Wednesday, April 23, 2008

Sleep hygiene

Sleep problems are quite common in my practice. Interestingly, most of my patients know why they have the problem. They tell me they stay up too late, or interrupt sleep by taking stimulating drugs such as cold medicines, or by having thoughts related to work. Or they over-stimulate themselves before bedtime with late-night activities such as television. Here are few tips everyone should follow.

Regular Bedtime:
Go to bed at about the same time every night, but only when you are tired. Set your alarm clock to awaken you at the same time every morning--including weekends and regardless of the amount of sleep you have had. If you have a poor night's sleep, don't linger in bed or oversleep the next day. If you awaken before it is time to rise, get out of bed and start your day.

Avoid napping.
If you nap throughout the day, it is no wonder that you will not be able to sleep at night. Napping is allowed for older people only, if they can limit them-self to 20-30minutes maximum and if they have no difficulties going to sleep at night and maintaining sleep through the night.

Avoid caffeine 6 hours before bedtime.
This includes caffeinated beverages such as coffee, tea and sodas, as well as chocolate. Herbal teas such as Chamomile are great substitutes. Drink them at least 1.5 hours before bedtime; otherwise your urinary bladder will wake you up.

Regular exercise is helpful in getting a good night’s sleep, but not if it is done right before bedtime. Vigorous exercise before sleep can delay sleep. You cannot force yourself to sleep by exercising during that same day. Morning exercise also has little beneficial effect on sleep. The best time to exercise is in the afternoon or early evening. Even then, “it probably won't help you sleep unless you exercise on a regular schedule,” according to
The word “regular” is key when it comes to exercise.

Avoid heavy, spicy, or sugary foods 4 hours before bedtime.
These can affect your ability to stay asleep. Spicy food is stimulating. Heavy food will put you to sleep, but will also wake you up or cause unrestfull sleep. One of my patients put it this way: “I woke up thinking that a big turkey and a small elephant were sitting on my chest”

Use comfortable bedding.
Uncomfortable bedding can prevent good sleep. Evaluate whether or not this is a source of your problem, and make appropriate changes. Sometimes a leg pillow may help.

Find a comfortable temperature setting for sleeping and keep the room well ventilated. If your bedroom is too cold or too hot, it can keep you awake. A cool (not cold) bedroom is often the most conducive to sleep.

Reserve the bed for sleep and sex.
Don't use your bed as an office, workroom or recreation room. Let your body "know" that your bed is associated with sleeping.

Eliminate distractions:
get rid of noise and light as much as possible. Animals, even your favorite cat or dog who loves to sleep with you, should be kept out of your bedroom. My old dog used to snore and had dreams of running, and he moved so vigorously that he rearranged small pieces of furniture at night.

To do list before bed time:

Have light snack. Turkey is good, because it is very high in L-Tryptophan.

Practice relaxation techniques.

Keep a piece of paper by the bed so you can immediately write down “important things” that need to be done tomorrow and then “forget “about them till morning.

Establish pre-sleep rituals, such as cool shower or a few minutes of light reading.

If not sleepy in 20-30 minutes get up, go into another room, and read until sleepy.

Avoid sleep medications by all possible means!
Benzodiazepines (commonly prescribed sleep medication) tend to be very addictive. Some doctors are more conservative about prescribing them, but others give them freely, especially to older patients. Insomnia cannot be corrected with pills. At best, sleeping pills have only limited usefulness. They provide a temporary solution to insomnia.
The older you get, the more you tend to absorb and excrete all medications more slowly. Your nervous system may also be more sensitive, which, in turn, may increase the effects of combining drugs.

Sleeping pills may cause older people to stumble or fall, feel groggy or hung-over, or appear forgetful and senile. Casual overmedication killed both of my in-laws, but what was worse, it put my father –in-law into a psychiatric word before he died, due to faulty diagnosis of his poor mental condition. Please check the medications your parents and grand-parents are taking, and make sure that both you and your loved ones understand the purpose of medication, dose levels, and side effects and contra-indications.

Herbs and nutritional supplements to try
Valerian or Passionflower in the form of teas or tinctures;
Melatonin 3 mg to induce sleep;
GABA (Gamma-aminobutyric acid), an inhibitory neurotransmitter;
L-Tryptophan, 500 mg before bedtime.

Stay helthy.