Rx for Poor Sleep

By Lauren Muhlheim, Psy.D.

Appeared in Parkway Health Newsletter, May 2009

Many people experience difficulty sleeping, whether due to stress or bad sleeping habits.  If you have chronic sleeping problems, in most cases taking sleeping pills is not the best or safest option.  Sleeping pills are designed primarily for short-term use and may cause physical or psychological addiction which can exacerbate your sleeping problems when you stop taking them. They may also cause excessive daytime sleepiness.

Through some basic clinically proven behavioral strategies, many people with insomnia can improve the duration and quality of their sleep.  These strategies are not a “quick fix,” but will give you more effective and safer results than sleeping pills in the long run.  Don’t give up after one or two nights.  It may take several weeks to break poor sleep patterns and up to 10 to 12 weeks for significant, long-term improvement.

Establish a regular sleep schedule

Try to stick to a regular schedule, going to sleep at night and waking up each morning at a consistent time no matter how much you slept during the night.  Do not nap during the daytime.  Naps can decrease the amount and quality of your nighttime sleep.  Instead, even if you are tired during the day, force yourself to stay awake until your regular sleep time.  Resist the temptation to sleep late on weekends which can shatter your biological rhythms. 

Follow a sleep ritual prior to going to bed.  Performing the same activities night after night becomes a well-learned reminder for rest.  These might include taking a bath, brushing your teeth, washing your face, and reading a book. 

Exercise

Exercise regularly during the day or early evening.  Exercise will help relax your muscles, discharge excess energy, and improve sleep.  However, don’t exercise within 5 hours of bedtime as this may interfere with sleep. 

Control your consumption

Avoid caffeine after lunch and avoid alcohol and nicotine.  Smokers often find it more difficult to fall and remain asleep due to withdrawal.  While alcohol might make you drowsy, it can also disrupt the soundness of sleep.  

Reduce fluids after dinner-time (to reduce bathroom trips which disrupt sleep).  Similarly, avoid eating large amounts of food too close to bedtime, but don’t go to bed on an empty stomach as hunger pangs can also keep you awake.

Condition yourself to associate your bed with sleep

Avoid spending wakeful time in bed to prevent the creation of competing associations that interfere with sleep. Don’t spend large amounts of time reading or watching t.v. or working in bed.  If you aren’t asleep 10 minutes after you get into bed, get up and leave the room for a quiet activity like reading.  When you begin to feel sleepy, return to bed; if you don’t fall asleep in 10 minutes, leave again.  Repeat until you’re so tired you fall asleep within the 10-minute limit.  In six weeks, you should be able to settle down for the night on your first try.

Make yourself comfortable and relaxed….

You’ll sleep best in surroundings where you feel secure and relaxed.  Make sure the room is quiet and at a comfortable temperature.  Shut off the t.v.  Make your room dark - your biological clock relies on light as one of its strongest cues for wakefulness.  Try to make your bed as comfortable as possible.  

If you need more serious focus, use some relaxation techniques prior to going to sleep.  These can include simple yoga exercises, relaxation breathing, or guided relaxation.  Relaxation tapes can be downloaded from the website (www.brainplayground.com).

Address problematic thinking that interferes with sleep

If you tend to be a worrier, set aside a time early in the evening to focus on problems or make a list of pressures, things to do, etc.  Train yourself to leave daytime pressures at the bedroom door.

Examine your mistaken thoughts and beliefs about sleep and keep it in perspective.  In most cases, the frustration over not sleeping has more impact on mood than the actual lack of sleep.  Trying really hard to sleep often backfires, making sleep even more elusive.  Most people are bad estimators of their sleeping patterns.  Even when you think you didn’t sleep at all, you probably slept several hours.  Many people worry that if they don’t get enough sleep they’ll be a wreck the next day.  There’s little reason to be afraid of insomnia:  while unpleasant, the truth is, for most tasks, one sleepless night will not dramatically affect performance

Seek help

If sleep does not improve after several weeks of using the above techniques, consult your medical doctor.  While the majority of sleep problems are benign, others may be a sign of something more serious.  Emotional problems such as depression and underlying medical problems such as sleep apnea can manifest as sleep disorders.  

Sweet Dreams!

Dr. Lauren Muhlheim is an American psychologist who relocated to Shanghai along with her family.  She practices at Parkway Health and the Community Center Shanghai and is President of the Shanghai International Mental Health Association.