How to Sleep Better

Difficulty: Moderately Challenging

Instructions

Step 1

Tired of being tired? Improve your sleep hygiene.

Few things are as frustrating as a string of sleepless nights, and in their sleep-deprived desperation, many people reach for sedating medications or alcohol for immediate relief. However, there are some very basic interventions that are often overlooked that can make an enormous difference in our ability to get enough rest. These measures can be called “sleep hygiene” and help us create the right environment to fall asleep and stay asleep.
Step 2

Budget yourself enough time to sleep.

Sleep is often the first thing to be compromised when life gets busy, but this is not a long term solution to your time management issues. I suggest to patients that they pare down on social commitments and learn to say no. This can be a challenging task if you feel guilty saying no to people or if you feel like you should be able to do it all. One exercise I find to be a helpful reality check if you are feeling time pressure is to map out a typical weekly schedule, including all of your usual work, family, and leisure time responsibilities. Block off your time for exercise, sleep, and relaxation, and don’t forget to include time to run your errands, check the kids’ homework, watch your favorite TV show, catch up on your email, and do the laundry. You must block off 7 to 9 hours for sleep and keep the hours that you are sleeping somewhat consistent from day to day. If you work rotating shifts, you need to factor that in as well and allow yourself extra sleep time. Any new commitment that comes along has to have a time slot where you can budget it in your schedule before you allow yourself to commit to it, or you need to turn it down. Of course you will need to deviate from the schedule you created, but it sometimes helps to see that there just is not enough time in the budget for everything, and so it is perfectly appropriate to prioritize and make choices about how to spend our time. People who get enough sleep live longer, so you are not really “saving” time in the long run by cutting corners on your sleep now.
Step 3

Start preparing for a good night’s sleep in the daytime.

Is your daily routine contributing to your sleep problem? Try to eliminate any caffeine after noon. Consider any stimulating herbal supplements or energy drinks that you may be taking as well, and restrict their use to the morning. Nicotine is a stimulant and should be avoided, especially near bedtime. If nighttime trips to the bathroom are an issue for you, do not drink any liquids after dinner. If you feel invigorated after exercise, schedule your exercise earlier in the day, not near bedtime. Do not nap in the daytime, even if you did not sleep well the night before, or you will not be tired enough to sleep at your bedtime. If you must nap, keep it to no longer than 20-30 minutes. For many people, even moderate alcohol use or eating spicy food disturbs their sleep or gives them vivid dreams. Getting exposure to sunlight for 15 minutes early every morning can also help reset your Circadian rhythm so you feel sleepy at night.

Sometimes keeping a journal of what you suspect your own triggers may be is helpful. Keeping a written record can help you decide if eliminating the suspected triggers is working, and it is useful to keep a list of ideas of what you might try changing next. It also contributes to feeling that you are proactively addressing your problem.
Step 4

Create a peaceful sleeping environment.

The time leading up to bedtime needs to be relaxing. Establish a regular evening routine, and avoid vigorous exercise late in the day. Try a soothing bath, or a warm cup of milk or non-caffeinated herbal tea before bed. Not every herbal tea is decaffeinated, so do not assume that it is caffeine-free unless it says so on the label.

The bedroom needs to be your quiet place. Kick out the pets at night and shut the door. Turn off all the electronics, phones, screens, and lights. Some people prefer to turn the clock face away from them, especially if it is illuminated. A white noise machine, or even just running a fan for the soothing noise, is helpful. Do not leave the TV or radio on while you sleep since these are stimulating your brain. Try using earplugs, especially if your partner snores or if you are a night shift worker trying to block out daytime traffic. Darken the windows with black-out curtains or hang a blanket over the window. Keep the room cool. It is very important for your whole family to minimize interruptions while you are sleeping—-this may mean you also need to train your children to sleep through the night and to entertain themselves in their room when they awaken. If you share your bedroom, you will need to work it out if your partner snores or keeps different hours.

Keep the bedroom a place for sleeping only. Do not bring work into your bed, and you might even consider only watching TV and reading outside the bedroom. Get out of bed and go into another room if you can’t sleep, do a quiet activity, and try to lie down again in a half hour.

Get up the same time every day, even if you didn’t sleep well, so that you will be tired enough to sleep the next night. Sometimes a sleep-deprivation training method is helpful: this a process by which you reduce the number of time spent in bed by 30 minutes each night until you sleep through the night and are sleepy at bedtime. You can gradually increase the amount of time you spend in bed once you are sleeping well.
Step 5

Consider the "alternatives."

Relaxation exercises, such as sequentially constricting and relaxing each part of the body, can be helpful. Meditation, prayer, and deep breathing exercises may be of benefit as you try to wind down. Cognitive behavioral therapy incorporates many of these techniques and a therapist can teach them to you in great detail.

Alternative medicine approaches may help as well. Acupuncture, massage, naturopathic or herbal remedies, and learning visual imagery techniques may all improve relaxation and quality of sleep. Some people benefit from the herbal supplement melatonin at bedtime, particularly if you are coping with jet lag.
Step 6

Maximize your health.

If you have other chronic health issues, consider whether you have done all that you can to keep them well controlled, and consult with your primary care provider about maximizing your wellness. Often our vigilance wanes over time and we need to remind ourselves to get back on track with lifestyle interventions and sometimes medications. If you are on any medications affecting your sleep, discuss the timing of your medications with your prescriber, since sometimes switching a sedating medication to the evening or a stimulating medication to the morning may be helpful.

If you have respiratory allergies and postnasal drip and cough are keeping you awake, be sure you are keeping your bedroom allergen-free. If you have an irritable bladder or enlarged prostate causing you to make frequent trips to the restroom during the night, try to get most of your fluid intake earlier in the day, not just before dinner. If you are experiencing anxiety or depression, consider what else you could be doing to improve your situation and your coping skills. Remember to avoid eating immediately before lying down if you have gastro-esophageal reflux. If you are dealing with peri-menopausal hot flushes, there are a number of remedies you can try. And working on pain management can go a long way towards improving your sleep.
Step 7

Rule out or address undiagnosed medical issues.

If simple sleep hygiene is not working within a few weeks, see your primary care provider to rule out any medical problems that may be contributing to your insomnia. While you work to improve the sleep, prescribed medications are more effective and have fewer side effects than over the counter medications. If you share your bed, it is helpful to know if your partner says you snore or gasp for breath, or describes you as restless in your sleep.

Sometimes a sleep study is suggested. Many patients are reluctant to do this since it requires spending the night in a strange place, but getting this information early on helps pinpoint cause of the insomnia so you receive the appropriate treatment sooner. Without this information, finding a remedy for your insomnia is more of a trial and error process, which means more sleepless nights for you in the long run. There are many medical causes of insomnia and each is treated differently. Many sleep study centers also have a team of specialists to help address your specific sleep problem after the sleep study.

Keep in mind that the long term use of sedatives may just be masking a problem such as restless leg syndrome, sleep apnea, or depression, and can contribute to rebound insomnia. Sleep apnea in particular, if left untreated, can contribute to heart enlargement and sudden death. There are certainly patients for whom longer term use of sleep medications is appropriate, but they should not be taken lightly or without further investigation into the cause of the insomnia.

Comments

mil102 said

on 10/28/2008 I need to take heed to this article, because I never get more than 5 hours of sleep a day, until it come down on me and I can't go any further. Great Info! 5*s
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