Restorative Sleep
Restorative sleep is a lifestyle medicine pillar because sleep duration and quality are independently and bidirectionally linked to cardiometabolic disease, mood, weight, and adherence to every other domain. The exam tests guideline hours, the first-line treatment for insomnia, and the screening you owe a patient who sleeps badly.
The targets
- Adults: 7–9 hours per night; older adults 7–8; school-age children 9–12; teenagers 8–10.
- Regular timing matters as much as duration; short sleep (under 6 hours) is associated with insulin resistance, weight gain, hypertension, and impaired immunity, while long sleep often reflects underlying illness.
- Caffeine has a half-life of about 5 hours; alcohol shortens sleep latency but fragments sleep and suppresses REM.
Clinical approach
Screen for obstructive sleep apnea (snoring, witnessed apneas, daytime sleepiness; STOP-BANG), restless legs (check ferritin), depression, and shift work. For chronic insomnia disorder, cognitive behavioral therapy for insomnia (CBT-I) is first-line and outperforms hypnotics over the long term.
CBT-I components
Stimulus control (bed only for sleep and sex; leave the bed if awake and return when sleepy), sleep restriction with a prescribed window, cognitive restructuring of sleep-related worry, and relaxation training. Sleep hygiene alone is necessary but rarely sufficient. A consistent wake time is the strongest anchor; long or late naps and weekend catch-up sleep worsen insomnia.
Worked example
A 45-year-old woman reports 4 nights/week of 60-minute sleep latency for 6 months and requests zolpidem. Reasoning: establish chronic insomnia disorder; start CBT-I rather than a hypnotic; fix the wake time, restrict time in bed to estimated sleep time, get out of bed when awake; taper zolpidem gradually; screen for depression and apnea. Melatonin is not the answer here.
Traps
- Offering sleep hygiene as the whole treatment for insomnia disorder.
- Recommending melatonin for chronic insomnia instead of CBT-I.
- Missing sleep apnea in a sleepy, snoring patient - sedatives can worsen it.
- Using alcohol as a sleep aid.
- Trusting wearable sleep scores over the clinical history.