Getting to Sleep -- and Staying There
(September 8, 2020)
Most people need eight hours of sleep a night to be (and feel) fully rested. I'm going to take that a step farther and say that normal people need eight hours of sleep a night to be healthy. Anyone who needs less should not be admired, but rather tenderly pitied, in the same way that you would someone with a disfiguring birthmark or with a close relative in the headlines. That will give you the proper mindset with which to view sleep.
As I was saying earlier, insomnia is a "problem in falling and/or staying asleep". It is a problem that can usually be improved, if not eliminated entirely, by making lifestyle adjustments. Especially the "falling asleep" part. The "staying asleep" is harder, but still doable.
Most insomnia fixes that you see touted are for difficulty in falling asleep. Many of them are not useful for people who have trouble staying asleep. Be that as it may, none of these suggestions will get you in any trouble, so they are worth considering no matter what your issue. And some of them are known to help both problems. So.
Insomnia-inducing habits are mainly those that pump you up when your body needs to get into winding-down mode. It's all part of that circadian rhythm thing, the natural daily physiological cycle that your body follows. Circadian rhythms (like most physiology) are heavily dependent on the proper signals from the environment. When the sleep signals are confusing, insomnia of some kind is often the result.
Those signals can be inappropriate noise or light, activity, stress hormones, temperature, certain substances with lingering stimulative action, etc. Wrong place and wrong time for a cue, and you won't sleep properly because your body thinks you need to be awake. Most sleep disruptors, then, interfere with your ability to sleep by keeping you from sinking into a properly relaxed state.
That's why the following can be very helpful.
-- Going to bed and getting up at the same time every day (even on weekends). When it's time to sleep, your brain will already be working on it.
-- Eliminating caffeine and alcohol for at least the last few hours before bedtime. Lingering stimulation from both can keep you awake (or wake you up). If quitting shortly before bedtime doesn't do it, knock them out altogether for a week and see if THAT helps. If it does, then you can fool with fine-tuning the timing.
-- Exercise reduces muscle tension and lets you relax better in the evening -- as long as you did it earlier in the day. This helps with both falling and staying asleep. Vigorous exercise late in the day can cause insomnia by not letting you wind down, however, so do it early. Definitely before supper.
Those things I just listed have scads of evidence for their workability. There's also:
-- Eliminating sugar, again especially late in the day.
-- Fiddling with your bedroom's temperature. 65 degrees Fahrenheit is an ideal sleeping temperature for most people (the range is 60-72). Cooling off the bedroom (and/or taking a warm shower or bath before bed, so your body gets sleepy as it cools) can help with both falling and staying asleep. If you're waking up at night hot, keeping ice or cold water near the bed might help you adjust your body temperature without having to move around too much.
-- Turn the lights down slowly before bed time, to sort of simulate sundown to darkness. And then keep it very dark, with blackout curtains if need be. This is trying to control light cues.
-- Another light cue is computer screens. You can try no computer or phone time for at least two hours before bedtime. Your pineal gland puts you to sleep by using fading light to begin converting serotonin to melatonin, and that's what makes you drowsy. Bright light, especially the blue frequencies that computer screens emit, messes this up.
So now you're asleep. Hooray! But you keep waking up and can't get back to sleep. You've got plenty of company. About 50% of us have had that as a problem. Here are a few suggestions just for that.
-- There's a normal sleep cycle of about 90 minutes, where you go deeper and then come back up closer to awakening, then go down again. This is ENTIRELY NORMAL. In fact, a lot of pre-industrial age cultures had a period in the middle of the night where people would allow themselves to awaken for various activities (like, YOU know ;-) ) Also writing, cooking and visiting neighbors with similar inclinations.) So coming up towards awareness during the night is part of the regular sleep cycle. You just don't want to come all the way back up unless you have something fun planned for it.
To fix this difficulty, do not let your brain go into "day mode" when you awaken at night. This is the problem that most people have, especially when it has happened a few times and becomes a self-fulfilling prophecy. ("Aaaaaah! I'm awake again!") The best thing to do, and I speak from personal experience as well as repeating what the experts say, is to have a very calming mental technique to do as soon as you realize that's what's going on. I know that Dr. Weil is rather irritating, but nobody's perfect, are they, so I recommend his 4-7-8 breathing technique for this purpose:
And when you wake up, don't look at the clock. Wham! Wide awake.
-- The mattress. PLEASE don't forget the mattress. It's often prolonged sleeping in an uncomfortable position that will wake someone up after a few hours, whether they realize it or not. Although some mattresses are better than others (and there's even research out there as to which ones are better if you're a side sleeper, if you have arthritis, etc.), if yours is more than ten years old almost any new mattress will be an improvement. Same with the pillow. They are both true investments in your health, so get good ones that work for you. If you are waking up in the morning with discomfort that you did not go to bed with, chances are one or both of these is the culprit -- and chances are just as good that some form of that discomfort is what is waking you up at night as well.
If you buy a new mattress, make sure that it has a great return policy and that you follow the rules until you know you're going to keep it. You don't want to be stuck with one that doesn't work for you.
-- Your jammies fall into the comfort category as well (they can especially affect your temperature) and are a lot cheaper and quicker to change than your mattress.
-- Anything calming you do during the day may help, since stress and anxiety is a big factor in both types of insomnia. So exercise, yoga, meditation, you know -- all that kind of stuff. It may not seem like you're targeting the wakefulness directly, but that doesn't mean that it won't work. Or at least help.
-- That alcohol thing I mentioned earlier? Alcohol may help you get to sleep, but it WILL also cause you to wake up several hours later.
-- Don't eat too late, and don't eat too much. I know that the Europeans do it and get away with it. Just try it, and quit arguing. This is helpful for both falling and staying asleep.
More in the realm of anecdote are:
-- White noise / nature sound machines and calming music. CALMING music!
-- Journaling, writing down positive thoughts of the day, happy feelings, all that kind of thing.This is good for anyone whose mind is racing and keeping them from sleeping.
-- Diffusing essential oils. Especially lavender, but there are others as well.
-- The experts say that the "supporting evidence remains weak" for acupuncture helping with insomnia. And I don't doubt that that's the current state of the evidence. But it happens that acupuncture (mainly) and Chinese herbs (also) are what I use, and they work for me most of the time.
-- If you nap, keep it under a half an hour. This works for both falling and staying asleep.
-- Turn off the smartphone, wifi, and anything else that sends information through the air in a scary spooky way. There is not the slightest bit of scientific evidence for that, but people swear by this, including me. So I don't know what to tell you. I use some homeopathy too, which has been proven not to work, and it works great for what I use it for. Go figure.
Anyone whose insomnia isn't yielding to the lifestyle issues discussed earlier should get checked for sleep apnea and the like. If it's an obvious physiological reason that's waking you up (hot flashes, needing to use the bathroom) then of course that's what needs to be addressed. But most commonly it's the mind getting busy with day stuff. Btw, almost half of women going through menopause experience night awakening and difficulty getting back to sleep. These ladies particularly may benefit from acupuncture and/or Chinese herbs.
-- Pills of various sorts. I am not going into that. Try these suggestions, have your doctor check you as necessary. THEN try CBT (cognitive behavior therapy) for insomnia issues. People who know about these things recommend a few sessions of it before trying medications, and therefore lots of insurance will pay for it. After all that, then you can start looking for Stuff To Take. But leave that till the end. Even if you wind up with a bottle of Something that you take occasionally, you'll be better off having made healthy changes to your life first.
Ok, that was a lot of work to put together, and even more work to read, I'm sure. So we're both going to take the rest of September off now. See you in October!#
--dr. diane holmes
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