Sleep Hygiene Guidelines Sleep hygiene is the preferred treatment for insomnia. People who suffer from insomnia can most often find relief just by changing a few habits. The results from making these small changes are much more powerful than you might realize. Medications for sleep do not fix the problem. If taken for more than a few weeks, they can potentially cause you to be unable to sleep without them. These medications have negative side effects, whereas the behavioral changes only have positive ones. The long term side effects of taking sleeping pills is not known at this time, though I wouldn't be surprised if we find them to have more serious negative effects than are currently claimed. If sleep hygiene doesn’t completely fix the problem, then you should give thought to a program of sleep restriction. Changeable habits to relieve insomnia can be broken down into four different categories: • Your emotional well-being • Daytime activities that prepare you for sleep at night • Evening practices that allow your body to wind down before bedtime • Practices for when you cannot sleep Your Emotional Well-Being Undiagnosed or under-treated depression or anxiety can be a contributor to insomnia. Treatment with medications may be helpful, but studies have suggested that a special type of counseling called Cognitive Behavioral Therapy is helpful in eliminating insomnia in both people who are seriously depressed or anxious, as well as those who have very minor symptoms. This type of therapy is usually based on a set number of visits and tends to be more structured than other types of psychotherapy. It is the basis of some of the more popular self-improvement programs that have sprung up in the last few years, including the new field of Positive Psychology. Daytime Activities That Prepare You for Sleep at Night First, you need to understand a little about how your body regulates its drive for sleep. We’ll discuss two drives for sleep: a hormonal clock that is sensitive to sunlight exposure, and a buildup of physical exhaustion from a day of moving the body through its paces. Melatonin The hormonal clock is driven by melatonin, which is released by your brain in response to varying amounts of light. When the sun begins to set on the horizon, the light intensity decreases, prompting the release of melatonin. It’s called the dark hormone. The rise in melatonin continues throughout the evening. This causes changes in your body temperature and level of arousal, getting you ready for sleep. Concurrent with this rise in melatonin is an increase in physical exhaustion. As the rising melatonin compliments the mounting physical fatigue, your body easily slips into sleep. Melatonin production in nature is tied to sunlight. In our world of artificial lights, this hormone's production can be altered. This alteration can be one factor contributing to insomnia. Interestingly, by altering melatonin production, artificial light may have effects more widespread than originally thought. Some research has suggested that interference with melatonin production by bright lights in the evening may be tied to increases in some cancer rates. Several hours prior to bedtime, you should start decreasing the intensity of your artificial light exposure. Start dimming the lights. Brush your teeth, and any other bathroom routines that usually require bright bathroom lights, one hour or more before bedtime. For the last hour or more, avoid bright lights. Use as dim a light as possible while you get ready for bed. If you like to read before going to bed, use a dim light. Reading by a dim light will not ruin your eyesight. In addition, avoid watching TV or using the computer, as these both interfere with melatonin production. If you get up in the middle of the night to urinate, have a night light in the bathroom so that you don't have to turn on the main light. A fixed wake-up time is of great importance in developing a good sleep pattern, more important than a fixed bedtime. If you are having trouble sleeping, then keep a fixed wake-up time, even on weekends. In the morning, get out of bed and expose yourself to bright light to turn off that melatonin so you can start your day. Going on a walk at sunrise is great way to start the day. Bright lights in the house or a light box can also be helpful. This helps set your internal clock or the circadian rhythm as it’s also called. I've been experimenting with some glasses and some light bulbs that block out the blue light wavelengths that are responsible for suppressing melatonin production. You would wear these glasses, or use only these yellow light bulbs, for an hour or two before bedtime, so that you start producing melatonin before you try and go to sleep. This rise in melatonin before bedtime should help ease you into sleep. Or when you get up at night to feed the baby or visit the restroom, you could use one of their special light bulbs so as not to interrupt your production of melatonin. In my house, we’re using these yellow light bulbs in our bedside lamps. The light quality is fine for reading. The bulbs are relatively inexpensive. Why don’t you give it a try and let me know if it works for you. See this site for more information. . LowBlueLights.com Physical Exhaustion and Fatigue I work in an office, sitting down most of the day. During the course of my workday, I walk a maximum of one or two miles. At the end of the day, I’m often extremely tired. I've been busy all day, sometimes working through lunch. My body feels like it has run a marathon. Here's the key point: it hasn't. There is a difference between the body and mind fatigue that most of us experience during a normal workday, and the fatigue felt after strenuous exercise. One promotes a smooth transition to sleep; the other does not. Humans are designed to walk long distances, up to twelve miles over the course of a day in search of food. The natural world requires a level of physical effort every day that makes the number of calories burned at the modern workplace pale in comparison. While I feel tired after a long day, my body has not built up a real physical burden of fatigue. That is only provided when I take time out each day to exercise my body in the way in which it was designed. I suggest that you try to get the equivalent of at least an hour of walking, three to four miles, each day. You could walk the dog for an hour, take two thirty-minute walks, or run or do some other high intensity workout that would translate into the same amount of work for thirty minutes. This is a minimum. If you're designed to walk twelve miles a day, a one hour walk seems pretty easy in comparison. However, don't exercise within a couple of hours of bedtime. Humans don't see well at night, so in nature we tapered off exercise as the evening progressed. Napping If you are having trouble with sleep at night, DO NOT nap in the daytime. Substances That Interfere with Sleep If possible, avoid substances that interfere with sleep: • Caffeine, even in small amounts, may interfere with sleep for many hours. • Nicotine is a stimulant and interferes with sleep. • Alcohol, while it can induce sleep, usually leads to overall sleep disruption, with rebound awakening when the alcohol is metabolized after a few hours. • Be aware that certain medications can interfere with sleep. Two of the most common are theophylines and steroids. These are just a couple of the dozens of medications capable of disrupting your sleep. Evening Practices That Encourage Your Body to Wind Down and Get Ready for Bedtime Is it OK to eat late at night? A lot of people suffer from gastric reflux (heartburn) if they lay down within an hour or so of a meal. For these folks, it is best to eat their last meal several hours prior to bedtime. Also consuming too many fluids near bedtime is a frequent cause of nighttime urination. In general, if you have insomnia, complete your dinner about four hours before bedtime, and limit your fluid intake starting about two hours before bedtime. Do not watch TV or play on the computer/Internet for one to two hours before bed. Most importantly, don’t do these activities after bedtime. These activities may seem relaxing while you are doing them, but they are actually activating your brain, using a primitive orienting reflex that was developed to alert you to danger. Many people are subtly more anxious after they turn off the TV or computer than they were while they were using it. Don’t mistake this as evidence of a calming effect of television or the Internet. The anxious feeling is a withdrawal from the sudden cessation of extreme visual stimulation. This is double trouble. These activities have an activating effect on many people. They also involve light sources that decrease the flow of melatonin. Avoid bright lights for 30 to 60 minutes prior to bed and whenever you get out of bed. Put a dim night light in the bathroom so that you don’t have to turn on the bright overhead light. Bright lights will confuse your brain, making your internal clock think it’s daytime. Try a warm bath or shower 90 minutes before sleep. Although not just before sleep, as we sleep better as our body temperature cools, not when it heats up. Many people find that keeping a diary and writing down all that is on their mind, such as the next day's schedule, helps leave all those thoughts on paper, and helps them to fall asleep. Having a yoga, meditation or relaxation routine, lasting from ten minutes to half an hour can be the key to getting you ready for sleep. This type of practice can put some space between your hectic day and your upcoming sleep period. I have found that a mindfulness yoga routine lasting 15 or 20 minutes is the key to a good night’s sleep for me. It serves to stop my mind from going over the activities of the day or dwelling on the next day. You can look at my Yoga and Meditation web page, or at a CD called “Sleep Solutions.” Your Bedroom Environment Your bedroom should be dark; get special curtains if needed. The room should be quiet. If this is impossible, consider trying earplugs. However, some people do better with some background white noise. The importance of a good mattress should not be underestimated. Poor quality mattresses lose their support more quickly. The mattress should support your spine in its normal position, relieving the need for muscles to work at support while you sleep. The bedroom should be reserved for either sleep or sex. Other activities such as reading and TV often promote wakefulness, not sleep. What to Do if You Can’t Sleep Try not to anticipate poor sleep. Worrying about whether you will fall asleep often means you won't. While a poor night’s sleep leaves you feeling badly the next day, it isn't a fatal disease. If you just trust your body, you will sleep. Allow yourself to get enough sleep. Some people need 8 hours, some less, some more. You cannot learn to do with less sleep than you physiologically need. You need enough sleep to feel alert and well rested during the day without struggling to stay awake, even in quiet restful situations. If you need less sleep than 8 hours, do not spend the extra time in bed, this often actually leads to more interrupted sleep. Once again, if you do get out of bed, avoid exposing yourself to bright lights. Put night lights in the hall and bathroom so you can navigate around the house in the dark. If you can't fall asleep or do not feel sleepy, don't lie in bed trying to sleep. This often will make the problem worse. After lying awake in bed for no more than thirty minutes, get up and do something that is not too stimulating. Avoid housework or homework. Try reading a somewhat boring book in dim light. Read light material. Better yet, try a relaxing stretching or meditation routine. If you don't fall asleep within the twenty to thirty minutes, you can stay in bed if you have the skills to keep yourself relaxed and calm. For example, if you use a technique like mindfulness meditation (see the web page on Yoga and Meditation for details), you could stay in bed and practice this till you fall asleep. I've had many a sleepless night when I've practiced this mindfulness meditation technique laying in bed for the whole night. Sure I didn't sleep, but in the morning, I felt remarkably relaxed and refreshed, and I slept fine the next night. I would caution you, that if you don't have a similar meditation or relaxation technique to practice while you lie there in bed, it's better to get out of bed. Laying awake, letting your mind race or worrying about how little sleep you're going to get is the worst thing you can do. This creates a situation where you associate being in bed with anxiety and worry. This behavioral association can become quite strong, sometimes being the sole perpetuating factor keeping the insomnia going night after night. Besides the meditation resources on the Yoga and Meditation web page, there is a CD called “Sleep Solutions” on the Other Sleep Resources web page that has some guided meditations. If you spend most of the night in meditation, even if you are sleepy in the morning, you’ll also be very relaxed. Your day will go better being calm and sleepy. If you spend the night worrying about getting sleep, you’ll be sleepy and crabby, and your day will not go well. I hope this has been helpful.

Sleep Hygiene Guidelines

Sleep hygiene is the preferred treatment for insomnia. People who suffer from insomnia can most often find relief just by changing a few habits. The results from making these small changes are much more powerful than you might realize. Medications for sleep do not fix the problem. If taken for more than a few weeks, they can potentially cause you to be unable to sleep without them. These medications have negative side effects, whereas the behavioral changes only have positive ones. The long term side effects of taking sleeping pills is not known at this time, though I wouldn't be surprised if we find them to have more serious negative effects than are currently claimed.

If sleep hygiene doesn’t completely fix the problem, then you should give thought to a program of sleep restriction.

Changeable habits to relieve insomnia can be broken down into four different categories:

• Your emotional well-being

• Daytime activities that prepare you for sleep at night

• Evening practices that allow your body to wind down before bedtime

• Practices for when you cannot sleep

Your Emotional Well-Being

Undiagnosed or under-treated depression or anxiety can be a contributor to insomnia. Treatment with medications may be helpful, but studies have suggested that a special type of counseling called Cognitive Behavioral Therapy is helpful in eliminating insomnia in both people who are seriously depressed or anxious, as well as those who have very minor symptoms. This type of therapy is usually based on a set number of visits and tends to be more structured than other types of psychotherapy. It is the basis of some of the more popular self-improvement programs that have sprung up in the last few years, including the new field of Positive Psychology.

Daytime Activities That Prepare You for Sleep at Night

First, you need to understand a little about how your body regulates its drive for sleep. We’ll discuss two drives for sleep: a hormonal clock that is sensitive to sunlight exposure, and a buildup of physical exhaustion from a day of moving the body through its paces.

Melatonin

The hormonal clock is driven by melatonin, which is released by your brain in response to varying amounts of light. When the sun begins to set on the horizon, the light intensity decreases, prompting the release of melatonin. It’s called the dark hormone. The rise in melatonin continues throughout the evening. This causes changes in your body temperature and level of arousal, getting you ready for sleep. Concurrent with this rise in melatonin is an increase in physical exhaustion. As the rising melatonin compliments the mounting physical fatigue, your body easily slips into sleep.

Melatonin production in nature is tied to sunlight. In our world of artificial lights, this hormone's production can be altered. This alteration can be one factor contributing to insomnia. Interestingly, by altering melatonin production, artificial light may have effects more widespread than originally thought. Some research has suggested that interference with melatonin production by bright lights in the evening may be tied to increases in some cancer rates.

Several hours prior to bedtime, you should start decreasing the intensity of your artificial light exposure. Start dimming the lights. Brush your teeth, and any other bathroom routines that usually require bright bathroom lights, one hour or more before bedtime. For the last hour or more, avoid bright lights. Use as dim a light as possible while you get ready for bed. If you like to read before going to bed, use a dim light. Reading by a dim light will not ruin your eyesight. In addition, avoid watching TV or using the computer, as these both interfere with melatonin production. If you get up in the middle of the night to urinate, have a night light in the bathroom so that you don't have to turn on the main light.

A fixed wake-up time is of great importance in developing a good sleep pattern, more important than a fixed bedtime. If you are having trouble sleeping, then keep a fixed wake-up time, even on weekends.

In the morning, get out of bed and expose yourself to bright light to turn off that melatonin so you can start your day. Going on a walk at sunrise is great way to start the day. Bright lights in the house or a light box can also be helpful. This helps set your internal clock or the circadian rhythm as it’s also called.

I've been experimenting with some glasses and some light bulbs that block out the blue light wavelengths that are responsible for suppressing melatonin production. You would wear these glasses, or use only these yellow light bulbs, for an hour or two before bedtime, so that you start producing melatonin before you try and go to sleep. This rise in melatonin before bedtime should help ease you into sleep. Or when you get up at night to feed the baby or visit the restroom, you could use one of their special light bulbs so as not to interrupt your production of melatonin. In my house, we’re using these yellow light bulbs in our bedside lamps. The light quality is fine for reading. The bulbs are relatively inexpensive. Why don’t you give it a try and let me know if it works for you. See this site for more information. . LowBlueLights.com

Physical Exhaustion and Fatigue

I work in an office, sitting down most of the day. During the course of my workday, I walk a maximum of one or two miles. At the end of the day, I’m often extremely tired. I've been busy all day, sometimes working through lunch. My body feels like it has run a marathon. Here's the key point: it hasn't. There is a difference between the body and mind fatigue that most of us experience during a normal workday, and the fatigue felt after strenuous exercise. One promotes a smooth transition to sleep; the other does not. Humans are designed to walk long distances, up to twelve miles over the course of a day in search of food. The natural world requires a level of physical effort every day that makes the number of calories burned at the modern workplace pale in comparison. While I feel tired after a long day, my body has not built up a real physical burden of fatigue. That is only provided when I take time out each day to exercise my body in the way in which it was designed. I suggest that you try to get the equivalent of at least an hour of walking, three to four miles, each day. You could walk the dog for an hour, take two thirty-minute walks, or run or do some other high intensity workout that would translate into the same amount of work for thirty minutes. This is a minimum. If you're designed to walk twelve miles a day, a one hour walk seems pretty easy in comparison. However, don't exercise within a couple of hours of bedtime. Humans don't see well at night, so in nature we tapered off exercise as the evening progressed.

Napping

If you are having trouble with sleep at night, DO NOT nap in the daytime.

Substances That Interfere with Sleep

If possible, avoid substances that interfere with sleep:

• Caffeine, even in small amounts, may interfere with sleep for many hours.

• Nicotine is a stimulant and interferes with sleep.

• Alcohol, while it can induce sleep, usually leads to overall sleep disruption, with rebound awakening when the alcohol is metabolized after a few hours.

• Be aware that certain medications can interfere with sleep. Two of the most common are theophylines and steroids. These are just a couple of the dozens of medications capable of disrupting your sleep.

Evening Practices That Encourage Your Body to Wind Down and Get Ready for Bedtime

Is it OK to eat late at night? A lot of people suffer from gastric reflux (heartburn) if they lay down within an hour or so of a meal. For these folks, it is best to eat their last meal several hours prior to bedtime. Also consuming too many fluids near bedtime is a frequent cause of nighttime urination. In general, if you have insomnia, complete your dinner about four hours before bedtime, and limit your fluid intake starting about two hours before bedtime.

Do not watch TV or play on the computer/Internet for one to two hours before bed. Most importantly, don’t do these activities after bedtime. These activities may seem relaxing while you are doing them, but they are actually activating your brain, using a primitive orienting reflex that was developed to alert you to danger. Many people are subtly more anxious after they turn off the TV or computer than they were while they were using it. Don’t mistake this as evidence of a calming effect of television or the Internet. The anxious feeling is a withdrawal from the sudden cessation of extreme visual stimulation. This is double trouble. These activities have an activating effect on many people. They also involve light sources that decrease the flow of melatonin.

Avoid bright lights for 30 to 60 minutes prior to bed and whenever you get out of bed. Put a dim night light in the bathroom so that you don’t have to turn on the bright overhead light. Bright lights will confuse your brain, making your internal clock think it’s daytime.

Try a warm bath or shower 90 minutes before sleep. Although not just before sleep, as we sleep better as our body temperature cools, not when it heats up.

Many people find that keeping a diary and writing down all that is on their mind, such as the next day's schedule, helps leave all those thoughts on paper, and helps them to fall asleep.

Having a yoga, meditation or relaxation routine, lasting from ten minutes to half an hour can be the key to getting you ready for sleep. This type of practice can put some space between your hectic day and your upcoming sleep period. I have found that a mindfulness yoga routine lasting 15 or 20 minutes is the key to a good night’s sleep for me. It serves to stop my mind from going over the activities of the day or dwelling on the next day. You can look at my Yoga and Meditation web page, or at a CD called “Sleep Solutions.”

Your Bedroom Environment

Your bedroom should be dark; get special curtains if needed.

The room should be quiet. If this is impossible, consider trying earplugs. However, some people do better with some background white noise.

The importance of a good mattress should not be underestimated. Poor quality mattresses lose their support more quickly. The mattress should support your spine in its normal position, relieving the need for muscles to work at support while you sleep.

The bedroom should be reserved for either sleep or sex. Other activities such as reading and TV often promote wakefulness, not sleep.

What to Do if You Can’t Sleep

Try not to anticipate poor sleep. Worrying about whether you will fall asleep often means you won't. While a poor night’s sleep leaves you feeling badly the next day, it isn't a fatal disease. If you just trust your body, you will sleep.

Allow yourself to get enough sleep. Some people need 8 hours, some less, some more. You cannot learn to do with less sleep than you physiologically need. You need enough sleep to feel alert and well rested during the day without struggling to stay awake, even in quiet restful situations. If you need less sleep than 8 hours, do not spend the extra time in bed, this often actually leads to more interrupted sleep.

Once again, if you do get out of bed, avoid exposing yourself to bright lights. Put night lights in the hall and bathroom so you can navigate around the house in the dark.

If you can't fall asleep or do not feel sleepy, don't lie in bed trying to sleep. This often will make the problem worse. After lying awake in bed for no more than thirty minutes, get up and do something that is not too stimulating. Avoid housework or homework. Try reading a somewhat boring book in dim light. Read light material. Better yet, try a relaxing stretching or meditation routine.

If you don't fall asleep within the twenty to thirty minutes, you can stay in bed if you have the skills to keep yourself relaxed and calm. For example, if you use a technique like mindfulness meditation (see the web page on Yoga and Meditation for details), you could stay in bed and practice this till you fall asleep. I've had many a sleepless night when I've practiced this mindfulness meditation technique laying in bed for the whole night. Sure I didn't sleep, but in the morning, I felt remarkably relaxed and refreshed, and I slept fine the next night. I would caution you, that if you don't have a similar meditation or relaxation technique to practice while you lie there in bed, it's better to get out of bed. Laying awake, letting your mind race or worrying about how little sleep you're going to get is the worst thing you can do. This creates a situation where you associate being in bed with anxiety and worry. This behavioral association can become quite strong, sometimes being the sole perpetuating factor keeping the insomnia going night after night.

Besides the meditation resources on the Yoga and Meditation web page, there is a CD called “Sleep Solutions” on the Other Sleep Resources web page that has some guided meditations.

If you spend most of the night in meditation, even if you are sleepy in the morning, you’ll also be very relaxed. Your day will go better being calm and sleepy. If you spend the night worrying about getting sleep, you’ll be sleepy and crabby, and your day will not go well.

I hope this has been helpful.