Helpful Hints to Help You Sleep

Poor sleep habits (referred to as hygiene) are among the most common problems encountered in our society. We stay up too late and get up too early. We interrupt our sleep with drugs, chemicals and work, and we overstimulate ourselves with late-night activities such as television.

Below are some essentials of good sleep habits. Many of these points will seem like common sense. But it is surprising how many of these important points are ignored by many of us. See the Center for Clinical Interventions website for free worksheets about sleep hygiene, how to use a sleep diary, insomnia, cognitive distortions: https://www.cci.health.wa.gov.au/Resources/Looking-After-Yourself/Sleep  

The following factors are important for optimal sleep hygeine:

Your Personal Habits

• Fix a bedtime and an awakening time. Do not be one of those people who allows bedtime and awakening time to drift. The body "gets used" to falling asleep at a certain time, but only if this is relatively fixed. Even if you are retired or not working, this is an essential component of good sleeping habits.
• Avoid napping during the day. If you nap throughout the day, it is no wonder that you will not be able to sleep at night. The late afternoon for most people is a "sleepy time." Many people will take a nap at that time. This is generally not a bad thing to do, provided you limit the nap to 30-45 minutes and can sleep well at night.
• Avoid alcohol 4-6 hours before bedtime. Many people believe that alcohol helps them sleep. While alcohol has an immediate sleep-inducing effect, a few hours later as the alcohol levels in your blood start to fall, there is a stimulant or wake-up effect.
• Avoid caffeine 4-6 hours before bedtime. This includes caffeinated beverages such as coffee, tea and many sodas, as well as chocolate, so be careful.
• Avoid heavy, spicy, or sugary foods 4-6 hours before bedtime. These can affect your ability to stay asleep.
• Exercise regularly, but not right before bed. Regular exercise, particularly in the afternoon, can help deepen sleep. Strenuous exercise within the 2 hours before bedtime, however, can decrease your ability to fall asleep.

Your Sleeping Environment

• Use comfortable bedding. Uncomfortable bedding can prevent good sleep. Evaluate whether or not this is a source of your problem, and make appropriate changes.
• Find a comfortable temperature setting for sleeping and keep the room well ventilated. If your bedroom is too cold or too hot, it can keep you awake. A cool (not cold) bedroom is often the most conducive to sleep.
• Block out all distracting noise, and eliminate as much light as possible.
• Reserve the bed for sleep and sex. Don't use the bed as an office, workroom or recreation room. Let your body "know" that the bed is associated with sleeping.

Getting Ready For Bed

• Try a light snack before bed. Warm milk and foods high in the amino acid tryptophan, such as bananas, may help you to sleep.
• Practice relaxation techniques before bed. Relaxation techniques such as yoga, deep breathing and others may help relieve anxiety and reduce muscle tension. 
• Don't take your worries to bed. Leave your worries about job, school, daily life, etc., behind when you go to bed. Some people find it useful to assign a "worry period" during the evening or late afternoon to deal with these issues.
• Establish a pre-sleep ritual. Pre-sleep rituals, such as a warm bath or a few minutes of reading, can help you sleep.
• Get into your favorite sleeping position. If you don't fall asleep within 15-30 minutes, get up, go into another room, and read until sleepy.

Getting Up in the Middle of the Night

Most people wake up one or two times a night for various reasons. If you find that you get up in the middle of night and cannot get back to sleep within 15-20 minutes, then do not remain in the bed "trying hard" to sleep. Get out of bed. Leave the bedroom. Read, have a light snack, do some quiet activity, or take a bath. You will generally find that you can get back to sleep 20 minutes or so later. Do not perform challenging or engaging activity such as office work, housework, etc. Do not watch television.

A Word About Television

Many people fall asleep with the television on in their room. Watching television before bedtime is often a bad idea. Television is a very engaging medium that tends to keep people up. We generally recommend that the television not be in the bedroom. At the appropriate bedtime, the TV should be turned off and the patient should go to bed. Some people find that the radio helps them go to sleep. Since radio is a less engaging medium than TV, this is probably a good idea.

Other Factors

Several physical factors are known to upset sleep. These include arthritis, acid reflux with heartburn, menstruation, headaches and hot flashes. 

Psychological and mental health problems like depression, anxiety and stress are often associated with sleeping difficulty. In many cases, difficulty staying asleep may be the only presenting sign of depression. A physician should be consulted about these issues to help determine the problem and the best treatment.

Many medications can cause sleeplessness as a side effect. Ask your doctor or pharmacist if medications you are taking can lead to sleeplessness.

To help overall improvement in sleep patterns, your doctor may prescribe sleep medications for short-term relief of a sleep problem. The decision to take sleeping aids is a medical one to be made in the context of your overall health picture.

Always follow the advice of your physician and other healthcare professionals. The goal is to rediscover how to sleep naturally.

Source: Sleep Hygiene | University of Maryland Medical Center http://umm.edu/programs/sleep/patients/sleep-hygiene#ixzz2sNimOdov 
University of Maryland Medical Center 

Practical advice for better sleep:

Behavioral Changes

1. Exercise- People who exercise regularly (30 minutes of exercise 5-6 days per week, heart rate at least 110) have been shown to have less sleep problems.  It is best to exercise six or more hours before planning on going to bed.

2. Diet – Avoid any caffeinated products after noon.  Also, spicy foods and large dinners tend to interfere with sleep onset.  Finally, avoid high-calorie, high sugar content foods 3-4 hours before bed.  A warm glass of milk does sometimes help in feeling sleepy.

3. Alcohol use – Alcohol helps with sleep induction but results in early awakening with difficulty falling back asleep.  It also inhibits deep sleep cycles, which is where the body gets the most benefit from sleep.

4. Light – The best environment for sleep is for the room to be as dark as possible.  Some people prefer a small night light and this can be experimented with.  f.lux is an app that eliminates “blue light” from computer or smart phone screens.   This minimizes the effect that these devices have on disrupting Melatonin.

5. Noise – White noise may be helpful, and may drown out external street noise, noise from neighbors, other parts of the house, etc.  You can buy white noise machines on-line at http://www.marpac.com.

6. Temperature – Make sure the room and bedding are not too hot or cold.

7. Music – Lots of people feel that they fall asleep easier with music.  This is may be true, but having music on may ultimately interfere with sleep as it may wake a person up.  Generally quiet, classical music without lyrics is the most relaxing.

8. TV – This is similar to music.  People may fall asleep with the TV on, but ultimately the noise and light from the TV interfere with deep sleep cycles and can wake a person up.

9. Napping – People with insomnia (difficulty initiating or maintaining sleep that causes impairment in function for more than one month) should avoid napping at all.  Short naps otherwise (10-20 minutes can be restorative) can be taken during the day.

10. Biofeedback can help with relaxation and with a sensation of warming to the skin.  The body likes to have a cool core temperature a bit warmer skin temperature for sleep.

11. If you are not asleep within 20-30 minutes of laying down, get out of bed.  You can read in a dim light that is behind you.  Read something boring and go right back to bed once you feel sleepy.

12. Keep sleep and wake cycles as regular as possible.

13. Cognitive strategies include writing anything down you are worried about so it is on paper and not in your head.   Also retrain your focus on the comfort of your bed, get away from thinking about not being asleep.  Remind yourself that “it is not the end of the world if I am not asleep right now; I will survive if I don’t get great sleep tonight.”

Sleep Restriction

Sleep restriction involves a strict schedule of bedtimes and rising times.  This can be difficult because it takes discipline to change sleep and wake times and stick to them, but ultimately, the “sleepdrive” is increased through partial sleep deprivation.

Most people require around 7-8 hours of sleep, but this various greatly.  You should set your bedtime so that you get whatever your optimum amount of sleep is.

Naps should be avoided if you have insonmnia.   If you need a nap it should be kept under 30 minutes.

After the sleep/wake cycle is reset, which may take two to three weeks, there is usually significant improvement in sleep.

Stimulus Control

The goal of stimulus control is to break associations between the sleep environment and wakefulness by staying in bed or in the bedroom only when sleepy or asleep. A person practicing stimulus control should not engage in any activities incompatible with sleep while in the bedroom.  This includes work issues, watching TV, and laying in bed while wide awake. It is hard to do, but if you are awake and not feeling tired, it is helpful to get out of bed and read a boring or low-key book or engage in another relaxing activity until you feel tired. Drinking a glass of warm milk may help you feel sleepy.

Cognitive Therapy

In this practice, you engage with your therapist to identify, challenge and replace beliefs and fears about sleep or the loss of sleep with realistic expectations regarding sleep and daytime function. Generally a few sessions are required to help train how to do this, but once you understand the process, it can be continued without the therapist.

Progressive Relaxation

With this technique, one learns how to recognize and control muscular tension through audio tapes or CD’s. This technique requires practice.