Take Control Over Your Insomnia
Sleep impacts mental and physical health more than you probably realize. As I’ve discussed before, chronic sleep deprivation has shown links to obesity, Type 2 diabetes, heart disease, and dementia. Lack of sleep in general also affects emotion regulation, depression, anger, and anxiety. Use these guidelines to develop a plan for improving your sleep. My recommendation - It will take time for your sleep to get back in line, so once you begin your sleep plan, stick with it for at least 4-6 weeks. Like establishing any new habit, it takes patient commitment to see it stick.
*BUT, before you read any further - while the below Cognitive Behavior Therapy based tools are extremely helpful in getting your sleep back on track, the research examining treatment methods for insomnia has found “sleep restriction” to be the most effective tool. This will be discussed separately.
Consistent sleep schedule: Just as the universe and our planet have their own rhythms, so do our bodies. Respect it, yo! Keep a regular wake-up time each day, 7 days a week. That’s right folks, no extra sleeping in on the weekends if you want to do this the legit way! Keeping a consistent wake time helps maintain your circadian rhythm so that your body learns to sleep at the desired time and low and behold, we end up noticing we are naturally falling asleep at the same time each night. Important - get up at the same time every day regardless of how little sleep you received the night before. I recommend setting an alarm clock and put it across the room so that you have to get up out of bed to turn it off.
Go to bed only when sleepy: Adult bedtime is a mythical creature, like a unicorn. What your circadian rhythm says reigns. Only get into bed when you literally feel like you could fall asleep. We need our brain to associate the bed with sleep. If we go to bed just for the sake of going to bed (to watch tv, hang out with the spouse, because you’re bored, or because it’s just your mythical bed time, etc) you aren’t actually falling asleep right away. This amount of time being awake in bed weakens that crucial association your brain needs to have about the bed.
Get out after 20 minutes: Same reason as above. Whether its trying to initially fall asleep, or go back to sleep in the middle of the night, more than 20 minutes awake in bed begins to weaken that association. Get out! Do something boring or relaxing, like read the oven manual, sit on the floor and pet your cat, meditate, stretch out physical tension. DONT do anything too stimulating. Get back into bed when you feel sleepy again.
Use the bed for sleep and sex only: Why? You guessed it - non sleep activities weaken the brain’s association. Do not watch TV in bed, listen to the radio, eat, or use a computer or your phone. I even recommended that you read in a different room and not in your bed. I just crushed your world I’m sorry for that.
Avoid the clock! If you have a clock in your room, get rid of it, or at least turn it around so that you can’t see it. Same with resisting the temptation to look at your phone during the night. Two reasons: 1) Clock watching causes worry about not sleeping and further frustrates —> wakes you up, and 2) the light exposure wakens your brain up too (more on the Pineal Gland below).
Bedroom environment: Ideally, moderate bedroom temperature and as quiet and dark as possible. Outside noises can be masked with a fan or a white noise machine (there are also smartphone apps for white noise). You can also use earplugs. If your room is not dark enough, consider buying a sleeping mask or getting blackout blinds. My husband loves wearing my pink mask (husband being thrown under the embarrassment bus accomplished!) Try to make your bedroom a calming place, free of clutter or things that will trigger stress.
Limit caffeine: It stays in your system more than you realize. Half life is 8 hours and even so, it can continue building up in your system if you keep drinking it. Be mindful of other sources of caffeine, such as soda, energy drinks, and chocolate, in addition to coffee and tea. Some over the counter medications (e.g., Excedrin) also contain caffeine. People with insomnia are often more sensitive to caffeine than they realize.
Avoid nicotine: While many smokers claim that smoking helps them relax, nicotine is a stimulant. The false perception of relaxation you feel after that smoke is actually the withdrawal ending, not the actual nicotine calming you down.
Lay off the booze: While having a few prior to bed can certainly help one fall asleep, it actually can decrease the deep stages of sleep (which are vital for physical and emotional restoration), and you may not realize it, but you’re having frequent wake ups. You also may have experienced the “Alcohol Rebound Effect” - it’s what happens when you find yourself waking up about 4 hours later wide awake and can’t fall back asleep. That is indication your body just metabolized the alcohol out of your system. Consider not consuming it any closer than 4 hours before going to bed and limit it to small quantities. Lame, I know.
Sleeping pills are the devil: Who actually likes the Ambien trip adventures anyways?! Sleeping pills cause your body to forget how to sleep on its own. Sleep medications are only effective temporarily, losing their effectiveness after 2 to 4 weeks when taken regularly. Over time, sleep medications can actually make sleep problems worse. Withdrawal from sleep medications (when you stop taking them after having taken them regularly) can lead to “insomnia rebound,” which means it is harder for your body to fall asleep naturally. Keep use of sleeping pills infrequent, but don’t worry if you need to use one on an occasional basis. Talk to your doctor about any prescription or over the counter sleep medications you are taking.
Melatonin: Nope. Melatonin is a hormone that your body produces naturally in the evenings to promote onset of sleep. I say this lovingly - you likely do not have insomnia because you don't have enough melatonin production. You have insomnia because of the behaviors you are doing to cause it. Thus melatonin supplements you are taking are not doing sh**. If they are, it’s likely placebo. However, melatonin is very helpful for shift work as well as getting back your sleep rhythm from traveling.
Eating: Don’t overindulge, eat too spicy, eat too soon before bed, and, according to one of my patient’s - don’t eat pot pies… (I’m kidding. But he really did believe pot pies caused him bad sleep). A light bedtime snack, such as glass of warm milk, cheese, or a bowl of cereal can promote sleep. Avoid snacks in the middle of the night because awakening may begin to be associated with hunger and can cause weight gain.
Avoiding naps: The sleep you obtain during the day takes away from your body’s natural desire to sleep at night. If you must nap, schedule it before 3:00pm and don’t sleep for more than 15-25 minutes. If you nap for an extended period of time, you fall into deeper stages of sleep, and that disrupts actual sleep because you just took away from it.
Allow yourself at least an hour before bedtime to unwind: Find what works for you to wind down. I call this the “Buffer zone”. You wouldn’t put your toddler in front of a scary movie with a cappuccino before bed, would you? Treat yourself like you would a toddler. Do things that start to become associated with “almost bed time” (i.e. lights being turned low, no more screen time, pajamas, tea, a shower before bed, etc).
Exercise: Because it’s good for you. Also, it makes you tired. However, don’t exercise within 2-3 hours of bedtime as it elevates your nervous system activity including your core body temperature which interferes with your ability to fall asleep.
Take a hot shower or bath before bed: Because it relaxes you and because it “artificially” raises your body temperature which then makes Stage 2 sleep occur a little easier.
Schedule Worry Time: If your insomnia is in the middle of the night, this may especially help you. Give yourself 10-20 minutes during the day to worry yourself blue in the face. We often are too busy or purposely distract ourselves during the day to allow for processing and checking in with ourselves about what’s going on emotionally and mentally. (See my blogs about this in the Health & Lifestyle section). Set your cell phone timer. It often helps to make a list of your worries, but be sure to do nothing else during this time other than writing or thinking about your worries. Once the time is over, move forward with other activities.
Keep a worry list by your bed: If you find yourself worrying and thinking about your To Do’s while in bed, guess what?! Your brain associates your bed with worrying and thinking. Stop it. Keep a pen and paper next to your bed. If you find yourself becoming troubled by certain thoughts or worries, write them in a list on the paper, and return to sleep. Dont try to solve anything. Most life problems aren’t accomplished at 2am anyways. Sometimes we worry because subconsciously, we are afraid that we are going to forget about something important. Transferring the thought or worry to a piece of paper allows your mind to let it go.
Lastly, insomnia can be what is called “secondary”, meaning, there is something else that is causing your sleep issue: depression, generalized anxiety disorder, obstructive sleep apnea, menopause, PTSD. These things need to be treated first in order for your sleep to improve.
Good luck and hang in there!