Sunday, September 25, 2011
In my practice, I often meet people who can't seem to get a good night's rest. Some have a tough time falling asleep; others find that they wake up frequently throughout the night. Some fall asleep quickly, but repeatedly wake up too early and can't seem to get back to sleep. Still others sleep well throughout the night, but they never seem to feel rested. I'm not surprised to learn that many of them have been taking sedatives, either over-the-counter or prescription. What does surprise me is the number of people who have been taking sedatives for years, often with little or no success, but have never been advised by their prescribing physician to examine their sleeping habits. And while there certainly is a place for medication in the world of sleep improvement, many of these sedatives impact quality of sleep by keeping people from spending as much time in deeper, slow-wave sleep. Some of these medications come with undesirable side effects, and others have a potential for tolerance or addiction. With time, some people find that the pill stops working as well. In extreme cases, people are eventually sleeping even worse than before they ever started taking the pill.
At that brings me to a rule-of-thumb to ponder. Medication doesn't teach us anything. A pill is typically not "the cure" per se. In fact, there is no one simple cure to complex problems. Medication is typically a tool that people can use to minimize their symptoms enough to focus on long-term solutions. It often gets people functional enough to learn what they can do to improve their lives.
So what can we learn to improve our sleep? Here are some non-medication, lifestyle strategies that most of my clients have found helpful. In fact, I have never worked with a client who struggled with sleep who did not at least find these strategies helpful. Some have even found themselves returning to a full night's rest-problem free. These strategies are particularly near and dear to my heart; I use them myself. When I was younger, I repeatedly struggled with falling asleep at night. These days, I consistently drift off minutes after my head hits the pillow.
Before covering these strategies, it's important for me to stress that difficulty sleeping can be caused by a number of things-lifestyle habits, acute stressors (e.g. relationship problems, work problems, financial problems), mental health disorders (e.g. anxiety disorders, depression, Bipolar Disorder), withdrawal from addictive substances, use of addictive substances (e.g. alcohol, marijuana, cocaine, amphetamines), respiratory disorders, sleep apnea, etc. I encourage my clients to see a physician, preferably a sleep specialist, to rule-out biological disorders that might be impacting sleep. However, clients who typically see me have already sought medical attention.
The following evidence-based sleeping tips can be helpful:
1) Change your diet to be more conducive to a good night's rest. Some foods are better for sleep than others. Focus on foods high in melatonin, potassium, magnesium, and L-tryptophan, such as cherries, bananas, and milk. Avoid foods high in fat content or carbohydrates. Eliminate both stimulants and depressants in the few hours prior to going to bed. Caffeine and sugar are stimulants; they inhibit sleep. While many people rely on depressants like alcohol or marijuana to help them fall asleep, they are typically unaware that such depressants tend to decrease the amount of time that the brain spends in slow-wave sleep (deeper sleep) and REM sleep. A person may fall asleep and may even sleep for a good number of hours, but they do so at the expense of sleep quality. Also, some foods are better than others for a good night's rest.
2) Wash your bedding frequently. Personally, I was mine at least once a week. Why does this help? We find fresh scents more relaxing, and dust and debris in the bedding may impact our breathing at night without us even realizing it.
3) Keep your room temperature low at night. Our body's set temperature decreases at night. While a "comfortable" temperature varies from person to person, the range between 65 and 72 degrees is typically recommended. Are you skeptical? Think about it-human beings have always slept better at night, when temperatures are lowest. And we often sought cooler environments (e.g. caves) for sleep in ancient times.
4) Keep your room as dark as possible and eliminate TVs, radios, and other visual and auditory distractions. Most people understand why its important for the room to remain dark, but many swear that the TV or radio helps them to fall asleep. Here's the problem-a structure in the brain called the amygdala is constantly scanning the horizon for changes in tactile, visual, and auditory stimuli-even while you sleep. The more noise and lighting changes throughout night (i.e. from a TV set), the more the brain tends to linger in shallower sleep stages. This mechanism is in place to protect us from potential dangers at night. Some people still swear that they can't fall to sleep without a TV or radio, so I advise them to at least consider using a timer that will automatically shut the device down after a set amount of time to avoid distraction throughout the night.
5) Exercise regularly. Have you ever exhausted yourself physically during the daytime and then found yourself easily passing out at night? This comes down to simple math. If you aren't burning energy during the day, your body finds sleep, which in part serves to re-energize and replenish these energy resources, less necessary. More exercise = more calories burned = more fatigue at night. But there's a catch: Avoid exercising too late at night. It takes time for your body to come down from that energetic state. Best to exercise in the morning, late afternoon, or early evening.
6) Avoid tossing and turning in your bed. Ideally, your brain needs to associate your bed with rest, not struggle. If you find yourself tossing and turning, its best to get out of bed and do something relaxing, preferably in a different room. Then come back to bed and try again.
7) Avoid dwelling on negative or stressful thoughts at night. Easier said than done, right? When you dwell on anxious or negative thoughts at night, you may partially or fully active the sympathetic nervous system, which in turn activates your body's fight or flight system, a state incompatible with sleep. Why? Because your brain is perceiving a potential threat-real or imagined-in your environment. There are several strategies that you can use to combat these anxious thoughts at night. You can try thought stopping, a strategy in which you actually tell yourself to stop thinking anxious thoughts and then distract yourself with a cognitive task, such as counting backwards from 500 in increments of 7. Thought dumping or flooding involves getting out of bed, giving yourself an allotted amount of time to dwell on anxious thoughts, preferably scribbling them down rapidly on a notepad, and then giving yourself permission to rest. Why does this work? If you already got all of your thoughts down and immortalized them on paper, then your brain doesn't have to toss them around as much because you're aware that the thoughts have been recorded and can be reviewed the next day. Part of your worrying can be explained by your brain's need to make sure that you remember important things that could become problems. You may also want to see a Cognitive Behavioral Therapist to learn how to challenge and replace these thoughts so that they don't keep you up as much at night. Prayer, meditation, jotting things to remember on a pad or planner, and talking to a supportive friend or family member can also be strategies to help reduce your anxious thinking at night.
Okay, so these 7 tips are a start, but they're only a snapshot of dozens of helpful sleep strategies. For more info, visit my "Helpful Links" page, scroll down to "Sleep Improvement Tips," and review the the articles listed. Happy reading!
Wishing you a good night's rest,
Sources: National Sleep Foundation, Psychology Today, Health.com, WebMD