People struggling with sleep is one of the main topics throughout the coronavirus pandemic. Problems falling asleep and staying asleep; neither are good! That’s why we are offering some resources to help with that. Please remember, when trying to change a behavior (especially one that is stress-induced) repetition is the key! Once you find something that helps, keep doing it regularly and things should improve!
Improving Sleep through Behavior Change
Sleep Hygiene Guidelines
Good dental hygiene is important in determining the health of your teeth and gums. We all know we are supposed to brush and floss regularly. Those who do so are more likely to have strong, healthy gums and less cavities. Similarly good sleep hygiene is important in determining the quality and quantity of your sleep. Below are guidelines for good sleep hygiene practices. Review these guidelines and evaluate how well you practice good sleep hygiene.
Caffeine: Avoid Caffeine 6-8 Hours before Bedtime. Caffeine disturbs sleep, even in people who do not think they experience a stimulation effect. Individuals with insomnia are often more sensitive to mild stimulants than are normal sleepers. Caffeine is found in items such as coffee, tea, soda, chocolate, and many over-the-counter medications (e.g., Excedrin). Thus, drinking caffeinated beverages should be avoided near bedtime and during the night. You might consider a trial period of no caffeine if you tend to be sensitive to its effects.
Nicotine: Avoid Nicotine before Bedtime. Although some smokers claim that smoking helps them relax, but nicotine is a stimulant. The initial relaxing effects occur with the initial entry of the nicotine, but as the nicotine builds in the system it produces an effect similar to caffeine. Thus, smoking, dipping, or chewing tobacco should be avoided near bedtime and during the night. Don’t smoke to get yourself back to sleep.
Alcohol: Avoid Alcohol after Dinner. Alcohol often promotes the onset of sleep, but as alcohol is metabolized sleep becomes disturbed and fragmented. Thus, a large amount of alcohol is a poor sleep aid and should not be used as such. Limit alcohol use to small quantities to moderate quantities.
Sleeping Pills: Sleep Medications are Effective Only Temporarily. Scientists have shown that sleep medications lose their effectiveness in about 2 – 4 weeks when taken regularly. Despite advertisements to the contrary, over-the-counter sleeping aids have little impact on sleep beyond the placebo effect. Over time, sleeping pills actually can make sleep problems worse. When sleeping pills have been used for a long period, withdrawal from the medication can lead to an insomnia rebound. Thus, after long-term use, many individuals incorrectly conclude that they “need” sleeping pills in order to sleep normally. Keep use of sleep pills infrequent, but don’t worry if you need t use one on an occasional basis.
Regular Exercise: Get regular exercise, preferably 40 minutes each day of an activity that causes sweating. . Exercise in the late afternoon or early evening seems to aid sleep, although the positive effect often takes several weeks to become noticeable. Exercising sporadically is not likely to improve sleep, and exercise within 2 hours of bedtime may elevate nervous system activity and interfere with sleep onset.
Bedroom Environment: Moderate Temperature, Quiet, and Dark: Extremes of heat or cold can disrupt sleep. A quiet environment is more sleep promoting than a noisy one. Noises can be masked with background white noise (such as the noise of a fan) or with earplugs. Bedrooms may be darkened with black-out shades or sleep masks can be worn. Position clocks out-of-sight since clock-watching can increase worry about the effects of lack of sleep. Be sure your mattress is not too soft or too firm and that your pillow is the right height and firmness.
Eating: A light bedtime snack, such a glass of warm milk, cheese, or a bowl of cereal can promote sleep. You should avoid the following foods at bedtime: any caffeinated foods (e.g., chocolate), peanuts, beans, most raw fruits and vegetables (since they may cause gas), and high-fat foods such as potato chips or corn chips. Avoid snacks in the middle of the nights since awakening may become associated with hunger. If you have trouble with regurgitation, be especially careful to avid heavy meals and spices in the evening. Do not go to bed too hungry or too full. It may help to elevate you head with some pillows.
Avoid Naps: Avoid naps, the sleep you obtain during the day takes away from you sleep need that night resulting in lighter, more restless sleep, difficulty falling asleep or early morning awakening. If you must nap, keep it brief, and try to schedule it before 3:00 pm. It is best to set an alarm to ensure you don’t sleep more than 15-30 minutes.
Allow Yourself At Least an Hour before Bedtime to Unwind: The brain is not a light switch that you can instantly cut on and off. Most of us cannot expect to go full speed till 10:00 pm then fall peacefully to sleep at 10:30 pm. Take a hot bath, read a novel, watch some TV, or have a pleasant talk with your spouse or kids. Find what works for you. Be sure not to struggle with a problem, get into an argument before bed or anything else that might increase your body’s arousal.
Regular Sleep Schedule: Keep a regular time each day, 7 days a week, to get out of bed. Keeping a regular awaking time helps set your circadian rhythm set so that your body learns to sleep at the desired time. Set a reasonable bedtime and arising time and stick to them. Spending excessive time in bed has two unfortunate consequences – (1) you begin to associate your bedroom with arousal and frustration and (2) your sleep actually becomes more shallow. Surprisingly, it is very important that you cut down your sleep time in order to improve sleep! Set the alarm clock and get out of bed at the same time each morning, weekdays and weekends, regardless of your bedtime or the amount of sleep you obtained on the previous night. You probably will be tempted to stay in bed in the morning if you did not sleep well, but try to maintain your new schedule. This guideline is designed to regulate your internal biological clock and reset your sleep-wake rhythm.
Sticking to the Changes You Make
It can be difficult to stick to a self-management program. However, it is important to remind yourself that the sleep guidelines have been extensively researched and represent the best science has to offer for conquering a long-term insomnia problem. Literally, thousands of individuals have improved their sleep through following the guidelines. The following points may help you to stick to the guidelines.
1. Find activities to engage in when out of bed during the night.
- Plan activities to engage in when you are not in bed at night because you can’t fall asleep. These activities should be non-stimulating.
- Prepare any materials needed to get out of bed (e.g., robe, book, etc.) ready prior to bedtime.
2. Identify cues to determine sleepiness and time to return to bed.
- Examples of “Sleepy Behavior” include yawning, heavy eyelids, nodding off, etc.
- Remember that the longer you stay up and the sleepier you are, the quicker you will fall to sleep.
3. Use alarm clock to maintain regular arising time.
- You may also want to plan social, work or family commitments soon after waking to increase motivation to adhere to arising time.
4. Find competing activities to fight the urge to take a nap before your bedtime.
- These activities should be physical (e.g., housework, walking) rather than cognitive (e.g., reading) or passive (e.g., watching TV).
- Examples include: taking a walk, having someone visit in the evening, talking on the phone to a friend, working a puzzle, drawing, etc.
5. Secure support from your spouse/significant others.
- Typically your bed partner will be deeply asleep and will not notice you getting out of bed.
- Have friends/family members help you adhere to the sleep guidelines. For example, a family member could play a game with you to help you stay awake until bedtime.
6. Remember the time-limited nature of following these procedures.
- It usually takes 2-3 months for a sleep problem to get totally better but most people see improvements within 2-3 weeks if the consistently follow the guidelines. Isn’t sticking to the guidelines for this short period worth it if your sleep ultimately improves?
Trouble falling asleep…
- Calm: “This app offers resources to reduce stress, calm down, and improve sleep. This includes things like guided meditation, stories to help you fall asleep, and music to help relax and fall into sleep.
- Relax Melodies: Sleep sounds: “Relax Melodies sleep app allows you to combine sounds and melodies with guided meditation and brainwave beats to help you unwind and ease into sleep” (ASA, 2020).
- White Noise Lite: “The app comes loaded with several looped sounds, such as a burning campfire, swaying boat, and thunder. You can also set a gentle alarm (guitar strum, chime, violin, and more) to wake you up.”
- Headspace: “The free version has “sleepcasts,” which are 45-55 minute-long audio experiences (kind of like adult bedtime stories) that help you visualize calming experiences, like a slow-moving train or a walk through a garden.”
Help with staying asleep and maintaining a sleep cycle/ sleep routine…
- Sleep Cycle- Smart Alarm Clock: The Sleep Cycle Alarm app performs sleep tracking to record your sleep habits. Using the Sleep Cycle Theory, the alarm wakes you during light sleep. To achieve this, you set a window of time to wake up. The sleep app senses your sleep movements and rings to wake you at the optimal time in your sleep cycle. This allows you to wake up feeling refreshed.” (ASA, 2020)
- CBT-i Coach: “The app will guide you through the process of learning about sleep, developing positive sleep routines, and improving your sleep environment. It provides a structured program that teaches strategies proven to improve sleep and help alleviate symptoms of insomnia.”
- Sleep Cycle Power Nap ($1.99): This app allows you to set the time for a short 20-minute power nap or a full nap of 90 minutes. Your phone’s accelerometer senses when you fall asleep and then sets the alarm to wake you up.
- Stop, Breathe, & Think: “This app provides daily emotional check-ins, and recommendations relating to meditation, sleep tracking, breathing and yoga.”