A GUIDE TO BETTER SLEEP
Good sleep is one of life’s pleasures. Most people can think of a time when they slept well and sleeping really wasn’t an issue. At that time sleep came naturally and there was no need to think about sleep habits. If sleep has become an issue and you are sleeping poorly then the first step is to have habits that will promote healthy sleep.
If you are sleeping poorly the recommendations in this guide should improve your sleep, but don’t expect change overnight. In some cases things might get worse for a short time before they get better; it may take many weeks to retrain the rhythms which control your sleep. [If you are sleepy you should not endanger yourself or others by engaging in potentially dangerous activities such as driving] You will also need to be disciplined and adhere to the recommendations as closely as you can. For some this will mean making large changes to the way you behave both at night and during the day, while for others it may be minor changes that are required.
Do not worry if you don’t sleep.
Worrying about a lack of sleep will not make you sleep longer. Indeed lying in bed trying to induce sleep or worrying about a lack of sleep usually promotes wakefulness. Sleep is not a state of mind that can be induced, instead we must surrender ourselves and sleep comes over us.
You may ask: “But shouldn’t I be concerned if I am not getting enough sleep?” In some ways the answer is yes and you should act on this concern by following the recommendations in this guide. On the other hand, concern and worry are detrimental to your sleep. Rest assured poor sleepers abound, but these people continue to carry out their daily tasks because they are getting the “core” sleep that the body needs to keep going. I know this “core” sleep is probably far from the refreshing sleep for which you yearn. For now you are going to have to accept the amount of sleep your body gives you and begin to retrain your rhythm by following the recommendations in this guide.
Maintain the same waking time each morning.
Do not over sleep. Sleeping-in weakens the body’s sleep rhythm (circadian rhythm). Wake at the same time each morning. If you really want a sleep-in, have no more than 30minutes. Avoid the temptation to sleep late even if you have had a bad night’s sleep as this just weakens the sleep rhythm. Use an alarm clock to ensure you wake at a consistent time each morning. Some exercise outside after waking will help your body consolidate its sleep rhythms as well as being good for your general health.
Have a bedtime ritual which allows you to relax.
Our modern lives are extremely busy. If we are not working we are often enjoying leisure activities which include TV, video games or internet use. These are activities which stimulate arousal making it hard for the brain to induce sleep, and/or maintain sleep.
Don’t eat large amounts of food before bed, instead have a light carbohydrate snack, warm milk drink, warm bath, or listening to relaxing music or read. You may even want to perform a specific relaxation routine.
Dedicate at least one hour to winding down prior to bedtime.
Go to bed when you feel relaxed, comfortable and ready to sleep.
Don’t go to bed early just because you have been sleeping badly. Go to bed at approximately the same time each night, but ensure you are relaxed and comfortable, ready to sleep.
Do not nap during the day.
Your body needs to develop a predictable and sustainable sleep pattern. Daytime napping tends to decrease the quality of night time sleep and confuses the body clock. If you are exhausted and can’t follow this recommendation then a 20min nap preferably in the early afternoon is acceptable. If you are sleepy, resist the urge to sleep by staying active, for example by getting up and moving about.
Ensure you cannot see and do not look at your clock overnight.
When sleeping the only reason for a clock in the bedroom is to act as an alarm. You should turn your clock around or banish it altogether from the room (that’s if you are tempted to peek).
Do not stay in bed if you are awake for more than 15-20 minutes.
If waking for periods during the night is a persistent problem for you, then follow this recommendation. If you are unable to sleep for what you perceive to be about 15-20 minutes (remember you will not have a clock to tell you the time) then get out of bed. It is best to set-up a chair with a lamp for this occurrence. Do something that isn’t stimulating, and ensure you minimise direct light into your eyes. Stimulating tasks and light directly into the eyes (e.g. room lighting) will weaken the sleep rhythm. Once you feel sleepy then return to bed. If you again fail to sleep after 15-20 mins then repeat the procedure. It may seem difficult but when added to the other recommendations we know from experience it works.
If you are finding it difficult to fall asleep at the start of the night then you can remain in bed a little longer than the 15-20 minutes mentioned above. Wait for up to about 30 minutes before you get up. Your mind will tell you when it is no longer worth waiting for sleep to come over you. If you are not relaxed and comfortable then you will generally find it difficult to sleep. In this instance you are better off getting out of bed as described above.
If you continue to consistently wake during the night, or wake prior to your desired rising time you should restrict the time you have in bed by going to bed later. Initially add half the time you think you are awake during the night to the time you go to bed (e.g. if you are consistently awake for 1 hr during the night go to bed 30 minutes later). [Note: Keep a diary of your sleep for a week prior to doing this calculation. Do not restrict yourself to less than 5 hours in bed per night.] Remember go to bed when you are relaxed and comfortable. Once you are asleep for the majority of your time in bed you can increase your time available for sleep by going to bed 15 minutes earlier. If this all sounds a bit complicated or this advice doesn’t seem to help then ask your health professional to guide you through the process. They may get you to fill in a more formal sleep diary to make the process easier to follow and monitor.
Limit bed activities to sleep and sex.
If you have trouble sleeping, then you need to retrain your body to associate the bed with sleeping. You should avoid watching TV, reading or working whilst in bed.
Do not use bed as a place to solve problems.
A useful technique is to write down thoughts, worries & plans prior to your period of relaxation. Sometimes you can come up with a plan of action to solve issues, at other times the concerns may be on-going. In any case you can leave your anxiety or stress until tomorrow and use overnight as a period to rejuvenate, so you can face the challenges of the next day. Need more help? In some cases you may find that you need more help in carrying out this recommendation. I would suggest you then seek professional help from your G.P. or a qualified psychologist with experience in sleep disorders.
Seek professional help if you suspect you have depression or an anxiety disorder.
These conditions can have a significant effect on your ability to sleep. If you have one of these conditions you will need professional advice that is well beyond the recommendations in this guide. An excellent source of information concerning these conditions, and checklists of symptoms can be found at www.beyondblue.org.au. We recommend you seek advice from your G.P. or physician if you suspect you have one of these conditions.
Do exercise during the day but not within 4 hours of bedtime.
Doing some exercise for at least 30 minutes 5-7 days a week is great for your general health and your sleep. Don’t exercise within 4 hours of bedtime as this tends to increase your level of arousal and makes it difficult to sleep. If you need advice on how to start an exercise programme or have any concerns, then discuss these with your physiotherapist.
Avoid caffeine after noon.
Caffeine is a stimulant and can lead to difficulty initiating and maintaining sleep. It also results in changes to the depth of sleep. Coffee is a major source of caffeine (especially espresso and brewed varieties) but remember that cola drinks, tea and chocolate also contain caffeine which may alter your sleep. Be careful to reduce your caffeine intake slowly or you may experience withdraw symptoms some of which include headache, irritability, anxiety, depression, and flulike symptoms. Aim to limit yourself to 1-2 cups/serves in the morning.
Avoid alcohol in the evening prior to sleep.
Whilst alcohol can be used to help you get off to sleep, the problem is that it causes lighter and interrupted sleep later in the night. The overall effect is reduced sleep quality. Alcohol will also increase snoring and exacerbate sleep apnea if it is present. Try and minimise or avoid alcohol after 3pm especially if waking early or during the night is a problem for you.
Avoid nicotine and be aware of the effects of medications.
Nicotine is a stimulant which makes it more difficult to sleep. Giving up smoking presents its own challenges for many, and so you may need to seek professional help.
If you are experiencing sleep difficulties it may be a side-effect of medication. You may need to read your medications product information or seek further information from your G.P. or pharmacist.
Be sure your bedroom is quiet, dark, and a comfortable temperature.
All these factors will enhance the chances of consolidated sleep.
The body’s temperature falls when we are asleep. Overheating will make sleep less likely to occur. Ensure your room is a comfortable temperature and well ventilated.
Your room should be dark during the period you want to sleep. Light acts to alter your sleep rhythm, so darken your room if light is getting in. Once you are awake at your designated time, try to expose yourself to light. This will consolidate your sleep rhythm.
Ensure your pet is not disturbing your sleep.
While pets can be man’s best friends their nocturnal activities can setup a pattern of sleep disturbance.
Visit your G.P. or physician if you need further advice, or if you are unable to manage the symptoms.
If you are currently undergoing traumatic life circumstances or experiencing stress or loss, you may find that you need more help than is found in these recommendations. Visit your G.P. or physician.
If you gain little benefit from these recommendations then you may need further professional help as you may be suffering from a sleep disorder. There are a number of sleep disorders which should be considered when there are symptoms of poor sleep and daytime fatigue, for example sleep apnea. Sleep apnea is associated with other features such as regular snoring, and pauses in breathing overnight, and sufferers are frequently overweight. More information about sleep apnea, its diagnosis and treatment can be found at our web site www.sleepandlifestyle.com.au. If you have further concerns, discuss these with a healthcare professional.
Prepared by Dr Grant Willson
Director, Sleep and Lifestyle Clinic
This Guide contains general information only. We are not responsible for any error, omission, misrepresentation, or misstatement in the Guide. Any medical information contained in this Guide is general information only. Nothing in this Guide should be construed as advice or recommendation and you should not rely on anything in this Guide as the basis for a decision or action. You must rely only on the specific advice of a registered medical practitioner or other healthcare professional.