Ten Steps to Better Sleep
Lots of people suffer from sleep problems. Approximately ten percent of the population suffer from chronic sleep problems and up to thirty percent will say they had noticeable difficulties in the past year (see references).
The old saying “you need eight hours of sleep a night” may be a myth. There is a lot of difference in how much sleep people need. Some people seem to thrive on a few hours while others are still dragging after ten. You need to find out what is your ideal sleep time.
The best way both to find out your ideal sleep time and to define the scope of the problem is to keep a sleep log for a week. Include the time you went to bed, the approximate time you fell asleep, how many times you woke up and how long those awakenings were (i.e., just got up and went to the bathroom and fell back asleep or woke up and was up for an hour), when you got up for the last time, the quality of sleep, and how you felt the next day. You can also keep track of anything else that might be of importance. For instance, you may want to know what is keeping you up so late each night. A sample log is included in the electronic version of the document available for download below.
Once the sleep log is done, have a good look at it. For some, this can let you know that you are actually getting more sleep than you thought. For others, you may not be getting as much sleep as you think you need but your daytime functioning is fine so you can go back to wondering if this really is a problem. For the rest of you, the log is baseline data that should help you focus your efforts.
Now that you have the baseline data, we are ready to start to work. There are many different techniques you can use. The ones in this list are in no particular order. You can change one at a time or all at once. Some may be more relevant for you than others. Again, you can use your completed sleep log to help you get started.
1. Get Educated
Sleep has five different stages. The first four stages are of progressively deeper sleep. The first stage is so light that if you were awakened from it, you would probably state that you weren’t sleeping. The fifth stage, called REM for Rapid Eye Movement, is associated with dreaming and, on a brain scan, it would look as if you were awake. During the night, we cycle through the stages several times. As the night progresses, we spend more time in REM. After a sustained period of sleeplessness, people often find that when they do get some sleep, it is filled with dreams, dreams that are bizarre and intense but on reflection meaningless. This is often called “REM-Rebound.”
One night of sleep deprivation leads to daytime sleepiness but typically does not affect performance. What does affect performance is how much people are feeling frustrated or angry because they did not get the sleep they wanted. The more we can remind ourselves that everyone has an occasional sleepless night and that we are probably getting more rest than we think, the better we will be functioning the next day and the more likely we are to get to sleep. This is because worrying about sleeping is not going to lead to sleeping.
2. Cut Out Stimulants
The biggest stimulant is caffeine, which we all know comes in coffee. However, caffeine also comes in many soft drinks (check the label) and in chocolate including chocolate milk (milk by itself will help you sleep). Decaffeinated coffee also contains a trace of caffeine. You need to decide for yourself if this is enough caffeine to cause a problem.
Do not drink coffee within a few hours of when you want to go to bed. Most people need to cut off in the early afternoon. Some people need to go off caffeine entirely for a while. There are two ways to approach this problem.
The first way is to cut out all stimulants, wait three days for the headache to go away, and then see what happens to your sleep. Once your sleep is improved, you can decide if you want to reintroduce the coffee or not. If so, you can do it gradually by having some coffee in the morning and seeing if it affects your sleep. By trial and error, you can discover if you can have any coffee and what time you need to stop drinking it.
The other way is to experiment with stopping the coffee earlier and earlier in the day until you are able to sleep. This takes a lot longer than just cutting out the coffee but reduces the withdrawal symptoms.
2a. Stop Smoking
Along with all the other health benefits, stopping smoking can help your sleep because nicotine is a stimulant. At the very least, do not smoke within a few hours of going to bed. As with coffee, you can keep pushing it back earlier and earlier in the day or you can go cold turkey and later decide if you want to reintroduce nicotine.
For those of you who find smoking relaxing, it is probably the ritual of smoking that is relaxing rather than the nicotine. See if you can find another ritual that is also relaxing such as making a cup of herbal tea or sitting and doing some deep breathing for a few minutes.
2b. No Alcohol Before Bed (OK, I know it’s not a stimulant)
Although many people like having a drink at night to relax, it actually interferes with the sleep cycle by disrupting the REM stage. Although it can help some people get to sleep, they have more problems staying asleep. Not a good idea. If you are drinking to go to sleep, try cutting out the alcohol for 60 days and see what happens. If you are so stressed that you cannot relax without an external aid, get some professional help so that you can deal with the stress better. There are a lot of very effective treatments available. A psychologist can be very helpful with this.
Exercise has several other health benefits in addition to helping you to sleep. There are some cautions, however. The first is that you do not want to exercise right before going to bed. Exercise releases adrenalin, which needs to clear the body before you can sleep. Exercising right after work is a great way to get rid of the workday stress and make a transition to home time. As with everything, experiment to find out what is going to work for you.
4. Cut out the Naps
If you are not sleeping at night, there is a temptation to make up for it by sleeping during the day. This would be an instance of short-term gain for long-term pain. The nap will feel good right away but it will not help you consolidate your sleep. The goal is to get a good night’s sleep so that you don’t have to sleep during the day. You may find yourself sleepy for a few days but you want to be getting your sleep at night. (This does not apply to the elderly who naturally sleep less during the night and are fine with naps during the day.)
5. Schedule a Worry Time other than Bedtime
We all worry. Some just do it more efficiently than others. Some people get their worrying done during the day and are able to relax at night. Others do it at bedtime. Still others do their worrying at 2 a.m. With today’s hectic lifestyle, we need time to stop and figure out what goes on our to-do list and how are we going to schedule everything and how are we going to get everything done and who do we need to call and so on and so forth. The more things you have to do in a day, the more important it is to take time at the beginning and the end of the day to decide what is important and how it is going to get done. However, it is best if this can be done sometime other than bedtime. There is a rush of adrenalin as we look at all of tomorrow’s potential stressors. By scheduling 20 minutes to do this, we start to feel more in control. It’s a great lifestyle technique that helps us feel and be more in control of our lives. It also helps us sleep because we can go to bed knowing that things are under control. This saves us from having to wake up in the middle of the night to worry “whether this was done” or “how am I going to remember to do that.” If you do have a scheduled worry time and you still wake up at night remembering something, quickly write it down on a pad of paper by the bed so that you can deal with it in the morning. Trying not to think about a particular issue does not work.
6. Have a Wind Down Time
After you’ve done all your chores for the day, exercised, done your worrying and scheduling, take some time just to be quiet. We do this for our children but we forget to do this for ourselves. We need a transition time before turning out the light. This can be the whole ritual of getting ready for bed and reading a book for a while. Some people like to relax and watch TV. Fine, as long as you pay attention to what you are watching (and avoid the coffee and cigarettes). High-energy shows lead to high energy in you, which is not conducive to sleeping. Watching quieter shows is more likely to help you wind down. The same is true for books. Some books are more conducive to sleeping. (As tempting as it is, textbooks are not to be deliberately used to help you fall asleep. That creates a sleep association you don’t want.) For those of you who are really into fiction (or mysteries or horror etc.) you may want to have two different books going at once; the one you read during the day and the one you read at night.
In addition to your reading material, pay attention to the entire ritual around sleep. You will want to gradually transition from daytime to sleep time. Slow yourself down. Have your bedtime rituals like brushing your teeth and washing your hands. Having a ritual will help you feel complete which will help you feel more secure and therefore better able to sleep.
7. Turn Down The Lights At Night
Our bodies are programmed to go to sleep with the sun and get up with the sun. Our circadian rhythms are longer than 24 hours and need the light to help us reset each day. Excessively bright lights can throw this off. If you need help waking up in the morning, turn on the lights. At night, go from bright to dimmer lights as you move toward the bed. This simulates a time of dusk, which naturally helps our bodies prepare for sleep. If you need to get up at night, avoid bright lights.
8. Bed is for Sleeping
Some people seem able to do anything anywhere and have that last cup of coffee before bed. We’re not those people (we’re usually married to those people). We need to make an association between bed and sleeping. Doing anything else on the bed reduces the strength of that association. Bed is not for watching TV, studying, writing letters, playing games, or pillow fights (sad). If you are having a lot of problems falling asleep, you may not even be able to read in bed.
9. Get out of Bed if You are Not Sleeping
If you are lying in bed not sleeping, all you are doing is learning an association between lying in bed and not sleeping. You need to get up. You actually want to learn an association between sleep and bed. If you go to bed and cannot get to sleep within a relatively short period of time (some people say ten minutes, I prefer thirty), you need to get up and do something quiet elsewhere. This is equally true for not being able to sleep at the beginning of the night and not being able to go back to sleep in the middle of the night. It is important that whatever you decide to do is quiet and relaxing. The goal here is not to wake you up; it is to put you to sleep. You can read a book in a comfy chair or listen to some quiet music or practice your deep breathing. This is not the time to exercise. This is not the time to get involved in an exciting TV show. Stay up until you feel sleepy and then again go to bed. You may not get much sleep in the first night or two but you are doing an important task of changing the associations you have with your bed from lying awake to being asleep. The goal is for your body to learn that when you lie down in bed, it is time to sleep.
10. Get up at the Same Time Every Day
This is by far the most painful step. The problem is that your body needs to learn a routine. Your body is designed to have a routine. It is also designed to have a circadian rhythm that is slightly longer than 24 hours. This means that your body’s clock needs to be reset daily and this happens when you get up in the morning. What happens when you go to bed late and sleep in late? You reset your internal clock to the new time. This happens very quickly. Unfortunately, it is much more difficult to reset your clock in the other direction so that you are going to bed earlier. This becomes a problem for most people in two places: one is weekends; the other is when you have been up all night not sleeping.
Let’s start with weekends. Friday and Saturday nights we tend to stay up late knowing that we can sleep later the next morning. Sunday night, though, we can’t get to sleep and Monday morning is a nightmare. What’s happened is that you have reset your internal clock to the new schedule. We call it jet lag when people slip from one time zone to another. By going to bed late and sleeping in on weekends, we are doing it to ourselves twice a week. For the next three to four weeks you may have to go home early from that party so that you can get some sleep before your alarm goes off. Once you have firmly established healthy sleep patterns, you will have more leeway to have an occasional late night but until things are established, that alarm needs to be set for Saturday and Sunday. One compromise is that you could stay up late on Friday and sleep in on Saturday and then spend Saturday night getting yourself back on schedule. If that works, great. If not, you may need to get up both days.
Lets talk about the morning after you’ve spent the whole night looking at the clock every ten minutes. Your alarm goes off and you realize that you don’t really need that much time to get ready for work. You could sleep in a half-hour and get away with it. And a bit more sleep would do you a world of good, wouldn’t it? Actually, this is one of those short-term gains for long-term pain scenarios. Remember that your internal clock is set by the time you get up so by sleeping in, you are resetting your clock. This will perpetuate the problem. Remember also that you can go a day or more without having much sleep. You may feel groggy during the day but in the long run you are better off getting up at your regular time and getting that routine established.
Those are the basic steps for sleep hygiene. It’s time now to stop reading and put some of these things into practice. Remember that the key to success is to try something consistently for at least two weeks. If you have tried them all consistently, and still are having problems sleeping, or just want more help, feel free to consult with a psychologist who can help fine-tune the techniques to match your needs and can help with stress- management in general. Good luck with this and pleasant dreams.
The statistics are from:
Bastien, C., Morin, C., Ouellet, M., Blais, F., & Bouchard, S. (2004). Cognitive- Behavioral Therapy for Insomnia: Comparison of individual therapy, group therapy, and telephone consultations. Journal of Consulting and Clinical Psychology, 72(4) 653-659.
Espie, Cl, Inglis, S. & Harvey, L. (2001). Predicting clinically significant response to Cognitive Behavior Therapy for Chronic Insomnia in general medical practice: Analysis of outcome data at 12 months post treatment. Journal of Consulting and Clinical Psychology, 69(1) 58-66. Date Time to Bed Time Fell Asleep Number of Times Awake Length of Time Awake Time up in Morning Sleep Quality Effects