One of the most common complaints that health providers hear is: “I can’t sleep.” About 40 million American adults will report an issue with sleep during the past year, about 30 million have sleep apnea (intermittent breathing cessation during sleep), and 25 million have sleep issues from shift work. Poor sleep can lead to excessive daytime sleepiness (EDS). This, in turn, can lead to accidents and disasters, and health ramifications because we are often totally unaware of how our capabilities are reduced—we have become so habituated to a low level of alertness. Sleep quality and length is a stronger predictor of mortality than tobacco use, high blood pressure, or obesity, and affects our physical and mental stamina as we age. REM sleep and dreaming are beneficial for memory, learning, emotional healing, raising our pain threshold, and expanding consciousness (like a natural physiological yoga, so to speak).
Chronic insomnia is a strong predictor of depression, and depression is often an indicator that poor sleep is in play. Some believe that the fatigue that comes with depression is simply the body’s exquisite mechanism to force rest. Sleep issues can lead to or exacerbate many conditions including reduced resistance to viral infections, obesity, diabetes, cardiovascular disease, cancer and/or chronic inflammation and pain.
In the purest sense, sleep is a “letting go of being awake,” rather than making ourselves sleep. We cannot intentionally will ourselves to sleep—in fact, attempting to do so will make it worse.
Sleep issues (insomnia, dyssomnia) are typically categorized as difficulty falling asleep, difficulty staying asleep, or non-restful sleep (waking unrefreshed). If you are having issues with sleep, consider and experiment with the following to see if your sleep quality and/or quantity improve:
- Caffeine: This substance can disrupt sleep even if only 8 oz is consumed in the morning. Avoid caffeine, even in small amounts such as chocolate or tea.
- Alcohol: Many believe that alcohol helps them sleep. In fact, it can induce drowsiness and speed the falling-asleep process. Unfortunately, the sleep that follows is ragged and not restful. Alcohol also suppresses melatonin resulting in frequent awakening. Avoid alcohol as a regularly consumed beverage, and save it for special occasions if you are not able to completely abstain.
- Sugary foods and snacks: Foods with a high insulin-index or high glycemic-index can disrupt sleep by engaging our “awake” metabolism, rather than our “sleep” metabolism. Avoid these foods within 3-4 hours of sleep. If you must have a sweet snack, eat it earlier in the day to allow your body to fully metabolize it.
- Exercise: While exercise is exceptionally helpful when done early in the day, when done within 3-4 hours of sleep, it can have a negative impact on sleep. Rise and shine!
- Breathing: If you snore or someone tells you that you stop breathing while you sleep, discuss the possibility of sleep apnea with your physician.
- Keep a regular rhythm: Work to retire at about the same time each evening, and awaken at about the same time each morning.
- Modify your environment: Keep the bedroom cool (68 degrees F), completely dark.
- Learn your mode of optimal sleeping by experimenting with each of the following for a minimum of two weeks: 1) Lie down in bed BEFORE you feel your energy is totally exhausted, even an hour prior, and engage in any activity that allows your body to unwind and release energies from the day that do not belong to you. 2) Allow your energy to become completely exhausted before you drop into bed. Complete your bedtime routine ahead of time, so that when you are exhausted there is nothing else you need to do other than “drop into bed.” 3) Get into bed before your energy is exhausted, and work, read or watch television until you feel your energy is exhausted. 4) Get into bed before your energy is exhausted and release the energies of the day that are not yours. Do this by engaging in peaceful, unwinding activities such as reading a relaxing book or listening to calming music until you feel your energy release.
- Rhythms: Our planet is becoming increasingly brighter day-by-day. Exposure to bright light beyond normal circadian rhythms can be particularly disruptive. This includes exposure to smart devices. Avoid exposure to smart devices the hour before sleep. If you must access these devices, set them to “night mode.” There are also glasses that can be purchased to eliminate the retina-activating blue light of smart devices that do not offer night mode. Menstrual cycle rhythms can disrupt sleep—keeping a diary of how sleep changes during your cycle can help you identify when you may need more or less sleep.
- Shift work: As much as you are able, keep to a consistent sleep schedule.
- Behaviors: Do not watch the clock if you find yourself in wakefulness. Avoid “post-dramatic stress disorder” by not watching action-filled television shows prior to bedtime. Avoid excessive web-surfing the hour prior to bedtime. Keep electronic devices two arms-lengths from your body. Do not sleep with a device in your bed or on your person, including a Fitbit type of device on your wrist, remembering that pacemakers and medical devices are excluded! If you awaken with the racing thoughts of your “monkey mind,” take a moment to write down a few of your racing thoughts, make note of any dream you are having, or make note of something you need to do in the morning. “Monkey-mind” is extremely common and needs to be tamed with practice. You can use this phrase: “Monkey-mind, get in the back seat, you are not driving right now.” Avoid engaging in stimulating conversations or arguments prior to bedtime. Develop a “safe-phrase” such as “this is an important matter to me/you/us, but it doesn’t work for me to discuss this so close to bedtime. How would it be if we planned a time to discuss this tomorrow/next week/etc.?”
- Individual space: Try sleeping alone. For many, sleeping alone can be very beneficial. If your partner moves a lot during sleep, it can be very disruptive to you and make the sleep situation feel unsafe while you sleep. Also, the energy of your partner can “leak” onto you—if they are having vivid dreams, for example, your sleep can also be disrupted. If your partner snores, this can be exceptionally disruptive. Initially, sleeping alone can feel very odd, or even lonely, but given time, you will likely find your sleep to be more restful.
- Pain: If chronic pain keeps you awake, discuss this with your provider or see a Pain Specialist.
- Recreational drugs: Depending on the particular substance involved, your sleep can be disrupted in any or all of the three insomnia categories.
- Sleep aids: Avoid starting any pharmaceutical sleep aids, or use them for only critical issues and for very short periods of time. Sleep medications and benzodiazepines are extremely dependence-forming, and while they may help you fall asleep, the sleep they provide is NOT the same. Benadryl (diphenhydramine) can be used without forming physical dependence, but emotional dependence can occur.
- Napping: Once considered an essential component of the daily routine (and still so in some countries), we have moved away from napping in favor of working even more hours, and increasing our stress levels. Naps have been shown to lower blood pressure, regulate emotions, and improve task performance. The ideal nap is 20 minutes in the middle of the day.
- Try various natural remedies: lavender on a cotton ball near your pillow, valerian root, Rescue Remedy, Perelandra ERS, calming caffeine-free teas, melatonin (low doses often work best); breathing exercises.
We are defenseless when we sleep. If you do not feel safe in life, you will not feel safe in sleep. See a psychotherapist to identify emotional or behavioral issues that may be keeping you from falling asleep, or returning to sleep if you awaken.
You can still obtain rest, even if you are not fully asleep. If you find yourself lying awake, say to yourself “I may not be asleep, but I am still getting rest.” Allow yourself to surrender to sleep.
©Jun 2019 – Genevie Kocourek, M.D. is Board Certified in Family Medicine and practices at The Ommani Center. She is the founder of Trinity Integrative Family Medicine and focuses her practice on integrative care and prevention of disease for the entire family.