So here we show you how to nip each type of sleep-disturbance pattern in the bud with the best self-help techniques. (See ” Sleep-Disorders Clinics” on page 80 for help in determining when your sleep problem is serious enough to deserve a sleep-medicine specialist’s attention.)
PATTERN #1: TROUBLE FALLING ASLEEP
Release the pressure valve. It’s one thing to have trouble sleeping. It’s quite another to start worring about having trouble sleeping. Before long, the worry itself can start to interfere with your ability to fall asleep, even when the initial cause of sleeplessness is gone. Fortunately, there’s much you can do to eliminate this second tier of trouble.
“Trying to sleep is the worst thing you can do,” says Peter Hauri, Ph.D, director of the insomnia program at the Mayo Clinic in Rochester, Minnesota, “because the more you try to sleep and focus on sleeping, the harder it will be to fall asleep.”
One thing that adds to the pressure of falling asleep is seeing the bedroom clock–a reminder of how late it is. “The clock in the bedroom is poison in most cases,” says Dr. Hauri. “It puts too much pressure on you to fall asleep. You only struggle with yourself, trying harder and harder to sleep the later it gets.” He suggests that you set your alarm and stick it in a dresser drawer. Hide your watch, and throw a towel over the VCR clock, too.
Relaxation techniques (such as meditation, counting your breaths, slowly tensing and relaxing muscles, and others) can help. Find one you’re comfortable with and remember not to try too hard to relax, or you’ll just make yourself more tense. Dr. Hauri offers this counting method in his book No More Sleepless Nights (John Wiley & Sons, 1990):
With your eyes closed and while lying in bed, let your body go limp. Count slowly from 100 to 0, seeing the numbers being written one below the other, like they’re on descending stair steps. Feel your body relax. Keep counting until you fall asleep.
Control in-bed time. When time spent tossing and turning is added to sleep time, the in-bed period may begin to spread too far, and quality of sleep can be affected. “It’s like water spreading over a big area. The longer you stay in bed, the shallower your sleep will be,” says Dr. Hauri. “Most people stay in bed too long when they haven’t slept through the night. So they learn to associate the bedroom with tossing and turning, not sleeping.”
So retire to your bedroom only when you’re sleepy. Don’t make yourself go to bed at a certain time if you aren’t tired.
Some sleep experts say that you shouldn’t read, eat or watch TV in bed. If you’re having trouble falling asleep, they say, get up and go to another room until you’re sleepy again, no matter how many times a night this happens. the goal is to associate your bedroom with sleepiness (and pleasure), not frustration.
Watch your tolerance for you-know-what. It would be hard to find someone who didn’t know that caffeine can hinder your ability to fall asleep. But here’s something you might not realize: Your body’s tolerance of caffeine can be dramatically altered as you grow older.
Try reducing the caffeine in your diet for a few weeks. (Decrease it slowly, becayse some heavy caffeine users experience headaches, irritability and other withdrawal symptoms at first.) If you sleep better and are less anxious, caffeine could be the culprit in your insomnia. Dr. Hauri recommends that if you have insomnia you should consumer fewer than two eight-ounce cups of coffee a day, and never have caffeine after lunch.
One more thing to keep in mind: Even if caffeine isn’t keeping you from falling asleep, it can cause you to wake up more often during the night, and can make sleep less restful.
Sleep in synch. Many people who can’t fall asleep are suffering from delayed sleep phase syndrome (DSPS). Their circadian rhythm–a kind of internal clock–is out of synch with the world they live in.
They find themselves going to sleep at 3 a.m. and staying in bed until noon. They may get the normal length of sleep, but it comes at the wrong time. And when they have to get up early, they suffer sleep deprivation.
Fortunately, there is a solution: bright light. How bright is bright? “About four to five times brighter than ordinary indoor lighting,” says Al Lewy, M.D., Ph.D., director of the sleep and mood-disorders clinic at the University of Oregon Health Science Center.
Bright light helps to reset the body’s circadian rhythm, or internal clock, which has been found to control hormone levels, body temperature hormone levels, body temperature and arousal. “You use the bright light as soon as you wake up for 30 to 120 minutes per day. Then each day, or every other day, you move your wake-up time (and therefore your light-exposure time) to 15 minutes earlier, until you’re waking up at the desired time.
“This should automatically move your sleepiness time earlier so you fall asleep earlier,” says Dr. Lewy. Though success with this technique has been reported in a matter of days, he says. “It usually takes a few weeks. And you may need to use light exposure every other day or so, 15 to 60 minutes duration, to maintain the correct sleep phase. If you’re waking up early already, obviously you don’t need to shift your wake-up time progressively earlier. But you do need to get bright light as soon as you wake.”
You can purchase a light box, available through some drugstores and medical-supply houses. “They’re simply portable lights that use ordinary fluorescent bulbs, covered by a plastic diffuser,” says Dr. Lewy. The light should shine on your face from above at a 45-degree angle, while you look forward the light (but not into the light) once or twice a minute. It’s best to scan the light from side to side.
PATTERN #2: UNSOUND SLEEP
Increase body heat. Regular exercise has often been advised as a means of improving sleep. Now researchers have discovered a link between exercise and nightime body temperature. And it’s becoming clear that with exercise, how and when really matter.
The body’s temperature normally goes up during the day and down at night, sometimes by as much as 2[degrees]F. But insomniacs have less variation: They don’t get as warm in the day or as cool at night, and their sleep is shallow and fragmented. But if you heat up your body with a workout about six hours before bedtime, you’ll start cooling down just as you want to go to sleep. Be sure not to exercise sooner than three hours before going to bed, or the stimulant effect of the workout might keep you awake.
Aerobic exercise that gets your heart rate up is what you need–walking, running, cycling–and you must be consistent. Three times a week will help your heart, but it might not be enough to promote sleep. Twenty to thirty minutes, five days a week is a good target to shoot for.
Nix the nightcap. Many people like to have a nightcap to put them to sleep–29 percent of those reporting sleep difficulties in a national survey use alcohol to help them sleep. While alcohol may induce sleep. While alcohol may induce sleep, at the same time it lowers the quality of your sleep and leaves you prone to waking up during the night. And drinking to induce sleep can lead to dependency.
Forget the smokes. Nicotine is a stimulant. It raises blood pressure, gets the heart going faster and makes your brain more active. If you’re a heavy smoker, nicotine withdrawal during the night may awaken you.
Feel drained. If you often find yourself waking up to urinate at night, try walking around the house or doing some other mild activity for 5 or 10 minutes an hour or so before you turn in. This helps circulate fluids into your kidneys, stimulating you to visit the bathroom before retiring. You should also avoid drinking liquids two hours before retiring.
Go for peace and quiet. If you’re easily distracted during the day, you might be easily distracted at night, too. Besides wearing earplugs, you might try turning on a fan to mask distracting noises, or try listening to a tape of a waterfall, waves or rain.
Calibrate the room temp. A room that’s too cold or too hot can awaken you. Make sure before you retire the room temperature is comfy.
Tame your tummy. Avoid heavy, spicy foods at night. They might increase your production of stomach acids and give you indigestion and awaken you.
PATTERN #3: TOO EARLY ASLEEP, TOO EARLY AWAKE
Get the light treatment. Many persons have no trouble falling alseep or sleeping soundly through the night. Their sleep appears normal. But they cannot remain awake beyond the early evening hours and they cannot
manage to sleep until sunrise.
They’re suffering from advanced sleep phase syndrome (ASPS), which is essentially the opposite of delayed sleep phase syndrome. Whereas the latter is prevalent in young persons, advanced sleep phase disorder becomes more common with age.
Once again, a light box offers a solution: “One or two hours of bright light, to end about one hour before the desired sleep time, is best,” says Dr. Lewy. “Try this for two weeks. Shift the light-exposure time gradually later (15 minutes a day until you reach the desired time), say from 7-9 p.m. to 8-10 p.m. Gradually decrease the daily exposure to 30 to 60 minutes.”
Not all persons experience early awakenings have ASPS. “Depression can also cause early-morning awakenings,” says Dr. Walsh.