Guidelines for Getting Better

The most important habit to form to support good sleep: have regular and awakening time each day, including weekends. You can’t make up for lost sleep, so sleeping in on weekends may feel good, but disrupts the sleep pattern. Brains seek patterns and can more easily establish regular sleep when it occurs at the same time every night and morning. This pattern enhances the ability to re-establish the natural day-night we are born with. If necessary, use an alarm clock for bedtime. Don’t believe you can use a “second wind” for external productivity. That surge is meant to be used for necessary sleep functions--internal productivity.

Before bedtime: Caffeine and nicotine: Avoid both 6-8 Hours before bedtime. Caffeine and nicotine are stimulants that stay in the system a long time. They stimulate the production of hormones that create wakefulness—cortisol and adrenaline. If they are still active when it’s time to go to sleep, the wakefulness hormones compete with the rise of , associated with relaxation and sleep. The circadian rhythm is overridden and sleep is either delayed or degraded in quality.

Alcohol: avoid alcohol after dinner Alcohol often promotes the onset of sleep, but as alcohol is metabolized sleep becomes disturbed and fragmented. It might make going to sleep easier, but the fragmented sleep often leads to awakening just a few hours later with difficulty going back to sleep.

Eating A light bedtime snack, such a glass of warm milk, cheese, or a bowl of cereal can promote sleep. Avoid heavy meals just prior to sleep. Avoid snacks in the middle of the night since awakening may become associated with hunger.

Exercising Regular exercise is included in any health regimen but also promotes good sleep. The impact on sleep may take several weeks to be noticeable, but it truly helps. Avoid exercise 2-3 hours prior to bedtime as that could stimulate rather than soothe the nervous system.

Get enough daylight. Natural daylight this is a powerful cue to turn on the hormones of wakefulness and it supports the circadian rhythm. If you can’t get outside, sit by a window. If neither are possible, the use of a light box can be helpful.

Avoid . The sleep you obtain during the day takes away from your need at night, resulting in lighter, more restless sleep, difficulty falling asleep or early morning awakening. If you must , keep it brief (10-15 minutes), and if possible, take the nap about 8 hours after arising.

Have a cool down period 90 minutes before getting into . Allow your brain to begin to move in the direction of sleep by reducing stimulation, and reducing light from electronics which is more in the blue part of the color spectrum that stimulates wakefulness. A shower or bath is both soothing and promotes a drop in body temperature when you step out of the warm water. This drop is a natural part of the sleep state and is a physical cue for the onset of sleep.

The Environment: Moderate Temperature, Quiet, and Dark Extremes of heat or cold can disrupt sleep. Since the body’s core temperature drops a degree or so, a cooler environment promotes better sleep.

A quiet environment is more sleep promoting than a noisy one. Noises can be masked with background white noise (such Sleeping Pills: Sleep as the noise of a fan) or with earplugs. Medications are Effective A darkened room is important. It supports the circadian Only Temporarily. rhythm and production of melatonin. Blackout shades may be Despite advertisements to the contrary, important. over-the-counter sleeping aids have little impact on sleep beyond the Be comfortable. Be sure your mattress is not too soft or too placebo effect. Studies show that firm and that your is the right height and firmness. Avoid prescription sleep medications lose their wearing constricting clothing which can impede the natural flow effectiveness in about 2 - 4 weeks. They of the lymphatic system. also create sleep that is missing the slow wave delta stage of sleep that is most Leave electronics outside of bedroom. If you’re a clock restorative. Over time, sleeping pills can watcher, that includes a clock face and alarm clock. make sleep problems worse and may have long term effects on the brain. Limit your time in bed. When sleeping pills have been used for Restrict your sleep period to the average number of hours you a long period, withdrawal from the have actually slept per night during the preceding week. Too medication usually leads to rebound much time in bed can decrease the quality of sleep and . Thus, after long-term use, contribute to the maintenance of existing sleep problems. many individuals incorrectly conclude Don’t lie in bed for extended periods of time and not sleep. that they “need” sleeping pills (OTC or You are creating an association between the bed and not prescribed) to sleep normally and then sleeping. If you aren’t asleep in about 15-20 minutes go ahead prematurely abandon efforts to get off and get up. Do something outside the bedroom that is relaxing sleeping medications. While and not stimulating. When you feel sleepy (i.e., yawning, head occasionally the use of sleep bobbing, eyes closing, concentration decreasing), then return to medications may be appropriate on a bed. Don’t confuse tiredness with sleepiness. Tiredness doesn’t short-term basis, keep the use of them lead to sleep, only sleepiness does. Use your bed for sleeping infrequent. and play with your partner, but don’t use it as command central for other activities.

4201 Lake Boone Trail, Suite 201 Martha F. Simpson, Ph.D., LCAS Raleigh, NC 27607 HRC Behavioral Health & Psychiatry, P.A. P: 919.256.2196 (v/m) E: [email protected]