Dr. David Henderson
March 24, 2014
David Henderson
Sleeping Beauty

The Center for Disease control reports that insufficient sleep contributes to:

1. Depression
2. Unattractiveness
3. Skin aging
4. Weight gain
5. Less sex
6. More arguments
7. Marital dissatisfaction

As a physician and psychiatrist, poor sleep quality is one of the most common complaints I hear. Insomnia can include trouble falling asleep, trouble staying asleep, and early morning awakenings. There are a number of factors that contribute to a poor night’s sleep. Many people think that medication is the only option, but with a few simple tricks, the majority of people with insomnia can see drastic improvements. Here are some that my clients have found helpful:

1. Only use the bed for sleep and for sex. The body learns by association. If you use the bed for anything other than what it was designed for, the body begins to associate it with that activity. So if you study in bed, watch T.V. in bed, or handle marital problems in bed, your body will not associate the bed with sleep but with stimulation and frustration and will prepare accordingly. The only exception is sex. Researchers recommend sexual intercourse right before bed because in the postcoital state (after orgasm), the body releases a hormone called oxytocin which helps you relax.

2. Get up at the same time every morning…EVERY morning. Yes, that means even on the weekends. Studies have shown that it doesn’t matter as much what time you go to bed, but what time you get up that helps to regulate the sleep cycle. Even if you have a crummy night’s sleep, you are better off cutting your losses, lowering your expectations for the coming day, and catching up the following night. And as much as you love a lazy morning on the weekend, if you are sleeping in late, it probably means you are not allowing yourself enough time to sleep on the weekdays and your body has learned to exclude the weeknights as a restful time.

3. Only sleep when you are tired. A lot of people get into bed at 9, 10, or 11 because it’s the expected thing to do. The problem is, if you are not tired (because of poor sleep hygiene, perhaps), getting into bed begins a ritual of tossing and turning before you can sleep. You are better off getting 5 hours of continuous sleep rather than 8 hours of fitful sleep. So, pick the time that you need/want to get up each morning and subtract the total number of hours you actually spend asleep. That is the time you should go to bed. For example, if you need to be up by 7am and you are only getting about 5 hours of actual sleep time a night, then start out going to bed at 2 am. Eventually, as your body resets itself, you might start getting tired at 1:30am or 1 am or 12:30am. Gradually add a ½ hour onto the total time and watch your sleep return. This step also means that if it takes you more than 20 minutes to fall asleep, you should get back out of bed, proceed to step 4 and return only when you start dosing off again.

4. Create a ritual before bed. You would think this is the easiest part. For many, it is actually the hardest. We live in an over-stimulated culture. Winding down after a long day of work has become difficult. Gone are the days of sitting on the front porch in a rocker sipping a mint julep (never had one, myself, but an old southern gentleman at my church in South Carolina used to talk about it and it sounded so delicious!). Nowadays, most people watch T.V., work on the computer, or check apps on their smartphone right up until the time of sleep. These kinds of activities are so over-stimulating, that the brain takes longer to shut down. People who engage in these activities report a subjective sense of “racing” thoughts. Some ritual behaviors to incorporate include:

a. Reading a pleasant book (No studying – I usually recommend James Herriot books like All Creatures Great and Small.)
b. A warm bath/shower.
c. Application of a fragrant cream/lotion to help you relax.
d. A light snack.
e. Go to the bathroom!! (I thought my kids were the only ones I needed to remind on this one, but no, adults forget too!)
f. Journaling the events of the day.
g. Quiet music.

5. Avoid stimulants and alcohol before bed. We all like our Starbucks coffee! (Actually, I can’t stand their Pike, which is all they brew after noon, but I still buy it for some reason! That is a subject for another post!) Using a stimulant like caffeine actually interferes with the chemical fluxes that help to regulate our sleep. Adenosine is a chemical that builds in our system the longer we stay awake. It is a byproduct of energy molecules in the body. The longer we stay awake, the more adenosine we have flowing through our system and the sleepier we get. Caffeine is an adenosine receptor antagonist, which means it blocks adenosine’s ability to induce sleep. Alcohol, on the other hand, binds to GABA receptors in the brain, which do sedate us, but prevent us from experiencing the deeper, more restful stages of sleep. For this reason, it is important to avoid both.

If you have done all of these things consistently and still can’t seem to sleep or if you sleep through the night and still don’t feel rested during the day, talk to your physician about an underlying medical or psychiatric condition that may be contributing.

Question: What tips or tools have you found helpful in getting a good night’s rest?
Thanks to Bettersleep.org for some of the statistics in this post.