I’m writing this post while working an overnight shift on
inpatient psychiatry. Sleep (or lack there of) is on my mind.
One of the most frequent complaints I hear in my outpatient
practice is that people have a hard time sleeping. It’s also a common late-night
call from nurses concerned about their patient’s inability to sleep. Good sleep
is important for everyone, and it’s especially important for optimizing both our
physical AND mental health. So what can we do to sleep better?
Good sleep hygiene is the first step. What is sleep hygiene?
It’s those practices that can help us to sleep well. The National Sleep
Foundation lists eight practices that can help us achieve good quality sleep—I’ve
added some additional information from my rotations with a sleep specialist.
There is much more information on all of these 8 areas, but here is a brief
summary:
1. Be in your bed and sleep the right amount—not
too little and not too much (reminds me of Goldilocks and the Three Bears). Beds
should only be used for sleep and sex—nothing else. Setting regular bedtimes
and regular times to get up can also help.
2. Limit day time naps to no more than 30 minutes.
3. Avoid caffeine and nicotine close to bedtime,
and use alcohol only in moderation. While alcohol can make you fall asleep
faster, it interferes with your sleep later in the night.
4. Exercise every day—even as little as 10 minutes of
aerobic exercise helps. However, some people have a hard time sleeping if they
have a strenuous work out close to bed time so if you fall into that category
it is best to exercise earlier in the day.
5. Avoid foods that give you heartburn/indigestion
before sleep. For me drinking a sparkling water right before bed results in waking
up with painful heartburn a few hours later. Other people are bothered by spicy
foods. You probably know your own
offenders so it’s best to avoid them.
6. Make sure you get some sunlight every day, and
keep your room dark at night. This can strengthen your sleep wake cycle which
can improve the overall quality.
7.
Establish a calming bedtime routine. A bath,
lavender or other calming scents in an infuser, reading or whatever works for
you. Make your own rutine and que your body into knowing it is time to turn off
the day and restore itself.
8.
Set up a sleep environment that’s pleasant for
you. Comfortable bedding, cool temperatures, limited lighting (including screens—you
can even set your iPhone to dim to a “Night Shift” setting which changes the
screen to warmer color to help you sleep better), noise machines, anything that
works for you. I have black out curtains in my new home and my sleep has improved
dramatically.
But what happens if you try all of the above and still have
difficulty? I recently attended a lecture on CBT-I. I’d never even heard of it.
It’s a type of cognitive behavioral therapy specifically for people with
insomnia and it reportedly works extremely well and fairly quickly. I’d love to
hear from anyone who’s had success with it because the data presented with the
lecture was encouraging.
Another option is to try melatonin which is sold over the
counter. Melatonin is the hormone that our pineal glands produce that regulates
our sleep wake cycle. It can help reset the body’s clock (such as when you are
working night shifts or traveling across time zones). For some people it can
also improve sleep. For a natural remedy that has few side effects trying
approx. 3mg-6mg can be very helpful for some people. There is even a new
time-release form available by prescription called Rozerem. (Stay tuned for a
future post on melatonin as it is one of my most commonly prescribed
medications).
And, if sleep is still elusive it is time to see your
doctor. There could be an underlying medical problem interfering with your
sleep, or other issues such as an undiagnosed depressive or anxiety disorder.
Prescription medications could also be indicated, although in my practice they
are never the starting point.
Now time for some ZZZZZZs.
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