Better Sleep Without Medication
Karen Muller, PhD
Think you can get by on less than 8 hours of sleep? Unlikely, although it is true that some people need less sleep. To test whether you are getting enough sleep, notice whether you need to sleep in or nap on the weekend. If you do, you are sleep deprived. Sleep deprivation not only makes you feel tired, it effects cognitive function, increases mood problems like anxiety, and even has a negative impact on immune system and cardiovascular function. Yes, you are more likely to catch the flu or cold that’s going around if you don’t sleep enough, and you are more likely to develop heart disease.
For sleep issues related to hypervigilance such as difficulty going to sleep, or waking up and having trouble getting back to sleep:
- Sleep hygiene: associate your bed with sleep and lovemaking by avoiding other activities in bed. Don’t watch TV, eat, or do your taxes in bed. To avoid associating your bed with tossing and turning, get up after 30 minutes to one hour of wakefulness. Do something soothing like reading something that is calming or something boring like a simple task like washing dishes or sorting laundry. Go back to bed when sleepy.
- Observe a calming down ritual for the last hour before going to bed. You can’t expect to go from full speed ahead to sleep instantly. Bathing and other hygiene, reading or watching TV are fine. Doing roughly the same things every night helps. Don’t eat for at least 2 hours before bed.
- If you are awake because of worry, thoughts about things you need to do or ideas, get up and write them down. Write down your To Do List or ideas and get them off your mind. For worries, do a worry journal: spend no more than 30 minutes writing stream of consciousness about what is on your mind. Just dump it on the page. Don’t worry about grammar, logic or punctuation. Write as fast as you can without censoring. After you have poured out the main worries, take a step back and re-read it. Be as sympathetic and helpful to yourself as you would to a friend. This process will often help you relax and let go of worries you can’t change and see solutions to things you can change.
If you need to get up and write worries often, the worry journal can be effectively used as a prevention strategy. Use the same process on a regular basis. Your worries won’t wake you up at night if you address them regularly.
- Take 1-3 mg melatonin 2-4 hours before going to bed if you watch TV or use a computer or other electronic device before bedtime. The blue light seems to shut down melatonin production, a hormone that tells the brain to go to sleep. Melatonin is a naturally occurring hormone, not a drug. Bright outdoor light in the morning for 10-15 minutes helps discontinue melatonin production.
- Try listening to a self-hypnosis or guided meditation, such as “Easing Into Sleep” available on drmiller.com or those available from Meditation Oasis.com, such as "ISleep Easy ". ISleep Easy is also available as an app for your smart phone. Listen as you go to sleep or when you wake up in the night. Nature sounds or soothing music are other options for bedtime listening. Try different options to see what you enjoy. Bedtime listening serves two functions: distraction from your busy thoughts and active relaxation.
- Mild to moderate aerobic exercise for at least thirty minutes five days a week greatly helps sleep, not to mention its many other health benefits. If you walk or bike outdoors first thing in the morning, it also helps shut down melatonin, triggering the wake up signal your brain needs to feel alert. Even a ten-minute walk or eating breakfast outdoors will help sleepyheads wake up because the sunlight through the retina triggers the alert response. When weather makes early morning sunlight unavailable, a light box that simulates sunlight is helpful for people who are prone to winter depression, as well as those with chronic trouble waking up in the morning.
Exercise reduces stress and helps sleep by lowering cortisol levels. High cortisol happens as part of the fight-flight response to stress. Although modern stressors do not usually require fighting or running away, our bodies evolved to respond to physical threats. The stress hormones like adrenaline and cortisol triggered by a stressful event (criticism, illness, even self-judgment) need to be flushed out of the body by doing something equivalent to the fighting or running away out bodies were designed to do when stressed. It is important to exercise at least four hours before sleep not right before bed, because exercise is stimulating.
- Caffeine consumption can interfere with sleep. If you also suffer from anxiety, it is imperative that you minimize caffeine. One cup of coffee in the morning is ok for most people, although some cannot sleep well and manage anxiety drinking even one cup. Caffeine consumed after 3:00 in the afternoon is a common culprit for poor sleep. If you need to reduce caffeine, do so gradually so that you don’t have withdrawal symptoms of headache. Substitute something healthy that you enjoy. De-caf is ok, especially water-processed. I have had more miracle cures for panic attacks, poor sleep and anxiety by cutting down caffeine than any other single intervention.
- If you snore, you may not realize that snoring, or rather, struggling to breathe, is probably waking you up several times a night. Sleep apnea causes or exacerbates many cases of insomnia. Sufferers are still tired after eight or more hours of sleep nightly because they don’t get enough deep sleep. They wake up when they are in light sleep as they start to go into deeper sleep because the lax soft tissues of the soft palate start to block the airway. The body splutters awake to keep from suffocating. They go back to sleep and the whole process starts again. Usually, it seems as if the awakening is because of a full bladder, but the full bladder is only noticed because apnea has awakened the sleeper. Ask your primary care doctor for a sleep study if you snore. Treatment of sleep apnea brings almost overnight relief.
Improving your sleep will improve your cognitive function, your body’s ability to heal and your moods. If these self-help measures don’t do the trick, a psychotherapist trained in behavioral treatments for insomnia may be able to help. If you must resort to medication, ask your doctor for one of the medications that are not habit-forming such as trazodone or other sedating anti-depressants at a low dose or buspirone, an anti-anxiety medication. Enough good quality sleep is essential, so it’s worth pursuing even if it takes persistence.
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