When it comes to chronic sleep disruption, quick fixes are neither.
by Brian Curtis, Ph.D.
Limit caffeine before bedtime. It takes about 10 hours to completely clear from your bloodstream. Take your usual time of getting in bed and subtract 10 hours. BOOM! You have found your personalized STOP-THE-CAFFEINE-NOW time each day.
Limit alcohol 4-6 hours before bedtime. Its sedating properties can help you fall asleep faster, but it can fragment your sleep, lead to more awakenings, and leave you feeling unrefreshed in the morning.
Avoid large meals before bedtime. Indigestion and acid reflux are a bummer when your goal is to sleep sweetly.
Limit bright light and avoid electronic devices before bedtime. Bright light, especially those pesky blue melatonin-suppressing wavelengths, can alter our 24-hour sleep-wake rhythm and get us all mentally stimulated when we're supposed to be turning off for the day.
Keep your bedroom cool and comfortable. Our core body temperature needs to drop by about 2-3 degrees Fahrenheit to effectively fall asleep and stay asleep. Thermostat around 65 degrees Fahrenheit people!
Get that exercise! Increased physical activity during the day can help us fall asleep faster and stay asleep longer. Just try and ensure the vigorous exercise isn't occurring within 3 hours of bedtime. Don't want that core body temperature to increase (see previous tip). Adrenaline and sleep also don't play well together.
As someone who specializes in treating people with chronic insomnia (difficulty falling asleep, staying asleep, or waking up too early with difficulty returning to sleep for 3 months or longer), I often hear this complaint.
Hop on YouTube and type in "tips and hacks for insomnia" and you'll get videos with millions of views.
We like our tips. We like our hacks.
And if you're someone experiencing short-term insomnia (insomnia lasting one month or less), evidence suggests that these tips, also known as Sleep Hygiene recommendations, may effectively resolve your insomnia.
But for those of us whose insomnia has lasted 3 months or longer, the evidence suggests that tips aren't enough.
Sleep Hygiene is generally not effective as a stand-alone treatment for chronic insomnia.
If you are struggling with chronic insomnia, here is what the evidence suggests is the ULTIMATE tip:
***You need more than tips. You need a practice***
When it comes to chronic insomnia, what we need is new learning.
You've had months, if not years, to learn that your pillow and sheets are a lovely place for worry, planning, chronic stress, and exercise in the form of tossing and turning.
We need to re-train our brain and our body that the bed and bedroom is the place for rest, relaxation, and restoration.
Like any training, this takes skill building. And building skills takes practice.
Although tips can help you learn how to play the piano (correct finger position!), they're not enough. We need to practice.
Sleep Hygiene tips are not to be discounted. They are very important and serve as one of the five core components of the #1 recommended treatment for chronic insomnia: Cognitive Behavioral Therapy for Insomnia (CBT-I).
In addition to Sleep Hygiene, here is the practice of CBT-I:
We need skills to decrease the tension in our minds and bodies during the day and night, especially in that pre-sleep period.
Diaphragmatic breathing, paired muscle relaxation, guided imagery, meditation, light stretching, yoga, writing out worries before bedtime ... many other tools in the toolbox.
Not every one will be a slam dunk.
Let's find the skills that work for you.
Then we practice.
We need to learn that we can fall asleep when we get in bed, like we used to.
Daily monitoring of your daily sleep-wake schedule can give a sense of your current sleep-wake pattern.
We use that information to temporarily limit the total amount of time you spent in bed each night.
When combined with limiting or eliminating napping during the day, this builds up sleep pressure (that friendly sleep-promoting chemical in the brain called adenosine) and will allow you to fall asleep and stay asleep easier the following night.
This can also help reduce stress and anxiety about a night of poor sleep.
"Ya, I'm a little sleepy, but I'm building up ADENOSINE for tonight!"
When you're able to more easily fall asleep and stay asleep, your time is bed is increased gradually until you reach the total sleep time that helps you feel refreshed during the day.
If your mind is whispering, or shouting, "HEY, we're NOT falling asleep right now buddy!" ... get out of bed.
If your mind is silent, a good guideline is if it feels like it's been 20 minutes or so (NO CLOCK WATCHING!) and still no sleep ... then out of bed you go.
Here is where we bring in those relaxation skills you're already learning and practicing.
Breathing, muscle relaxation, meditation, light stretching, take a bath, whatever it is, do it until you're sleepy (eyes heavy, head nodding).
Then, back to bed.
ANOTHER 20 minutes or so and your mind getting chatty? Get out of bed.
Rinse and repeat.
This takes practice. You're re-training your brain and body. Be patient and commit to the practice.
Believe it or not (GET IT?!?), what we believe about sleep really matters when it comes to insomnia.
Do you believe that you're losing control over your ability to sleep?
Do you need 8 hours of sleep to function the next day?
What about an hour or more of napping to catch up on missed sleep?
Do you think that one night of poor sleep will disturb your sleep schedule for the rest of the week?
Does it seem like you can't ever predict when you'll have a good or poor night of sleep?
Is insomnia essentially a problem with brain chemistry that requires medication?
Our beliefs impact our behavior, which impacts our learning, which impacts our beliefs, which impacts our behavior ...
Talking about the evidence for and against these beliefs combined with objective data from daily tracking of your behavior and sleep-wake pattern can make a big difference to your sleep moving forward.
This post isn't another series of sleep tips.
The great thing about CBT-I is that it's individualized according to your unique medical history, psychological history, social history, sleep-wake pattern, and treatment goals.
Temporarily decreasing your total sleep time can be very dangerous depending on your occupation, social obligations, physical health, and mental health.
I've had patients look like they wanted to spit in my face when they hear the word "meditation" come out of my mouth. Others grin widely and mentally start unrolling their yoga mat.
My hope is that you find the path forward that is effective for you to finally overcome the difficulties you're currently having with sleep.
This new learning and practice can truly be life-changing and life-saving.
Please feel free to reach out to me personally if you feel overwhelmed or unsure about where to even begin.
I always offer free 15-minute video consultations for this very purpose.
You can email me at brian@honestsleep.com or schedule that free consultation at https://honestsleep.clientsecure.me/
This stuff is my favorite thing to talk about, so feel very welcome to get in touch.
Here's to giving yourself the gift of sleep in 2022.
Not a new tip. A new practice. A new year. A new you.
- Brian
