Sunday, November 3, 2019

Healthy Sleep


Image result for sleeping dog


    This week's focus is on  physical (and mental) health. 

    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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