Sleep Hygiene
Why Can’t I sleep Doc?
Insomnia, or trouble sleeping is a problem that has reached epidemic proportions. The array of sleeping pills marketed by drug companies is constantly increasing and are easy to reach for when patients come in complaining of poor sleep. While there is sometimes a roll for medication, the first and most overlooked aspect should be ‘sleep hygiene.’ This means learning about all the tools in your own toolbox to help your sleep.
Some people have trouble falling asleep, staying asleep, or waking up in the very early morning hours or a combination of these problems. Often, poor sleep has been an issue for years, but periods of life stress or other internal and external factors can make the problem worse and this is when people often seek medical help.
Before we start to discuss sleep hygiene, we’ll define some words:
Melatonin– the body’s natural sleep hormone, made in your brain in an area called the pineal gland. Some external stimuli and times of the day shut off production of melatonin and can lead to sleep disturbances if you don’t have any melatonin released at bedtime.
REM sleep-This is the stage of sleep where dreaming happens. We have several cycles of this sleep each night and we need it to keep our immune systems and brains functioning well.
Sleep Hygiene–basic behaviours:
- No daytime napping
- Go to bed and wake up around the same time each day. Try not to wake up at noon every weekend for example and then expect your body to be happy on monday morning when your alarm goes off at 7am
- Avoid TV computer screens and iPhone screens right before bed (a 2hr pre-bed electronic shut of zone is strongly encouraged). Why? Screens give off blue light which can inhibit the brain’s natural melatonin production.
- Sleep in total darkness as light can also disrupt melatonin production. This means shutting off all computer screens, cell phone screens, and possibly getting heavier curtains for your bedroom if it still light enough to see your hand a few feet in front of your face.
- If there is noise from neighbours or a bed partner, try wearing earplugs to decrease stimulation
- Keep your bedroom a comfortable temperature but avoid having it above 22 degrees C, as a room that is too warm (or too cold) can disrupt sleep.
Sleep Hygiene–Effects of Substances on Sleep:
- Cut down and consider cutting out caffeine. Some people are so sensitive to caffeine that even if they only consume it in the morning, the effects linger on into the evening and can disrupt sleep. If you drink more than two cups of coffee or other caffeinated beverage each day, start by cutting down gradually over a few months time to avoid withdrawal and headaches. For example, if you usually have two cups of coffee, alternate 1.5 and 2 cups for two weeks, then cut back to 1.5 cups, etc. You can mix decaf and regular coffee together if you make your own at home. Just make sure the decaf is water-decaf and not chemically decaffeinated,with is also unhealthyAlso, consider also ‘sneakier’ caffeine culprits such as chocolate, tea, and weight loss supplements
- Avoid alcohol, especially close to bedtime. Many people will use a drink to relax and prepare for sleep but alcohol actually disrupts your sleep cycle and deprives you of the deep ‘slow wave sleep’ that you need to feel well-rested after a night’s sleep, as well as decreased REM sleep (the stage of sleep with dreams), also vital to health. Landolt, H.-P., et al. Late-afternoon ethanol intake affects nocturnal sleep and the sleep EEG in middle-aged men. J Clin Psychopharmacol16(6):428-436, 1996.
- Avoid drinking anything two hours before bedtime so the need to urinate (pee) is reduced in the middle of the night
- Your last meal should be eaten 3 hours or more before bedtime, as digesting a bit meal can make it harder to fall asleep and disrupt the sleep cycle. If you need to have a small snack before bed, a few nuts or nut butter on a whole grain cracker is the best choice because these foods have tryptophan in it–a precursor to melatonin (the ‘sleepy’ hormone!)
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Melatonin as a sleep aid can be used in the amounts of 3-6mg a half hour before bedtime if the behavioural strategies are not enough. Most people tolerate this supplement well but there are potential side effects for a small percentage of people of vivid dreams or nightmares. Melatonin is especially useful for people doing shift work or with air travel across time zones where natural melatonin production may be disrupted.
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