Sleep is fundamental to good mental and physical health. Sleep is the first item on our symptom checklist when you come to our office to complete paperwork. Sleep deprivation affects working memory and attention and makes it difficult to manage stress, anxiety, and depression. When we are trying to reset a sleep schedule, the first item (1. Restrict your sleep) is essential as a starting place. I frequently hand this out to my clients and patients. The handout is titled:
“Best Practices for a Good Night’s Sleep”
- Restrict your sleep between your usual bedtime and arising time. Always get up and go to bed at the time you set, whether you slept well or not. This rule applies to weekends as well. The amount of restriction varies depending upon your current pattern. For example, your counselor may suggest you stay up until midnight and get up at 5:00 am whether you slept or not. Persist with the restriction until you fall asleep regularly, and then add an earlier bedtime a bit at a time. Add back only after sleep stabilizes each time.
- Develop a ritual of winding down before bedtime. Do not watch blood and gore on television or read Stephen King novels before bedtime. Reschedule conversations about stressful subjects for daytime problem-solving. Do some meditation. Pray or read positive affirmations or scripture. A hot bath or shower can be relaxing. The drop in body temperature following the bath can make you sleepy.
- Avoid alcohol as bedtime approaches. While alcohol may help you fall asleep, it will tend to cause early awakening and interfere with your sleep quality.
- Do not use caffeine at least six hours before bedtime. Remember, many sodas and iced tea contain caffeine. Caffeine will interfere with your ability to get a deep sleep. Medications and over-the-counter medications may contain stimulants that keep you from a deep sleep or cause sleep-onset insomnia.
- Stop watching television, using your computer, or using fluorescent lighting an hour before bedtime. Sources of blue light stimulate the hypothalamic system. Spectrum blue light will suppress the production of the natural sedative melatonin
- Do not take naps. Stay awake until your usual bedtime.
- Avoid using over-the-counter sleep aids and only use prescribed medications for sleep for short periods. Becoming dependent upon sleep aids suggests biological, psychological factors, or emotional distress. Cognitive-behavioral therapy (CBT) was most effective for sleep problems and provided long-lasting positive outcomes compared to medication, placebo, and medication plus CBT (Jacobs et al. Archives of Internal Medicine 2004).
- Get out of bed. If you can’t fall asleep within 15 or 20 minutes, get up and do some relaxing activity. Read a book or magazine (not a thriller or page-turner), or listen to quiet music. When you feel sleepy, return to bed. Repeat this cycle as often as necessary until it is time to get up.
- Nonetheless, even if you don’t feel that you slept, get up. Sleep restriction (see rule #1) will help you fall asleep. When you get up because you are not falling asleep, don’t make the room too bright because this may act as a cue to your brain to wake up.
- White noise can block out conversations or other sounds that get your attention. A fan or sound machine works well for most people.
- Exercise almost every day. Start with small steps and gradually work your way up to a target of 45 to 60 minutes. This number is cumulative, e.g., two or three short walks can quickly add up to 45 minutes or more. Some people are stimulated by late exercise, which may keep them from falling asleep; however, everybody is different, and late exercise may be just fine as long as it is not too intense.
- Turn your clock to the wall so you aren’t waking up and checking how much time you have to sleep.
- Use your bed only for sleeping and sexual activity. Avoid watching TV (see rule #4), paying bills, or reading in bed. You are trying to teach your brain and body that it is time to sleep when you go to bed.
- Make sure you have a comfortable bed, and the temperature is right. Cool rooms with warm blankets can be helpful.
- Eat a snack if you feel hungry. Being hungry can interfere with your ability to fall asleep. Avoid heavy meals or foods that may induce acid reflux or indigestion. Dairy products or meats containing tryptophan may aid your sleep.
- Slow your breathing down to 4.5 to 6 times per minute while relaxing. Use this app on iTunes or on Google Play to develop the skill of breathing to relax. You may find this is a quick route to falling asleep most of the time.
- After you get up, turn on the bright lights or go outside into the sun and turn your face in the direction of the sun. Hang out in the sunshine for twenty minutes with your skin exposed to aid in the production of vitamin D. The sun’s light can help reset your biological clock.
David L. Barnhart, EdD
Licensed Counselor – Supervisor
Board Certified Clinical Mental Health Counselor
