e.g. a ‘lumenator’ or a Seasonal Affective Disorder [SAD] lamp).
Summary: Multiple studies have found that significantly increased exposure to bright morning light improves sleep quality and quantity. We found negligible risks to this practice as well as possible benefits to mood and alertness, though this does require some time and money to set up.
Improving night-time air circulation
Ranking: 4th
Intervention: Leaving a window or internal door open while sleeping.
Summary: There is reasonable evidence to suggest that high levels of carbon dioxide can accumulate overnight in a closed room and that this reduces sleep quality. Leaving a window open overnight is a simple and effective solution with minimal downsides.
Mindfulness-based stress reduction (MBSR)
Ranking: 5th
Intervention: Completing an app-based mindfulness-based stress reduction course (MBSR) (e.g. Calm; The Mindfulness App)
Summary: Mindfulness-based stress reduction courses are associated with improved total sleep time and reduced sleep disturbance. MBSR is not targeted at sleep as an intervention and likely offers significant additional benefits.
Why sleep matters
The selection effects of choosing to read this article mean that you are likely already convinced that improving your sleep is a valuable use of your time. In case that is a poor assumption, this is a very brief argument in favour of the importance of sleep.
Sleep is fundamental to wellbeing
35% of American adults are estimated to sleep less than seven hours on average. This is considered sleep deprivation, with more than seven hours of sleep a night the consensus recommendation.
Sleep deprivation is linked to a higher risk of many (perhaps most[2]) negative health conditions, including hypertension, coronary heart disease, diabetes, and obesity. It has also been directly linked to lower reported quality of life and wellbeing.
This makes sleep one of the most effective interventions for improving other aspects of wellbeing. Though health issues like those above can in themselves reduce the quality of sleep, there seems to be a range of tractable ways in which to improve sleep regardless.
Modern living is not set up for ideal sleep
Perhaps some of the practices suggested here feel to you like an excessive intervention into the natural process of sleep, something that should not require supplements or training programmes. But in the excellent words of the writer Gwern Branwen, ‘I would point out to such readers that they are already profoundly tampering with their natural sleep cycle, and indeed, all of Western civilization is tampering with it’.
People tend to go to bed more than an hour earlier each night when taken away from any artificial light through the evening. Mobile phone use in the evening is a direct act of sabotage on the quality of your sleep.
Common (sense) interventions
The focus of this research is to explore the effectiveness of practices that are likely to be new to the majority of readers. Given this, we have omitted the exploration of a few common suggestions for improving sleep that are nevertheless worthy of some mention:
- Use earplugs or a white noise machine if you frequently notice ambient noise when trying to fall asleep.
- Install blackout blinds or wear an eye mask if you are often woken up early by ambient light.
- Choose a realistic time to get up each day and stick to it as much as possible. Trying to catch up on sleep over the weekends is ineffective and can be counter-productive in disrupting your circadian rhythm.
- Minimise the use of your bed for anything that isn’t sleeping.
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Read the rest of this report on the EA Forum.
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