Sunday, March 3, 2013

Sleep Better - 4 Tips To Fall Asleep

Many people struggle to fall asleep. Having the odd sleepless night is not a big deal, but day after day of poor sleep can have a major impact on your health and sense of well-being. A patient of mine asked if I would post a few tips for those who struggle with sleep.

First, a caveat: there are many causes of insomnia. If this is a major struggle of yours, it's worth having a detailed clinical evaluation. For example, perhaps the main cause is Obstructive Sleep Apnea and the best treatment for your restless sleep is weight-loss and a CPAP breathing machine.

That said, irrespective of the cause, it's also worthwhile learning what factors you can control to improve your sleep.

Here are 4 sets of tips I find helpful:

Basic Sleep Hygiene

Many factors influence the ease at which you can fall asleep. You don't necessarily need to do all of these, but likely the more you do the better. You've probably heard some of this before:
  • Go to bed and waking at the same time each day is the best way to regulate your circadian rhythm
  • Make sure your bedroom is sufficiently dark and quiet
  • Sleep in a bed you find comfortable
  • Dim the lights as early as you can to allow melatonin levels to rise
  • Do something to relax before you go to bed, like meditate or have a hot bath/shower
  • Don't use your bed for anything other than sleeping and physical intimacy (there are exceptions, for example if you've conditioned yourself for decades to fall asleep after reading in bed) 
  • Understand your caffeine sensitivity: for most people caffeine after 3p or so will interfere with sleep (caffeine has an ~8 hour half life)
  • Alcohol can be sedating but it always worsens sleep quality. Some people can do fine with a drink or two, others need to avoid completely
  • Exercise daily - for me, this is the single most important thing I can do to guarantee a good nights sleep. Exercise increases sleep quality. Just be aware that intense exercise late at night can be activating and keep you up.

Advanced Sleep Hygiene

Turns out there are some new discoveries based on sleep physiology that offer even more insight into factors that help, some of which I learned at last years American College of Lifestyle Medicine meeting:
  • Being well hydrated: this enables your peripheral blood vessels to dilate (see below) without a large increase in heart rate. However, try to drink a lot during the day as if you drink a lot right before bed you might have to wake to urinate.
  • Be warm before you go to bed, but sleep in a cooler environment - to induce sleep your body dilates blood vessels to lower your body temperature. Presumably it won't be able to lower your temp much is you are already cold. So make sure your extremities (hands and feet) are warm before going to bed.
  • Many find the combination of black-out shades and a dawn-simulator light an effective combination for creating a dark sleep environment and having light wake you up.
  • Don't use a back-lit screen an hour before you go to bed (i.e. computer, ipad, smartphone, TV, etc.) as the blue light will decrease melatonin production.
  • If you nap in the afternoon, limit your naps to 30 minutes or less.

Advanced Sleep Hygiene for when you wake up in the middle of the night

  • Don't make the classic mistake of stressing about it. This will keep you up. Sleep quality is not significantly decreased by waking once or twice at night to pee. Avoid looking at the clock when you awake. 
  • Drink a cold glass of water - this will cool your body down (as above).

Sleep Induction Techniques

Most people have racing thoughts, worries, aches or pains that "prevent" them from falling asleep. Trying to force these thoughts, feelings or worries to stop only serves to activate your brain and make it even harder to fall asleep. Instead, some savvy clinicians have realized that diverting attention to a sleep-inducing concentration can be very effective.

I learned this technique from Richard Shane PhD - the idea is to mimic the sensation of falling asleep, which is universal in humans. Thus the term "falling" asleep. 
  1. Pick A Sleep Position. Find the most comfortable position you can to fall asleep and commit to staying in that position for 20 minutes without tossing and turning.
  2. Allow Your Tongue to Relax. Notice the position of the tongue? Is it pressing hard against the roof of your mouth? Allow it to relax a tiny bit and press less hard. You don’t need to move the tongue.
  3. Allow Your Throat to Relax. Notice if your throat is tight or open. Imagine the sensation of yawning or a relaxed neck and throat. You don’t need to move your throat. 
  4. With One Hand Over Your Heart, Notice a Falling Sensation of Your Chest When You Breath Out. Pay attention to falling in and down sensation as the chest wall cradles the heart space every time you breath out. Your breathe will often be shallow and will pause at the end as you are falling asleep. This is normal. You don’t need to change your breathing. Just pay attention to the falling sensation...and keep your attention there.
Wishing you all sweet dreams and restful sleep.


bindin Gorgia said...

Very nice post. I like it. Thank you for sharing. It will be helpful to Study and doing Thesis or Research on this topic

Vegan`MD said...

Thanks @bindin Georgia. Sleep is a fascinating topic, I agree.