Can't Sleep?

Here are some tips to relieve insomnia

This is Sleep Awareness Week, so it’s a good time to talk about ‘sleep hygiene’, that is, strategies used for healthy sleep. About one-third of adults suffer from insomnia, and it is more common in older adults and women. Occasional wakefulness at night is normal, especially in times of stress. But if insomnia is a problem for a long time, quality of life and work are affected. It is an important risk factor for cardiovascular diseases, diabetes, and mental illnesses.

Here are some tips to help:

• Physical activity. People that are more active during the day usually have less trouble going to sleep at night. Recommended guidelines for activity are 75 minutes of vigorous activity (running, cycling hill, swimming) or 150 minutes of moderate activity (walking, gardening, yoga, pickleball) a week, in addition to strength training twice weekly. Increase your activity gradually if you are not used to being active, and check with your doctor before starting any new exercise program. Avoid physical activity within three hours of bedtime; this can be too stimulating.
• Avoid electronic screens, including television, computer, and mobile phone, for at least an hour before bedtime. These devices emit blue light which inhibits melatonin secretion, a hormone from the pineal gland that is critical for our sleep cycle. If you must use these screens close to bedtime, use blue-light glasses that filter the blue light.
• Stay on a regular schedule for bedtime and waking. The switch to daylight savings time this week doesn’t help, but stay consistent as much as you can. Most people need at least seven to eight hours of sleep nightly, so plan accordingly.
• Limit caffeine intake, especially in the evening. Some people are more sensitive to caffeine than others and may need to avoid caffeine in the afternoon also. See what works for you.
• Try a relaxing cup of hot herbal tea before bedtime. I enjoy a lavender and mint blend. There are lots of choices of herbal tea without caffeine. Many people find chamomile tea relaxing. It can have a diuretic effect, however, so see how it works for you.
• Limit alcohol intake. Although alcohol can help you go to sleep more quickly, it decreases REM (rapid eye movement sleep) which is restorative and needed for a healthy sleep cycle. Alcohol intake can cause wakening in the middle of the night even though you fall asleep quickly.
• Establish a relaxing bedtime routine. This could include your cup of herbal tea, breathing exercises, soothing music, meditation, or prayer. A warm bath with Epsom salts can also be helpful. Epsom salts contain the mineral magnesium, which calms the muscles.
• Mind-body approaches. Meditation can be an extremely helpful tool for sleep. You can find specific guided meditations for sleep on phone apps such as Insight Timer and Headspace. Behavioral therapies--Cognitive Behavioral Therapy, and formal mindfulness training--are strategies that require professionals. Your doctor will likely need to refer you to a therapist or sleep specialist for these.
• Deep, slow, regular breathing using your abdomen and not just your chest can help you relax. Make your exhale longer than your inhale. This type of breathing tells your body that it is okay to get out of the stress mode and into relaxation mode. Examples of specific breathing exercises include:
  • Box breathing – Inhale for 4 counts, hold for 4 counts, exhale for 4 counts, hold for 4 counts
  • 4-7-8 breathing – Inhale through the nose for 4 counts, hold for 7 counts, and exhale through the mouth with a whoosh for 8 counts. Note that the counts do not need to be full seconds; it is the ratio that is important. When you are starting with the 4-7-8 breath, you can repeat it four times in a set. 
• Essential oils, such as lavender, cedarwood, orange, tangerine, and valerian can be very helpful. My favorite combination is lavender, cedarwood, and orange. These can be diffused at the bedside or diluted in a carrier oil used as a roll-on to use on your pillow.
• Several botanicals and supplements can be helpful for sleep. Check with your doctor before using any botanicals or supplements.
  • Botanicals that have been used for sleep include valerian, ashwagandha, hops, and passion flower.
  • Supplements.
    • Melatonin is the most commonly studied and used supplement for sleep. This supplement is typically a synthetic form of the natural hormone that helps to induce sleep. A side effect of melatonin can be grogginess in the morning. If this occurs, try a lower dose. To avoid grogginess, start with a dose of 0.5 to 1 mg of melatonin. This may involve using the liquid form of melatonin since most pill forms are 3 mg and higher. The safety of long-term melatonin use has not been established. It is generally considered safe for short-term use. Safety in children is not established and it is generally not recommended for children.
    • Magnesium is a mineral that calms the body. Many Americans do not get enough of this mineral. Natural sources include green, leafy vegetables, nuts, peas, beans, and whole grains (grains in which the outer layer has not been removed). Magnesium can be taken as a supplement in the evening after checking with your doctor.
• The bedroom should be cool and dark. See what temperature works best for you. If you have a clock that emits light at your bedside, put the light on the dimmest setting and turn it away from your eyes.
• Only use the bed for sleep and sex. If you cannot go to sleep after 20 or 30 minutes, get up and go somewhere else to read (but not on an electronic screen) or do something relaxing (a cup of herbal tea?) until you feel sleepy.
• Eating a healthy, anti-inflammatory, plant-based diet will help your digestion and allow for better sleep as well. Avoid eating a large meal close to bedtime. This can increase gastric reflux which is uncomfortable and may keep you awake.

If you or your partner notice that you are snoring and waking up frequently, you may have obstructive sleep apnea. This disease increases the risk of high blood pressure and heart disease and usually results in fatigue during the day. Tell your doctor about these symptoms and see what they recommend about whether to have a sleep study. There are several types of non-surgical treatments, ie, devices, that can help to improve your breathing and make you feel much better.

Try these tips consistently and monitor your response. If you continue to have insomnia, you may want to keep a sleep diary. This helps you notice certain activities that may affect your sleep. https://sleepeducation.org/resources/sleep-diary/ Go over the diary with your doctor to see if they have other suggestions to help.

For long-term considerations, it is worth reviewing the American Academy of Sleep Medicine’s thoughts about daylight savings time.  https://aasm.org/aasm-opposes-permanent-daylight-saving-time-bill-sunshine-protection-act/ They oppose a permanent change to daylight savings time, noting that bright morning light is crucial for a healthy mood. They favor making standard time the permanent choice.

In the meantime, chill and sleep well.

For more information about self-care and a spiritual boost, check out our book, Breath for the Soul: Self-Care Steps to Wellness.