A Good Night’s Sleep

If that headline caught your attention, you may be one of the 70% (by one estimate) of Americans who have trouble falling asleep, staying asleep, or waking up feeling rested from sleep. If you don’t sleep well, you are probably quite aware already of the ways sleep deprivation lowers energy and impairs judgment, mood, concentration, coordination, comprehension and memory.

These days, medical science is even more concerned with the growing evidence that insomnia is one of the most powerful contributors to such major health problems as obesity, diabetes, heart disease, hypertension, immune system disorders, severe mental illnesses, general disease risk and overall life expectancy.

While the specific science of this is beyond the scope of this column (though it’s pretty interesting stuff!), it comes down to the fact that chronic sleep deprivation increases inflammation levels in the body…and inflammation is now known to play a key role in the development and maintenance of many chronic diseases.

So if you or yours have persistent difficulty with getting a good night’s restful sleep, it is something to take seriously, and to take steps to address: your overall health depends on it!

In planning my topic for this month’s column, I had intended to write about a topic associated with military veterans in some way (since it’s Veterans’ Day Month),unnamed which was exactly what got me to the topic of sleep, since sleep is one of the most prominent and frequent symptoms of Post Traumatic Stress among veterans of deployments, and one that makes other symptoms worse.

According to the Dept of Veterans’ Affairs, insomnia has been found to occur in 90-100% of Vietnam-era Veterans diagnosed with Post-Traumatic Stress. It was also the most commonly reported symptom in a survey of Veterans from Afghanistan and Iraq.

Given the demands of the job for active duty servicemen and women, problems with sleep are hardly surprising: soldiers are trained to be highly and persistently vigilant, able to instantly react in case of need. And once the most reactive part of our nervous system (that fast-acting part of our brains connected with our fight-or-flight response) has been trained to remain always activated or ready to activate, re-training to relax is…well, complicated.

Which is why, in their trainings for behavioral health therapists on a range of conditions (but especially for trauma-related conditions), the U.S. Center for Deployment Psychology (CDP) places tremendous emphasis on accurately and thoroughly evaluating and treating problems with sleep. And because the factors that may be contributing to insomnia for one veteran  (or civilian, for that matter) may be very different from that of another, (even if both have experienced acute or prolonged trauma), The CDP advises that behavioral health therapists begin with a detailed, exhaustive (these take a couple of sessions just to complete) structured interview in order to comprehensively review and  identify potential contributing factors. Clients are asked, meanwhile, to complete a detailed sleep diary for a couple of weeks. Click here for these resources)

What I have learned from using both these tools with people in my practice is how very individual and complex a given person’s sleep problems can be –civilian or military– and how very important it is, therefore, to take whatever time it takes to gather all the data that might even possibly be related to a given person’s sleep issues. Often, in the process of doing so, surprising discoveries are made that can naturally suggest a remedy.

All that said, everyone with sleep difficulties would do well to start with the basics of what is antiseptically referred to as good “sleep hygiene,” since the strategies involved can go a long ways toward ensuring a good night’s sleep. But don’t take my word for it— give them a try!

1) Avoid caffeine, alcohol, nicotine, and other substances that interfere with sleep

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News flash: caffeine and nicotine interfere with restful sleep, and are generally best avoided for four to six hours before bedtime. And while alcohol may help you fall sleep, it also causes wakefulness, “rebound anxiety,”  and generally poorer quality of sleep later in the night. So if you do drink, experts advise (for this and general health reasons) no more than one to two drinks, and none within three hours of bedtime

2) Turn your bedroom into a “sleep room.”

A quiet, dark, comfortable and cool environment can do a lot to support sleep. Turn down the heat, turn off all artificial light, and use earplugs or white noise machines to mask sound. Make sure your mattress and pillows are right for you. And if a pet regularly wakes you during the night, you may want to consider keeping it out of your bedroom (I know, I know: I don’t want to do that either!). And keeping electronic devices out of the room will help to strengthen the mental association between your bedroom and relaxation, while also reducing your exposure to the electromagnetic fields (EMFs) they emit, which are thought to interfere with normal sleep. Better yet, unplug your WiFi system at night altogether: the EMFs they emit have been implicated in melatonin suppression in humans, and there is evidence that their higher rate of oscillation (vibration cycles) affect the natural electromagnetic field of your body at rest…and not in a rest-supporting way! In short: make your bedroom a place that becomes associated with sleep and sex and rest only, by furnishing and using it for only those activities.

3) Establish a sleep-supportive pre-sleep routine

Train your subconscious to prepare for sleep by developing a pre-sleep “transition” routine. This might include taking a bath or shower, putting on night clothes, reading a book, meditation, or relaxation exercises. Avoid stressful, stimulating activities (like doing work or discussing emotional issues). And if you tend to take your worries to bed, create a ritual to deliberately set them aside for the night: write them down, for instance, and then put them in a box or jar until morning…and close the lid.

4) Go to bed when you are tired

Struggling to fall sleep just leads to more tension…which makes sleep even less likely! So go to bed at the hour that is right for you, even if this means going to bed earlier or later than your partner. Then, if you’re not asleep after 20 minutes, get up and go do something relaxing (preferably not involving electronics) until you feel tired enough to sleep. But keep the light dim; bright light stimulates the brain.

5) Don’t watch the clock!

images-1Checking the clock when you are trying to fall asleep (or after waking at night) increases stress, making it harder to fall asleep. In addition, a digital clock emits a steady stream of artificial light that stimulates the brain even when your eyes are closed. Turn your clock’s face away from you.

6) Expose yourself to natural light

Exposure to natural light in the morning and regularly during the day is essential to keeping our internal clocks on a healthy sleep-wake cycle. So let in the light first thing in the morning and take sun breaks during the day if you work indoors.

7) Keep your internal clock set with a regular sleep schedule

Going to bed and waking up at the same time each day programs the body’s “internal clock” to expect sleep at a certain time each night. Some sleep experts say that waking up at the same time each day no matter when you went to sleep the night before is the most important of the two in setting and maintaining your body’s clock.

8) Experiment with napping

For some, afternoon napping may make sleep more difficult at night. For others, it may help nighttime sleep by easing the “fight to stay awake” exhaustion that can actually make falling asleep more difficult later. So experiment! If you do nap, it’s better to keep it short (45 minutes or less) and before 5 p.m.

9) Make your evening meal early, and light.

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Finish dinner at least two hours before bedtime and avoid foods that cause indigestion and reflux.  Eating early and lightly in the evening also allows the body to “cool down” (from the metabolic heat of the digestion process) by bedtime…and cooler body temperatures “cue” the body for sleep.

10) Ditto with your evening fluids!

Drink water throughout the day, then not close to bedtime. This will help you stay hydrated enough not to wake thirsty, while also avoiding the need for nighttime trips to the bathroom.

11) Exercise wisely

Exercise in general can help you fall asleep faster and sleep more soundly. But vigorous exercise late in the day can be more stimulating than relaxing, so save that long run or Zumba class for the morning (or at least several hours before bedtime) and relax with a “restorative yoga” DVD instead.

12)  Follow through!

Some of these behaviors will be easier to include in your daily and nightly routine than others, and none of them may have immediate results. But if you persist with them, your chances of achieving restful sleep will definitely improve.

If sleep problems persist even so, try keeping a sleep diary on your own, and/or use a structured interview questionnaire to ask yourself the relevant questions, and see what they point to– you may be surprised at the associations you are able to make on your own. In addition, consulting with your primary care and/or a behavioral health provider (counselor) trained in sleep problems is always a good idea (clinical hypnosis, for instance, can be very effective). Your PCP can take steps to diagnose and treat what may an underlying medical issue contributing to sleeplessness (there are many that do). And a behavioral health care provider can help you to further identify mental, emotional or behavioral factors, and to plan behavioral strategies that can lead to better sleep.

Sweet dreams…

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