Sleep is a biological requirement for life, just like breathing, eating and hydration.

And yet, it’s the only one people will push aside when time is tight.

“You don’t hear that about the other biological requirements for life,” says Dr. Michael Grandner, director of the Sleep and Health Research Program at the University of Arizona. “Sleep is seen as unproductive, and there’s nothing more un-American than unproductive time.”

According to Grandner, who also directs the Behavioral Sleep Medicine Clinic at Banner-University Medical Center, the battle for more and better sleep is cultural rather than individual. Work, technology and the pressure to stay “busy” all play a role as larger systems.

“These aren’t a bunch of individual choices,” he says. “It filters down into your bedroom.”

And there is a cost, he stresses, explaining that although sleep is adaptable, that flexibility has a limit.

Insomnia Explained

According to the Centers for Disease Control and Prevention, adults need at least seven hours of sleep each night, and more as they age. Insomnia is a condition in which it is difficult to fall asleep and stay asleep. Sleep, when it happens, may not be high quality. Poor sleep may include not feeling rested — even with an adequate number of hours — and repeatedly waking up during the night.

According to the National Sleep Foundation, about 40 million Americans experience insomnia each year, and more than 57% of older adults experience a decline in quality of life and overall health because of the condition.

Acute insomnia is short-term and can be triggered by stress. It generally resolves on its own. Chronic insomnia, however, is more serious and includes insomnia for at least three nights of the week for at least three months.

According to the foundation’s 2023 Sleep in America poll, sleep health is strongly associated with mental health. Results showed adults who slept fewer than seven hours per weeknight were three times as likely to experience “moderate to severe depressive symptoms” as those who slept seven to nine hours each night.

Individuals may develop sleep issues when they feel like they have too much to do, have difficulty detaching from the day, and may have health issues like sleep apnea or chronic pain, says Grandner. Insomnia may also develop when the stress of sleep becomes predictable, which can mean even the sight of your bed brings a sense of dread.

“Your bed becomes the dentist’s chair,” he says.

What Can Be Done

Sleep should not be thought of as a “cost,” but as an “investment in time,” says Grandner.

“We’re all living paycheck to paycheck with our sleep,” he explains, stressing it’s a mistake to ask how much sleep can be afforded.

Instead, he recommends calculating how much sleep may be needed to feel well-rested and productive the next day. From there, count backwards, allowing time to wind down before going to bed. Being in bed, he says, should not be the first time the brain has to process the events and issues of the day.

“Budget for it,” he says. “Plan that time earlier. Then the bed doesn’t become your thinking space.”

Flipping the script, he recommends setting an alarm for bedtime rather than for waking up.

“Your sleep is like a Labrador. You trained it,” he says. “You want to change it; you have to train it.”

If sleep becomes difficult, Grandner suggests getting out of bed. Reading or listening to music or a podcast may help to relax.

Good sleep habits or sleep hygiene, says the CDC, include going to bed and waking up on a consistent schedule, ensuring the bedroom is quiet, dark and at a comfortable temperature.

Electronic devices like TVs, computers and smart phones should not be kept in the bedroom.

Avoiding large meals, caffeine and alcohol before bed can help, as can being physically active throughout the day.

The National Sleep Foundation adds that spending time in bright light during the day — natural or the equivalent — can help. As can eating meals at consistent times, a consistent wind-down period and no electronics an hour prior to bedtime.

Melatonin, says Grandner, is a sedative that tells the body it’s nighttime, but that’s about it. Sleep medications also may have side effects. Rather than medications, he recommends cognitive behavioral therapy for insomnia.

Building better habits

Cognitive behavioral therapy for insomnia involves identifying and eliminating beliefs and behaviors that negatively affect sleep, and using strategies to develop good sleep habits, according to the foundation.

The American College of Physicians in 2016 recommended CBT as an initial treatment for chronic insomnia, stating the treatment could be initiated by a primary care physician and accessed in individual or group in-person sessions, as well as by telephone, online or through books.

In addition to developing a better wind-down and bedtime routine, as well as getting out of bed when sleep becomes difficult, as Grandner advises, CBT can also include learning relaxation techniques and how to remain “passively awake,” according to the Mayo Clinic. This involves learning to let go of worries about sleep. Biofeedback, in which a device is used to monitor heart rate and muscle tension, can also help to show patterns that affect sleep.

The Mayo Clinic notes sleep medications are short-term and may have negative side effects. While CBT may take longer to solve sleep problems, it can provide a more long-term solution. For some individuals, a combination of medication and CBT may be appropriate, experts say. The first step is seeking help.

Grandner credits a colleague with a quote that provides perspective on the issue.

“Sleep isn’t something you do. Sleep is something that happens when the situation allows it.”