Nighty Night! How to Get the Sleep You Need

Are you getting 7-8 hours of uninterrupted sleep every night? 

Wait let me rephrase that  … are you over 55 and getting 7-8 hours of uninterrupted sleep every night without taking anything?

Because I’m not.

I used to. I’d fall asleep literally sitting up in bed with my Kindle in my hands. At some point, my husband would remove it (because he’s an insomniac), and I’d gain consciousness again 8-10 hours later. NOTHING happened in between. Total oblivion.

But lately, when I finally fall asleep (caffeine stopped, exercise done, Kindle down, lights out, post hot shower), I do so only to WAKE BACK UP anywhere from 1-4 hours later. And then, I’m in middle-of-the-night-psychotic hell. Here’s a little glimpse into what happens in my brain next:

Okay, okay, I’m NOT going to turn the lights on. I’m just going to breathe and relax. Did I turn the stove off? I’m sure I did, but should I check? Nah, I know it’s off. Okay, relax. Where’s the cat? Oh the cat… did I put the rug she pee peed on in the dryer? Is the dryer still on? I probably shouldn’t fall asleep with the dryer on. Dryer sheets. I need to add that to the grocery list … but what else do we need? Wait, where’s my husband? Is he okay? He’s probably just walking around, but maybe he went to check on the dryer/cat/grocery list and fell down and is hurt.

By that point, he’s usually back from whatever nightly perambulation he was on so I can go back to thinking about how I can’t fall asleep.

While it seems like fun to think about getting a text-pal in a time zone that’s 6-8 hours ahead of mine, the fact is that not getting enough sleep can have severe consequences on your physical and mental health … and I can’t afford either of those!

So, I did some checking into the most current research and information about insomnia – and if these suggestions don’t help you get sleep, just try reading this at bedtime – I’m pretty sure it can bore you into unconsciousness!!

What is insomnia?

According to the American Academy of Sleep Medicine, insomnia is defined as “persistent difficulty with sleep initiation, duration, consolidation or quality.”  It is more prevalent in older adults (30% to 48%), women (25%), and people with medical and mental health issues. (Oh, I am SO SCREWED!)

In a 2018 article entitled “What’s New In Insomnia Research,” Dr Dieter Riemann, the founder of the European Insomnia Network said, “Ultimately, insomnia rates have risen because there are so many more distractions in today’s society. It’s much harder to relax, to wind down, to shut out disturbing thoughts, and having a lot on your mind can interfere with how well you sleep.”

It’s much harder to relax, to wind down, to shut out disturbing thoughts, and having a lot on your mind can interfere with how well you sleep.

AND THAT WAS PRE-PANDEMIC!

Although I couldn’t find any research later than 2018, Google Trends affirms a dramatic increase in internet searches for insomnia as we’ve experienced the COVID-19 global pandemic. Studies are being discussed to determine whether an increase in insomnia symptoms as a result of the pandemic will persist and lead to higher rates of chronic insomnia (trouble falling asleep or staying asleep at least three nights per week for three months or longer).

Techniques for Overcoming Insomnia

CBT-I

For chronic insomnia in adults, guidelines published in 2016 by the American College of Physicians, and supported by the British Association for Psychopharmacology, and jointly the National Institute of Health and the Sleep Research Society recommend that Cognitive Behavioral Therapy – Insomnia (CBT-I) as the first-line treatment.

CBT-I is a short, structured, and evidence-based approach to insomnia. The program typically takes 6-8 weeks and involves cognitive, behavioral, and education components that help you control or eliminate negative thoughts and actions that keep you awake, develop good sleep habits, and avoid behaviors that keep you from sleeping well. To find a practitioner, contact your physician, the Society of Behavioral Sleep Medicine or the American Board of Sleep Medicine.

Unfortunately, due to the widespread need for this treatment, there aren’t enough CBT-I professionals to meet the current demand. However, researchers have developed successful digital, group, and self-help formats as alternative ways to provide treatment.

In a year-long study (Northwestern Medicine and University of Oxford) involving 1,711 people, researchers found online cognitive behavioral therapy (CBT) improved not only insomnia symptoms, but functional health, psychological well-being and sleep-related quality of life.

If you’re interested in participating in a study on the efficacy of online CBT-I, the Stanford University Sleep Health and Insomnia Program (SHIP) is recruiting participants. Click here for more information.

Behavioral changes

Not quite ready to try the structured approach with CBT-I? There are a LOT of other things you can do to help you fall asleep and stay asleep. So with an attitude of optimism, these are some of the easiest things you can try TONIGHT to help you get the sleep you need. 

Take a shower or bath and add aromatherapy
People who took baths or showers (even as short as 10 minutes) measuring between 104°F–108.5°F 1 to 2 hours before bedtime found that going from warm water into a cooler bedroom causes your body temperature to drop, naturally creating a sleepy feeling. Sleep-inducing aromatherapy ingredients for your bath can provide added benefit. Many are available already mixed, and you’ll find some great recipes here.

Try relaxing music
Various studies report that slow, soothing music can lower the heart rate and relax the body, reduce anxiety and stress, or simply distract from stressful thoughts that prevent sleep. Look for playlists that feature songs with an “ideal” tempo of 60-80 beats per minute on Spotify and other music resources.

Set an intentional “worry” time earlier in the day
Plan a 15-minute worry break during the day to process thoughts. During this time, you might consider writing a to-do list or thinking about solutions to your concerns. Actively working on this during the day will keep you from giving it space at night.

Start a gratitude journal
In a study of college students who reported insomnia, expressing gratitude in writing each evening at bedtime helped improve their sleep compared to baseline. 

Breathe Deeply
Breathing exercises are designed to bring the body to a more relaxed state by bringing down some functions that can make you anxious. Want to try some now? Download “Deep Breathing and Guided Imagery for Relaxation and Sleep” here.

Try imagery distraction
Studies show that guided imagery, where you are given a specific cognitive task (and involving all of your senses), can calm your body and relax your mind.  You can find many guided imagery scripts online and on apps such as Headspace, Calm, and Spotify. You can also download “Deep Breathing and Guided Imagery for Relaxation and Sleep” here.

Make your bedroom comfortable for sleep:
Be Cool
Our body temperature is cool while sleeping and warmer when we’re up. So the goal at night is to mimic that change in body temperature. Research advises setting your thermostat to 60–67°F at night.

Avoid clocks in your bedroom
People who have trouble falling asleep or staying asleep tend to focus on the time and the fact that it’s passing while they’re watching it – the perfect storm for anxiety and sleeplessness! Don’t look at the time in relation to your sleep routines. However if you need an alarm, turn the clock away from you or place your alarm clock where you can’t see it.

Don’t go to bed unless you are sleepy
Ultimately your goal will be to go to sleep and wake up at the same time each day (weekends included). BUT for now, you should not get in bed unless you are sleepy. By the way, you’re supposed to read that book (made of paper) in another room until you’re sleepy and THEN go to your bed. Reading IN BED is not allowed! Who knew?

If you don’t fall asleep within 20 minutes of turning off the lights, or if you wake up and can’t fall back asleep in 20 minutes, get out of bed and reset
Lying awake in bed for too long can “create an unhealthy mental connection between your sleeping environment and wakefulness.” Get up and try a “reset break.” During this time you should do something relaxing like read a book,, have a cup of camomile tea, or listen to relaxing music. The goal here is to shift your attention away from trying to go to sleep, which is NOT a relaxing exercise!

Bed is for sleep (and for some people – sex) not awake activities
It’s not your home office, so bringing your laptop, TV, and food into bed with you is a no no. Your bed should conjure feelings that are conducive to sleep, and research shows that these activities can trick our brains into thinking this space is for these activities and thereby training it to be more awake than sleepy in bed. If space is an issue (studio apartments, etc.) then use one side of the bed for sleep only, and the other side for other activities. This is a last-resort option!

Stick to a sleep schedule
While you’re aiming to go to sleep at the same time each night, it’s also important to wake up at the same time each day, regardless of the time you went to sleep at night. If you didn’t sleep well at night, chances are you’ll fall asleep more easily the subsequent night. Alternatively, if you allow yourself to stay in bed to “catch up,” you may find it difficult to go to sleep that night. 

Stay active
A great stress reliever, regular exercise has been shown to improve the quality of sleep. Research suggests that you get your exercise in at least three hours before you turn in.

Check your meds
Many medications can affect your sleep. Check with your physician or pharmacist to see if anything you’re taking might be causing your insomnia. 

Avoid or limit naps
Especially when you’ve had a bad night’s sleep, the temptation to take a nap can be powerful. But don’t. However if you just can’t avoid it, limit your nap to 30 minutes or less and don’t nap after 3 pm.

Don’t tolerate pain
If you have pain that is affecting your sleep, talk to your doctor about a pain reliever.

Be aware of when you need light, and when you need dark
Exposing your body to light, whether it’s natural light or a digital device (e-reader, phone, tablet, etc), tells it to be alert. Darkness, on the other hand, promotes a sense of sleepiness and boosts the natural production of melatonin. During the day, try to expose your body to natural or artificial light (light boxes work great). But at night, turn off digital devices and keep your bedroom as dark as possible. 

Focus on trying to stay awake
I’m not sure I’ll try this one … but some studies have shown that when you force yourself to feel sleepy, your chances of falling asleep decrease dramatically. However, although research is mixed, some studies have shown that people who try the “paradoxical intention” to stay awake tend to fall asleep faster. Let me know if this works for you!

Acupuncture
Some studies have shown that acupuncture may be a beneficial treatment for insomnia, but more research is needed. Ask your doctor how to find a qualified practitioner (unless you’re from my hometown … in which case I have a great name for you!)

Weighted blankets
A recent study of 120 adults published in the Sept. 15 issue of the Journal of Clinical Sleep Medicine found that weighted chain blankets are a safe and effective intervention in the treatment of insomnia. “A suggested explanation for the calming and sleep-promoting effect is the pressure that the chain blanket applies on different points on the body, stimulating the sensation of touch and the sense of muscles and joints, similar to acupressure and massage.”

Yoga or tai chi
Some studies suggest that the regular practice of yoga or tai chi can help improve sleep quality.

Avoid certain foods and drinks
A few hours before bed, avoid caffeine, alcohol, large meals, and foods that induce heartburn. However, consider eating (in moderation and earlier in the day) from these five food groups that support good sleep:

  • Eggs
  • Cheese
  • Nuts, especially almonds and walnuts
  • Fatty Fish
  • Teas, expecially chamomile

Prescriptions, OTC Medicines, and Herbal Treatments

FIRST, TALK TO YOUR DOCTOR before you try any of these remedies.

Totally exempting myself from legal ramifications, prescription medications like Eszopiclone (Lunesta), Ramelteon (Rozerem), Zaleplon (Sonata), and Zolpidem (Ambien, Edluar, Intermezzo, Zolpimist) are often prescribed for insomnia although doctors prefer to limit their use to a few weeks because of side effects including balance issues, daytime drowsiness, and the concern of their habit-forming tendencies. 

Over-the-counter sleep aids
Because the Food and Drug Administration does not mandate that manufacturers show proof of effectiveness or safety before marketing dietary supplement sleep aids, talk with your doctor before taking any herbal supplements or other OTC products. Some products can have harmful interactions with certain medications.

Drugs like Benadryl,  Aleve PM, and Unisom contain antihistamines that can help you sleep but are not intended for regular use. Additionally, side effects including daytime sleepiness, dizziness, confusion, cognitive decline are possible, which may be worse in older adults.

Melatonin
Some research shows that the hormone melatonin can help reduce signs of jet lag and can help you fall asleep. Side effects can include headaches and daytime drowsiness. While generally considered safe, the American Academy of Sleep Medicine advises caution when using melatonin.

“Evidence-based recommendations published by the AASM indicate that strategically timed melatonin can be a treatment option for some problems related to sleep timing, such as jet lag disorder and shift work disorder. However, another clinical practice guideline published by the AASM suggests that clinicians should not use melatonin in adults to treat chronic insomnia, which is what many are experiencing during the pandemic.”

“Melatonin isn’t a ‘one-size-fits-all’ solution to nightly sleep trouble,” said Jennifer Martin, who has a doctorate in clinical psychology and is a member of the AASM board of directors and a professor of medicine at UCLA. “People who have difficulty sleeping should try making changes in their bedtime routine and environment first, and if that doesn’t help, or their insomnia becomes chronic, they should work with their medical provider to find the best treatment option.”

Valerian
There’s mixed study results on this plant-based supplement, but you should talk to your doctor before trying it. Some people who have used valerian in high doses or for a long time may have liver damage, although it’s not clear if valerian caused the damage.

One more thing to try
If you’re still having trouble falling asleep, try reading the articles in this list of resources. Let’s just say, I didn’t have any trouble falling asleep!! Now gey schluffen!

Resources:

The Anerican Academy of Sleep Medicine

The American Academy of Sleep Medicine (Facebook)

“Cognitive Behavioral Therapy for Insomnia (CBT-I)”

“The management of unwanted pre-sleep thoughts in insomnia: distraction with imagery versus general distraction”

Effects of Constructive Worry, Imagery Distraction, and Gratitude Interventions on Sleep Quality: A Pilot Trial

“Can Music Help You Sleep Better?”

“Google Trends reveals increases in internet searches for insomnia during the 2019 coronavirus disease (COVID-19) global pandemic”

“Behavioral interventions for insomnia: Theory and practice”

Mayo Clinic – Insomnia

“What’s New in Insomnia Research?”

“Sleep aids: Understand over-the-counter options”

“Weighted blankets can decrease insomnia severity”

“Insomnia symptoms, overall health improve with online insomnia program”

“What to do when you can’t sleep”

“Behavioral interventions for insomnia: Theory and practice”

“Healthy Sleep Habits”

“Five Foods That Support Good Sleep”

“Sleep tips during isolation: Preventing insomnia”

“Missing the mark with melatonin: Finding the best treatment for insomnia”

“Prevalence of chronic insomnia in adult patients and its correlation with medical comorbidities”

“One in four Americans develop insomnia each year: 75 percent of those with insomnia recover”

Insomnia (Sleep Foundation)

“Insomnia in the Elderly: A Review”

US Department of Health and Human Services – Women’s Health – Insomnia

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