Thursday, September 16, 2010

Sleep Hygiene: How to get a good night’s sleep.

Reduce and manage stress as much as possible

* Set a sleep schedule and keep it within ½ hour every night of the week, with the exception of one or two nights when you may stay up later. If you have to work a rotating shift schedule, then keep a schedule according to your shift. (Rotating work schedules have their problems and should be avoided when possible.) Do not nap. Keeping a regular schedule helps to condition your body to expect sleep at certain times. Young children can have naps, Infants must have frequent naps and Toddlers should have naps. Children should stick with the same schedule, within a ½ hour variance as much as possible seven days a week.

* Early to bed early to rise. There is a lot of wisdom in the old adage. Even though some people are just not morning people, for some, this can help their sleep patterns.

* Avoid sleeping too much or too little. At least a couple of times a week you should stay in bed until you wake up without an alarm, and then don’t just lie in bed. Again you want to condition your body that bed is for sleeping, not just lying around.

* Bed is for sleeping and for married adults, certain pleasurable activities, nothing else.

* Do not watch TV in your bedroom or use it as an office or for a computer room. This is also part of conditioning your mind and body.

* Avoid stimulants such as caffeine and nicotine. Remember chocolate and many soda pops have caffeine. (If you must eat or drink chocolate, do not do it within 4 hours of going to bed.)

* Keep refined sugar to a minimum and do not consume refined sugar within 4 hours of going to bed.

* Avoid alcohol, while it may help you to get to sleep, it will make it more difficult to get a good night’s sleep.

* Sleep in a cool (not cold) room and warm (not hot) comfortable bed. Try wearing socks to bed (unless your feet are too hot) and in extreme situations where you have chronically cold hands, try mittens. Your body needs to regulate your temperature before you can get to sleep.

* Keep up a good exercise routine, but not within four hours of bed time. Stretching, yoga, deep breathing, are good right before bed.

* Create a relaxing bedtime routine and stick with it. This can last from 30 minutes to an hour. It can include stretching, yoga, warm bath, deep breathing, and reading. Avoid stressful activities and conversations right before going to bed or in bed.

* Do not eat a large meal before 4 hours of going to bed. Light snack right before bed, i.e.., warm milk, banana, just a little turkey (no preservatives). Avoid spicy food right before bed and possibly discontinue altogether if you continue to have problems.  Avoid drinking very much right before bed as it may cause you to have to get up and go to the bathroom in the middle of the night.

* Make sure you get good exposure to natural light. People who do not get outside often, are helped by getting the sunlight though the window. Natural light helps to maintain a healthy sleep cycle.

* Eliminate light, and distracting noise as much as possible. Sometimes quiet relaxing music or nature sounds can be helpful. Sometimes a comforting sound from the past can also be helpful. I find the light sound of a distant train very relaxing. If you enjoy it, baroque music is very conducive to a good night’s sleep.  (See music suggestions in the stress management posting)

* Do not ruminate over issues that cause you stress right before or at bedtime.

* Do not watch or let your children watch scary movies right before bed if it causes sleep disturbances.

* There are differing opinions about children sleeping with their parents.  When they are young and if it is for short periods of time it is usually not a problem.  If it becomes a problem, try taking your child back to their bed and lying there with them until they fall asleep then returning to their bed.  Try and find out if there is anything frightening them and if so remediate the problem.  If they are just missing you, cuddle with them for a while before bed.  Read stories as a part of the bedtime routine; but be firm and consistent about bedtime.

* If you do everything or most of the things mentioned here and do not fall asleep within 20 to 25 minutes, get up and do something relaxing for 30 to 45 minutes and then try again. If you wake up in the night and do not fall back to sleep within 20 to 25 minutes, get up and do something relaxing for 30 to 45 minutes.

* Consult with your physician if you have chronic sleeping problems (either too much or too little sleep, 8 hours is average for adults) or chronic pain that keeps you awake. If you are taking medications, speak with your physician about possible side effects that may cause sleep problems. Ask your physician if the medication can be switched to a different time of the day and if that might help.

* Avoid sleeping pills if possible. If necessary, consult your physician.

* Even if you do not get a good nights sleep, get up at your scheduled time. If you get less than 4 hours of sleep for three nights in a row or less than 2 hours of sleep for two nights in a row, consult your physician. If you sleep but do not feel rested on a chronic basis, even after you have tried these adjustments, consult your physician. If you stop breathing while sleeping, consult your physician.  You may have a serious sleep disorder such as apnea.

Additional techniques: Consult your physician before doing these (this is not just an idle disclaimer; you really must consult your physician before doing these). These can be used in bed to help you to train yourself to go to sleep.

* Deep breathing and simple counting. Try taking in a very deep breath in (through your nose), expanding your stomach, and then breathing out through your mouth. Count as you do this, perhaps to the beat of your heart, try to get to the point where you have three or four heart beats as you breath in and three or four as you breath out.

* Muscle tightening/relaxing and deep breathing. Start at your toes, curl them and tighten them while breathing in deeply. Relax your toes and breathe out. Flex your foot while breathing in deeply, then relax and breathe out. Push the heals of your feed into your bed while breathing in deeply, then relax and breathe out. Continue to do the same while tightening your calf muscles, then your thigh muscles, then your buttocks then while pushing your hands down, then tightening your shoulders then pushing your head down into your pillow. Do all of these on your back.

* Walking down stairs. Imagine yourself starting at the top of a beautiful bluff, overlooking a gorgeous ocean beach. Imagine there is a gentle and safe decline with stairs and a railing on both sides. Perhaps a gentle warm breeze. Imagine what it looks like and what it sounds and smells and feels like. Now imagine that the top step is number 200. One at a time walk down the stairs, stopping at each stair to say (in your mind) the next number, 199, 198 etc. Imagine how the smells, sights and sounds and feel changes at each step. See if you can make it all the way to the bottom while staying awake.

* Nightmares. If you can just let it go and forget about the dream, do so. If you can not, imagine how you could be empowered to make everything well. What could happen in the dream to make everything better. When my oldest daughter was young she used to have bad dreams about ghosts that would wake her up and then she would wake us up. They were menacing shadows. I asked her if she could imagine that the ghost was friendly and white like Casper. She said “no, pink Ghost” and that was the end of it. It rarely works this easily but you can take control of your dreams to create a more relaxing and pleasant ending.

* Do not worry about doing all these suggestions perfectly. Just do your best and do better the next time.

Allow a month of consistent effort and practice for significant improvement.

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