How to Get Your Sleep on Track (with Dr. Cara Ooi)

People struggling with sleep issues and insomnia often say they've tried absolutely everything to no avail. Traditional sleep hygiene advice like cutting screen time is difficult to implement in reality, and leads them to believe they’re “just a bad sleeper”.

This feeling of hopelessness acts as a real barrier to trying anything else or taking consistent action. But if we want to maintain a healthy weight and our overall well-being, quality sleep has to be prioritized.

Today, I’m sharing sleep physician and youth psychiatrist Dr. Cara Ooi’s expert strategies to get your sleep back on track.

The first steps to better sleep

In Dr. Ooi’s DECODE framework, she explains what needs to come together in order to get your sleep back on track, and why past attempts to sleep well haven’t worked.

When it comes to improving sleep hygiene, it’s helpful to think of it as a 3-piece puzzle that needs to come together. 

The 3 pieces of the puzzle are:

• Body Clock (your internal clock that runs on a 24 hour cycle) 

This has a really powerful influence over when you’re going to feel alert and when you’re going to be able to sleep well. It’s also important to be aware of the forbidden sleep zone, which is the few hours before bedtime when it's almost impossible to fall asleep. 

• Sleep Drive 

We build up drive and pressure for sleep the longer we’re awake and the more physically active we are. We need more sleep drive so that it’s easier to get sleepy and have a solid sleep. It also means we’re less likely to wake up and have long awakenings in the night. Having too little time awake and napping can deplete sleep drive.

• Activation 

Where there is enough sleep potential, but you still can't sleep, it means you’ve not had enough time to power down or there is something keeping you from settling. These are called sleep blockers and include things like activating emotions and activating drugs which prevent you from sleeping.

3 Ways to “jumpstart” your sleep

Dr. Ooi has discovered 3 “jumpstarts” that she has found everyone to benefit from. Even if it doesn’t make a huge difference immediately, they will set you up to benefit from later strategies. 

• Set up another place that is not your bed (a “cozy nook”)

One of the things we know that drives chronic insomnia is a negative association that can be developed with the bed. The bed then becomes paired with a state of being alert and not able to settle. The key thing is to stay out of your bed until you’re sleepy. Set up another place, your “cozy nook”, that plays the role of the bed and is just as appealing in the moment so that you don't default back into bed. 

• Set up a sleep kit

This enables you to create a toolkit of things on hand that you can go to when you're unable to sleep. Without a sleep kit, people usually end up going through things in their mind, going on their phone, or watching Netflix. It makes sense in that it provides a distraction, but it's not helpful due to the stimulation and the light. Therefore it’s important to go into that situation with a plan and anchor your mind onto things in the sleep kit, which will allow you to relax and calm down.

• Optimize light in your environment

We have access to artificial light all the time, and it’s a huge part of how we live our lives. But if you don’t address when you're getting light and dark, it's pretty difficult to expect to sleep well.

You don’t necessarily need to start with cutting out screens entirely before bedtime. If you can, that’s great, but if not, start with little tweaks. Certain products can be helpful like blue light blocking glasses, and turning off unnecessary lights can make a difference too.

Getting a lot of bright, outdoor light when you wake up will also support your circadian rhythm, and strengthen circadian signals, which helps with being ready for sleep at the right time.

Social Jet Lag

When you have a change in your wake up time that’s more than two hours, you can develop what we call “social jet lag”. The time you're getting your first light is constantly shifting back and forth. A lot of people have to wake up at a set time on weekdays like 7am, and then sleep in on weekends. If you wake at midday on the weekend, that could result in a 5 hour shift, which is the equivalent to taking a flight from Toronto to Hawaii on Friday and flying back on Sunday!

While you're shifting like this, you’re jetlagged and so probably not functioning at your best cognitively, feel physically unwell, depressed, and have difficulty regulating. We don't typically associate these problems with jet lag because it eventually goes away once your body adjusts to the timezone. But when you’re doing this every single weekend, you end up in a chronic state of social jet lag.

Should I work towards having a certain bedtime?

Ideally if you’re waking up at the same time, you’re also going to bed at the same time.

However, if it gets to your bedtime at say 10pm and you’re not powered down and your body’s not ready for sleep, then this isn’t helpful. 

It is key to align when you get into bed with when you have potential for sleep (this is based on the timings of your body clock + how much drive you've built up for sleep).

You don't want to get into bed until you're feeling like you're on the edge of sleep.

What if I’m a shift worker?

As a shift worker, you may not be able to make the circumstances perfect, but you can certainly improve things. A lot of the same principles that we use for good sleep are helpful for shift work, and these tips can help too:

• Make decisions ahead of time so it is easier to power down and when you do have the opportunity to sleep more, you’re likely to sleep well. 
• Overall, try to have a batch of shifts around same times
• If your shifts gradually get later, it is easier to stay up later as opposed to forcing yourself to sleep earlier
• Ask for shifts more aligned with your circadian rhythm.

Addressing revenge bedtime procrastination

Revenge bedtime procrastination refers to the decision to delay sleep in response to stress or a lack of free time earlier in the day. Much like late night snacking, if you don’t restrict yourself earlier in the day, it will serve you better at night.

If this is something you struggle with, there are several things that can make a difference:

• Make decisions ahead of time, e.g. what time you aim to go to bed

• Build out a simple bedtime routine. 

We procrastinate because we haven’t filled up our cup enough throughout the day. Can you schedule those things earlier in the day or chunk out your evening to include some self-care? This makes it much easier to shut things down at bedtime.

• Shape your environment and prepare your sleep kit ahead of time.

• Have conversations with other people in the home like your partner about when you can carve out time to spend quality time together, without it affecting your sleep.

Can I manage with behavioral intervention alone?

More people can manage without medication than what is currently occurring, however medication can absolutely play a role. It acts just like a cast when you break your leg but may not be a good idea in the long run. However, medication should always be used in conjunction with the non medication strategies which are also super effective.

More about Dr. Ooi

Dr. Ooi obtained her medical degree from Western University, then completed her residency and subspecialty training in General Psychiatry and Child & Adolescent Psychiatry at the University of Toronto. Dr. Ooi subsequently completed a fellowship in Sleep Medicine.​

She is the host of the DECODE Project Podcast.

Dr. Ooi is a fellow of the Royal College of Physicians and Surgeons of Canada and has an academic appointment (Lecturer) with the Department of Psychiatry at the University of Toronto.

Dr. Ooi practices general Sleep Medicine at the Toronto Sleep Institute and will soon deliver the DECODE programs at the DECODE Insomnia Clinic.

Visit her website

Watch the DECODE START video series

Follow her on Instagram

Listen to her podcast: DECODE Project

Integrate sleep into your professional work with the DECODE Insomnia START toolkit