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sleep issuesEditor’s Note:  This article gets BA50’s seal of approval! This is the best sleep article we have ever read, teeming with practical information.  It’s way longer than our usual word limit, but if you are having trouble with sleep, you will want to read every word (and if you fall asleep reading it…well, all the better!)

Wait!  I know what you’re thinking!  Yet another sleep article.  You’ve heard it all before.  From friends, family, even a stranger in health food store.  A tip, a quick fix.  Don’t drink coffee, get more exercise, don’t eat junk food.  This type of rice or that type of fruit.  The juice from the whatever fruit on the whatever island in the south pacific that only grows in the whatever season during El Nino years.  If so many remedies exist, then why do so many people STILL struggle with their sleep?  Getting consistent, restorative, natural sleep is rarely accomplished by taking something, even prescribed sleeping medications.  It’s just not that simple.  But words of wisdom from a snarky sleep guy like me just might help.

Insufficient sleep is a huge problem, so much so that in 2013 the CDC declared it a “public health epidemic”.  Poor/inefficient sleep affects everything about us both physically and mentally, and it goes the other way as well:  Our physical/mental status affects our sleep. My feeling is that it’s easy to get lost in the weeds about this.  Treating physical and/or mental health conditions often improves sleep, but at the same time, treating poor/insufficient sleep improves overall wellness.  So if you try some of the sleep strategies in this or any other sleep health book, and you are still struggling with your sleep (or experience excessive daytime sleepiness), talk with your doctor.

After over 25 years helping people with sleeping difficulties, I am keenly aware of the sometimes torturous effect that insufficient sleep has on a person.  Let’s be honest, in horrible places around the world, when bad people want to traumatize someone, it often involves a hard surface, bright light and loud noise, aka, sleep deprivation.  People (in the civilized world) struggling with their sleep often experience a bit of this trauma.  Poor sleep is no laughing matter.  I have found over the years, however, that I am more successful helping someone overcome poor sleep by a bit of a lighthearted approach.  Suggestions, not rules, presented in a doable way.

When it comes to prescription sleeping medication, your doctor is your best guide.  Sleep specialists usually do not recommend sleeping medication as a “cure” for poor sleep, but studies show that sleeping medication is widely prescribed by doctors.  Studies also show that some non-sleep medications (e.g., antidepressants) are commonly prescribed “off-label” for insomnia.  That means the FDA has not formally approved the medication for use to treat insomnia.  And then there are all of the over-the-counter (“OTC”) substances that purport to improve sleep, most with little to no science behind the claim.

A common experience is for sleeping medication (Rx or OTC) to work well initially, but then start to lose its effectiveness.  This can then lead to taking more of the medication, something called “dosing”.  Some sleeping medications can produce adverse side effects such as nighttime wandering or eating, and many are associate with morning grogginess.  And perhaps the most interesting thing about sleeping medications is that none have been proven to improve falling asleep much faster or sleeping much more than people taking a fake (“placebo”) pill.

Think about it this way:  Do you take a pill to get hungry?  Talk with your doctor.

Learning better sleep strategies is not rocket science, but it is more than simple lists like the ones you see in magazines at the checkout line at the grocery store.  Those of us in the sleep health field all have our own unique ways of helping those with insomnia, suggestions and ideas that go beyond a simple list.  Learning to sleep better requires an understanding of not just the “what”, but also the “why” and the “how” of certain morning, day, evening and night activities.  Here’s a simple example of what I mean:  Wearing a seatbelt is a good thing (the “what”).  But increasing the chance of someone actually wearing a seatbelt requires the “why” (you’ll be safer in an accident) and the “how” (click the belt when you get in the car).

Over the years, behavioral sleep experts have come up with highly effective ways to help people with insomnia, together called Cognitive Behavioral Therapy for Insomnia, or CBTI.  CBTI came to prominence in the 1970s and 1980s and usually involves these traditional components:

  • Sleep Hygiene (what you eat and drink, exercise, etc.)
  • Sleep Restriction (limiting time in bed)
  • Stimulus Control (associating the bed with sleep)
  • Relaxation (calming the body and mind)
  • Cognitive Restructuring (addressing negative attitudes and unrealistic beliefs about sleep)

Although CBTI is the recommended approach to overcoming chronic insomnia, few sleep professionals are formally trained.  Good online CBTI programs exist, but they can be expensive.  And I don’t know about you, but except for “Relaxation” the list of CBTI components sounds a little scary.  Restriction, Control, Restructuring?  Yikes!

And that brings me to the reason for this publication.  I wanted to share my highly effective sleep strategies, based on CBTI, in a simple, straightforward, regular-person (not scary) sort of way.  There are many sleep books and websites that can give you all the details of the background research behind these strategies.  Heck, reading the research might actually put you to sleep!  Just ask my wife, who has seen me fighting to stay awake many a late night while reading research about (wait for it) insomnia!  She just rolls her eyes and turns over.

I hope you enjoy this easy read.  It’s chock full of whats, whys and hows about great sleep strategies, developed over the last quarter century I’ve spent helping and educating clinical patients with sleep disorders, and presented with a few “Mike-isms” (pearls of sleep wisdom!)  My goal is to keep you awake and interested while reading it, not to make you feel like you’re studying for a final exam.  I also might point out that I myself do most of the things I will be talking about, and I’m a pretty good sleeper

So here is my version of how to sleep.  Enjoy!

“Trying” to Sleep

The first and most important thing to understand is that natural sleep is a passive event, and (as you probably know by experience) the harder you try to force it, the more elusive it becomes.  Naturally falling asleep is a completely passive event.  So when it comes to sleep, the key is to never “try”.

This experience may be very different from other parts of your life.  Maybe you are/were a business person, a student, or an athlete who succeeded with great effort.  Maybe you are used to controlling things – taking charge to make sure things go according to plan.  Sleep is different, a bit of a paradox.  Actively trying to will yourself to sleep or back to sleep leads to frustration and makes it less likely sleep will happen.

As a taste of what really “trying” feels like, toss a tennis ball up and down and catch it a few times.  Easy, right?  Now try it with your eyes closed.  More challenging, right?  You have to concentrate, focus… really try.  If this reminds you of the feeling you have while trying to get to sleep (or back to sleep), you likely struggle with your sleep.

So to get started, join me in a sleep mantra:

“Natural sleep cannot be forced.”  

“The harder I try, the worse it gets.”  

“So from now on, I’ll never try.”  

Call it the first Mike-ism.  Try saying it to yourself before you go to bed, or in the middle of the night if you are awake.

Not “trying” to sleep is perhaps the most important key to sleep.  Much of the remainder of this article will teach you simple strategies that help prevent you from trying to force sleep.

Light Exposure

Light is our main time cue.  The sun goes up, the sun goes down, and as humans, we have lived our lives around this pattern for centuries.  But besides giving us information about time, light is also our strongest sleep cue.

Let me shed some light on light:  The sun has been around a lot longer than 1879, the year that Thomas Edison invented electric light.  (I think that was the year the first case of insomnia was diagnosed too, but I could be wrong)  We now have light on demand 24/7, as well as lots of electronic gadgets with backlit screens.  Some of these screens emit quite a bit of blue spectrum light, which make them look bright and cheery.  Great during the day, but the last thing your brain needs close to bedtime.

Why?  It turns out that blue, a high frequency piercing-sort of light, is the color of light that most stimulates our brain.  Blue light effectively disrupts our natural production of melatonin, an important sleep hormone our brain makes at night when it’s dark.  This all makes sense if you think about it this way:  The sky is blue most days, and we need to be alert during the day.   Then, as the sun sets, the blue sky turns a softer orangey/yellow color before the black of night, and the brain starts to make melatonin.

So us humans seem to shift into sleep mode easier by avoiding bright light and light from backlit screens at night.  But we live in a modern society with convenient, constant illumination.  So what can be done? First and foremost, as bedtime approaches, try to simulate dusk by gradually lowering house lights. Remember dusk?  I know, it’s so 1970s.  Dusk is that time when our brains would like to know that the day is over.  Think warm glows, like low-watt light bulbs, dimmer switches and candles, instead of TVs and computers before bed.  A good strategy is to set a time (maybe a half hour or longer if possible) before your expected bedtime when all screens are turned off.  What to do when the screens go off you ask?  We’ll get to that later.

Another easy thing might be to go outside for a minute or two right before bed (as long as it’s safe) and have a look around in the dark.  With your eyes open and very little light exposure, you send your sleepy brain a powerful message: sleep is imminent.  You see this effect when camping in the outdoors.  Ever notice how everyone starts yawning right after sunset while sitting around the campfire?  Even a camper who is struggling with their sleep at home often falls asleep easier and sleeps better in a chilly tent on a lumpy air mattress.  How is this possible?  Natural light exposure is a big factor, but there are other factors at play too, and you will learn about them in this booklet as well.

Morning

Oddly enough, the starting point for better sleep begins in the morning, when you start your day.  While you can’t control precisely when you fall asleep at night (sleep is a passive event, remember?), with a little will power you can definitely start your day at about the same time each morning, no matter how the night went.  The time you decide it ends is about all you directly control with your sleep, and this time should be very consistent.

What do I mean by consistent?  I would suggest no more than a two hour day-to-day variance.  In other words, if you normally get up for the day at 7:00am, I would suggest not sleeping in later than 9:00am.  Even better would be 8:30am or even 8:00am.  I know, the bed is the warmest, most comfortable place in our home.  Why would anyone leave it?  And I agree!  In fact, I get jealous watching the grandparents in the movie Willy Wonka basically living in their bed.  Ahhh.  But did you see the jar of sleeping pills on their bedside table?!?  Just kidding – it was a feel-good family movie after all.

A consistent morning get-up time is the best way to establish a stable sleep/wake circadian rhythm.  The word “circadian” means “about a day”, and it works behind the scene to make us more alert sometimes and more sleepy sometimes.  For example, ever stay up all night?  (Yes Mike, it happens a lot, that’s why I’m reading your booklet.)  You may experience a slight increase in alertness in the morning, followed by extreme sleepiness in the afternoon.  This fluctuation is your natural sleep/wake circadian rhythm at play.

Like with any other body rhythm, we function best when the rhythm is stable.  For example, we eat at roughly the same times so we feel better.  By anchoring the circadian sleep/wake rhythm with a consistent morning get-up time, you will feel naturally more awake during the day and more sleepy at night.  Even if you don’t get enough sleep right now, start with a firm commitment to start each day around the same time.  Every morning.  Your brain doesn’t care if it’s your day off.

How can you establish a more consistent morning get-up time?  Even though you may have crushed it with a sledge hammer when you retired, an alarm clock (or cell phone alarm) works best.  Spouses and dogs can work ok too, but they can be prone to human or canine error.  And some people sleep with their windows uncovered so the natural sunlight wakes them.  (You might warn your neighbors about doing this first though!)

Getting up each day at about the same time can take some effort, but it is well worth it.  It’s the start of sleeping better.  Getting up for the day too early or sleeping-in for hours essentially gives us something like jet lag, and that’s not fun.

Caffeine, Alcohol, Nicotine, Food and Exercise

Ok, I know earlier I may have seemingly dismissed the whole sleep hygiene thing, so please forgive me.  Sleep hygiene rules are what most people hear when they can’t sleep, and they’re sick of hearing it.  And for good reason:  In research studies, sleep hygiene rarely improves sleep just by itself.  It’s sort of like a person trying to get into shape for a marathon.  A good pair of running shoes is necessary, but getting a good pair of shoes is just the start – you still have to train.  So let’s do a quick what, why and how of good sleep hygiene.  You never know, you might pick up on something new.

Caffeine is one of the world’s most popular drugs.  It’s a powerful, long-acting stimulant.  In fact, if caffeine were discovered today, my guess is that it probably would be available by prescription only.  A cup of coffee can disrupt sleep for 6-8 hours afterward.  Even while we’re actually sleeping, it can make our sleep less deep and less restorative.  And caffeine is in more than coffee: chocolate, teas, sodas, even certain medications contain caffeine.  If you’re feeling a little sluggish in the afternoon, try a glass of cold water and a brisk walk outside instead of more caffeine.  Caffeine anytime after lunch is probably too close to bedtime.

Alcohol is the world’s most popular sleeping substance.  In fact, it works a lot like some sleeping medications do in our brain.  Besides being something that should be minimized for good health in general, there are three things that alcohol does to wreak havoc on our sleep.  First, alcohol is a carbohydrate, which means that we convert (“metabolize”) it into a sugar.  And since alcohol is usually consumed in the evening, this conversion happens while we sleep.  So more alcohol in the evening means more stimulating sugar in our body later in the night.  More sugar at night means a more wakeful brain and less restorative sleep.  Second, alcohol is a diuretic, which means more bathroom trips during the night.  And third, alcohol is a central nervous system depressant, which means it relaxes muscles and thus makes snoring worse (more on snoring later).

Nicotine is a relatively short-acting stimulant.  Even though a smoker will often say smoking helps them relax and get to sleep, while they sleep it can still disrupt sleep.  Not only that, smoking can mean coughing fits at night.  Plus there’s the danger of lighting things on fire at night while drowsy.  There you go, another reason to quit smoking – you’ll sleep better.

As far as food, the most important things are quality and quantity.  No surprise here: try to eat the right amount of good quality food.  Food you eat before bed and during the night may be the most impactful on your sleep.  Studies come out now and then trumpeting the benefits this food or that food (or drink) on sleep.  Caution is needed here.  No food or drink will put you into a natural sleep.  Falling asleep (or back to sleep) is a passive event.  Like sleeping pills, you might try a certain “magic” food or drink you’ve read about and sleep great for a few nights, but then it stops “working”.  This can be a slippery slope of expectations.

There is one substance, however, that is found in some foods that may make sense as part of a good bedtime snack: tryptophan, an essential amino acid that our body uses to make melatonin.

Everyone knows that turkey has a lot of tryptophan and everyone falls asleep after Thanksgiving dinner, right?  Of course, it could also be the glass of wine at noon, the 2000 extra calories consumed, or the comfortable couch after dinner with Uncle Sal going on about his indigestion again.  But I digress.  Lots of foods have fairly high amounts of tryptophan.  Dairy products, bananas, seeds, nuts, honey and eggs have a lot for example.  So if you’re hungry at bedtime, maybe instead of finishing off the dinner casserole, how about plain yogurt with sliced banana or almonds?  Or a glass of milk with cheese and crackers?  Green leafy vegetables have a lot of tryptophan, but most people don’t want to eat a salad for a bedtime snack.  Relying on a specific food or drink to put you to sleep is a slippery slope, but a tryptophan-rich bedtime snack will work with your natural sleep system.

Finally, this brings us to exercise, and (surprise!) exercise is good for your sleep.  It tends to make sleep deeper and more restorative, so in general the more the better.  About the only thing to be considered about exercise and sleep is when you exercise.  Most sleep experts recommend not exercising at night close to bedtime.  It can raise the level of certain chemicals in your body (e.g., cortisol) that keep you awake.  Exercise can also raise your core body temperature, which naturally falls when you fall asleep.  So check with your doctor about whether exercise is ok for you, and if you get the green light, then go for it!  Maybe that marathon is in your future – might just need better sleep.

Attitudes & Beliefs

Studies have shown that our attitudes and beliefs about sleep can affect our sleep.  In particular, irrational or rigid thoughts about sleep can perpetuate our insomnia (keep it going).   Ideas like staying in bed longer helps us sleep, or we need at least eight continuous hours of sleep each and every night or we’ll get sick, or if we don’t sleep well we’ll get fired from work.  These are highly unlikely/irrational attitudes and beliefs about sleep, and they can be like gasoline on the insomnia fire.  So let’s unpack these three examples.

Staying in bed a lot longer than we actually sleep can lead us to become conditioned to being awake in bed. Remember Pavlov’s dogs from high school psychology?  They learned to associate the sound of a bell (Dr. Pavlov entering the lab) with food, so they salivated (Dr. Pavlov gave them meat to get saliva samples for his research on digestion).  Same idea with sleep (not a salivating thing luckily):  As we spend more time in bed awake, we can begin to associate the bed, bedroom and bedtime with alertness.  Even the thought of going to bed can cause anxiety.  We’ll talk about how to reverse this anxiety and alertness later.

Want to wreck someone’s sleep?  Tell them they need a certain number of hours of sleep each night or they will probably get some terrible disease.  Yes, sufficient sleep for the long-term is critical for good overall health.  But humans are pretty good at coping with short-term sleep loss.  No need to panic about an occasional short night of sleep.  Your goal is to get as much sleep as you need to feel reasonably well the next day.  Period.  And the normal human experience with sleep is far from perfect:  All humans wake at least a few times each night.  Most of these awakenings are brief and not remembered in the morning.  As we age, sleep naturally can become segmented (happen in chunks), and we tend to get sleepy earlier, be awake more during the night, and take naps during the day.  So expecting to sleep all night long without waking up is completely unrealistic.

And for our third example, how many rough nights have you had?  And how many times have you been fired because of sleepiness?  You can do the math.  This is simply not likely to happen at all.

Sleep and wake are a Yin and Yang.  Each depends on the other, and since each day is different, each night is too. Sleep and wake are one big continuous 24 hour cycle, so it’s important to be flexible.  The key is to understand what has been consistently shown to help, learn how to implement these things for yourself, then just do your best.  Life happens and sleep will be affected, but a solid understanding of good behavioral sleep strategies will serve you well.

Relaxation

Humans are not very good at going full speed, and then quickly shutting down for sleep.  We need to wind down at the end of the day.  Think about the sun, our strongest sleep and time cue:  Does it “fall” out of the sky at the end of the day?  No, it “sets”.  So at the end of your day, gradually wind down.  Relax.

It is very important to understand that relaxing does not “put” you to sleep – sleep is a passive thing, right?  Becoming relaxed is the first initial step to becoming sleepy, and there is a long list of ways to relax.  A couple of “tried and true” ways to relax are tummy breathing and progressive muscle contractions. (Note: Check with your doctor about doing relaxation exercises – there are a few medical conditions that may make relaxation exercises unadvisable.)

Tummy breathing, also called abdominal or diaphragmatic breathing, is perhaps the oldest relaxation method around.  It’s used in most Yoga and meditation techniques.  It is also used in singing, playing wind instruments, public speaking, etc., anything which requires slow, deep, controlled breaths.  This type of breathing also tends to relax us.  For the basic core maneuver, lie down in comfortable clothes, put one hand on your chest and one on your tummy, and take a slow breath.  Which hand moved the most?  The goal is to breathe in a way that makes the hand on your tummy move up and down.  To me, the simplest way to do this is to let your waistline go.  This is counter to how popular culture tells us to breathe (tummy in, chest out), so it can feel a bit strange at first.  Take your time, expand your tummy with each slow breath in, and passively exhale.

When you have the basic maneuver learned, you might try pausing a moment before and after each inhaled breath.  Then as you exhale, you might consciously relax your jaw, neck and shoulder muscles (I call these three areas the Bermuda Triangle of stress).  A few minutes of this in the evening can be a great way to relax.

The other relaxation technique I like and has been shown to be very effective is progressive muscle contractions (sometimes called the Jacobson Technique).  This technique starts the same way as tummy breathing by putting yourself in a reclined position wearing comfortable clothes.  When you’re ready, slowly and systematically go through your body contracting, holding, and releasing different muscles.  You might start with your hands.  Make tight fists for about five seconds, relax about five seconds, then repeat, five seconds on and five seconds off.  Take a moment to notice the different feeling in your hands and forearms.  Warm and tingly perhaps?  Relaxed?  Next, maybe do your biceps – contract and hold, relax, repeat.  How do your upper arms feel?  When ready choose another muscle, working your way all through your body. (Tip: Go gently or skip any muscles that are not comfortable doing this.  For example, my calf muscles cramp easily, so I usually skip them.)

Progressive muscle contractions release muscle tension.  They also cause our body to release a little bit of endorphin.  Most of us know endorphin as the stuff that gives those crazy long-distance runners their “runner’s high”.  The effects of endorphin can be found in the word “endorphin”.  It stands for “endogenous morphine”.  It is a natural chemical that makes us feel relaxed.  And by doing progressive muscle contractions in the evening, you can generate a bit of natural endorphin for relaxation without raising your heart rate or body temperature as with aerobic exercise.

One other idea for relaxation is to consider a hot soak during the colder months.  This can be a great way to relax, but (like exercise), it should be done early in the evening, well before bedtime.   This is so your body temperature has a chance to fall, which is necessary for sleep.

Like I said before, there are many ways to relax.  Tummy breathing and progressive muscle contractions are just my favorites.  If purposeful relaxation is new to you, I strongly suggest (after an OK from your doctor) starting slowly.  Maybe turn the TV off one evening, put on some comfortable sweats, lie down on the couch or carpet, and try the breathing or muscle contractions for a few minutes.  I like to encourage people to “explore” relaxation.  No big time commitment.  And I know you’re sick of hearing this, but it needs repeating:  Relaxation does not put you to sleep. Sleep is a passive event, right?  Never try to force it.

Worry

In bed in the dark of night, we are alone with our thoughts.  Added to this is the fact that the parts of our brain that help with our rational, organized thinking start to go “off-line” when we get tired.  So our mind can become a breeding ground for worry.  What to do?  Get as much off your mind during the day as possible.  Literally, make a “worry list”.

Try listing a few worries that tend to be on your mind at night.  Next to each worry, write a couple ideas you could do to address (not formally solve) the worry.  Keep these ideas brief, practical and rational – a step in the right direction.  For example, if you write “I am worried about my finances”, I would not recommend “play the lottery” or “start a Ponzi scheme and invite all my friends”.  Instead, you might put down “review last month’s expenses and try to save $20 this month” or “talk with Uncle Dave about how he manages his finances”, or something like that.  Then at night, remind yourself that you did some productive worrying.  You don’t need to worry about anything now.  Heck, you can worry longer tomorrow.  You will begin to take control of those worries swirling around in your head at night, keeping them literally “off your mind” while in bed.  Oh, and now and then, actually do one of the things you wrote down.  Make the phone call, go to the website, etc.

You may be writing “I am worried about my sleep” on your worry list.  This is common, and likely, given that you’re reading this booklet.  At the top of your list of ideas should be “talk with my doctor about my sleep concerns”.  And next should be “re-read this booklet”.

The Bed… er, SLEEP-room

If you think about it, your bedroom is really your “sleeproom”.  It’s where you go to sleep, right?  So from now on, refer to it as your sleeproom.  This may seem trivial but it can really help.  You don’t need to refer to it as your sleeproom when talking with your friends, but with your family and in your mind it’s your sleeproom.

A good sleeproom has some typical characteristics.  It should be dark, quiet, cool and comfortable.  Common sense, right?  Here are a few ideas to expand on these:

Mostly due to aging, we tend to become more sensitive to light while we sleep.  This may partly be due to the thinning of our skin as we age, and our thinner eyelids may block less light.  Regardless, making your sleeproom as dark as possible is always important for good sleep.  If needed, eye masks and window shades can help.

Even though we become less sensitive to sounds when we fall asleep, noise at night can be disruptive, especially if it is loud, high-pitched and/or abrupt.  A good sleeproom should be as quiet as possible, with one exception:  a soft, low-pitch, consistent sound.  This type of noise (e.g., fan, humidifier, etc.) can help “drown-out” other noises during the night and keep you asleep.  Ear plugs can also work well – I use them when I travel.

Humans sleep best in a cool environment.  When it gets a bit too cold at night, most of us prefer more covers as opposed to raising the temperature of the room.  But at the start of the night, cold extremities like hands and feet can make it hard to relax.  Blood flow to the hands and feet is a sign of relaxation, usually described as a warming sensation.  A simple idea is to go to bed wearing socks and/or gloves on cold nights, then take them off after a while once your feet and hands have warmed.  And on hot summer nights, you might try a room-temperature shower a little before bed and sleeping with a fan on.

The sleeproom should be comfortable and inviting.  Not just the bed, but the whole sleeproom.  Of course the bed should be comfortable, and that includes not just the bed and mattress, but also your blankets, sheets and pillow(s).  Nothing like good quality cotton in the summer and flannel in the winter.  But everyone is different.  My wife seems to switch pillows every couple of months, while I can sleep on most anything.  Just be careful, there is a large and growing bed/mattress industry eager to sell you the latest and greatest, sometimes at a high price.  The good news is that bed companies now seem to offer multi-night trials, so if what felt comfortable in the store is not so comfy at home after a while, it can probably be returned.

There are other things to consider for a good sleeproom:  bedpartners with different sleep schedules, bedpartners that like to watch TV in bed, dogs and cats in the sleeproom, C-PAP machines, etc.  Each situation is different, but the more your sleeproom is a sanctuary, the better.

Bedtime

The best time to go to bed is when you are sleepy, not when you’re just tired, bored, or because the late show is over. Sleepy.  As in struggling to stay awake.  But how do you really know when you’re sleepy enough to go to bed?

It is very common for people to watch TV or be on their computer in the evening.  We have busy lives, and evening/night is when we have time to use these devices for entertainment (or extra work).  They can distract us, and distraction can actually be good for drifting off to sleep (more on that in the next section).  But as we learned earlier, backlit screens = blue light = melatonin disruption.  Plus, have you noticed how TV shows just roll on, one right after the other?  In the past, commercials were shown between programs, and this gave us time to consider going to bed. Not the case anymore.  And computers offer social media, work email, online banking, etc., huge time drains that can eat into sleep time.  To me, the “time drain” aspect of TVs and computers is at least as bad for our sleep as the light exposure aspect.

But perhaps the main reason that backlit screen time is bad for our sleep is that it can make us forget what it feels like to get and stay sleepy.  This may sounds strange, so let me explain.  Let’s go back to nature, our camping example.  Outside of our modern society, we are much more keenly aware of the onset of night.  The transition of day to dusk to night is salient, unavoidable – it engulfs us.  We have no choice but to get sleepy, and we feel it.  On our couch at home in front of the TV, we may get sleepy, but we don’t feel the start of sleepiness happening.  It just happens.  In fact, one of the more commonly heard experiences from people with insomnia is that they fall asleep on the couch, get woken up by their spouse or a noise on the TV, drag themselves to bed, and then Zing!  Alert.  No sleep.

So learning what getting and staying sleepy feels like may take some re-learning.  At the end of this booklet, you can read about my smartphone app that can greatly help with this.

And to finish this section, a Mike-ism:

If you want to know if you’re sleepy enough to go to bed, don’t look at your clock, look at your mirror.  

Distraction

A great way to avoid trying to force sleep is to distract yourself.  In the “old” days, when someone couldn’t sleep what were they told to do?  Count sheep.  It was the gold standard of boring, monotonous activities, and the hope was to bore ourselves to sleep.  Ever try this?  I did once.  Made it to about 11 sheep and wanted to scream.  (I’ve also wondered if sheep with insomnia count jumping humans.  Again, I digress.)

When you lie down to sleep, it is critical to understand something:  You can’t think about nothing.  The human brain (even mine) is too big – we quickly tune out boring monotony.  Thoughts can then easily become worrisome ruminations, leading to more insomnia.  As humans, we are always thinking about something, all the time.  So just like counting sheep, the “blank slate” approach in bed doesn’t work very well either.

So what works well?  Once you are sleepy with worries off your mind (“worry list”), the best strategy is to use the amazing, limitless theater of your mind to distract yourself.  Imagery for distraction.  And it’s simple.  In your mind, just picture a pleasant image, a memory, a part of a favorite book or movie, a “happy place”, etc.  Let your mind drift there.  Don’t remember everything?  Who cares, make it up – it’s your mind after all!  You might look through an old photo album to jog your memory of a great time from your past.  Or leaf through a magazine about a favorite hobby or distant land you’d like to visit.  At night, when you close your eyes to fall asleep, take yourself there.  Really get into it, recalling all the sights, sounds, smells, the whole experience.

Reading before bed is perhaps one of the best ways to get sleepy.  Reading distracts us, takes us somewhere mentally.  Keeps us from focusing on bedtime and sleep.  Distraction through reading can keep us from “trying” to sleep.  And to clarify, I’m talking about reading a paper book of some sort (not a backlit computer screen).  You know, those things 10 for a dollar at garage sales.  Who would have thought they could help the world sleep better!

If reading in low light is difficult visually, audio stories are a great option.  Most libraries have them on loan for free.  Pop in a story and your headphones and away you go.  You might even flip through a magazine at the same time to keep yourself even more distracted.  When you feel the strong wave of sleepiness, turn it off and go to bed.

The simple technique of distraction through mental imagery can also do one amazing thing for someone struggling with insomnia:  It can make going to bed enjoyable.  You get to think about whatever you want to think about.  Where can you take yourself tonight?

The Clock

Do you frequently check the time at night?  Look at the clock, sigh, then roll over, again and again?  Guess what – some smart researchers found that when people don’t check the time at night, they are less anxious about being awake, and they tend to be awake less.  For many of us, the clock is a cue for worry at night.  Checking the time also makes us do math, and for most of us, that’s not fun.  Do you really NEED to know the time at night, or just WANT to know the time?  In nearly every situation, it’s the latter.

The solution is quite simple.  Arrange things so you can’t check the time.  You might take a moment to look around and locate your time devices.  Maybe move your alarm clock (and/or cell phone) across the room and position it so you can’t see the time display.  You don’t need to look at it for it to wake you up in the morning, right?  Look for other places you might get a peek at the time: on the way to the bathroom, in the living room if you’re reading at night, the microwave clock, etc.

Want to take it to the next level?  Avoid the clock even before you go to bed.  I do this.  Not knowing the time at night is one of those sleep gems that can really make a big impact.  And it’s simple – just takes some willpower to not peek at the time.

So here is a “time-tested” Mike-ism for you:  The first step in dealing with being awake at 2am is to not know that it’s 2am.

Awake at Night

Awake in the middle of the night – oh joy.  This is perhaps the most frustrating and challenging type of insomnia.  Here’s the deal: Just like we can’t force ourselves to fall asleep or back to sleep, we also can’t force ourselves to STAY asleep.  So once again, the key is not to “try”.  When you know you’re awake, or perhaps more accurately “alert”, and you feel that returning to sleep easily is just not going to happen, try these:

Shrug.  Mentally and literally.  A healthy indifference to being awake at night can help keep worry in check.  Next, repeat your sleep mantra (see earlier section on “trying”).  Then, if your mobility allows, leave the bed (yep, Pavlov and his dogs again).  Just take a deep breath, put your foot on the floor, and go to another room.  If it’s cold, maybe wear a robe, slippers and maybe use a heating blanket.  Maybe a cup of warm decaf tea.  Have a fireplace that’s easy to use?  Turn it on.  (Note:  If your mobility is limited, maybe sit in a chair near the bed, or at least sit up in bed.)

Do something that does not involve a bunch of light or any backlit screen (TV, computer, etc.).  What to do you ask?  The list is endless and personal to your preferences.  Maybe read, write, draw, knit, paint, lie down and breathe for a moment, have a light snack if hungry, listen to music, listen to an audiobook, play a card game, do a crossword puzzle, do a jigsaw puzzle…everyone has different things they like to do. Maybe you can rediscover an old hobby?

It is important to find something you actually like to do, not something really boring, and have it set up and ready to go before you go to bed.  You don’t need to be fumbling around your closet in the middle of the night.  Be patient – allow your sleepiness to return.  Go back to bed only when you’re sleepy (more than tired, bored or exhausted).  If you become alert back in bed, even if it happens right away, repeat the process:  Shrug, mantra, leave the bed.

This is sleep bootcamp, clinically called “stimulus control”, and it’s one of the most effective strategies for overcoming chronic insomnia.  But it takes some effort and it can take a few nights to have an effect.  But for long-lasting improvement for the difficult experience of being awake at night, it’s recommended by nearly all sleep experts.

Important note:  Frequent short awakenings at night can often be caused sleep apnea, restless legs, medications, or any one of countless other things, so as always talk with your doctor about your sleep.

Snoring

If you noticed someone having difficulty breathing out in town one day, would you avoid them, walk away, get irritated at them, or laugh at them?  Of course not.  You would likely help the person struggling to breathe any way you could.  When someone is snoring, their airway is also restricted, but bed partners get annoyed, put in earplugs to ignore the noise, or move to another room to sleep.  When someone is snoring at the movie theater, others may chuckle.

People who snore a lot are often more tired during the day.  This is thought to be caused by the brain not allowing itself to stay in a stable sleep pattern because it is detecting the body working harder to breathe.  So sleep can be less restorative.  Shallow sleep can also lead to weight gain, less exercise, even personality changes.  The risks of heart disease and stroke also increase the longer that loud snoring goes untreated.  And as body weight increases, snoring usually gets worse, which makes sleep quality worse, which leads to adverse changes in hormones that regulate hunger (leptin and ghrelin), which can lead to further weight gain.  A vicious cycle.

But there are two things that can significantly worsen snoring that (theoretically) can be altered quickly.  The first is alcohol consumption before bed.  I mentioned this earlier in the Sleep Hygiene section.  As a CNS depressant, alcohol makes muscles relax.  There are muscles supporting the tissues at the top of our airway, an airway which can be narrow to start with in some people.  Alcohol can be something that causes the airway to get even more narrow, which makes snoring louder.  Obviously more challenging for some people than others, reducing or eliminating alcohol in the evening can really help reduce snoring.

The other behavior that can worsen snoring is sleeping in the supine (back) position.  People who snore usually snore loudest while sleeping on their back.  In fact, some people snore only while sleeping on their back.  This happens because gravity pulls back on the tongue and jaw, making the airway more narrow, which increases snoring.  A possible solution?  If possible, don’t sleep on your back.  How you ask?  Put a couple of tennis balls in a tube sock, then clip or sew the sock to the back of your sleep shirt vertically down the middle.  Then during the night, if you roll onto your back, you’ll feel the lump.  This will be your cue to roll to one side or another.  Over time, the tennis balls may train you to stay off your back while you sleep.  If you cannot sleep on your sides (e.g., due to physical ailments), you might try a foam wedge to prop up your upper body while you sleep, reducing the effect of gravity on your airway.  In fact, there is a whole industry of gadgets and devices designed to help people stay off their back during sleep.  As with anything, research any sleep-related product thoroughly before purchasing.

Very important note:  If you snore loudly, or if you have been told that you stop breathing at night, tell your doctor right away.  You may have sleep apnea, a dangerous and potentially life-threatening, but very treatable, sleep disorder.  Snoring and sleep apnea tend to go hand in hand, so if you are witness to loud snoring (or worse, silent pauses in breathing), do not avoid, ignore, or laugh at it.  Get that person to the doctor!

Napping

A lot of people try to take naps, but can’t fall asleep.  (There’s that “try” word again!)  Aside from children and the elderly, the rest of us are probably best to avoid naps most days.  However, an occasional, short, early-afternoon nap can be restorative, especially after a rough night of sleep.

A short nap (20-30 minutes max) means that if you do fall asleep, you likely will not quite get into a deep state of sleep.  This may seem strange:  Why wouldn’t you want to sleep deeply in a nap?  It is sleep, right?  Yes, but when us humans wake out of a deep state of sleep, we can feel groggy and disoriented, sometimes worse than we felt at the start of the nap.  And if the nap goes over an hour, you will likely not only experience some deep sleep but also some Rapid Eye Movement (REM) sleep.  A full, complete deep + REM cycle, especially if done later in the afternoon, can reduce our sleep drive at night, making getting to sleep and staying asleep more difficult.

What’s the best way to take a short nap in the early afternoon?  First and foremost, make sure you’re sleepy.  Not just bored, tired or exhausted, but sleepy.  Struggling to stay awake.  Make your sleep room cool, dark, quiet, and comfortable, and set your alarm.  Maybe breathe with your tummy a few times.  Let your mind drift.  Then just see what happens.  When your alarm goes off, get up.  Don’t worry if you fell asleep – you may not know if you did, and that’s ok.  Grab a glass of ice water and get some light to get your alertness back.

Some famous people in history (like Thomas Edison and Salvador Dali) used to hold small objects (such as ball bearings or a spoon) in their hand when they were sleepy during the day.  If they fell asleep briefly, they dropped the object(s).  Apparently Edison knew the restorative value of a short nap – I mean, the guy invented just about everything (we’ll forgive him for the light bulb thing).  And from what I understand, Dali took brief naps to get his creative juices flowing too.  Maybe that’s how he got the idea for his signature stylish mustache.  Who knows.

A short nap can be a great supplement to insufficient sleep at night, especially as we age, have an irregular work schedule, or have caregiving duties at night.  And anyone could have a rough night for any reason:  a windy night, an emergency phone call in the middle of the night, a neighborhood cat fight, etc.  In those cases, a longer “recovery” nap may be in order.  So decide the purpose of your nap:  take the edge off a little daytime sleepiness (short nap), or recover from an exceptionally rough night for reasons out of your control (longer nap).  When in doubt, keep the nap short just to be safe.

Sleep Training

Do you struggle frequently with getting to sleep or do you wake up for long periods of time at night?  Are you working with your doctor to get off sleeping medication?  Or convinced you’ve tried everything to help your sleep?

In 2007 and validated again in 2012, sleep scientists in Australia discovered a clever way to help people with chronic sleeping difficulty.  In a sleep laboratory (with expensive equipment), they gave a group of people with chronic insomnia a series of short sleep trials to fall asleep.  Each short sleep trial was ended if either 1) sleep occurred, or 2) if the sleep trial ended with no sleep.  The subjects were then immediately asked if they thought they had fallen asleep, and then told whether or not they were correct.  Subjects got out of bed for a few minutes, then returned to do another sleep trial.  It was sort of like “practicing” falling asleep.  And it worked!

Over a number of these sleep trials, the subjects “learned” what it took to fall asleep.  All of the research subjects were able to get off (and stay off) their sleeping medication afterward, and the majority of them rated themselves as “good” sleepers for months afterward.

So, can you do sleep training?  Yes!  Assuming you don’t have a complete sleep research laboratory at your disposal, all you need is the Sleep On Cue™ smartphone app to do sleep training at home.  Instead of fancy machines and wires attached to your head, the Sleep On Cue™ smartphone app uses a call/response method to tell if/when you fall asleep each sleep trial.  Sleep training with the app can be done around bedtime for an hour or two (or longer) following any rough night of sleep.  Sleep training can help you relearn what it feels like to fall asleep.  And this can lead to much greater confidence in your sleep.

The app not only offers sleep training, it also allows you to take a custom nap.  Punch in how long you have for your nap as well as how long you actually want to sleep if you do fall asleep, then away you go!  Learn to sleep on cue!

Sleep Coaching and Workshops

As sleep trouble can be a very personal thing, I am happy to offer sleep coaching via cell phone or Skype call.  This is easy, convenient, affordable, but most of all effective!  With over 25+ years helping people with sleep, significant progress can usually be made in just one coaching session.  Another option is an on-site sleep health workshop.  I’m in the northwest US, but am willing to travel to speak to groups about sleep.  Just drop me a note if you’re interested in either!

All For Now

Really hope you got some helpful information from this reading!  Sleep and wake are one big 24-hour cycle, so remember to take a long-term approach.  Behavioral change is effective for sleep, but it can take some time and a little effort.  But is it oh so worth it!

Disclaimer:

This publication is for general interest and education only.  This publication is not a medical treatment nor is it meant to modify or replace medical advice you have been given.  Always talk to your doctor about your health, including your sleep and your medication.  Never drive or do anything that would be dangerous if you’re sleepy.

This article was first published on http://www.sleeponq.com/sleep-health/

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