In past posts we’ve talked about the impact alcohol can have on sleep, which is widely known. Nicotine also has an impact, which seems less well known by the public.
Studies show that nicotine changes sleep, so that it takes longer to fall asleep initially, people sleep a lower percentage of the time in bed, and REM sleep and total sleep time is decreased. None of these are effects we want!
According to the Centers for Disease Control “In 2010, 43.5 million adults (19.3%) in the United States were current smokers—21.5% of men and 17.3% of women.” So that’s about 1 in 5 people who are exposing themselves to nicotine, and suffering the consequences on their sleep.
If you are someone who struggles with sleep, and smokes, it may be worth the effort to stop smoking in order to improve your sleep, and reap all the other health benefits too. Many state health departments have ‘Stop Smoking’ helplines, and your primary care physician can assist you.
To make a perfect ‘Sleep Cave’:
1. Dark. Should be as dark as a cave, this allows your natural melatonin levels to soar at night and help you sleep.
2. Quiet. Ever sleep in a basement and have a better night’s sleep because it was so quiet? Turn off everything that makes a sound, thus asking for your attention. Do what you can to keep the dog from barking, or his collar from jingling. If there are irregular sounds, a soft white noise machine might be helpful.
3. No electronics. Did a caveman have little lights flashing, or sales texts chirping in the night? Research this last year shows that many people are woken multiple times each week by the phone. Make sure you are not one of these folks by putting your electronics to bed in another room.
4. Comfy. Sleeping surfaces vary widely around the world. What’s most important is that the bed is comfortable for you. Unfortunately bedpartners can prefer different firmness in the mattress. Modify it with extra padding so it’s softer for one, or put a firm board under the mattress so it’s firmer for the other person.
5. Cool. People sleep better when it is cooler than 65, or even cooler at 60 degrees. Adjust both the temperature of the room, and the covers so you aren’t waking up too hot. Many patients tell me they like the bed to be warm when they get into it in the evening, but then get too hot in the night. You can use a heating pad, electric blanket, or hot water bottle to warm the bed beforehand, but then turn it off once you are in bed.
6. Minimal ‘stuff’. Back to those cavemen, they didn’t have so much stuff in their sleeping quarters, did they? Remove all the things from your bedroom that are thought provoking or call for action. You want the bedroom to be a place that you are ‘off-duty’ from the responsibilities of the day.
Although none of these recommendations are high tech, they are based on solid research, and make a huge difference in how well you sleep. Making these changes will be worth it as you get optimal sleep and all its’ daytime benefits!
The new Sleep In America Poll came out today, the first day of National Sleep Awareness Week 2011.
This poll was all about our use of technology during the hour before bed, our nightly sleep, and daytime function. Here are some of the highlights:
– 63% say that during the week their sleep needs are not met
– 60% say they have a sleep problem almost every night
– 95% of us use technology during the hour before bed a few nights a week or more
– 20% of 13-29 year olds say they are awoken by a text, phone call or email several nights a week
-22% of 13-18 year olds are clinically sleepy
– About 10% of 13-45 year olds say they drive drowsy 1-2 times a week
Even the light from your TV or laptop is enough to suppress melatonin. During the hour before bed your melatonin should be increasing, allowing you to become sleepy and fall to sleep easily. The time for bright light is in the morning to get energized.
There are many ways a person could experience insomnia. It could be difficulty falling asleep at the beginning of the night, or being awake for an extended time in the middle of the night, or waking too early.
Whatever time it is, being awake in bed can often lead people to feel frustrated, angry or hopeless about their sleep. As you can imagine, these feelings do nothing to help a person fall asleep. Let’s talk about some strategies to use to help yourself fall asleep.
An ‘Over-active’ Mind
Frequently people tell me that their mind is going a mile a minute once they are awake in bed, that they have ‘buzz brain.’ In this situation, you want to establish boundaries with yourself that bedtime (from lights out to wake time) is not a time to think things through.
So first of all, schedule time 2-3 hours before bed to jot down the thoughts that arise at night, and put them to rest. Spend just 10 minutes on this, so you don’t get further entrenched in those thoughts. You can use any format that works for you – a To Do list, journal, problem and solution brainstorming list, calendar system, or any other format.
Second, if thoughts arise in the night, tell yourself that you already thought about it, and will have time tomorrow, now is time to rest. Putting your thoughts aside like this is a skill, and like all skills, you will get better the more you practice.
Follow this up with purposefully substituting thoughts that help put you to sleep. Some strategies are: a sleep promoting visualization (think dozing on the warm sand at the beach), or slow deep breaths, or repeating a prayer or mantra. For people who are also physically restless, doing progressive muscle relaxation starting with the feet can help still both the body and mind.
Almost everyone has difficulty sleeping occasionally, and these strategies can help quiet the mind and promote sleep. Establish with yourself that during your sleep time you are “off duty” from all types of thinking or planning. You will feel better for having a good nights sleep, and be better able to think things through well during the day.
Several years ago I had a neighbor who worked odd hours. Sometimes she’d work in the day, sometimes leave for work at 4pm, and sometimes she’d be in her office for more than 24hrs. Our kitchen and dining room looked out onto her driveway and front door so we frequently saw her coming and going.
And thank goodness we could see her! Several times she pulled into her drive in the morning after being gone all night, and fell asleep right there in the car, with her head on the steering wheel and the engine running. We’d go and wake her when we noticed that the engine wasn’t turned off.
This is just one example of the dangers of drowsy driving. What would have happened if she’d fallen asleep on the road, or if nobody had been there to wake her up?
Once your baby starts to have more sleep at night (about 7 weeks old), you can start to teach them to sleep well. At this point, you can observe when your child is sleepy, and put them down to sleep at that time. The first signs of sleepiness are that your child will become quiet, will stop making eye contact, and will no longer be interested in toys. If your baby starts rubbing her eyes or is fussy, then she is getting overtired. Gradually the times that your child naps will become routine, consolidating into two naps after 6 months of age.
Sleep is interesting because it is shaped by both our physiology and our habits. Here are some habits that will help your baby sleep well.
– Have a bedtime routine that is consistent each night, for instance “Bath, bottle, book, bed.” Write this down and post it so everyone who puts the baby to bed can do it the same way. Research shows that after just 3 weeks of a consistent, relaxing bedtime routine, babies fell asleep more quickly, woke less in the night, and return to sleep more easily.
– Put the baby to bed sleepy but still awake, so that he learns to fall asleep by himself.
– Be thoughtful about the sleep environment your child falls asleep in, and make sure it will be the same during night wakenings so he can return to sleep easily. For example, if the room will be dark and quiet in the middle of the night, it should be dark and quiet when he is put to bed at the beginning of the night.
– Decide what strategy you will use in the middle of the night to help the baby return to sleep, and be consistent each time. Again, post this strategy so you can refer to it in the middle of the night when you are tired.
The most important thing to teach your infant is that when she is sleepy she goes to sleep, and the way to help her fall asleep easily is to be consistent with good sleep habits.
So . . . ’tis the season for making New Year’s Resolutions. Here’s my healthy sleep resolutions that will help make this the best year ever!
1. Get enough sleep each night, enough so I am ready to get up and start the day with enthusiasm!
2. Stop work, TV and computer about an hour before bedtime so that I can unwind before lights out, and fall asleep easily.
3. Schedule my work day in accordance with my circadian rhythm – mentally hard work in the morning and late afternoon, with filing and less demanding tasks during the mid-day circadian dip (for me this is about 1:30-2:30pm)
4. Keep my bedroom a great sleep environment – cool, dark, quiet, and without all that clutter which makes me think of my ‘To Do’ list rather than sleep.
What sleep resolutions will you make this year?
Dr. Catherine Darley is director of The Institute of Naturopathic Sleep Medicine in Seattle. More at www.naturalsleepmedicine.net
I get this question all the time from patients who ask “what about naps?” Let me give you a little information about naps and night time sleep. Another day we’ll look at the effect of naps on alertness and performance.
There are several things to know before deciding to take a nap or not. First of all, from the time we wake until the time we go to bed our sleep drive increases. This sleep drive helps us fall asleep easily. When a nap is taken, it decreases our sleep drive back to zero, and there is less time than normal until bedtime, so at bedtime our sleep drive is less than normal. This can result in difficulty falling asleep, or in a short sleep duration.
The second thing to understand is the sleep cycle. There are four stages of sleep – REM, and NonREM stages 1, 2, and 3. Stage 3 is considered “deep” sleep, and is the most difficult to wake up from. We cycle through all these stages every 90-120 minutes. So a short nap of 30 minutes, or a longer nap of an hour and a half is best. This helps avoid waking out of stage 3 sleep and feeling groggy.
So overall, if you are going to take a nap, take it earlier in the day so that your sleep drive has time to build up again before bedtime and help you fall asleep easily. Also time your nap for less than 30, or more than 90 minutes so that you can wake feeling alert, not groggy.
Do you know someone who suffers from chronic pain? It may be back pain, headaches, pelvic pain, fibromyalgia . . . many types of pain sufferers also experience sleep disruption. Unfortunately, people can get into a cycle in which pain disrupts their sleep, and insufficient sleep makes pain worse. This may seem logical, but let’s look more specifically at pain and sleep interactions.
A few chronic pain conditions are known for sleep disruption. One of them is fibromyalgia. 70% of fibromyalgia patients have sleep complaints, and one study found that 27 of 28 had sleep-disordered breathing. When the breathing was treated with CPAP, patients had a 23-47% improvement in symptoms. 80% of cluster headache patients are found to have obstructive sleep apnea. For those patients who experience insomnia due to pain, it’s been shown that Cognitive-Behavioral Treatment (CBT-I) will improve their sleep, and may slightly decrease pain.
How to Minimize the Effect of Chronic Pain on Sleep
When people are in pain and their sleep is disrupted, they may feel like they need to catch some ZZZs whenever they can, even during the day.
As best you can, maintain the difference between daytime activity and nighttime rest. Stay awake and engaged during the day, and be sure to get bright light, preferably outside. During the night, keep lights out, and minimize your activity. This will help consolidate your sleep in the night.
If you need to rest or lay down because of pain do so somewhere other than your bed or bedroom. Make yourself a comfortable spot in the living room, maybe an easy chair or day bed. This maintains a strong association of your bed as someplace to sleep.
Get tested for sleep disorders if necessary, especially as discussed above.
If you are taking prescription pain medications, be aware that some of them can cause sleep disruption. You may want to ask your prescribing doctor to review your medications, and switch them if appropriate.