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There are several different types of insomnia. An insomniac may have difficulty falling asleep or staying asleep. He may wake up too early or he may sleep through the night but wake feeling unrefreshed, as though he has only skimmed the surface of sleep without going in deeply.
Insomnia has adverse impacts on mood, concentration, creativity, and the ability to cope with stress. It heightens the risk of injury, increases the likelihood of becoming obese, and contributes to a broad array of health problems.
Anxiety disorders and sleep disorders can create a vicious circle, with anxiety making it difficult to sleep and lack of sleep causing anxiety attacks. Recent research suggests that sleep disorders can actually trigger the onset of anxiety disorders (Anxiety and Depression Association of America, 2012). Those who have difficulty sleeping are also more likely to suffer from mood disorders such as depression (Harvard Medical School, 2008).
In addition to anxiety disorders and depression, insomnia can be caused or worsened by other sleep disorders, such as narcolepsy (falling asleep spontaneously at inappropriate times), sleepwalking, grinding teeth during sleep (bruxism), restless leg syndrome, and sleep apnea. However, many people suffer from insomnia as a result of lifestyle and environmental factors, such as too much light exposure at night, consuming heavy meals in the evening, noise, uncomfortable beds, and other problems.
Here are some techniques for improving sleep that have proven effective for many people. Experiment to see which ones work best for you.
Set a Regular Sleep Schedule
If you go to bed and wake up at the same time each day (including weekends), your body is more likely to wind down at an appropriate time in the evening and perk up at the right time in the morning.
If you choose to nap, it’s better to take a nap early in the day to catch up than to sleep in and alter your sleep cycle. However, napping too late or too long can trigger insomnia later on. Ideally, naps should be limited to 30 minutes. Eliminate them altogether if they contribute to your insomnia.
If you do have a bad night, don’t go to bed early the next night. Stick with your regular schedule to avoid disrupting your sleep cycle. Maintaining other routines such as exercise and meal times can also be beneficial.
Fight Daytime Drowsiness
Many people who suffer from sleep problems tend to get drowsy in the daytime, leading to inactivity or long naps, which can worsen insomnia at night. Staying active, particularly during drowsy times, is beneficial. Exercising, cleaning the house, doing yoga, gardening, or engaging in some other physical activity can help during low times. You may have force yourself to get going, but once on the move, you’ll probably become more alert, especially if you do something that exposes you to fresh air and natural light.
According to Griffin (2010), vitamin B12 deficiency is associated with fatigue and other nervous system problems, and Dr. Edmund Bourne (2005) recommends B complex supplements for those suffering from anxiety and panic disorder (see Vitamin B as an Anxiety Remedy for more information). Supplementing with B vitamins in the morning or early afternoon may help with both daytime sleepiness and anxiety (vitamins tend to work synergistically, which is why taking a full B complex that contains all the B vitamins is often recommended).
If you do take an effective dose of vitamin B each day (for example, B-Complex 100), it will turn your urine bright yellow. Don’t be alarmed – this effect is harmless. Also, in addition to potentially waking you up, vitamin B acts as a mild diuretic (Nutritional Supplements Knowledgebase, 2012), so it’s not a good idea to take it right before bed.
Low blood sugar can also cause daytime sleepiness. If you think this may be a problem, eating more frequent smaller meals and cutting out sugary snacks may help.
Boost Your Melatonin
Melatonin is known as the sleep hormone because it helps to regulate sleep cycles. Exposure to bright light in the evening (TVs, computer screens, etc.) can disrupt melatonin secretion when you need it. You can increase your melatonin by getting more natural light during the daytime (spend time outdoors, sit near a window, use a light box, etc.) and by decreasing light exposure at night:
- Turn off the computer or TV at least 20 minutes before going to bed (do relaxation exercises or yoga, listen to music, or read using a bedside lamp with a low-watt bulb).
- Use lower-watt light bulbs in all rooms, or at least in the bedroom (this is also good for the environment).
- Avoid reading from backlit devices (such as an iPad) at night (choose a non-backlit eReader instead).
- Keep the room you sleep in as dark as possible when turning in for the night by turning off electronic devices that put out light, drawing the curtains, and shutting the bedroom door if hall lights are left on for people who are still awake (if you can’t make the room totally dark, use an eye mask).
- Have a dim nightlight in the bathroom or use a flashlight if you have to go in the night to reduce light exposure.
If you do all of this and still experience sleep problems, there are melatonin supplements available. Appropriate doses are safe for most adults. However, this supplement can have side effects and interact with certain medications, so check with a doctor before taking it.
Tire Yourself Out
Start a fitness program or increase the duration and intensity of your exercise if you already engage in mild physical activity. Regular cardio exercise not only improves sleep for most people, but also has proven anxiety reduction and mood enhancement benefits.
Try to get some cardio exercise every day, gradually building up your endurance and capacity for more intense exercise if you have been sedentary in the past. Don’t exercise shortly before bed though – some people find that this makes it difficult to wind down and go to sleep.
You don’t have to become a marathon runner to get benefits from exercise – you just need to become more active on a daily basis. See How Much Exercise Do People Need? for guidelines.
Keep the Bedroom Environment Sleep-Friendly
Most people find it easier to relax and sleep in quiet spaces. However, it’s not always possible to keep things silent. Masking stressful sounds with white noise (for example, a sound machine, fan, etc.) or soothing music can be helpful. Earplugs are also an option.
Most people sleep best in rooms that are slightly cool (approximately 18°C or 65°F) and well-ventilated. Heat, humidity, or excessive cold can contribute to sleep problems.
Invest in a Good Mattress and Bedding
Mattresses that are too small, too firm, or not firm enough can all cause discomfort that adversely impacts sleep. Even having the wrong pillows can be a problem. If you wake up stiff and sore (and it’s not attributable to physical activity, illness, or injury), your bed may be the problem.
Not being able to get sufficient sleep will have a negative impact on your life, so a comfortable bed and bedding are worth prioritizing if you suspect that this may be a problem.
Use Your Bedroom for Sleep Only
Ideally, the bedroom should be used only for sleep so that your body becomes trained to fall asleep quickly and stay asleep when there. However, this isn’t realistic for most people.
Sex, listening to relaxing music, and reading (with a low-watt bedside lamp) in the bedroom probably won’t do any harm to your sleep cycle, but watching television, listening to energetic music, making phone calls, or doing anything else in the bedroom that involves bright light or excessive noise could be a problem. Working or studying in the bedroom is a particularly bad idea. You want your brain to associate that room with sleep, not intellectually demanding activity.
Develop a Bedtime Ritual
Doing the same thing to wind down each night helps train your body to shift into sleep mode once the ritual begins. Good options include:
- Having a bath (raising your body temperature before bed causes a subsequent temperature drop, which aids sleep)
- Reading by soft light or listening to audiobooks
- Listening to relaxing music
- Yoga/stretching
- Relaxation techniques such as deep breathing; progressive muscle relaxation; meditation; or visualizing a calm, peaceful place to set your nervous system into a calmer mode
Develop Sleep-Friendly Food and Drink Habits
Don’t eat heavy meals at night, particularly rich, fatty foods or big carbohydrate feasts. Your body will be actively digesting when you lie down, which can keep you awake. Also, lying down with food in your stomach (particularly acidic or spicy foods) can trigger heartburn. Drinking too much of anything before bed is also a bad idea, as you’ll probably be woken up by the need to use the bathroom.
Some people sleep better if they have a light snack shortly before bed. Smith et al. (2012) recommend granola or whole-grain (low-sugar) cereal with low-fat milk, a banana, or half a turkey sandwich. As long as the snack is small, relatively bland, healthy, and not fatty, it should be alright.
Alcohol can help you fall asleep, but will often reduce the quality of that sleep and even cause you to wake up in the night (rebound insomnia). Anything with a stimulating effect (coffee, caffeinated tea, cola, chocolate, certain medications, nicotine, etc.) can also trigger insomnia. To increase the likelihood of getting a good night’s sleep, avoid stimulating substances and alcohol for at least 4 hours before going to bed.
Eating a healthy diet in your day-to-day life helps with sleep as well. Consuming plenty of fresh produce, complex carbohydrates, and high-quality proteins will improve overall well-being.
Don’t Allow Bedtime to Be Worry Time
Don’t lie in bed worrying – instead, visualize peaceful scenes; daydream about positive things; or engage in other calming, positive, undemanding mental activities. If you have a lot of concerns, schedule a time well before bedtime to be your worry time. This will be your time to think about problems and come up with solutions. Making good use of your worry time should help you let go of worries when it’s time for bed.
If you find that worries flood into your brain as soon as you lie down and you have trouble getting rid of them, keep a notepad and pen by the bed and write down the things you think you need to do or worry about. That way you’ll know that you won’t forget them, so you can let them go for the night. You’ll be better able to solve problems and get things done in the morning after a good night’s sleep (and some worries will even seem silly the next morning, so you’ll be able to discard them altogether).
Change Your Attitude Toward Sleep
Do you view sleep as the enemy, stealing time that could be better spent getting things done? Does going to bed with tasks left unfinished feel like defeat? These attitudes can trigger sleep problems.
The following are some ways to develop a more positive relationship with sleep:
- When you go to bed, aim to relax rather than desperately trying to sleep. Becoming desperate about sleep makes it more difficult to achieve it.
- Don’t lie in bed for hours feeling frustrated. The Sleep Health Foundation recommends getting up and going to another quiet, dark room for 20 minutes (doing nothing) until you feel sleepy. The important thing is to avoid simply lying in bed and feeling anxious about sleep, because this creates a negative association with the bed.
- Try to stop worrying about sleep so much. Assuming that it’s not caused by a medical problem or triggered by substance abuse, sleeplessness self-corrects eventually – when you get tired enough, you’ll sleep.
- Cognitive-behavioural therapy is helpful for many people who suffer from sleep disorders or anxiety disorders, especially those who trigger and maintain their own insomnia by worrying excessively about sleep.
Panic Attacks During Sleep
Many people who suffer from panic disorder experience panic attacks while asleep. Waking up in terror with a pounding heart, sweating, trembling, shortness of breath, and other nasty symptoms can be a horrific experience. While the causes of nocturnal panic attacks aren’t known for sure, they’re probably similar to waking panic attack triggers (anxiety, stress, too much caffeine, etc.). Nocturnal attacks tend to last less than 10 minutes, though it can be difficult to relax enough to sleep for some time afterward.
If you have a panic attack in the night, you probably won’t be able to get back to sleep for a while, so it’s usually best to get up and out of bed and do a few ordinary things (pat the cat or dog, have a drink of water, do a boring chore, etc.) until the attack ends. Don’t do anything too stimulating (such as watching TV, using the computer, etc.). Engaging in slow, deep breathing will usually end the attack sooner and help you relax. Don’t go back to bed until you feel that you could actually sleep – you don’t want to associate your bed with anxiety and restlessness.
If you’re having trouble winding down after an attack, try doing a brief relaxation exercise such as progressive muscle relaxation or meditation.
This article assumes that you have a clean bill of health and that insomnia is the problem, not illness. It’s always best to consult a doctor to rule out physical health problems, particularly if you have concerning symptoms in addition to the insomnia.
References:
- Anxiety and Depression Association of America. (2012). “Sleep Disorders.” ADAA.org.
- Carbonell, D. (2012). “Nocturnal Panic Attacks.” AnxietyCoach.com.
- Division of Sleep Medicine, Harvard Medical School. (2008, 15 December). “Sleep and Mood.” HealthySleep.Med.Harvard.edu.
- Griffin, R.M. (Reviewed by D.C. Leopold, MD, 2010, 8 December). “Vitamin B-12 (Cobalamin).” WebMD.com.
- Hall-Flavin, D.K., MD. (2012, January 26). “Nocturnal Panic Attacks: What Causes Them? Can Someone Have a Panic Attack While Sleeping?” The Mayo Clinic, MayoClinic.com.
- Marano, H.E.. (2009, July 31). “Sleep or Suffer.” Psychology Today, PsychologyToday.com.
- Nutros (Nutritional Supplement Database). (n.d.). “Vitamin B6”. Nutros.net.
- Sleep Health Foundation. (2011). “Anxiety and Sleep.” SleepHealthFoundation.org.
- Smith, M., MA; Robinson, L.; Saisan, J., MSW; & Segal, R., MA. (2012, April). “How to Sleep Better.” HelpGuide.org.
- University of Maryland Medical Center. (2011). “Melatonin.” UMM.edu.