To Sleep, Perchance to Dream- part I

Sleep remains one of medicine’s mysteries. Why do we even need to sleep? We don’t yet know the answer to this basic question. We do know that sleep is critically important to our health and happiness. Part I of this blog will cover sleep hygiene and what you can do yourself to improve your sleep- Part II will cover over-the-counter and prescription meds. (And thanks to Liz for suggesting this topic!)

An important point to remember is that insomnia is a very common symptom in a variety of psychiatric illnesses. In these situations, the cure is to effectively treat the underlying illness, which will then have the secondary effect of improving the insomnia. If you focus just on the sleep problem you’ll go astray. With that caveat, people with depression, anxiety, etc. can benefit from implementing the below techniques and tips for good sleep, so long as they make sure their underlying illness is being treated as well.

Regularity of sleep patterns is important. No one expects you to go to bed at exactly the same time and get up at exactly the same time every day- but coming somewhat close gets your body and mind into a rhythm. The people who seem to struggle with this the most are the night-shift workers- many of whom with families try to keep a normal schedule on their days off and then a night-shift schedule while working. The human brain is designed to sleep at night and stay awake during the day. I understand there may be many good financial reasons to work the night shift- just remember you pay a price with your sleep and mental health when you do so.

Exercise is one of the best treatments and preventatives for insomnia. My patients know I push exercise hard- it helps with lots of things! Just be careful not to exercise too late in the day- evening exercise can make it hard to wind down for the night.

We spend roughly a third of our life in bed- I say the natural consequence of this is that we should buy the best mattress we can afford. And resist the temptation to fall asleep in your recliner or sofa.

Establish a nightly bedtime routine- avoiding electronic screens of all types an hour or so before bed is advised. Many people tell me “I can’t fall asleep without the TV on.” White noise machines can be had for $15 on Amazon- try one of those instead. Many people find it relaxing to read for a while before sleep.

Caffeine is a powerful drug often overlooked because it’s legal and in so many things. People with significant insomnia should have “extreme moderation” in the use of caffeine- morning use is generally fine but try decaf coffee, tea, or soda from the afternoons on.

Many prescription psych meds can adversely affect sleep and keep that in mind if insomnia is a new problem. Antidepressants like Wellbutrin and Prozac, antidepressant adjuncts like Abilify, and of course the stimulants like Adderall and Vyvanse can all do it.

Napping tends to be generally problematic. People get into a vicious cycle where they’re tired from a poor night’s sleep and take a nap, which makes it harder to sleep again the next night. For people over 65 napping is less of an issue as advancing age tends to worsen nighttime sleep regardless and an afternoon power nap often helps seniors get through the evening.

Finally, one of the core principles of “stimulus control therapy,” one of the well-researched and validated therapy techniques for insomnia, is that you don’t want to spend too much time lying awake in bed. If you don’t get to sleep within a reasonable time frame of 30 minutes or so, get up and read, take a bath, or do something else relaxing for a while. When you think you might be able to get back to sleep, then go and lie back down in bed.

Next blog post we’ll discuss medications for sleep! Until then, sweet dreams. . .