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Key points
- Sleep is important for a variety of functions such as digestion, immunity, and cognition.
- Implementing good sleep strategies can help promote better rest.
- Strategies to improve sleep include maintaining a sleep schedule, avoiding daytime naps, reducing caffeine, and addressing anxiety.
Everyone has an occasional restless night, but frequent nights of troublesome sleep are very disruptive. Lack of deep restorative sleep can impair one’s focus and concentration, increase irritability, and decrease patience. In addition, sleep is important for a variety of regulatory functions including digestion, immunity, and brain function. So, it is prudent to pay attention to your sleep and do what you can to improve it. Here are eight essential issues for quality sleep.
1. Rule Out Obstructive Sleep Apnea
One thing to rule out is called obstructive sleep apnea (OSA). This is caused when the throat muscles relax and block the airway, and for a moment, you stop breathing. Most people quickly wake up to start breathing again. Some signs that you might have OSA are waking up frequently or gasping for air, snoring, and in spite of sufficient hours of sleep, waking up in the morning still tired. Common risk factors are age, obesity, and being male.
However, post-traumatic stress disorder (PTSD) is also a risk factor for OSA and affects more women than men. Women with a history of sexual trauma are at elevated risk for OSA, but it is something easily overlooked. If you think you may have symptoms of OSA, then it requires further evaluation by a sleep expert. If you are a candidate, your sleep will be tested with either a home test or in a sleep lab. Your sleep will be monitored to test oxygen levels and the number of apneas or episodes of not breathing. This is important to test before using over-the-counter sleep aids that may prohibit waking up, which is essential to start breathing again.
If you do have OSA, you may be a candidate for a device called a continuous positive airway pressure (CPAP) machine, which keeps your throat open so you can breathe. This can be obtained by prescription from your doctor. There are also some new alternative devices on the market that may be helpful. For some, changing positions from sleeping on your back to sleeping on your side can help. This is called positional sleep apnea. Try sleeping on your side to see if that helps.
2. Consider Caffeine
The next issue to assess is the intake of substances that could interfere with sleep. The number one culprit is caffeine. When people wake up tired, it is natural to reach for one’s beloved coffee for a get-up-and-go boost for the day. However, most people are not aware of caffeine limits and the impact on quality of sleep. The FDA recommends not to exceed 400mg in a day, and that’s about four small (8oz) cups. Most cups are larger than this. In addition, caffeine is in soda, tea, chocolate, energy drinks, and some migraine medication. The ounces can add up very quickly. Some people are more sensitive and a fraction of this amount would lead to disrupted sleep.
The problem with regards to sleep is two-fold: Caffeine is related to initial insomnia (which means difficulty falling asleep) and it also impairs deep restorative sleep. This means even if you can fall asleep, the quality of sleep is impacted—thus leading to waking up feeling tired and reaching for more coffee.
One client swore that caffeine had absolutely no effect on him, but he had symptoms of chronic insomnia, irritability, and fatigue. He reluctantly agreed to an experiment of cutting out coffee for three weeks. He reported that he felt great, was sleeping much better, and feeling less anxious. He decided to switch to drinking an herbal tea that his daughter bought him. He said he was so surprised that his symptoms were related to the coffee. Knowing that people love their caffeinated beverages, and understanding that some claim the taste of decaf is inferior, I suggest the following trick: When you brew your coffee, mix half decaf and half regular. The taste should be fine, and it cuts the caffeine in half. Maybe try your own experiment and see how you feel.
3. Avoid Daytime Naps
Although a nice cozy nap on the couch sounds great, it is not so great for a good night’s sleep. If you find yourself taking frequent naps, you are likely not getting enough sleep during the night and feeling tired. Your body is trying to compensate for lack of sleep. However, this perpetuates the pattern of diminished sleep at night. It is recommended not to take naps, but rather allow yourself to be tired when you go to sleep. If it’s a bit earlier than your regular sleep time, that is OK. But the goal is to sleep during the night, not during the day.
4. Stick to a Sleep Schedule
Did you know that you should set your sleep schedule by your wake-up time? Regardless of what time you go to sleep, set your wake-up time to be the same every morning. This will help your body regulate your sleep cycles. You will naturally fall asleep at a certain time and wake up at a certain time. Even if you are still tired, it helps to get up to support your body’s natural sleep rhythm.
5. Address Worrying
Other culprits that prevent good sleep are nagging worries, anxiety, not wanting to forget something, anticipation of the next day’s activities, worrying about getting up in time not to be late, thinking about negative things that could happen (e.g., “what if” thinking), etc. These thoughts activate the release of neurotransmitters that are energizing, stimulating, and definitely not supportive of sleep. Preparing for sleep is the time when we want a calm mind, not one that is excessively busy. One strategy is to keep a journal by your bed and use it to write everything you want to remember or think about the next day. Let the thoughts rest in the journal, and allow your mind to take a break.
6. Wind Down and Relax
If you are watching television, typing on the computer, or scrolling through your phone right before bed, you might not be giving yourself time for your mind to wind down and relax. Screen time is activating. Scary movies are activating. Eating ice cream is activating. Having an argument is also activating. These things can interfere with the release of melatonin which is the chemical that makes us tired.
Instead, practice a calming ritual before sleep. Maybe enjoy a bath, music, meditation, doing some stretches, or writing in your journal. Allow yourself to have some calming time before sleep. To help with melatonin production, make sure you sleep in a dark room. Some people supplement with a low dose of melatonin purchased over the counter. Try a very small dose (.5 -1 mg) to see if that works. Higher doses have been associated with strange or disturbing dreams. People tend to sleep better in a cool, dark room, with clean sheets, a cozy blanket, and a soft but supportive pillow. Make your bedroom your sanctuary and give yourself some time to wind down.
7. Set Your Intention
Before you go to sleep, set your intention. This means focusing on positive thoughts and affirming that you intend to have a deep restful sleep with liberating dreams. Since you are the author of your dreams, it helps to put your mind into a positive state before sleep. You can use a positive focal point, imagery such as either recalling a happy memory or constructing a fantasy, reading positive affirmations, or listening to relaxing music. Many people like to pray before they go to sleep, as this helps the intention for a safe rest. What do you intend?
8. Focus on Rest
Finally, trying to sleep when you can’t sleep is certainly going to disrupt your sleep. Instead, after 20 minutes, get out of bed. Calm your mind. Then, maybe engage in a boring task. The old wives' tale of counting sheep is actually rooted in some truth. Counting, reading a boring or technical book, or doing a repetitive task has been found to make people sleepy.
Another strategy is to focus on relaxing or resting instead of sleeping. If you are in bed, imagine you are so relaxed that your body is sinking into the bed. Your muscles are melting into the bed. Your body may feel heavy and fully supported. Focus on wiggling your toes and then take slow deep breaths, exhaling completely. Remind yourself that you are safe, loved, strong, and supported. In this moment, you are OK and there is nothing else for you to do right now, but to be here and rest. Think of a beautiful image, something that makes you happy. Remind yourself that this is your time to enjoy getting a good night’s rest.
