The Optimized Doctor

Getting a good night’s sleep


For most things, the harder you work at it, the more successful you’ll be. Except when it comes to sleep. Nothing frightens sleep away faster than an all-out effort to find it. And yet, it should be the easiest of all health habits to cultivate. Sleep should be a hardwired, physiologic, default condition (sort of like eating and sex, all are which are evolutionary imperatives). And yet, lack of sleep is a common and grave problem even in our safe and comfortable modern environment.

A lit lamp and a book on a bedside table tru/E+/Getty Images

Sleep really is the keystone to your health, without which all other healthy choices would fall to the ground, ineffectual. Lack of sleep depletes your willpower, making it less likely you’ll actually go to the gym or be able to resist that bear claw pastry calling you back to the break room. Poor sleep impairs your ability to lose and keep off weight. It can lead to mistakes of inattention – a problem if you’re flying a plane or screening for melanoma.

As a recovering insomniac, I’ve scouted out the territory for you and have taken a few notes as a Baedeker on your journey to better sleep. Tracking sleep is easy; most any fitness tracker or smart watch outfitted with the right app will do the work for you. I’ve used my Apple Watch and Pillow for years. (I’ve no conflict of interest). I’ve found that the quality score it provides each night is interesting, but not all that important. Using pad and paper you could just as easily quantify your sleep: How many hours were you in bed, asleep, and how did you feel the next day.

Here is something important I learned about myself: I don’t need 8 hours. You might not either. Most articles say that we adults need 7-8 hours of sleep. I wasted a lot of effort trying to keep it above the 7-hour mark. Then I realized that even on nights when I got 6-7, I felt fine the next day! Don’t assume you need 8 hours. It could be 6 or it could be 9. It might in fact change depending on how you slept recently, what is happening in your life, or which season it is. If you feel alert and well rested, then you’ve likely found all the sleep you need.

Let’s assume you aren’t well rested. Now what? Like most of good health, a behavioral approach is needed to get you on the right path. You’ve likely heard that bright, particularly blue, light is harmful to falling asleep. Good news! Most devices will let you filter blue light out if you must continue that “Better Call Saul” binge. Better options: Leave your tablet in the living room and plug in your phone on the opposite side of the room (with a short cord). Invest instead in a book light and actual books. There is something about the patina of paper that can encourage sleep to come find you.

Keep the room comfortably cool. What’s important here is the temperature drop. That is, going from warm to cool. This is why a warm shower or bath before getting into bed can help you. Your temperature will drop, a signal for sleep.

Dr. Jeffrey Benabio, director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego.

Dr. Jeffrey Benabio

So now you’re asleep. But wait, you say you’re awake again and it’s 3:00 a.m.? This is sleep maintenance insomnia. You lie there, patiently waiting, like anticipating your waiter’s return when you’re eating in Rome – ah, you could be there all night. Nothing you do seems to bring sleep back around. The best advice is to try to retrain yourself that when you are up, you’re up, and when in bed, you’re asleep. You can try getting up, moving to a different room. Try meditation or reading. Wait until you feel the urge to sleep sneak back on you, then head back to bed. Although sometimes difficult, you might consider riding it out. If you can’t fall back, then get on with your day (although I don’t recommend sending emails at 3:45 a.m., it freaks people out, I’ve learned). The following night, you will likely be sleep deprived and might find you can fall asleep easier and for longer.

Be forgiving. Unlike your diet or exercise, sleep isn’t as much in your control. You can work a little harder in spin, or double your effort to keep to your plant/keto diet. But for sleep, you must just be patient. It will come. When it is good and ready.

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at

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