I've touched on sleep hygiene in the past, but thought I'd post the handout I got from the Penn Sleep Center. It is more detailed than things I've written about, and for anyone suffering with insomnia, I want to offer as many resources as possible. So, without further ado, the wonderful tips from the Penn Center for Sleep Disorders. My input is in italics; the rest is right from the experts.
A. Maintain a regular sleep/wake schedule
1. Keep the same rise time and bedtime every day. Fun? Not so much. Worth it? Absolutely. This was one of the most helpful tips for me.
B. Maintain a healthy diet
1. Include foods high in carbohydrates. I would add that they should be complex carbohydrates, like whole grains and produce. Refined carbs, like white bread and white rice, are going to convert to sugar much more quickly, which can destabilize your blood sugar and make it more difficult to sleep.
2. Foods that contain carbohydrates are: breads, pasta, rice, cereal, fruits, vegetables, & milk.
3. Going to bed hungry or eating a large meal before bedtime can worsen sleep.
4. If hungry at bedtime, eat a light snack or drink a glass of milk.
C. Avoid or minimize the use of caffeine. My friend Maggie would say this is cruel and unusual punishment, and might not even be humanly possible. It is difficult, especially if you've got a serious coffee habit. But if you have trouble sleeping, caffeine's only going to make it worse. Try to taper off, and eventually -- I promise -- you'll be sleeping better and need it less. (Don't worry, Maggie. If you sleep fine, I'm not going to suggest you give up the good stuff.)
1. It is a stimulant that interferes with sleep.
2. The effects can last as long as 8-14 hours.
3. One cup of coffee contains 100mg of caffeine and takes 3 hours to leave the body.
4. Most sodas and teas, some headache and cold medicines, and most diet pills (evil buggers!) will worsen sleep.
5. It is recommended not to drink coffee, tea or soda after Lunch. If you continue to have difficulty falling asleep, avoid drinking caffeinated beverages after Breakfast. I'll say it again -- if you're a particularly atrocious sleeper like I am, you're probably better off without any caffeine at all. I found it was the ritual I missed in the morning, almost as much as the caffeine. Now I make tea to sip while I get ready for the day. It's a different ritual, but a ritual nonetheless.
D. Avoid alcohol. I hate this one. I hate how important it is, and what a difference it makes in my life if I'm drinking or not. This might be the most frustrating for me. As with caffeine, I try to supplement the ritual. My bartenders know if I'm not sipping a Bluecoat gimlet, I'm going to be drinking club soda with lime by the gallon.
1. You may feel it helps you get to sleep, but for most people it causes awakenings as well as poor sleep later in the night. It's true. Drat.
2. Alcohol can make snoring and sleep apnea worse.
E. Smoking cigarettes will interfere with sleep. Just in case you needed another reason to quit...
1. If you currently smoke, begin to cut back on nighttime smoking.
2. Stopping smoking is a helpful step to improving your sleep. The best way to quit smoking is to be involved in a group meeting along with the patch or gum.
F. Over-the-counter sleeping medications:
1. None of the medications currently available OTC help you get into deep sleep. I took Tylenol PM almost every night for ten years. It's horrifying to think of all the REM sleep I missed. It also feels absolutely amazing to not depend on it any longer; I know longer feel anxious if I spend the night somewhere and forgot to bring Tylenol PM or Benadryl. Knowing I don't need it makes it that much easier to fall asleep.
2. These medications only help you fall asleep faster.
3. OTC sleeping pills may make your sleep worse later in the night like alcohol.
G. Maintain a regular exercise schedule. Just in case you needed another reason to start exercising...
1. Walking is an excellent form of exercise. The best time is early in the morning (7am-9am). I personally think that you walk is much more important then when you walk. If after work is more likely to become a habit for you, embrace it. Just get fresh air and some blood moving.
2. Light stretching can be done on rainy days.
3. Guard against strenuous exercise before bedtime. It is too stimulating and may prevent you from falling asleep.
A. Do not nap during the day (unless your sleep doctor has told you that you may).
1. Not napping will allow you to sleep much better at night.
2. Exercise instead of napping. This is one of those tips that makes me want to say, "You've never suffered from really serious insomnia, have you? You try exercising after getting two hours of sleep all week." That said...if you can reach down and pull this off, I bet it would help. I don't let myself nap, but I have yet to be barely able to stay awake and then decide to go running. If you can do that -- huge kudos to you.
3. Stay active during the day when you feel sleepy.
B. Eat meals at the same time each day, every day. OK, I just saw this for the first time. Haven't tried it, but I imagine it helps in getting your body on schedule. File that one away.
1. 3 to 4 small meals per day are better than 1 to 2 big meals.
C. Plan evening activities that promote relaxation.
1. Read or listen to music.
2. Avoid using watching TV in bed to fall asleep. The late night news in not very relaxing. I would take this a bit further -- avoid all screens 90 minutes before bedtime. Dim lights will help you transition more easily.
3. Meditate before bed. (That isn't on the Sleep Clinic list. I think it should be.)
D. If you tend to worry about things while lying in bed:
1. Make a list of things to deal with tomorrow. I keep paper and a pen next to bed so I can jot down things that pop into my head, rather than worry about remembering them.
2. Make a list of things to do before bedtime. Part of my night time routine includes doing a quick pick-up of my apartment. Otherwise I lie in bed thinking about the dishes in the sink. This pretty much tops the list of Things Not Worth Losing Sleep Over.
E. Keep regular bedtimes and rise times.
F. Do not spend too much time in bed "chasing sleep." In other words, if you're not sleeping, get out of bed and do something else. It may seem counterproductive, but it helps train your body that bed is for sleeping, not thinking. With time, this can prove to be one of the most useful tips.
G. Do not attempt to "make up for lost sleep" on weekends or holidays. It may not work and it means you are not up to par for the second half of the week.
H. Develop a sleep ritual: do the same things each evening before retiring for the night to give your body the cues that it is time to settle down.
I. Relax in bed.
1. Take several deep breaths (in through your nose and out through your mouth) while lying in bed and relax tense muscles, starting with your toes and working up to your head.
J. If you can't fall asleep:
1. Get up and move to another room.
2. Stay up until you are sleepy and then return to bed.
3. If you still cannot fall asleep, get up again.
4. Repeat this cycle until you fall asleep.
K. Do not use your bed as a place to read, watch television, argue, or catch up on office work. This was really tough for me to give up. My bed is by far the most comfortable place in my apartment, and sometimes all I want is to lie in bed and read the paper or dive into a book. Right now, I'm on the search for a comfy chair instead.
L. Set your alarm to get up at the same time each morning, regardless of how much sleep you got during the night, in order to maintain a consistent sleep/wake schedule. In case you weren't counting, this is the third time they've mentioned this. It's important. If you do only three things, tips J, K, and L would be my strongest recommendations.
M. Keep the bedroom dark and at a temperature that is most comfortable for you so that you are not waking up too cool or too hot.
N. Block out noises that can disturb your sleep.
1. Sponge earplugs or "white noise" made by fans, air conditions, or a white noise machine.
O. Go to bed only when you are sleepy.
P. Do not watch the alarm clock and worry about the time or lost sleep. Try to think about something that is relaxing and/or enjoyable.
There you have it. It's a lot, but try to take encouragement from that rather than feeling overwhelmed. There are so many different tools you can try. If these don't work, of if you want additional help, I would suggest a Cognitive Behavioral Therapist specializing in sleep who can walk you through specific exercises designed to tackle your biggest barriers to a good night's sleep. It's a commitment, but you can get there. Honest.
Sleep Hygiene
A. Maintain a regular sleep/wake schedule
1. Keep the same rise time and bedtime every day. Fun? Not so much. Worth it? Absolutely. This was one of the most helpful tips for me.
B. Maintain a healthy diet
1. Include foods high in carbohydrates. I would add that they should be complex carbohydrates, like whole grains and produce. Refined carbs, like white bread and white rice, are going to convert to sugar much more quickly, which can destabilize your blood sugar and make it more difficult to sleep.
2. Foods that contain carbohydrates are: breads, pasta, rice, cereal, fruits, vegetables, & milk.
3. Going to bed hungry or eating a large meal before bedtime can worsen sleep.
4. If hungry at bedtime, eat a light snack or drink a glass of milk.
C. Avoid or minimize the use of caffeine. My friend Maggie would say this is cruel and unusual punishment, and might not even be humanly possible. It is difficult, especially if you've got a serious coffee habit. But if you have trouble sleeping, caffeine's only going to make it worse. Try to taper off, and eventually -- I promise -- you'll be sleeping better and need it less. (Don't worry, Maggie. If you sleep fine, I'm not going to suggest you give up the good stuff.)
1. It is a stimulant that interferes with sleep.
2. The effects can last as long as 8-14 hours.
3. One cup of coffee contains 100mg of caffeine and takes 3 hours to leave the body.
4. Most sodas and teas, some headache and cold medicines, and most diet pills (evil buggers!) will worsen sleep.
5. It is recommended not to drink coffee, tea or soda after Lunch. If you continue to have difficulty falling asleep, avoid drinking caffeinated beverages after Breakfast. I'll say it again -- if you're a particularly atrocious sleeper like I am, you're probably better off without any caffeine at all. I found it was the ritual I missed in the morning, almost as much as the caffeine. Now I make tea to sip while I get ready for the day. It's a different ritual, but a ritual nonetheless.
D. Avoid alcohol. I hate this one. I hate how important it is, and what a difference it makes in my life if I'm drinking or not. This might be the most frustrating for me. As with caffeine, I try to supplement the ritual. My bartenders know if I'm not sipping a Bluecoat gimlet, I'm going to be drinking club soda with lime by the gallon.
1. You may feel it helps you get to sleep, but for most people it causes awakenings as well as poor sleep later in the night. It's true. Drat.
2. Alcohol can make snoring and sleep apnea worse.
E. Smoking cigarettes will interfere with sleep. Just in case you needed another reason to quit...
1. If you currently smoke, begin to cut back on nighttime smoking.
2. Stopping smoking is a helpful step to improving your sleep. The best way to quit smoking is to be involved in a group meeting along with the patch or gum.
F. Over-the-counter sleeping medications:
1. None of the medications currently available OTC help you get into deep sleep. I took Tylenol PM almost every night for ten years. It's horrifying to think of all the REM sleep I missed. It also feels absolutely amazing to not depend on it any longer; I know longer feel anxious if I spend the night somewhere and forgot to bring Tylenol PM or Benadryl. Knowing I don't need it makes it that much easier to fall asleep.
2. These medications only help you fall asleep faster.
3. OTC sleeping pills may make your sleep worse later in the night like alcohol.
G. Maintain a regular exercise schedule. Just in case you needed another reason to start exercising...
1. Walking is an excellent form of exercise. The best time is early in the morning (7am-9am). I personally think that you walk is much more important then when you walk. If after work is more likely to become a habit for you, embrace it. Just get fresh air and some blood moving.
2. Light stretching can be done on rainy days.
3. Guard against strenuous exercise before bedtime. It is too stimulating and may prevent you from falling asleep.
Night Time Tips
A. Do not nap during the day (unless your sleep doctor has told you that you may).
1. Not napping will allow you to sleep much better at night.
2. Exercise instead of napping. This is one of those tips that makes me want to say, "You've never suffered from really serious insomnia, have you? You try exercising after getting two hours of sleep all week." That said...if you can reach down and pull this off, I bet it would help. I don't let myself nap, but I have yet to be barely able to stay awake and then decide to go running. If you can do that -- huge kudos to you.
3. Stay active during the day when you feel sleepy.
B. Eat meals at the same time each day, every day. OK, I just saw this for the first time. Haven't tried it, but I imagine it helps in getting your body on schedule. File that one away.
1. 3 to 4 small meals per day are better than 1 to 2 big meals.
C. Plan evening activities that promote relaxation.
1. Read or listen to music.
2. Avoid using watching TV in bed to fall asleep. The late night news in not very relaxing. I would take this a bit further -- avoid all screens 90 minutes before bedtime. Dim lights will help you transition more easily.
3. Meditate before bed. (That isn't on the Sleep Clinic list. I think it should be.)
D. If you tend to worry about things while lying in bed:
1. Make a list of things to deal with tomorrow. I keep paper and a pen next to bed so I can jot down things that pop into my head, rather than worry about remembering them.
2. Make a list of things to do before bedtime. Part of my night time routine includes doing a quick pick-up of my apartment. Otherwise I lie in bed thinking about the dishes in the sink. This pretty much tops the list of Things Not Worth Losing Sleep Over.
E. Keep regular bedtimes and rise times.
F. Do not spend too much time in bed "chasing sleep." In other words, if you're not sleeping, get out of bed and do something else. It may seem counterproductive, but it helps train your body that bed is for sleeping, not thinking. With time, this can prove to be one of the most useful tips.
G. Do not attempt to "make up for lost sleep" on weekends or holidays. It may not work and it means you are not up to par for the second half of the week.
H. Develop a sleep ritual: do the same things each evening before retiring for the night to give your body the cues that it is time to settle down.
I. Relax in bed.
1. Take several deep breaths (in through your nose and out through your mouth) while lying in bed and relax tense muscles, starting with your toes and working up to your head.
J. If you can't fall asleep:
1. Get up and move to another room.
2. Stay up until you are sleepy and then return to bed.
3. If you still cannot fall asleep, get up again.
4. Repeat this cycle until you fall asleep.
K. Do not use your bed as a place to read, watch television, argue, or catch up on office work. This was really tough for me to give up. My bed is by far the most comfortable place in my apartment, and sometimes all I want is to lie in bed and read the paper or dive into a book. Right now, I'm on the search for a comfy chair instead.
L. Set your alarm to get up at the same time each morning, regardless of how much sleep you got during the night, in order to maintain a consistent sleep/wake schedule. In case you weren't counting, this is the third time they've mentioned this. It's important. If you do only three things, tips J, K, and L would be my strongest recommendations.
M. Keep the bedroom dark and at a temperature that is most comfortable for you so that you are not waking up too cool or too hot.
N. Block out noises that can disturb your sleep.
1. Sponge earplugs or "white noise" made by fans, air conditions, or a white noise machine.
O. Go to bed only when you are sleepy.
P. Do not watch the alarm clock and worry about the time or lost sleep. Try to think about something that is relaxing and/or enjoyable.
There you have it. It's a lot, but try to take encouragement from that rather than feeling overwhelmed. There are so many different tools you can try. If these don't work, of if you want additional help, I would suggest a Cognitive Behavioral Therapist specializing in sleep who can walk you through specific exercises designed to tackle your biggest barriers to a good night's sleep. It's a commitment, but you can get there. Honest.
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2 comments:
Will not. Can not. EVER. I must have my coffee and giving it up IS cruel and unusual punishment.
SUCH A GREAT POST!! loads of info here!
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