Sleep: It's 1/3 of your life

The irony of starting this blogpost about sleep today, when I slept terribly last night at an Airbnb in Boston, finally getting out of bed at 4:50am to catch a plane flight home.  As I go through my day zombie-like I’m reminded of the fact that I used to feel this way fairly often, and how refreshing it is that this feeling has become mostly a memory.  Or, an unpleasant reminder when traveling.  

Back before I had children, one million, I mean six years ago, I was one of those people that needed her sleep.  After I had kids I got a clue as to how adaptable humans truly are.  Once my first was born my anxiety and restless anticipation would start to set in around sunset, because that’s when he would start crying and it wouldn’t stop until the wee hours of the morning. The longest it lasted was until 4am, and pacing the house with a crying baby I would chant to myself 4am, 4am I just have to make it until 4… and somehow we always did.

My second child, a daughter born 3 years later, slept beautifully as a newborn.  Unfortunately that is when my terrible insomnia started and I would lay awake next to her, staring at a peacefully sleeping baby, angry as hell that I finally had the opportunity to sleep but my body wouldn’t let me.  

Insomnia is a complicated thing and it affects every area of a person’s life.  Lack of sleep affects the immune system, leaving a person more prone to catching a cold or the flu.  Cognitive function is affected and thus its hard to think clearly.  Hormones in the body which influence hunger are affected which lead people to crave quick food energy in the form of sugar.  Chronic lack of sleep is linked to an increased risk of multiple health conditions such as heart disease, high blood pressure and diabetes.  

Why people don’t get enough sleep varies from person to person. Reasons include job schedules, lack of time to unwind, inability to relax, hot flashes, too much coffee, mental health conditions and chronic pain plus many others.  There will always be factors outside of our control.  For our purposes here we are going to focus on what we can control (ex. limiting caffeine and alcohol intake) and decrease the effects of the factors that we can’t (ex. crying baby) as much as possible.  Take what you need and leave the rest.

Make your environment work for you

Make your bedroom as dark as possible.  The first order of business is your windows.  Wake up when you want to, not when the sun rises.  The phases of the moon need not affect your sleep, or street lamps, motion lights or flashlight tag. There are many options for solutions here.  Room darkening curtains are worth their weight in gold.  There is also blackout film that you can apply directly to windows, the disadvantage being that you won’t ever see sunlight in your bedroom.  Blackout shadesor blinds are fantastic although rather pricey.  After you tackle your windows see where else there is extraneous light in your room.  Its best to keep electronic devices out of your bedroom but if they must stay, cover any tiny lights with black tape.  If you use an alarm clock, pick one that doesn’t have numbers that light up, cover it with tape or put it facing the wall.  The last thing that jives with a good night of sleep is an electronic light shining in your face.  Do you wear a fitbit to bed? Turn off the function that makes it light up if you turn your wrist.  I have been woken up many times by simply rolling over and fitbit light shines right in my eye.  Eye masks are also an option, however downsides include the fact that humans can perceive light through other cells in our bodies so a dark room is best for sleep.

Make your bedroom as quiet as possible.  I highly recommend the Marpac Dohm white noise machine to drown out ambient noise.  Alternatives include a multitude of smart phone apps or sleep sound machines, however the marpac is king. We use them in the clinic and I use them at home, in my room and my kids rooms.  Ear plugs are also an option however they tend to fall out and if you need an alarm to wake up at a certain time you may not be able to hear it.  They are the best choice if you share a bed with someone that snores.

Keep tv and work out of your bedroom.  The idea here is to associate your bedroom as a place to rest and relax. Work is definitely neither so don’t bring it to bed.  Watching TV in the bedroom is not advisable either, keep it on the couch.

Keep pets out of the bedroom.  Pet lovers, don’t hate me.  Also, this really refers to dogs, because who has had success keeping a cat from doing what it wants?  After night duties for 2 children who still sometimes wake up at 6 and 3 years old, I have zero patience for an animal interrupting my sleep.  However I barely slept last night and got up at 4:50am so I’m cranky today.  If your dog sleeps like a perfect angel more power to you!  

Keep your bedroom on the cool side.  A small fan to circulate air or an open window if you live in a quiet area can do wonders to keep your bedroom cool which is good for sleep.  Keeping the heat down a few degrees at night in the warmer months saves energy and improves sleep too. 

Weighted blanket. A few of my patients swear by a weighted blanket to help with sleep and nighttime anxiety.

Daily routine

Go to bed and wake up as close to the same time every day as possible.  This helps to establish a rhythm for your body, making getting up and going to sleep easier.  Aim for within 30 minutes of wake up and bedtime.  

Turn off electronics 1-2 hours before bed.  This one is huge.  Remember regular ol’ books? Yeah I forgot about those too because I’m addicted to audiobooks and podcasts.  Cracking a book, some journaling or conversation with your partner or a friend on the phone are great low-tech activities to wind down in the evening.

Avoid caffeine after noon and limit caffeinated beverages to 1-2 cups/day.  Everyone knows that caffeine is in coffee, however it shows up in various other foods and beverages as well.  Some soda contains caffeine (some root beer and orange soda- weird, right?), watch out for caffeine in tea, juice and chocolate.  Some medications contain caffeine.  Decaf coffee and tea also contain trace amounts of caffeine.  Caffeine gives you false energy and while it gives an initial lift it ends up robbing you of valuable rest later.  First become aware of how much caffeine you are consuming and then slowly cut down or even wean yourself off.  

Avoid high carbohydrate and sugary foods right before bedtime.  Dessert, I’m talking to you.  A blood sugar crash does not a restful night of sleep make.  I would also put alcohol in this category too.  Alcohol contains a ton of sugar and while initially it might help you go to sleep, frequently it will make you wake up.  Many of my patients report difficulty sleeping after a night of even moderate drinking.  And after a night of excessive drinking, you know what happens the next day.  If you are having serious sleeping problems, you may want to consider abstaining from alcohol for a while.  

Reduce Stress

Sleep requires laying relatively still, closing your eyes and relaxing. Our bodies don’t function like light switches, on and off.  If your day has been stressful and chaotic, it’s unreasonable to expect your body to just be able to shut itself down and sleep simply because it’s bedtime.  Racing thoughts, tossing and turning and waking up in the middle of the night are common occurrences when stress levels are just too high.  Incorporate some stress relief into your daily and weekly routine to help your body to rest when it’s time for bed.  

Acupuncture Acupuncture is the best way to manage stress.  Usually people feel much better after just one treatment, sometimes it takes a few.  Acupuncture is a great tool to manage ongoing stressful situations, people feel better able to cope and deal with what’s going on when they are getting regular treatment.  With chronic stress and trauma the physiological stress response of the body can get stuck “on”.  Acupuncture shuts it off so that people’s minds and bodies can rest and relax.  Acupuncture also helps with hot flashes and night sweats too.

Exercise Getting your body moving is essential to managing stress and improving sleep.  Some people feel too revved up when exercising in the evening. If that is you, switch your workout to the morning or afternoon.  It doesn’t have to be bootcamp or crossfit, a nice walk outside counts!  Yoga is also a great choice because it helps to relax your mind too.  

Meditation, progressive relaxation These are techniques to help relax your mind.  There are many guided meditations on youtube and various smartphone apps.  Personally, I use the Calm app, however Headspace is also popular.

Take a bath This is a nice thing to do in the evening after the kids are asleep.  You can just close your eyes and relax, catch up on a book or magazine, listen to some music or chat with your partner.

Supplements - CBD, Melatonin, Magnesium  Some people find a sedating supplement before bed helps.  Sometimes sleep issues are so bad that a prescription is necessary and that is ok. You have to sleep in order to function. However these supports do not have to be a long term solution, I encourage you to do what you need to in order to rely on these measures as little as possible.

Give it Time

You might be tired initially.  Especially if you are coming off caffeine for example, you might just be now aware of how tired you really are.  If you are finally tired, let yourself rest. Go to bed a little earlier for a while to allow your body to catch up.  Be easy with yourself. If you have had life long sleep problems it may take awhile to get better.  

Consider this a starting point to figure out what works for you.  If you are still not sleeping well and have other health concerns you may consider a sleep study. Sometimes people need to use a small machine (CPAP) to help their breathing while they are sleeping.  Don’t be afraid to ask your doctor her opinion.