10 Easy Steps to Better Sleep
In a 2005 Sleep in America poll, 70% of respondents said their physician had never asked them about sleep. I find this surprising given that in the same poll half of the respondents reported feeling tired or fatigued during waking hours at least 1 day a week. So why aren't we talking more about sleep?
It is important that so many people are fatigued during the day because we know it impacts cognitive functioning, work and school performance, quality of life, mortality and other health issues, and the risk of motor vehicle accidents.
"Sleep hygiene" is the term we use for structuring activities and changing the environment to promote sleep. Many of my patients who come in to the office complaining of fatigue proceed to tell me they go to sleep at midnight with their TV on and wake up for work at 6:45 A.M. That just ain't going to cut it.
Here are 10 Easy steps to better Sleep Hygiene:
1. Allow for sufficient time for sleep which is 8 hours for most of us.
2. Match your "bed time" to your sleep time so you don't spend too much time in your bed before you intend to go to sleep.
3. Avoid naps (by the way there are two kinds of people: nappers and non-nappers. Notice that non-nappers usually have partners that are nappers).
4. Daylight is a regulator of your circadian pacemaker so receiving enough light exposure during the day is critical to promoting proper sleep-wake functioning.
5. Avoid caffeine containing substances altogether after lunch if you have difficulty falling asleep.
6. Keep your bedroom quiet and comfortable (I know, I know, that's obvious).
7. Temperature control is also important and this is really interesting: people fall asleep better when their core body temperature is declining. So exercise and hot baths (which elevate your core body temp) should be avoided for at least 2 hours before bedtime.
8. Exercise and hot baths earlier in the day, however, appear to improve the quality of sleep and should be encouraged (same principal as above: increasing your core body temp during the day leads to greater temperature decline during sleep).
9. Alcohol and large meals are not recommended within 2 hours of sleep.
10. In general you should start to "wind down" for 1-2 hours before bedtime by engaging in a relaxing activity (remember the internet and TV are stimulating and not great, unless you are on DS of course).
Dr O.
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hello! I got a brilliant cd for better sleep, because i had cancer and ever since then i could not sleep properly i have uncomfortable feelings in my body which keep me awake, but when i put this cd on I am relaxing really well and fall asleep and never get to the end of it. I use zopyclone as well on occassions when it gets very bad, but mostly the cd. i got it from www.grimsbyhypnosis.co.uk on the cd page
By wilfred108 September 7, 2008 12:37am
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i think i have done all your steps but i have it been 36 days with sleeping probles and i had sleep only 22 hours all.I just got diagnose with bipolar disorder and i dont know hot to work with it. i don't sleep but next day I feel fine and go to work and do everithyng like i sleeped all night.
By yomaris June 29, 2008 3:04am
12
This is the first time I have read any of your articles. They are well written and informative. I especially liked the one on rx meds and weight gain. I have had 7 total spinal fusion of 61/2yr I am fused from T12 - L5 - s1 each surgery I gain on the average of 40 -60lbs I have zero metabolism and finally met with a diatician. On average I only eat 1000 calories and under usually more like 8-9hundred I was working out at the gym mainly pool therapy and some toning with weights I would work out approx 1 1/2 hrs a day and never lost a pound so when I met with the diatician we decided to cut my carbs to 125 and under in two months I have managed to take off 25lbs which is not much but not bad with no exercise. My concern is I am having a total knee replacement on Aug 4th. My diatician said that if I am fed introveniously give my height and weight which at the time was 282 5'8 the were giving me 1,666 through the IV that explains why I gain so much with each hospital stay I also have trouble with sever edema in my legs after surgery they will more than double and the take forever to get back to normal, do you have any suggestion how I can avoid these problems at my next surgery. When I had my last back surgery which was a yr ago this past june I ended up with a collapsed lund was on a ventilator for 4days came out of it they had to remove a whole left rib to fill a two inch gap that had deteriorated in my spine, anyhow I had severe pain on my left side my Dr ordered a Cat scan said he would call me at home with the results. The hospital would not let me leave until he called after an 1 1/2 they let me go home (his beeper battery died) The next morning the police were pounding on my door they thought I had died as they discovered 3 large blood clots in my right lung I still take coumadin.Any suggestions would be greatly appreciated so you have the whole picture all the meds I am currently on are Oxycontin 80mg 2x pr day, valium 10 mg 3xpr day Soma 2 350mg 3xpr day Tileptal 4xday Zoloft 100mg per day 25mg atenalol per day 6mg dilaudid per day&5mg coumadin 1 pr day the meds have finally evened out in my system My ankels have not
swollen for about 2wks now. I have noticed that if I drink what used to be my 5th food grou diet pepsie lol that my legs would swell so I try to limit it to 1-2 cans per day and alot of water I know I need to eat so my body does not go into starvation mode. I'm concerned when I go in the hospital agian they will give me high caliories iv Is within my right to ask them to loewer to like 1200 pr day. Any info you could give me on the meds I take as to which is the worse for swelling. I am also starting to really get into herbal meds also any info regarding these would help. I usually take arnica montana 200 for pain however 185 pellets only last about 2days. I have been on most of these meds for 61/2 yrs My Drs yell as I don't always take enough but I figure why take it if I can tollerate it I hate the narcotics. I have never had any trouble being weaned off of meds nor do I crave them. Sorry I rambled so much I just dont want the swelling and little bit of weight I have lost to return. I have gained close to 100lbs in under 3yrs I will take responsibility for about 30 the rest just keeps coming abain I know I haverambled but really would appreciate help. On a side note I do not use salt and watch the lables for salt content.
Have a wonderful day!
Hugs & God bless
Lisa
By hurtingangel June 27, 2008 1:27am
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That's tough Suzannaho1. I am very sorry to hear all of that. Just remember that suicide will probably do to your daughters what those other problems did to you. You have 4 beautiful daughters then make them first place in your life as suicide is a very selfish thing. You can make a difference in their lives and you should concentrate on that. I think that there is nothing more rewarding in life to see your kids grow up happy with life and careers and then hear them say that it was all due to such a wonderful parent(s) in their lives that believed in them and worked with them. Never focus on what you 'think' suicide will do for you but the lives it will destroy if you were to go through with it.
By Cody39 June 23, 2008 11:46am
10
I have always been one for having trouble with getting sleep. When I was young and being abused(incest) I had lots of nightmares IF I went to sleep at all. Mostly I didn't go to sleep cause I would be worring that HE would come into my bed again.
When I escaped that environment I then had a car accident and that started nightmares of re-living the accident.That continued for many months.
After I was married my sleep seemed to be more peaceful for 2 years but......... then my first daughter was stillborn and my dreams(nightmares) had a new trend to them.
I went on to have four other beautiful daughters who were good sleepers except for one who woke every hour for ten months.I was a grumpy MUM for those months I went without sleep.
I dont sleep very well even now and if I have any stressful events in my life I dont sleep at all. I went without sleep for almost a month whenmy husband left me.
Right now I am finding it very difficult to go to sleep after 3 friends died in one day and I am desperate for some GOOD sleep.
Dr. had me on suicide watch for the last ten days but says I should be O.K. now. Even though one of the funerals is 2moro.
At least I now know who I can call if I need someone in the middle of the night.
all sleep remedies gratefully accepted by this desperate nonsleeper
sue
By Suzannaho1 June 23, 2008 3:48am
9
Pinkgina, I used to have the same problem you did. I used to wake up at 1:30am and just remain awake until 3:30am before falling back to sleep. The problem can be anxiety as thinking about work used to keep me up. It also can be psychosomatic where you literally stress yourself over it. The way I stopped that was by buying alarm clocks that do not stay lit up even in the dark but instead require you to push a button to see what time it is. I have the kind that you can see the time projected onto the ceiling. I no longer look at the clock when I wake up at night but turn over and go right back to sleep. It used to cause me a problem if I turned over and noticed that it was 1:30am and then I would stress myself out wondering if I was going to lay awake for the next two hours. I used to get so agitated because I would keep opening my eyes seeing that clock staring me in the face and seeing each passing minute and that is why I eliminated them. The worst was waking up at 3:30am and knowing that my alarm was to go off in an hour and would stress myself out where I couldn't go back to sleep. Not looking at a clock at all was what helped me greatly.
My recommendation would be to give it a try. Also, do not allow stressful thoughts to fill your head such as, "What if I do not fall back to sleep?" The way I stopped those annoying thoughts was by opening my eyes for a brief second as it seemed to break the thought pattern. I also found thinking a certain thing every night would help me fall asleep fast. Do ask me why but thinking about flying over my town causes me to drift asleep fast. Whenever I would wake up in the night then sometimes I would just think the same thoughts but I am not sure if that will work for you. Also, if you have a thought that you woke up too and can't seem to get it out of your head then get up and go to the bathroom. Sometimes if I watch too much TV before bed then I will have that last episode I was watching playing through my head constantly while trying to sleep. I literally have to get up for a few minutes to get it out of my head.
The other suggestion is what Dr O gave about anxiety. Some people swear by Xanax to help them sleep. I personally hate drugs because I am afraid that I will depend on them. Years ago, my doctor gave me Ambien to help me sleep and it ended up putting me in the ER. This was before being diagnosed with sleep apnea. Ambien made my heart beat so fast because my body was constantly trying to wake up to take a breath. A later test revealed that in 90 minutes of sleep that I stopped breathing or had very shallow breaths (I believe they called it hypersomnia) 71 times in the 90 minutes of sleep. I have been wary of drugs ever since then as I thought I was having a heart attack. If you are not a loud snorer then you will not have this problem as loud snoring is one of the signs of sleep apnea.
I remember those sleepless nights and they do stink. Let me also suggest a sleep journal as that will help you possibly pin point the area of your problem. Sometimes your problem can be as simple as exercising too much or not at all. I suffered for a month with horrible sleepless nights all because of over exercising. I really was pushing myself to get in shape and didn't realize that it was actually affecting my sleep. Bills and hating work can affect a good night sleep too. Jot down the nights you slept good and if you did anything different the night before. I learned that my problem was job related because every Saturday and Sunday I would sleep like a baby.
One last thing, never read in bed or watch TV in bed. Leave the bed for two things only and that is sex and sleep. I learned this from another doctor that we need to train our minds to see the bed as a place of sleep and not a place to watch TV.
By Cody39 June 16, 2008 12:19pm
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Thank You
I love #10
By Maryca June 14, 2008 12:52am
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1) Looloo: you should maybe ask about a sleep study to rule out sleep apnea or restless legs...something causing you NOT to achieve nice deep level/restorative sleep
2) MTBOWELS: amazing advice
3) pinkgina: those early morning (3 or 4 AM) wakenings are classic for mood disorders (anxiety and depression) Im not sure if that is your issue but worth looking in to..and treating the anxiety will resolve the sleep issue...or should...
By DrOrrange June 13, 2008 6:51pm
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I found that a good protein snack before bed helps me sleep better. Carbs never work as my body will wake up craving food later. Sometimes I might have a protein drink that is low in sugar before bed or I might eat some meat.
Having my bedroom at 65 degrees is another big help to sleep for me.
I can't have my bedroom quiet but must have a constant sound going such as a fan and the bedroom must be pitch black.
I also learned that my body has a set time that it must be in bed by. I found that if I go to bed later than that time then I sleep like garbage. I have to be in bed by 9:30pm. I sleep bad too if I go to bed too early so I definitely have my certain time that I must get my butt in bed.
I had sleeping problems for years until it was discovered that I had sleep apnea. I was in good shape and yet had sleep apnea. Once I got used to having a mask over my face and a chin strap on then I slept great.
By Cody39 June 13, 2008 2:59pm
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Thank you for the info Dr. O. I wake up tired cause I toss and turn in my sleep but don't fully wake up. Any advise for that? I've taken tylenol pm sometimes to help me.
By looloo June 13, 2008 12:01pm
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I have no trouble getting to sleep but I wake at 3am and my mind is very active and I could get up and start working then. I have trouble getting back to sleep and often do just before its time to get up. Do you have any suggestions.
By pinkgina1212 June 12, 2008 8:02pm
3
Yeah, not only have I had trouble sleeping, but when I asked my doctor about it, it didn't even take my concerns about not sleeping seriously. I believe I asked him like 3 or 4 different times about it, that I knew I wasn't getting any sleep, and I knew laying there for 8 hours, and only getting maybe an hour or two at most, I knew if I was awake that much, I definitely wasn't getting REM sleep either, but he never took me seriously (this is my family doctor by the way)
So finally, I talked to my neurologist about it, since my family doctor didn't want to even answer my questions about it much of less address the issue. my neurologist put me on leunesta, but that medicine did no good at all. $100 medicine and I still wasn't sleeping any better then I was. The only time I could get him to take me seriously, was to mention that I've been having seizure issues lately. petite mal epileptic seizures, which I do have a history of. Finally then he says "well maybe your lack of sleep is bringing those back" and I'm thinking "yess finally someones listening to me" so he put me on this prescription medicine. I don't remember the name of it but you like take 1 pill, then 2, then 3 then 3 forever after that, ya know kinda like what you do for steroids. Well, that medicine started working "too" well, What I mean by too well, is I take the medicine and still don't sleep for 3-4 hours, but then when I do sleep, I pass out!! passed out for 14 hours the first night, 12 the next, so on and so forth, now I'm getting too much sleep if anything, and it still takes me hours and hours to get to sleep, so I'm not real sure if this medicine is working much better, but at least now someone is finally doing something. was like pulling teeth to get the doctors to do anything about my sleep problems.
By tcoburn June 11, 2008 6:25pm
2
Hi, I am finding as I get older (not quite a senior citizen, but getting close) I cannot sleep late in the mornings to "catch up" on missed sleep. Even if it adds up to 8 or 9 hours, sleeping late makes me really groggy and cognitive functioning is so messed up -- grogginess and slow thinking all day. In fact, anything that gets me off an 12 - 8 schedule or so messes me up.. Is this normal or does it have something to do with fibromyalgia ?(Sleep has always been a huge issue over the years .)
Thanks, Nancy
By Nancee June 11, 2008 2:57pm
1
Hi Dr. Orange,
I find I wake up during the night. It happens nearly every night. I am not sure why this happens. any suggestions?
Thanks a mill
Raid.
By Raid June 11, 2008 1:55pm