Sleep. So many of us take a good night’s sleep for granted, until we hit a time in our lives when it seems like some elusive unicorn we start chasing and can’t quite catch. Insomnia can be very difficult for anyone who has it. Let me share some information that can be helpful for those experiencing insomnia, and is good advice for the rest of us as well!

Following my usual pattern of advice, first seek out your regular doctor and have him or her examine you. Always rule out physical causes, even if you know you have a mental health disorder! A partial list of things your physician will look for include:  Breathing-Related Sleep Disorder, Chronic Obstructive Pulmonary Disease (COPD), Emphysema, thyroid disorders and Sleep Apnea.

Be aware there are different kinds of insomnia. The three most common are early insomnia, middle insomnia, and late insomnia. Early insomnia (also called initial insomnia) is when it takes forever to get to sleep. Typically 10-20 minutes is enough for most of us, but those with early insomnia can take hours. Early insomnia is typically a symptom of anxiety.

Middle insomnia refers to difficulties we have in maintaining sleep during the night. Middle insomnia is typically associated with depression, medical illnesses or pain syndromes.

Late insomnia refers to waking up early in the morning, much earlier than we need or want to wake up. This is frequently a symptom of major depression.

Regardless of medical or psychological causes, there are things all of us can (and probably should) do increase the quality and quantity of our sleep. This advice comes from well-researched evidence. This is actual advice I give my own clients. First, a list of Do’s:

1. Replace your mattress if needed. The experts say mattresses last 7-10 years. If you’ve had your mattress more than a decade, strongly consider getting a new one
2. Go to bed at the same time each day.
3. Get up from bed at the same time each day. Try to maintain something close to this on weekends.
4. Get regular exercise each day, preferably in the morning. There is good evidence that regular exercise improves restful sleep. This includes stretching and aerobic exercise.
5. Get regular exposure to outdoor or bright lights, especially in the late afternoon.
6. Keep the temperature in your bedroom comfortable.
7. Keep the bedroom quiet when sleeping.
8. Keep the bedroom dark enough to facilitate sleep.
9. Use your bed only for sleep (and sexual activity). This will help you associate your bed with sleep, not with other activities like paying bills, talking on the phone, watching TV, etc.
10. Establish a regular, relaxing bedtime routine. Relaxing rituals prior to bedtime may include a warm bath or shower, aromatherapy, reading, or listening to soothing music. Here’s a link to some suggestions.
11. Use a relaxation exercise just before going to sleep or use relaxing imagery. Even if you don’t fall asleep, this will allow your body to rest and feel relaxed.
12. Keep your feet and hands warm. Wear warm socks to bed if needed.
13. Write down problems on a notepad you may be thinking about or are worrying you, or tasks you need to do tomorrow. Do not dwell on any one thought, just jot it down and put the idea aside.
14. Remind yourself you only have two responsibilities once you get in bed: to relax, and to eventually fall asleep. That’s it. If you find your mind wandering, gently remind yourself of your only two responsibilities.

Next, the list of Don’ts. Let’s be honest, most of us are guilty of at least a couple of these:

1. Engage in stimulating activity just before bed, such as playing a competitive game, watching an exciting program on television or movie, or having an important discussion with a loved one.
2. Have caffeine in the evening (coffee, many teas, chocolate, sodas, etc.)
3. Read or watch television in bed.
4. Use alcohol to help you sleep. It actually interrupts your sleep cycle.
5. Go to bed too hungry or too full.
6. Take another person’s sleeping pills.
7. Take over-the-counter sleeping pills without your doctor’s knowledge. Tolerance can develop rapidly with these medications, and the quality of your sleep can go down as well.
8. Take daytime naps. If you do, keep them to no more than 20 minutes, 8 hrs before bedtime.
9. Command yourself to go to sleep. This only makes your mind and body more alert.
10. Watch the clock or count minutes; this usually causes more anxiety, which keeps you up. Turn the clock or your phone around or cover it up.
11. Lie in bed awake for more than 20-30 minutes. Instead, get up, go to a different room (or different part of the bedroom), participate in a quiet activity (such as reading), and then return to bed when you feel sleepy. Do not turn on lights or sit in front of a bright TV or computer, this will stimulate your brain to wake up. Stay in a dark, quiet place. Do this as many times during the night as needed.
12. Succumb to negative thoughts like: “Oh no, look how late it is, I’ll never get to sleep” or “I must have eight hours of sleep each night, if I get less than eight hours of sleep I will get sick.” Challenge your concerns and avoid catastrophizing. Remember that we cannot fully control our sleep process. Trying too hard to control it will make you more tense and more awake.
13. Change your daytime routine the next day if you didn’t sleep well. Even if you have a bad night’s sleep and are tired it is important that you try to keep your daytime activities the same as you had planned. That is, don’t avoid activities or stay in bed late because you feel tired. This can reinforce the insomnia.
14. Increase caffeine intake the next day, this can keep you up again the following night.

Most of us could do better on a few of these things, and if you’re having trouble sleeping it’s obviously even more important to make some changes. Do yourself a favor and don’t procrastinate. Do something today, even if it’s small, that will help! Please don’t hesitate to Contact Me if you have questions or concerns. Now go and help yourself get a better night’s sleep!