It’s time to say GOODBYE to Insomnia and HELLO to a Good Night’s Sleep
Good quality Sleep is one of the Four Cornerstones of Health and Wellbeing. The other three are Exercise, Nutrition and Mental/Emotional Resilience. Sleep is essential for every single process that takes place in our body. Sleep is an “active” brain function. Fresh fluids circulate in the brain which remove toxic byproducts of metabolism, almost like the kidney does for the whole body. This allows the brain cells to become fresh and revitalized. Memories are consolidated, the neurotransmitters that regulate mood and cognitive functions such as increased concentration, learning, and solving problems are restored. Sleep enhances our immune system, decreases hunger and the tendency to gain weight, and obviously increases our energy levels. In fact there are few natural experiences in life that beat waking up refreshed, cheerful and ready to take on a new day!
A good way of looking at the importance of sleep is to look at the long lists of maladies that are caused or worsened by chronic sleep deprivation. Poor sleep quality essentially worsens every negative symptom in the book. To name some, insomnia:
Increases weight gain
Causes fatigue
Increases symptoms of or causes depression, anxiety, mood swings and irritability
Increases risks of auto accidents. Depending on the amount of sleep deprivation, the risks can be equivalent to driving drunk.
Decreases work performance and makes easy tasks harder to accomplish.
Increases pain in fibromyalgia and virtually every other chronic pain syndrome.
Decreases immune function
Increases risks of dementia
Increases risks of hypertension and heart attacks
Increases risks of Diabetes
Increases risks of substance abuse
On a more positive note: There is no place like home and getting a good nights sleep! And the good news is that the best way to cure insomnia does not involve the use of sleeping pills. In fact the long term use of sleeping pills can increase the risk of many of the mental and emotional problems and cognitive disorders caused by sleep deprivation itself.
The most important first step in addressing chronic insomnia is ruling out sleep apnea, the leading UNDIAGNOSED risk factor for premature death in the United States. Making an appointment with a sleep specialist is job number one. If they feel you are at risk for sleep apnea they can set you up for a home sleep study. However many patients for a variety of reasons are unable to get a sleep study. For this reason we have come up with a simple self administered home test that closely simulates the part of a formal sleep study which checks for sleep apnea. Please see the image below and watch my brief YouTube video to learn how to do this. If this test shows the tell-tale signs of sleep apnea, it should make it easier to get treatment. At the very least, if it rules out sleep apnea, that is powerful information as you can now engage in the program listed further below to reclaim you healthy sleep patterns.
At Home Test for Sleep Apnea
Sleep Hygiene
Just like any other part of basic self-care, your sleep behavior could also benefit from hygiene. Your sleep environment, afternoon and evening activities, coping behaviors, and sleep routine are all part of good sleep hygiene.
Maintain a regular sleep schedule:
• Go to bed and wake up at the same time each day(+/- 20 minutes), even on weekends and holidays. This should help regulate your body's clock and enhance the quality of your sleep and wake time.
• If possible, avoid naps. If you have to take a nap, try to keep it to less than one hour and avoid taking a nap after 3 p.m. Naps decrease the 'Sleep Debt' that is so necessary for easy sleep onset. Each of us needs a certain amount of sleep per 24-hour period. We need that amount, and we don't need more than that. When we take naps, it decreases the amount of sleep that we need the next night - which may cause sleep fragmentation and difficulty initiating sleep, and may lead to insomnia.
Your evening and bedtime routine:
• Practice relaxation techniques before bedtime.
• Deep breathing and visualization of a soothing scene.
• Take a warm shower or bath about 90 minutes before bed. A hot bath will raise your body temperature, and it is the drop in body temperature that may leave you feeling sleepy.
• Listen to soothing music.
• Drink a cup of non-caffeinated tea.
• Have a light snack, but avoid eating heavy meals near bedtime.
• Wait until you are sleepy before going to bed. If you're not sleepy at your regular bedtime, try to relax your body and distract your mind. A void exciting books or television that wakes you up.
Preparing the mind for sleep:
• Reduce stress. If you're worried about getting your work done, make a to-do list for the next day to assure yourself you have enough time to accomplish what needs to get done. Once the chores that cause you stress are down on paper, your mind is free to relax and think more pleasant thoughts.
• If you are worried, get out of bed. Write down your worries, make a list, put it aside. The bed is a place for rest, not worry.
• Unglue yourself from false or anxious beliefs about sleep, such as the idea that a single restless night will make you sick.
• Try to avoid emotionally upsetting conversations and activities before trying to go to sleep. Don't dwell on or bring your problems to bed.
Preparing the body for sleep:
• Avoid caffeine after lunch. The effects of caffeine may last for several hours after ingestion. Caffeine is a stimulant and reaches its peak effect in the first hour but with a half-life elimination of 3-7 hours. Caffeine is a potent sleep inhibitor and it increases sleep latency, night waking, decreases total sleep time, decreases slow-wave sleep, and impairs overall sleep quality. Remember, chocolate has caffeine, too.
• Don't go to bed hungry or full. If your stomach is too empty, that can interfere with sleep. However, if you eat a heavy meal before bedtime, that can interfere as well. Dairy products, turkey, and tuna contain tryptophan, which acts as a natural sleep inducer. Tryptophan is probably why a warm glass of milk is sometimes recommended. Dietary changes can also cause sleep problems, so make gradual changes if possible.
• Avoid alcohol of any type within six hours of your bedtime. Alcohol creates the illusions of good sleep but the architecture of sleep is affected adversely. Sleep is fragmented with deep sleep initially and a rebound of REM sleep later.
• Do not smoke or ingest nicotine within two hours of your bedtime.
• Exercise regularly, but avoid strenuous exercise within six hours of your bedtime. Exercise promotes continuous sleep. However, rigorous exercise circulates endorphins into the body which may cause difficulty initiating sleep.
• Ensure adequate exposure to natural light during the day. Light exposure helps maintain a healthy sleep-wake cycle.
• Avoid sleeping pills, or use them cautiously. Always use sleeping pills as prescribed by your physician.
Your sleeping area:
• Remove all TVs, computers, and other "gadgets" from the bedroom.
• Use your bedroom only for sleeping and sex (if that's right for you). The bedroom, and more importantly the bed, is not a place for watching TV, eating, chatting, working, etc.
• Keep your bedroom quiet, dark, and cool. Use curtains or blinds to block out light.
• If noise bothers you, consider wearing earplugs or using soothing music, a fan, or a "white noise" machine to block out noise.
• If you are a 'clock watcher' at night, hide the clock.
• Use a sleep mask and earplugs, if light and noise bother you.
• Extreme heat or cold should be avoided. A hot room can be uncomfortable. A cooler room along with enough blankets to stay warm is recommended.
• If light in the early morning bothers you, get a blackout shade or wear a slumber mask.
• If you need light, use off-light such as a night light in the bathroom or hallway.
• If your pets awaken you, keep them outside the bedroom.
If you can't fall asleep:
• If you are not asleep after 20 minutes, leave your bedroom and find something else that will relax you enough to help make you sleepy. Don't stay in bed awake for more than 5-10 minutes.
• This is called sleep restriction. Lying in bed when you're awake can become a habit that leads to poor sleep. Limiting the amount of time you spend in bed can make you sleepier when you do go to bed. That way you're more likely to fall asleep and stay asleep.
• If you find your mind racing, or worrying about not being able to sleep during the middle of the night, get out of bed, and sit in a chair in the dark. Do your mind racing in the chair until you are sleepy, then return to bed. No TV or internet during these periods! That will just stimulate you more than desired.
• If this happens several times during the night, that is OK. Just maintain your regular wake time, and try to avoid naps.
• Sit quietly in the dark or read the warranty on your refrigerator. Don't expose yourself to bright light while you are up. The light gives cues to your brain that it is time to wake up.
• Remaining passively awake. This involves avoiding any effort to fall asleep. Paradoxically, worrying that you can't sleep can actually keep you awake. Letting go of this worry can help you relax and make it easier to fall asleep.
If you continue to have sleeping problems, consider keeping a sleep diary. Write down when you go to bed, when you get up, how much time you spend in bed unable to sleep, total sleep time and other details about your sleep patterns.
The gold standard for the treatment of insomnia is Cognitive Behavioral Therapy that focuses just on sleep. Ideally, you should engage the services of a trained therapist to help guide you through the 5 week process. However, if you are unable for whatever reason to use a therapist, the monographs below will work very well IF you commit to the program from beginning to end. There is no shortcut or “hack”; it requires discipline and a will to change. However you will rapidly see some improvement just by reading the first part as it will dispel many of the myths of insomnia that are intimidating to you. It really helps to go through the program with a partner or group in order to encourage and keep each other accountable. The same principle holds true for the other health enhancing behaviors such as exercise and a sound, scientifically based nutrition program that are described in our health/wellbeing section.
Before embarking on the program, be sure to discuss your sleep problems with your PCP as they may be a symptom of another problem such as depression or anxiety. Treatment of underlying problems may solve the problem. Another common cause of insomnia for women is menopause. Night sweats are notorious sleep robbers. Also overactive bladder requiring frequent trips to the bathroom are another problem that can be addressed. We have a keen interest in bio-identical hormone replacement so be sure to let us know if you have these symptoms.
Ok now that you are committed to getting started on the program, please open the first pdf monograph listed below. Once you have completed it move on to the next one. They are designed to be done sequentially, from one to five. Move on to the next one when you have mastered the one you are on, even if it takes more time than expected. Be kind to yourself when you lapse, BUT get back on the program! Good luck and let us know how you are doing and if we can help you along the way.
Tracking your sleep is very important, one option that makes tracking sleep a breeze is a sleep tracking device like a Fitbit or similar wearable device.