Sleep hygiene: How to get to sleep / How to get back to sleep
When we use the word hygiene we tend to think of cleanliness, such as hand washing or teeth brushing. We get the word from Hygea, the Greek goddess of health. When we talk of sleep hygiene we are referring to practices and lifestyle issues that promote healthy sleep.
Hygea, the Greek goddess of health
Sleep hygiene is a complicated issue. In this article I will discuss simple ways that you can help yourself sleep better. Unfortunately, sleep hygiene often means changing our behavior, and we all know how much we humans love to change our own behavior.
Poor sleep has been linked to increased auto accidents, hypertension, diabetes, and depression according to the Centers for Disease Control and Prevention (CDC). In 2014 the CDC released a public wake-up call (sorry I couldn’t resist the pun) entitled: Insufficient Sleep Is a Public Health Epidemic.
Sleep specialists generally agree that children need 10 hours of sleep per day, teens need 9-10 hours of sleep per day, and adults need 7-8 hours of sleep per day. When surveyed, about 30% of adults report getting less than 6 hours of sleep per day. It is worse for teenagers, that report getting about 7 hours of sleep on the average school night.
These statistics sound bad, but what can be done to help ourselves sleep better?
Mrs. Oslow was telling me about how tired she was. She told of how her dog and cat tended to wake up, snarling and hissing, about 5 a.m. “I yell at them but it does no good, so I have to get up and feed them.”
When I suggested that the pets were cutting 2 hours off her sleep time most nights, she growled at me, “The boys can’t sleep by themselves, they need me.”
I hear this type of story a lot, “The phone wakes me up,” “The sunlight wakes me up,” “My husband is a loud clod in the morning and wakes me up!”
This type of distraction is environmental. Stuff in the environment of your sleep space that interrupts your sleep needs to be controlled. It is imperative that you make your sleep space conducive to your ability to sleep.
Part of controlling your bedroom environment is the physical stuff like your bed and pillow. Another part is the emotional stuff. Many people find that it is best to limit their bedroom to sleep and romance. That way you get used to sleeping and almost nothing else in your sleep area. Many patients argue with me initially about this, because they like eating, watching TV, or talking on the phone in bed.
I recommend patients with sleep issues use their bed only for sleeping and/or intimate behaviors that lead to sleep.
Over the last few years I have noticed a problem with cell phones and early morning sleep disturbance. One mom told me, “When one of my daughter's friends wakes up, she texts all the friends and the day starts for all of them. My daughter has started texting most mornings -hours before her alarm is set to wake her up for school.”
I pointed out to this mom that phones in the bedroom seemed like a bad idea for her child, and she said, “I know, I know, but my daughter won’t listen to me.”
I hope that you are starting to notice a pattern here. Even if you don’t want to, you have to control your, or your child’s, sleep area.
We humans are made to move a lot. The reality is that our mechanized world leads to us to get much less exercise in our everyday lives than our bodies are designed for. So we have to make an effort to get exercise. The more the better when it comes to sleep hygiene. However, it is best not to be physically active in the hours leading up to bedtime. Sorry, a jog just before bed tends to mess with getting to sleep and staying asleep.
It is best to develop a bedtime ritual that is physically relaxing and emotionally calming. Warm showers help, checking work emails tend not to. Reading for fun helps many people get drowsy, while the last minute study cram for tomorrow's big test is not calming.
Many people find that the same bedtime ritual and bed time helps a lot. Staying up late on weekends, for example, tends to set most people up for poor sleep the following week.
Many people also find that napping is not helpful for their sleep hygiene.
Alcohol, nicotine, caffeine, and late night food tend to mess with most people's sleep patterns. Most people find it is best to have at least 2 hours or more between food and going to bed.
How do I say this delicately? Having to get up to pee interrupts many adults' sleep patterns. Avoiding liquids at bedtime makes sense but is only half the battle. You also need to watch out for diuretics, things that encourage you to pee, such as decaffeinated tea, highly acidic fruits, alcohol, and caffeine (even the caffeine hidden in chocolate).
Salty food, such as corned beef or potato chips, earlier in the day can make you feel thirsty creating the need to drink more, and resulting in sleep interrupting urination later in the night.
Many medications act as diuretics. It is a good idea to read the medication insert.
Spicy foods and/or overeating can cause physical discomfort such as heartburn, that can interrupt your sleep.
There is no specific order to these power tips, you use them when you need them in the order you choose.
White noise is an indistinct noise that masks other sounds. Most people find that white noise in a room helps them not notice the little sounds that may interrupt their sleep.
You can buy white noise machines, but personally I think that is a waste of money. You probably already have a machine that can produce white noise.
Take your radio and put it on a frequency that has no radio signal. That between stations “static” is white noise. You want to have the volume low enough that you can just barely hear the static. The static vibrates your eardrum muting other sounds. Most people find this to be calming.
You can also get fancy. As I mentioned, there are white noise machines. Many therapist put them in their waiting rooms to help with client privacy. Most of the machines will also offer soothing sounds such as rainforest or ocean waves. There are apps for your iPhone that are getting positive reviews that cost a dollar.
Many people hold the tension of the day in their muscles. Tight muscles are not conducive to falling into restful sleep.
A relaxation technique of slowly pulling a blanket over yourself, starting at your toes, often helps.
Get into your sleep position. Then with your mind's eye super slowly pull a comforting blanket over your toes. Wherever the blanket covers mentally, notice the muscles and relax them. As you slowly breathe in and out, allow the muscles to get heavy on the bed. Then move your mental blanket up a little. Repeat the muscle relaxation along with the deep calm breathing. Slowly continue all the way up your body.
For kids I often talk of a sleeping bag. As the bag is slowly pulled up they can feel the warmth and comfort.
I like a relaxation technique called “Breathing the Feather” to help calm down my thoughts. This technique is helpful during the day as well as at night, whenever you feel your mind racing and your respiration is getting rapid.
With your mind's eye, picture a feather in front of you on a shelf. You can have any color feather you want but you have to be able to picture it distinctly.
The goal of the relaxation technique is to slowly inhale the feather, pulling it off the shelf and deep into your lungs. Then exhale the feather back onto the shelf.
Now remember, feathers are very light. As you inhale the feather it will float like a feather into you. Then float like a feather slowly back onto the shelf. You can’t rush a feather.
Many patients tell me that this technique helps them deal with life stress many times throughout the day as well as at bedtime.
This relaxation technique is calming and fun. In your mind's eye, find yourself going down on a slow rumbling escalator. The escalator is nondescript. You can’t see much but gray walls and a black rubber handrail. As you go down the escalator you can hear and feel the low mechanical rumbling, it is surprisingly calming.
At the end of the escalator you step off and take a few steps onto the next descending escalator. At the end of this escalator you step calmly onto the next escalator. Over and over you rumble down the escalators into a calming sleep.
For those of use that find ourselves having thoughts pop into our heads of tasks that “we just can’t forget”, I advise that you keep a note pad by your bed.
When the fear provoking thought of forgetting something pops into your head, jot it down so that first thing in the morning you can see it.
I advise not even opening your eyes to jot down the note. Just write the note from your sleeping position so that you can let go of the worry.
I keep a note pad by my bed for cartoon ideas. If something funny crosses my drowsy mind I jot it down. Over the years I have jotted notes down that I didn’t remember waking up and writing. I guess I get funny thoughts in my dreams. Works for me; I have some funny cartoons because of it.
This is a “G” rated article so I am going to speak softly here so my editor will let this get into print.
An orgasm is very good for relaxing us humans.
Avoid watching the clock. Most people tell me that when they watch the clock it builds up their anxiety as they realize how tired they will be if they don’t get to sleep right now. Instead of watching the clock, try one of the relaxation techniques described above. I advise that you even turn the clock face away so you can’t even glance at it.
I usually advise that you should not get out of bed if you find yourself awake for a long period of time. Even though you are probably not sleeping deeply, you are getting much needed rest.
BUT, if you are tightly wound and find yourself fuming at yourself for not sleeping… get up and go to another room. Do something very boring and nonactive. Then go back to bed. Reading is better than watching TV. Many patients tell me that they can watch TV until they have to start their day. The goal is to not stimulate your mind. It is best not to reward your disobedient mind for not sleeping when it is supposed to be sleeping.
Many patients tell me they sleep poorly most nights. But, when they keep a sleep diary, noting how they actually sleep, they find a pattern that tells a different story. Often this pattern helps them pinpoint causes for their sleep issues.
For persistent sleep issues that are causing you problems during the day, it is a good idea to talk to your doctor. Sometimes sleep disturbances can be a symptom of a medical condition that needs to be treated. Often sleep issues can be a negative side effect of medications. So, it’s better to be safe and voice your concerns to your medical doctor. If you find that anxiety is keeping you up, a referral to a cognitive behavioral therapist may be in order.
If you have anything to add, please send me an email.
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