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Sleep Hygiene Do's and Don'ts
The diagnosis and treatment of various sleep disorders is a personal passion of mine. One important factor that often gets overlooked when it some to sleep and various sleep disorders is proper sleep hygiene. For some people, falling asleep is as easy a putting your head down on the pillow, closing your eyes and viola! There are many medications that are available on the market that are used to treat sleep onset and sleep maintenance insomnia. Medications however tend to be more effective in a short-term basis. The ongoing use of sleep aids tends to develop a dependence upon them to fall asleep which interferes with patients need to develop good sleep habits, which further prolongs sleep problems. I tend to use sleep aids as a way to bridge the gap between insomnia and initiating proper sleep hygiene for an effective longer term treatment plan in which medications are no longer needed.
The first step in developing proper sleep hygiene is having a regular sleep schedule. You want to train your body to go to bed and wake up around the same time every day. That includes weekends, holidays, vacations and days off of school and work. Having a regular sleep pattern gets your body used to what it is expected to do at certain times of the day and night. Behaviors to avoid before bedtime are also important to keep in mind. It is always best to avoid having caffeine (coffee, tea, soda, chocolate), nicotine (cigars, pipes or cigarettes) or alcohol within 4-6 hours of the desired bedtime. All these substances have a stimulating effect on your brain activity which is not want you want to have when trying to fall asleep. Regular exercise about 4 hours prior to going to bed is also beneficial. When you exercise, your core body temperature increases. Over the next 4 hours, your core cools down which mimics the same natural drop that occurs in your body when trying to initiate sleep. A warm bath at night can be beneficial for some to help relax and loosen up tense muscles. Typically and empty stomach is best before sleep, but a glass of warm milk can be helpful to initiate sleep. Milk contains tryptophans which is a natural sleep inducer (so does Turkey which is why after Thanksgiving dinner, everyone is one the verge of sleep).
Keep in mind that bed is for sleep and sex only. You want to keep a clear distinction in your mind that when in bed, those are the only 2 activities it expects. When you get into bed, you don't want your brain thinking, now I get to watch TV, play or work on my laptop, eat, pay bills or read a novel. If after 20 or so minutes of laying in bed you do not fall asleep, you should get up do something calm or even boring. You don't want to lay in bed awake for extended periods of time since this sets up an association of feeling angry, frustrated and depressed while laying in bed. You do not want negative feelings, associations or thoughts while in bed. Try sitting quietly in another room wit the lights off (bright light incorrectly tell your brain that it is time to be awake), or read something boring like the phone book (school books always work well for me). You want to avoid doing anything that is too stimulating or interesting, since this will wake you up even more. When you feel sleepy again, go back to bed and try again. Another habit to avoid is watching the clock during periods of not being able to sleep. This also sets up a negative feeling of "oh no I only have X hours of sleep left" or "I can't believe it's 2 am and I'm still awake". These obsessive and negative thoughts only contribute to your insomnia. Have an alarm set for the desired rise time and unless you hear the alarm go off, it doesn't matter what time it is; it's sleep time!
Documenting behaviors and habits by use of a sleep diary or sleep log can be useful to visualize what's happening and how it influences you. As a sleep physician, I often use a sleep diary to track patients progress and adherence to sleep hygiene rules. Patients are often shocked when comparing their initial patterns to weeks to months later and seeing the dramatic difference and improvement.