Monday, May 14, 2012

Insomnia part 2: How is Your Sleep Hygiene?

May is National Better Sleep Month
Related Insomnia blog posts in this series:

Good Sleep Hygiene

We could all use a good night's rest.  As a nod to "National Sleep Better Month", this is part of a series of posts on insomnia resources to improve your sleep.  How is your sleep lately? [For more details on what defines good quality sleep versus chronic sleep deprivation, see the related posts.]

We all have a rough night of sleep now and then.  If your rough nights are more than once a week, check your sleep hygiene. Having good sleep hygiene is the simplest way to manage and prevent insomnia.

Regular Sleep/Wake Cycle
To encourage quality sleep, you should have a regular sleep/wake schedule. Ideally, you sleep when it is dark and wake when there is sunlight. Commit to 6-8 hours of sleep at once if you only sleep once a day. Sleeping at least 4 hours in a row helps your body experience to several deep REM cycles. REM cycles are very healing for the body. We will discuss ideal situations here. Not everyone has a career where they are able to work during the day and commit to a regular sleep cycle. Mothers and fathers of infants and young children are often sleep-deprived due to the nature of their responsibility. However, even sleep-deprived parents can make use of some of these tips to improve what sleep they are able to catch (and maybe help improve the sleep of the wakeful child).

Stick to a Routine
Have a bedtime routine.
Go to bed at the same time every night.
Wake at the same time every morning.
Start your “preparing for nighttime sleeping” routine at the same time every night.

Keep your Bedtime Routine Calming
Avoid stress or watching stressful or stimulating TV shows before falling asleep.
  • No TV in the bedroom.
    • The bedroom is a sacred place. The bed is for sleeping and sex only; any other use of the bed (for studying, watching TV, working on your computer) creates a poor environment for sleep.

Do NOT take Stimulants
That cup of coffee or tea at 3pm may be what is keeping you from falling asleep at 10pm.
If you are feeling tired during the day try this:
Drink at least 8 oz of fresh water (not ice-cold) and wait 15 minutes.
That “tired feeling” may actually be mild dehydration. Regarding hydration, drink enough water throughout the day.

Water Math
Remember that 1 cup of coffee or any equivalent stimulant (soda, tea) is a diuretic, which dehydrates the body. So, for your water math: 8 oz water + 2 (8 oz cups coffee) = -8 oz water. In other words, in that equation, you are behind 8oz of water on your hydration for the day even though you have consumed 24 oz of liquid.

Some exercise or movement every day is what we humans are designed for, no matter our age, health, or level of disability. Pick the exercise or movement routine that works best for you and stick to it. If you are having trouble falling asleep or staying asleep at night, consider the amount of movement/exercise and fresh air you had that day. Did you have enough? Too much? Too close to bedtime? In Traditional Chinese Medicine, exercise or movement is ideally done during the “Lung time” when the Lungs are energetically in an ideal state to take in fresh air and new qi from the beginning day. “Lung time” corresponds to 0300-0500 standard (non-daylight savings) time in American culture. Truly, “Lung time” is the beginning of the day, dawn-time, when the sun is just starting to peep over the horizon and the birds are waking. “Lung time” also corresponds to the yin aspect of the Metal element. Metal element corresponds to proper breathing (easy to breathe in and easy to breathe out) and grief.

Exercise and Digestion
One of the famous Chinese philosophers said (translated): “Take 1000 steps after every meal” for proper digestion. This can be as simple as a stroll around the block or a walk around the office building after eating a meal. This fresh air and movement aids in digestion, stress-relief, and better sleep.

Eating schedule
Do not eat too close to your bedtime. If your body is still trying to digest food as you are lying down to sleep, you may find you have symptoms of acid reflux and belching or abdominal cramping. Related to this, be aware of your food sensitivities. If you are sensitive to dairy or lactose-intolerant, a scoop of ice cream after supper is not a healthy idea. Find a non-food way to de-stress before bedtime. This also means avoiding alcohol and nicotine (cigarettes, chew tobacco, etc) in the evening. While the immediate effect of alcohol and nicotine can be relaxation, it causes wakefulness within a few hours.

Sleep Distractions that are difficult to Avoid or Control
Partner snoring
Waking due to loud noises (loud neighbors, baby crying, ambulance driving by with sirens, etc.)
You may be able to control these up to a point; but mostly you can focus on your reaction toward them.

Medications that can cause or worsen symptoms of insomnia
Check with your primary care provider if the medication you take for the following is aggravating your insomnia.Your physician may be able to find a similar medication for you that does not contribute to sleep problems.  DO NOT STOP your medications without the supervision of your physician.  Many of these medications, if not tapered properly can cause severe rebound insomnia and other more serious issues.
Medications prescribed for:
High blood pressure
High cholesterol
Sinus congestion (colds or allergies)
Pain medications (like opioids)
Anxiety and depression
Birth control

Related Blog post: Sleep Medications can cause Harm and Rebound Insomnia

You have GREAT Sleep Hygiene and Still have Poor Sleep
If you have improved your sleep hygiene to the best of your ability, talked with your physician about any insomnia-inducing medications, and you are still having poor quality sleep, see your Acupuncturist/East Asian Medicine Practitioner for a thorough Traditional Medicine evaluation and treatment. These Practitioners have a master’s or doctorate level degree from an accredited Acupuncture and Oriental Medicine program and have passed the National Acupuncture and Oriental Medicine board exam. For more on the training and education of Acupuncturists/Practitioners of Traditional Asian Medicine, see the blog post What is the Training Level of My Acupuncturist?.

Hope these tips help you have more quality sleep and thus gain resilience for your daily life. For more resources on insomnia and stress-related insomnia, see the links to videos, articles, and research below.


Related information on Insomnia and Good Sleep Hygiene
The Navy’s “10 Top Tips for Tip Top Sleep”
Cognitive Behavioral Therapy for Improving Sleep, a successful alternative to prescription
medications for insomnia.
Mayo's Napping Do's and Don'ts
The American Academy of Sleep Medicine. The 2012 annual meeting will be in June, SLEEP 2012.
The American Academy of Sleep Medicine (AASM) publishes research and sleep studies in the
following journalsSLEEP and Journal of Clinical Sleep Medicine (JCSM)

More on Insomnia and Stress, including Combat Stress and TBI -related Insomnia

Free Online and Phone Counseling for Stress
Online and phone counseling—free services through
Military OneSource or 1-800-342-9647 or online counseling site
The D-STRESS LINE or 1-877-476-7734
TriWest Online Free Counseling--see video
Veterans Suicide Prevention Hotline 1-800-273-8255
National Hotline 1-800-273-TALK
The Safe Hotline, Sexual Assault Support for the DoD community 1-877-995-5247 or 911

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