Bill Shakespeare called it “chief nourisher of Life’s feast” …yet poor sleep has become universal. Here are some answers to frequently asked questions I get from patients who are having trouble sleeping:
1. “Where do I start?”
I’d say 2 ways
A) Deﬁne your core problem and deal with it. Common causes include shift work, being sedentary, sleep apnea, depression, and pain. Worry is a good example: it usually gets worse when you are half awake and “catastrophize”. Break the cycle before it escalates by pre-answering your anxiety before bed (e.g. “I do have a presentation later this week, but I’ve set some time aside, and staying up won’t help.”). We have some more about stress and anxiety here
B) Associate your bedroom with sleep not wakefulness (e.g. watching TV, googling your kids rashes, getting text messages, netflix…). Think dark, cool, quiet. People often say to me, “I sleep fine once I hit the couch!”. That’s because they associate their couch with sleep (not their bedroom…)
2. “How can I improve the day after a bad night?”
Start by not obsessing about the night before… If you assume the day after an inevitable bad night will be horrible then, sure enough, it will be. Instead of saying to yourself “I only had 4 hours of sleep last night—I will be a wreck today,” say “I only had four hours but that’s OK – it happens now and then. I’ll sleep better tonight.”
3. “What is sleep hygiene?”
1) No caffeine after lunch
2) Limit alcohol. It might help at the beginning of the night, but then it messes with your sleep architecture and you don’t get a refreshing sleep (plus you have to get up to pee!)
3) No arguing pre-bed
4) Don’t clock watch. If you are twisting and turning, get up and do something relaxing and then come back. Counter-intuitively, people who get up sleep more. In fact when we monitor people, they sleep more that they think..
5) Don’t nap. If you sleep fine with naps then fine, but if you have problems sleeping then it is much better to NOT nap.
6) Move more. The data is limited but it looks like its more the daily habit of activity rather than one big effort.
7) Keep the same routine. (e.g. Wind down at 1030, sleep 11-7, even if you have a bad night get up at 7…)
8) If you have something your anxious about (I have to give a presentation on Friday) this can be “catastrophized” as you fade in and out of sleep. My advice is to write down on a piece of paper what would close the anxious loop (I have set aside 2 hours on Wednesday to do presentation) before it gets freaky.
Bonus: There are some sleep disorders (apnea,restless legs syndrome) that can be diagnosed by your partner (if you have one). Follow up with your doc if you’re concerned. A snoring partner is a common cause of insomnia…
4. “Should I use sleeping pills?”
Research shows that sleeping pills don’t work as well as people think. They might add 25 minutes to your sleep on average. The down side is that 1 in 6 people (especially older people) have a problem such as significant daytime fatigue, confusion and memory problems. People prone to addiction may want to steer clear and many will have a few bad nights when they stop taking sleeping pills. Talk about it with your doc or pharmacist. (http://www.ncbi.nlm.nih.gov/pubmed/16284208)
5. “What works best for insomnia?”
Cognitive Behavioural Therapy (check out our Mental Health 101 section) has been shown to be the single most effective cure for insomnia. A 2009 trial showed that CBT put insomnia into remission for 7 out of 10 people with persistent insomnia. Combining CBT plus good sleep hygiene and the tips mentioned above should put you where you want to be: asleep.
here are two good programs
– SHUTi An american 16 week program but based on the work of leading Canadian researcher Charles Morin. it cost $135 US
– Sleepio from Oxford. It costs about $7.50/week for 12 weeks
So that’s my top five for advice on sleeping better. But in the spirit of breaking down silos, it’s also important to remember that making positive changes in other areas – like eating better and being active can have ripple effects on sleeping!
For more about the science of sleep, sleep disorders, sleep hygiene and more check out the resources below. And don’t forget to let us know about the great stuff you’ve found.