Wiped Out

It's true, I've been a lousy poster as of late. My post-a-day goal when I started has dwindled to a post-a-week during September. It's not that I haven't been thinking about holistic health, or come up with things I've wanted to share. It's just that I've been absurdly exhausted lately. In bed at 8:30 on a Friday night kind of exhausted. In fact, in the last two weeks, I think I've been asleep before 10pm a record-breaking (for me) four times. I've canceled plans, postponed visits, delayed obligations. I'm not quite sure why I've been so beat, but I do know I had to just give into it and let it win. Maybe my body's been fending off these colds that have been going around, or maybe I've just had trouble adjusting to the change of seasons. Maybe it's work stress, or maybe it's frustration over a lot of little things. In the end, I suppose it's ok that I don't know why I'm so tired, just that I honor the exhaustion and give myself a free pass every once in a while.

That said, I'm an optimist, and there's something about today that makes me think I'm starting to turn the corner. I made myself a delicious raw vegan smoothie packed with all sorts of healthy things, like my magic enzyme powder and flax seeds and mango. I have acupuncture after work, and then my favorite yoga class a little while after that. I've recommitted to a booze-free lifestyle (for the time being), and am letting myself say no to things that seem more draining than restorative.

And now, back to work while my head is still clear. My to-do list is a bit daunting at the moment...

Is Decaf Better?

One of the cool things about this new venture (the holistic health counseling career track) is that friends and family now come to me with all sorts of health/diet related questions. Sometimes I know the answer. Often I don't. Which makes sense -- I haven't gone to school yet, have I? I love the questions, though, because they prompt me to research things I wouldn't otherwise think of. There's one question I was hesitant to look into, however. Snacks asked if decaf coffee is indeed worse for you than caffeinated coffee, due to the chemicals used in the process to extract the caffeine.

After some preliminary research (and if you have articles on the subject, I'd love to read them), my answer is the ever-so-helpful: It depends.

As a general rule, the thought of ingesting chemicals in the guise of food freaks me out. It's what caused me to give up artificial sweeteners and fake food like those weird frozen "yogurts" that are on every corner in New York. That said, if you have a fierce coffee habit, and caffeine has a strong negative impact on how you feel, I think decaf can be a good transitional aide. For me, I think caffeine is worse for my body right now than some chemicals that may or may not remain in the decaf coffee. Here's what the all-knowing Wikipedia had to say about the subject:

Decaffeinated coffee is also regarded as a potential health risk to pregnant women due to the high incidence of chemical solvents used to extract the caffeine. The impact of these chemicals is debated, however, as the solvents in question evaporate at 80–90 °C, and coffee beans are decaffeinated before roasting, which occurs at approximately 200 °C. As such, these chemicals, namely trichloroethane and methylene chloride, are present in trace amounts at most, and may not pose a significant threat to embryos and fetuses.

I'm not pregnant, but I often wonder about all those things pregnant women aren't supposed to eat because of how it will affect the fetus. Doesn't it make sense that those are things that maybe people just shouldn't eat in general? Think about it.

But I digress. I don't think caffeine is unhealthy for most people. Unless you have heart, sleep, anxiety, or blood sugar disorders, it's probably fine for you. Best not to have it, but not likely the first thing most people should address in their diets. If, however, you do suffer when you take caffeine, be aware that there is no national standard of what should be labeled as "decaf" when it comes to brewed coffee. The New York Times did an interesting piece showing that many decaf coffees from the major coffee stops -- Dunkin Donuts, Starbucks, etc. -- do in fact contain caffeine, sometimes as much as a can of Coke.

How is this information going to influence my coffee decisions? I'll probably revert back to the very very occasional decaf coffee, and keep away from the caffeine. It should be easier when the temperature drops, as I'll be craving more tea and less iced coffee. (Though I will always miss the caffeine-saturated Pumpkin Spice brew from Bucks County Coffee.) File this one away under the ever-popular heading of "In Moderation."

Sleep Hygiene

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.

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.

I Can Sleep!

In one of the opening scenes of Fight Club, the narrator (Ed Norton's character) talks about insomnia. Mine was never quite so bad -- I've always managed to get at least a little sleep, if not much -- but I can still relate to this quote: "When you have insomnia, you're never really asleep... and you're never really awake."

This summer, when I embarked on the Great Health Crusade of 2008, I knew that solving the sleep problem was essential. How could I expect to feel better if my body and mind didn't have the proper restorative period every night? For a decade I had relied on Tylenol PM or Benadryl to help me fall asleep. I knew these sleep aids prevented me from entering deep REM sleep, but they also kept me from tossing and turning until 5am. It was the lesser of two evils. But there had to be a better way.

When I hit my breaking point, I did a few key things that helped me get over my insomnia hurdle. I read a number of articles and books that link insomnia to hypoglycemia, or low blood sugar. Because I also had a number of other symptoms associated with hypoglycemia (will post in the future), I thought it would be a good starting point. Hypoglycemia is considered to be a prediabetic condition, and the nutritional management of the two diseases are very similar. A hypoglycemic diet is free of sugar, alcohol, caffeine, and refined carbohydrates, and it's best to eat protein at regular intervals. I made sure to eat a small portion of something with protein every 2-3 hours. Eating regularly was easy, but that whole caffeine-sugar-booze thing was a challenge.

It was a start, but it didn't help as much as I'd like. Sleepwise, at least. In terms of feeling good throughout the day, it made a world of difference.

The major breakthrough came when I broke down and went for an appointment at the Penn Sleep Center. This is one of many things that falls under that big bold heading of

Things my mother told me to do years ago that I ignored until I was in crisis and really wish I'd listened to her about the first time.

Alas. At least I finally came around. And what a difference it made!

I met with my doctor who gave me a list of things to change in my sleep behavior, and scheduled a follow up appointment with a cognitive behavioral therapist specializing in sleep. I took the suggestions to heart, but didn't think that just changing a few things in my routine could make a big difference. She didn't even test me for anything! She just listened! Oh wait... she listened. She said she thought the big problem was that I don't know how to turn my brain off at night, and I never really learned how to put myself to bed. So, in an effort to learn the skills most people learn at age six months, I had to make the following changes.

• Regular bedtime/rising time. Every day. Even weekends. For me, this is midnight/7:30a.m.
• Absolutely no reading/thinking/etc. in bed. Bed is for sleep. That's it.
  
• Turn off all screens (computer, tv, phone) one hour before bedtime.
• Establish a ritual. For me, I make sure my apartment is clean and lunch is prepped, put on my jammies, brew some herbal tea, and read a book or magazine in my favorite chair. Now that I've added meditation, I try to start my practice so I can crawl into bed at midnight.
• No getting into bed until I feel I'm about to fall asleep in my chair. When I'm on the brink of sleep, then I can go to bed. If this happens at 3am, so be it. If I get into bed, and my mind snaps awake, I have to get up, get out of bed, and go back to my chair until I'm about to fall asleep again. The point of this little run around is to train my brain that bed is for sleeping, not thinking.

It took commitment, planning, and getting over my ego to excuse myself from a few parties early enough to catch my bedtime. But the payout is huge! It's working! When I met with the cognitive behavioral therapist on Monday, he didn't change my routine at all. Of course, if things start to backslide and the insomnia returns, I'm to call him and he'll help, but for now, it looks like all system are go.

I never thought I would be able to fall asleep twenty minutes after getting into bed, especially without at least a mild sleeping pill. Now, so long as I follow my routine, I'm usually in pretty good shape. If I have a bad night, I know it's not the end of the world. And in a few weeks, when I'm really well conditioned to my sleep routine, I might even be able to stay out late on occasion, or, better yet, sleep in on a Saturday.

Do you have any other tips for beating insomnia or establishing a sleep schedule?