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Insomnia makes everything worse. It can lead to fatigue, depression, anxiety, irritability, loss of memory, and poor concentration. It can also impair the immune system, leading to a broad range of medical problems. If people are sleep-deprived for several days, they can even develop hallucinations, paranoid thoughts, and other kinds of psychosis. That’s a lot of bad stuff! In brief, sleep is extremely important.
Sleep Hygiene
Fortunately, there are many ways to help with insomnia. Some of these ideas are quite simple, and you can try them at home on your own. If you continue to have difficulty, do not get discouraged. Many other treatments can be explored with the help of your primary care provider and other healthcare professionals. However, a good way to begin is to try healthier sleep practices, sometimes called sleep hygiene. Restful sleep requires thoughtful preparation. It is not as simple as just climbing into bed and expecting to fall asleep. You need to do some planning. It’s worth it, though, because the benefits will last throughout the day. Make it a project. Make it fun. That’s sleep hygiene.Design Your Bedroom
First, your bedroom is wherever you sleep. If you live with a big family, you might be sleeping on a couch in the basement or on the living room floor. Depending on your profession, you might be sleeping in a hotel, on a ship, or in a cabin. For most folks, their bedroom is not ideal. But wherever you sleep, that’s your space, and it’s special. You need to design it. If you have the luxury of multiple rooms in your home, try to reserve the bedroom for rest, sex, and relaxation. Do work and stressful activities in other rooms. If you don’t have that luxury, that’s okay. Your “bedroom” could be that cozy pillow and blanket that you take out at night. Make your space special. Make it pleasant and make it comfortable.What else can you do to design your bedroom? Think about everything: bed, floor, ceiling, walls, light, sound, smell, and temperature. What wakes you up? For a lot of people, it’s the heat. For example, women in menopause are at risk of waking up with night sweats. That’s no fun. If you sleep with a partner, discuss the thermostat setting, doors, windows, and bedding. If one person finds it too cold, they have lots of options simply by wearing more clothing or using more blankets.
What about noise? Begin by controlling what you can. There may be limitations if you have a baby or an older adult at home who may need your care. However, soundproof your bedroom as much as possible for your situation. If you have older kids at home, talk with them. Remind them that there are many opportunities to make noise during the daytime. When it comes to your phone, learn how to turn off the ringer or put it in “do not disturb” mode. Finally, consider fans or white noise machines for outside noise (e.g., neighbors, motor vehicles). They work pretty well. You can also consider wearing earplugs if you live in a noisy area or have a partner who snores.
Daily Schedule & Exercise
Maintaining a consistent schedule is a big help. The body has a natural clock or sleep-wake cycle that is easily disrupted. Sometimes this internal cycle is called a circadian rhythm. If you fall asleep and wake up at different times, you will confuse your brain and endocrine system. Your body will not understand when it should be asleep. This is what happens with jetlag. It can also occur if you take naps, which you should avoid unless you really need one. If you do take a nap, try sleeping for less than an hour, perhaps in the early afternoon.One atypical sleep cycle can throw off your circadian rhythm. However, you can reset your clock by falling asleep (or at least going to bed) and waking up at the same time every day. Choose the times based on how much sleep you need for ideal functioning. Most adults need at least eight hours of sleep. Aim for feeling the best you can during the daytime. Resetting your body’s clock may take a couple of weeks with a consistent schedule. It may sound boring, but it will help you sleep. Exercise is also important. An early morning workout can help you wake up for the day. The afternoon is fine too.
Exercise, in general, is good for sleep. However, avoid rigorous workouts later in the evening. Increasing your heart rate can keep you awake for a few hours. In fact, it is helpful to begin relaxing or “winding down” several hours before you plan to fall asleep. Light stretching or meditation can be beneficial. A warm shower, bath, or massage can also help.
For any evening activities, avoid stress and excessive stimulation. Avoid loud music, violent movies, and stressful television. Minimize bright light, bright video screens, and blue light. Try setting your electronic displays to warmer colors of the spectrum or “night shift.” Also, do your best to avoid interpersonal conflicts. For example, if you are thinking of having a conversation that might lead to an argument, move that discussion to the daytime. Do everything possible to protect your evenings.
Food, Drink & Medication
Now let’s consider what you eat, drink, and put into your body. It can be helpful to have a small to moderate amount of food in your stomach because digestion induces the body to rest. However, too much food can cause acid reflux and regurgitation. Therefore, try to finish dinner at least two hours before lying down in bed. Spicy foods and carbonated beverages worsen reflux, so it’s a good idea to avoid them in the evening. Keep a record of which foods and drinks impact your sleep.
Stimulants are a common cause of insomnia. If you drink coffee or tea, a good rule is to have none after lunch. The caffeine in your blood can affect your sleep for at least eight hours. If you have caffeine in the afternoon, you may notice that it takes longer to fall asleep. Even if you do seem to fall asleep on time, the caffeine will prevent you from falling into the deeper, more restful stages of sleep. Most herbal teas are fine because they are not “real tea” and do not have caffeine. However, make sure that you understand the ingredients.
Alcohol will also affect your sleep. Although alcohol is a depressant and can make you sleepy at first, it will disrupt your sleep throughout the night. You are more likely to wake up during the night and have more shallow sleep. The ideal goal is to have no alcohol (for a wide variety of health reasons). However, if you do drink alcohol in the evening, a good guideline is one or two drinks at the most. Most people notice that the more they drink, the worse they sleep.
Many medications, and other substances, are either stimulating or sedating. It is a good idea to review your medications and any other herbs or drugs that you take with your primary care provider. They may be impacting your sleep. Sometimes the solution is as simple as switching an evening medication to the morning, or vice versa. During the same discussion, you can also explore if you have any medical conditions that may be affecting your sleep.
Chronic Insomnia
Suppose none of these ideas are working. You’ve tried so hard, and yet again, you’re staring at the ceiling in the middle of the night. Times like this can feel frustrating, depressing, and even traumatic. If you have been lying in bed too long (maybe 30-60 minutes), try engaging in a relaxing activity. Reading a book is a classic example. But anything that you find calming may work for you. You can also keep a sleep hygiene journal of thoughts or tips. For example, you can write a list of “middle of the night ideas” that have helped you in the past. Many people find journaling to be a helpful process and source of support.
During stressful times, it is important to remember that insomnia is always treatable. There is plenty of professional help available, partly because it is so common. One good place to begin is your primary care office. Most clinicians, including physicians and nurse practitioners, are very familiar with insomnia. They may give you great ideas that were not covered in this article. They may also recommend a trial of medication. If the treatment appears more specialized, they may refer you to a psychiatrist, neurologist, psychotherapist, or other mental health professional. As you continue to explore new ideas, remember that everyone is different, and it may take some time. However, with good sleep hygiene, and the help of your care team, you will be on your way to more restful sleep.
Websites with More Information
The Mayo ClinicThe National Heart, Lung, and Blood Institute
WebMD
