Matters of Sleeplessness - Part Two

Last week I talked about resetting sleep clocks and gaining better long term sleep quality, but what do you do if, despite your best efforts, you continue waking up in the middle of the night or still struggle to fall asleep?  There are still many options available to you, so don’t despair.  Ultimately, keeping good habits will eventually make you a better sleeper, but it does come easier for some than others.

A good place to start is increasing your activity level during the day.  Take a walk during your lunch break at work, get up early and go to the gym, or have a dance party with your kids after dinner.  Increased activity during the day will tire your body and make you more likely to sleep soundly.  You may also want to set your alarm a half hour earlier than usual and get up when it goes off every day, even on the weekends or when you have suffered a sleepless night.  You will likely experience a few days where you are seriously tired, but this will force your body to adjust.

Finally, if all else fails, teach yourself small meditations, breathing exercises or tension and release exercises.  It can be as simple as counting deep yogic breaths or practicing meditations.  Invest some time in finding CDs or podcasts of meditations that work for you.  Check out the Headspace application or Dr. John-Kabat Zinn’s mindful meditations.  For those who prefer an approach that involves more guided imagery, you can check out meditation CDs lead by Dr. Brian Weiss.  If you are unfamiliar with tension and release, it is truly simple.  Beginning at your feet, you tense and hold for a few seconds every muscle working your way up your body to your face.  As you release your hold on the muscle it should feel warm and loose.  This progression often helps your body to feel more relaxed and brings on sleep. 

If you are someone who doesn’t struggle to fall asleep but wakes often, try not to get out of bed when you awake during the night.  Keep your room dark and quiet.  Do not look at your phone or any other screen as this is stimulating to your brain and will affect your ability to sleep long afterward.  Changing bad sleep habits can take time, but the overall health and emotional benefits are worth all the work.

Matters of Sleeplessness

In my practice, I’ve noticed sleep deprivation effecting patients with increasing frequency.  Sleep is closely linked to your emotional state and your ability to control and regulate emotions.  A lack of sleep, especially for an extended period of time, can cause extreme mood swings and allow anxiety to run unchecked.  While I encounter a lot of people who struggle to fall asleep, I encounter just as many who wake up often throughout the night and struggle to stay asleep.  Unfortunately, waking during the night affects the quality of your sleep because it does not allow you to complete your body’s natural sleep cycles.  While quantity of sleep is important (the National Institutes of Health states that an average adult requires 7.5-9 hours of sleep each night), quality is even more important.  Without quality sleep your body cannot do the maintenance that is required for overall health and happiness.

If you are a poor sleeper, chances are this habit has developed over an extended period of time, but don’t despair.  There are things that you can do to improve the quality, and quantity, of your sleep.  Many doctors are now suggesting that people with sleep deprivation issues try melatonin to improve their sleep.  The problem with using melatonin long term is that it is possible that the use of artificial melatonin can decrease our body’s natural production of sleep hormones.  So while melatonin can be a useful tool to help reset our sleep clocks, it is my opinion that it should not be used for more than two weeks.  It is far better to try and reset naturally and create better long term sleep habits.

First, make sure that the place where you sleep is cool, comfortable, quiet and dark.  Use black out shades/curtains, and invest in a comfortable mattress and pillows.  For those that struggle to ignore outside noises a sound machine may be a good investment.  Second, avoid screen time within an hour of bedtime.  While we don’t always recognize it, the back lighting from screens is stimulating to our brains and can prevent quality sleep even when our bodies are obviously tired.  Third, avoid alcohol within an hour of bed time.  Studies have proven that we do not sleep as soundly when we drink alcohol right before bed.  If possible, it is good to try and keep your bedtime the same time throughout the week as well. Finally, create a good bedtime ritual.  A bedtime ritual can be anything that relaxes you and sends the signal to your brain that it is time to release sleep hormones.  A good bedtime routine is one that you can take with you no matter where you go.  Maybe you like to read a good book before bed, or have a cup of decaffeinated tea.  Perhaps you like to journal or do a mental breakdown of your day.  My favorite habit is a short meditation to clear your mind and relax your body.  Hopefully, if you make your sleep a priority you can improve your overall health and happiness.

Effecting Your Affect

When people first approach me regarding their depressed or anxious feelings and ways to make themselves feel better with easy intial changes that yield big results, I always ask about their eating habits, sleeping habits and exercise routine.  These are not things that one often associates with therapy but they have a huge impact on the way that you feel physically and emotionally.  If one of these things is neglected often your ability to regulate your emotions is drastically effected.

In regards to eating habits, I am not a nutritionist.  I do not deem myself the expert on what makes up a healthy eating regiment. I firmly believe that our bodies are miraculous things that have their own individual make up and, therefore, require different things to operate at their healthiest.  Common sense tells us that we should minimize things like sugar, caffiene, and processed foods while making sure that what we eat is a balance worthy of the food pyramid.  I am not a firm believer in completely denying yourself the things that you enjoy, even if they are not the healthiest option.  There is a sense of happiness and well being that comes from treating yourself to something you enjoy in moderation.  When I talk to my patients about eating habits I talk less about what they eat and more about when they eat.  I have often seen the power of small meals or snacks throughout the day help ward off anxiety symptoms that occur at specific points in patient's days.  So I do believe that maintaining a good level of calories and normal blood sugar can effect your ability to think clearly and calmly.

Sleep is an obvious factor in your overall mood.  Any parent can tell you about the lack of patience and positive attitude that comes with sleep deprivation.  Simply put, if you are not getting enough sleep your mind is not operating at it's best and you cannot use clear, calm self-talk to assist in problem solving.  Once your sleep cycle is off it can be a bit of a chore to reset it.  Because we are a society that often looks for a pill to solve the problem, many people have reverted to melatonin or sleep aides to try and help them get the appropriate amount of sleep.  The problem with these solutions is that after two weeks of taking melatonin your body slows down the production of your natural melatonin making it even more difficult for you to sleep without it.  It is much preferred to reset your sleep clock naturally through gradual shifts in sleep times, relaxation activities and routines.

The final factor in the trifecta is exercise.  The truth of the matter is that exercise releases endorphins.  Endorphins make you feel good.  Plus there is the added benefit of looking more toned and having more energy.  Both of which can't hurt when someone is feeling badly about themselves.  When I say exercise people are often thinking of going to a gym for an hour of brutal physical exertion that leads to the inability to move without hurting all over, but this is not what is required to get the mood benefit of exercise.  Something as simple as walking the dog for fifteen minutes a day can have a dramatic impact on your mood and outdoor exercise has the added benefit of vitamin D from the sun which also is known to boost your mood.

So if you are feeling down or having panic attacks take a look at your eating, sleeping and exercise habits.  I would be surprised if there was not room for improvement in these categories in your life.  Changing these things may not help you win the war against depression or anxiety but they will help prepare you to win the first battle.