Sleep hygiene is the collective set of behaviors and guidelines that research has consistently shown to increase the probability of achieving and maintaining improved sleep. Unfortunately, many of us have developed bad habits that detract from our ability to achieve sleep or the quality of our sleep. The first thing to realize is that we cannot make ourselves sleep. We can set the occasion for sleep to occur and assuming a reasonable life balance, we should be able to sleep. For those who have a history struggling with insomnia, they have lost confidence in their ability to sleep and are probably engaged in a control war with sleep. For them, the bed and bedroom may actually have become a conditioned anxiety stimulus. So if you are laying and bed, watching the clock, thinking how critical it is to sleep because you have a lot of important stuff to to the next day, the odds are that you will feel anxious and have poor success sleeping. This anxiety can very easily become conditioned to or associated with the bed and bedroom such that the bedroom is now a conditioned anxiety stimulus. The first step in sleep hygiene is to break up this unfortunate conditioning.
Stimulus Control – This is the cornerstone principle of sleep hygiene. Stimulus control refers to having the bed and bedroom as closely associated with sleep as possible and non associated with non-sleep as possible. Thus it is OK to stay in bed as long as we are sleeping. However, it is critical to get out of bed and do something relaxing in another room if we are not sleeping within about 20 minutes. If, after a while you feel sleepy, go back to bed. If again, you are not asleep within no more than 20 minutes, get back out of bed. If that means you get no sleep the first night, then so be it. The good news is that you will have incurred additional sleep debt which means that the urgency to sleep is being stored up in your nervous system which eventually will work to your benefit. Research is unequivocal: Those who adhere to this instruction, are far more likely to re-achieve normative sleep patterns.
Routine Sleep/Wake Cycle – The body has very accurate internal clocks that govern a host of internal metabolic and other processes. To help maintain accuracy of these systems, it is wise to have some regularity to some basic aspects of lifestyle; most importantly our sleep-wake cycle. It is important to try to get to bed at approximately the same time each day. Over time, the brain will signal when you are sleepy and will start shutting systems down in anticipation of sleep. If your routine is all over the road, then your brain has no way to know what time it is and your internal rhythms will be out of whack. Ideally, it is best if your sleep-wake cycle roughly concurs with the day/night cycle but obviously, for many this is not always possible.
Decompress – It is unreasonable to expect the body and mind to suddenly shut down after many hours of high physical and mental arousal following a full day. We need time to wind down and relax after a long day. Talking and low stress socializing, reading, listening to music are all fine. Intervals of deep relaxation or meditation practice are some of the best ways to wind down. One is ill advised to watch high arousal TV or play high intensity video games just before bed. In fact, the high levels of light eminating form media screens are likely to enhance activity in the brain. And exercise, while terrific, should be avoided late in the day for those with difficult sleeping since it can stimulate metabolic rate and impact sleep. Alcoholic beverages can enhance sleep onset, but can often cause early waking. New research shows that it increases deep sleep cycles but greatly diminishes time spent in REM sleep which is a critical component of sleep architecture. Many sleep drugs also inhibit REM sleep and should not be used with regularity. A hot bath or shower just before bed has the effect of cooling our core temperature which can elicit somnolence (sleepiness). The effect is not very long lasting so do this right before bed. There are also some relaxing herbal teas and other natural preparations that include such ingredients as valeria (nature’s valium), hops, skullcap, passionflower to name but a few, that can have soporific (sleep enhancing effects. one should always check with a professional to insure against any interactions or other concerns. Just because such substances are natural, does not always mean that they are completely benign. They do have active ingredients that have biological impacts.
It is critical to get good sleep. Failure to do so can have tremendous impacts on many aspects of physical and emotional health. That is why I spend so much time evaluating, and where necessary intervening in this area when necessary with my own patients. I highly recommend that if you have tried some life alterations and are still having persistent sleep difficulties, consult a health professional. Do not wait. The longer a sleep difficulty persists, the harder it can become to correct.
The next and final post on this topic will address the utilization of mindfulness and the principle of Wu Wei with sleep.
As always, you are invited to post comments, questions, disagreements and musings on life.
