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Good Night, Sleep Tight

Strategies for Better Sleep

About 75% of my patients complain of poor sleep. Most have tried everything, but still can't fall asleep, wake up in the middle of the night, or have bad dreams. Many of us feel tired the next day, even if we do manage to sleep through the night. Try these strategies to get the rest you need.

Poor sleep can look like many different things. Some people are even wrongly diagnosed, when actually they are just plain tired. Do you or your child seem to have:

-- learning problems

-- poor attention

-- hyperactivity

-- memory problems

-- no motivation

-- mood swings

-- irritability or anger

-- meltdowns or tantrums

-- depression

-- worry

-- poor coping skills

-- behavior problems or oppositionality

-- problems with drugs or alcohol

-- schizophrenic symptoms

Yes, even schizophrenic symptoms, such as hallucinations and delusions, can occur if we are severely sleep deprived. That doesn't mean you have schizophrenia (or other mental health issues) necessarily. Sleep problems make our bodies and mind act in ways that wouldn't happen if we were able to regularly get a solid night's sleep.  It's no wonder that sleep deprivation has been used to extract information from prisoners of war.

What if you do have, say, Attention Deficit-Hyperactivity Disorder (ADHD), learning difficulties, autism, or depression?  Sleep problems can make any mental health or physical health issue worse. In fact, improving sleep can be the single most important thing we do for ourselves.  Good sleep not only improves mental health, it also has a positive impact on heart health, obesity, diabetes, safety when driving, job performance, learning, memory, and personal relationships.

SLEEP BETTER TONIGHT!

Here are some easy tips to have a better night's sleep - maybe as soon as tonight. It's very important to try these ideas consistently for at least 2-4 weeks, or longer and get the whole family on board so you can support one another. Remember, don't give up if you don't see improvement right away. It can take time for your body to get used to the new routine, as sleep is highly habit driven. This is why many people say they have tried "everything," without success. You simply may not have given it enough time. 

Try these tips tonight:

-- Make your bedroom noisy. Add in "white noise" such as from a fan, humidifier, or white noise machine (my favorite is the SleepMate made by Marpac). This helps to mask sudden changes in noise levels in the house due to talking in the living room or siblings moving around in the next bed. It really helps on vacation when noises might be different enough to keep you up. Once we added this to our children's bedrooms, everyone began sleeping better. You can fade this support once better sleep is established.

-- Eliminate extraneous noise.  Some clients tell me that they want their children to learn how to sleep in noisy environments (or at least typical household noise), so they are reluctant to reduce sound levels.  You don't need to make your house the equivalent of a library, but some children and adults are more susceptible to frequent awakenings. If sleep trouble has been longstanding, it is more important to get back on track than to persist with a plan that's not working. When sleep has stabilized, then you can try re-introducing more typical levels of noise.

-- Keep Sparky out of the bedroom. Pets are cute and cuddly, but between barking, needing to be let out in the middle of the night, and trying to sleep on your pillow, they can really sabotage your sleep. Pets can also aggravate existing allergies, which makes sound sleep difficult. Instead, have kids sleep with a stuffed "Sparky" substitute or have your pet sleep outside your bedroom door.

-- Darker is better. Our eyes can detect light even when closed, and our brains respond to light by waking up. This keeps the level of "wakeful" hormones high, and "sleep" hormones low, preventing deep and restful sleep. Put in blackout curtains for deeper sleep and reduce early-morning awakenings (you can get these at Target or amazon.com). Turn bright clocks to the wall or keep them on the floor, rather than right beside you on the bedside table. Use only low-wattage night lights, and keep them in the hallway. If your child likes to fall asleep with a night light in his room, try turning it off after he is asleep.

-- The #1 sleep sabotager: screen time. End screen time 1 hour before bed. Computers, cell phones, TV, and video games all emit light at a wavelength that our brains interpret as daylight and it can keep you up, prevent falling asleep, and may make the sleep you do get very shallow and sub-optimal. Even if your teenager says that watching a video helps them to fall asleep, it is actually a very shallow sleep that is more easily disturbed. This is why it might be hard for your child or teen to get back to sleep if he awakens in the middle of the night -- the tv was turned off! It would be like having someone take our favorite pillow away in the middle of the night -- it would be hard to get back to sleep without it! Learning to fall asleep on our own is a skill that many of us need to learn. Give yourself (and your children) time to learn and practice this.

-- Get rid of all screens in the bedroom. Did you know that 20% of infants and toddlers have a TV in their room, and a whopping 43% of 3-4 year-olds do? Research has found a link between bedroom TVs and childhood obesity, inactivity, and low scores on reading and math tests. Research has also found that extensive viewing before age 3 may cause attention problems later. Give your child the opportunity to learn how to fall asleep on their own, without the crutch of screen time to disrupt deep sleep.

-- Turn off cell phones one hour before bed. Tweens and teens are bombarded with media at all hours of the day (and night). Some teens tell me that they sleep with their phones on their chests or under their pillow so they don't miss a single message. Social media is also a primary way that kids are being teased and bullied. Finding out at 11pm that someone is spreading a rumor about you is a sure-fire way to lose sleep. Make it easy on your middle- or high-schooler. Make it a household policy that kids give their phones to parents one hour before bedtime, to be returned once they are ready for school (while you're at it, make all meals media-free so you can focus on family time).  Let them blame you to save face with their peers. Practice what you preach by turning your own phone on silent or off once everyone is safe and sound at home, and you are ready for sleep. Charge all devices somewhere other than the bedroom to avoid being awakened by alerts, updates, etc.

-- Have a bedtime routine. Having a set routine cues our brain, that big habit-forming machine that drives our body, to get ready for sleep the minute we see our jammies and a cup of herbal tea. Keep it short, simple, and workable. No point in trying to have a nightly bath if it's not something you can maintain.

-- Make your bed a sleep haven. Keep your bedroom free of work, bills, and other stress-inducers. Move your desk out of your bedroom, or put up a screen or curtain to separate your work space from your sleeping space, or cover your work with a tablecloth or sheet when you’re done. Read relaxing books instead of thrillers at night, and don't catch up on emails in bed. Don't use your bed as a workspace during the day either (pay bills at the kitchen table).  Finish difficult conversations with your spouse before getting in to bed (or plan to pick up the conversation tomorrow), and don't chastise the kids for today's wrongdoings as you say goodnight. End the day on a positive note.

-- Avoid caffeine for several hours before bedtime. This seems like a no-brainer, but some herbal teas (green tea, white tea), root beer, orange soda, ice cream, and chocolate have enough caffeine to affect sleep. Some "energy" drinks also get their kick from the same caffeine that is in your espresso, not innocuous or short-acting "herbs."  Some people are affected by caffeine as much as 10 hours later. So try cutting off caffeine by 3pm, and move it back slowly until you find the right time for you.

-- Avoid alcohol. While a beer or two might make you sleepy, it disrupts sleep later. In fact, alcohol actually increases the number of times you wake up at night. Some people with insomnia may increase the amount of alcohol consumed, thinking that more alcohol means more sleep. However, the sleep-disrupting effects of alcohol actually increases the more you drink. So if you do imbibe, limit your consumption or keep it for the weekend (or a non-work day the following day). Get professional support if you or your family feel that you have a problem with alcohol or other substances.

-- Exercise: key to healthy sleep. Get 30-60 minutes of moderate exercise on most days of the week, and your sleep will improve.  Exercise regulates the brain chemistry responsible for healthy sleep-wake cycles, helping us to feel tired at night and wake up more refreshed in the morning. It also helps to reduce depression and anxiety, regulate bipolar mood cycles, manage hyperactivity, and reduce stress associated with chronic medical conditions. I advise regular exercise for all my clients, no matter their diagnosis or challenges they are working on. For best results, end vigorous exercise a couple of hours before bed.

-- Hydrate. About 60% of our body weight is water. If we don't drink enough, our body becomes sluggish and has trouble processing the foods, toxins, and stress that we take in during the day. Basic metabolic activity depends on it. Guidelines have recently been changed so that the old adage of "Eight, 8-ounce glasses of water a day" is no longer the golden rule. All non-alcoholic beverages count, including moderate intake of caffeinated beverages. Eating water-rich fruits and vegetables helps too. Drink more when the weather is hot, and when exercising. In general, women need about 9 cups of liquids per day, men about 13 cups. 

-- Try a Worry Book. This can be helpful for people who can't get to sleep, or who wake up in the middle of the night with their mind racing. Write down those thoughts that won't let you sleep ("don't forget to send that email," "talk to my child's teacher"). Knowing that you won't forget and can address things in the morning can help you to get back to sleep. A variation of this technique is a Worry Box, where you mentally picture placing your worries in to a box, and picture locking it. Open it up tomorrow, when you have the energy to face what's on your mind.

-- Tossing and turning? Get out of bed! If you have been awake for a while and can't get back to sleep, get up and try reading by a low-wattage (40-60 watts), non-fluorescent light. Read something boring, not something stressful, exciting, or too thought-provoking. Do not turn on the computer, TV, or check phone messages (remember those light waves wake us up). Also avoid work, exercising or eating, all of which revs our metabolism and wakes us up. A small cup of herbal tea might help relax you, but don't drink so much that you end up needing a bathroom trip as soon as you've nodded off. When you feel sleepy, get back in bed (instead of falling asleep on the couch).

-- Try visualization, deep breathing, or progressive relaxation. Make this part of your bedtime routine, or try one of these methods when you wake up at 2am and can't get back to sleep. You can also try these tips in bed. Even if you aren't able to sleep, you will at least experience calm relaxation, which is restorative. Visualization can help you relive the relaxation you felt, say, on the beach. Focus on the senses to heighten visualization's impact (feel the sand in your toes, hear the waves crashing). Deep breathing is a way to slow down the heart rate. Breathe in through your nose for a count of 5, breathe out through your mouth for a count of 5. Repeat 5-10 times. With kids, I call these "balloon breaths," or I ask them to picture blowing out birthday candles. Progressive relaxation involves tightening first your toes for a count of 5 while breathing in, then release your toes while breathing out. Continue with all muscle groups of the body: legs, arms, shoulders, chest, abdomen, etc. Finish with a whole-body clench and release. Try one of these techniques next time you're stuck in traffic or waiting in line!

-- Melatonin. Ask your physician whether melatonin might be a supplement that is right for you. Melatonin is a hormone made by our bodies that helps regulate sleep and wake cycles, and it is found naturally in some foods. It may be helpful for people who work night shifts, who have Seasonal Affective Disorder, or who have difficulty falling and staying asleep.  See WebMD for more information on melatonin.

-- Synch bedtimes. Ask your partner to synch their bedtime with yours (as much as possible). Even when others in the household are doing their best to be quiet, the idea that there is activity in the house makes it hard to fall asleep (this is one reason why kids keep getting out of bed – they don’t want to miss all the action!). For adults, it will be easier to let your body sleep when you know that your spouse is ready for bed at about the same time.

-- Watch for signs that may indicate that you or a family member has sleep apnea, which is a serious medical condition linked to thousands of deaths per year. Symptoms include: excessive daytime sleepiness, loud and irregular snoring, morning headaches, irritability, moodiness, poor concentration, obesity or hypertension, frequent night urination, loss of energy and depression. Source: The University of Maryland Sleep Disorders Center | University of Maryland Medical Center http://umm.edu/programs/sleep#ixzz2XAr0savW 
 

-- Get support. If you have chronic sleep trouble, or if your sleep has suddenly worsened and has not improved with these interventions, speak with your physician to rule out physical causes of sleep disturbances, such as sleep apnea, restless leg syndrome, allergies, asthma, heart disease, reflux, hyperthyroidism, certain medications, and other issues. If your physician has ruled out medical causes for your insomnia, get help with a trained psychologist or therapist who can determine if psychological causes are at the root of your sleeplessness. Stress, transitions, depression, anxiety, ADHD, bipolar mood disorders, post-traumatic stress, sensory processing disorders, and other issues can significantly impact sleep. A psychologist can also help develop strategies to help you get a good night's sleep.

For more information, see The National Sleep Foundation's website (http://www.sleepfoundation.org/), and the University of Maryland's Sleep Disorders Clinic website (http://umm.edu/programs/sleep

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