Sleep and Health
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One of the most frequent complaints I hear from my outpatient psychiatry patients is that they have a hard time sleeping. Good sleep is important for everyone, and it is especially important for optimizing both our physical AND mental health. So what can we do to sleep better?
Good sleep hygiene is the first step. What is sleep hygiene? It is those practices that can help us to sleep well. The National Sleep Foundation lists eight practices that can help us achieve good quality sleep—I’ve added some additional information from my medical training with a sleep specialist. There is much more information on each of these eight areas, but here is a brief summary:
- Be in your bed and sleep the right amount—not too little and not too much (reminds me of Goldilocks and the Three Bears). Beds should only be used for sleep and sex—nothing else. Setting regular bedtimes and regular times to get up can also help.
- Limit daytime naps to no more than 30 minutes.
- Avoid caffeine and nicotine close to bedtime and use alcohol only in moderation. While alcohol can make you fall asleep faster, it interferes with your sleep later in the night. If you have nights that you fall asleep easily but wake up at 2am, see if those early morning awakenings correlate with alcohol use.
- Exercise every day—even as little as 10 minutes of aerobic exercise helps. However, some people have a hard time sleeping if they have a strenuous workout close to bedtime so if you fall into that category it is best to exercise earlier in the day.
- Avoid foods that give you heartburn/indigestion before sleep. For some people sparkling water or other carbonated beverages right before bed results in waking up with painful heartburn a few hours later. Other people are bothered by spicy foods. You probably know your own offenders, so it is best to avoid them.
- Make sure you get some sunlight every day and keep your room dark at night. This can strengthen your sleep-wake cycle which can improve the overall quality of sleep.
- Establish a calming bedtime routine. A bath, lavender, or other calming scents in an infuser, reading, or whatever works for you. Make your own routine and queue your body into knowing it is time to turn off the day and restore itself.
- Set up a sleep environment that is pleasant for you. Comfortable bedding, cool temperatures, limited lighting (including screens—you can even set your iPhone to dim to a “Night Shift” setting which changes the screen to warmer color to help you sleep better), noise machines, anything that works for you. Black-out curtains can be extremely helpful as well.
But what happens if you try all the above and still have difficulty? One option is therapy. There is a form of therapy called CBT-I. It is a type of cognitive-behavioral therapy specifically for people with insomnia and it reportedly works extremely well and quickly.
Another option is to try melatonin which is sold over the counter. Melatonin is the hormone that our pineal glands produce that regulates our sleep-wake cycle. It can help reset the body’s clock (such as when you are working night shifts or traveling across time zones). For some people, it can also improve sleep. This is a natural remedy and it has few side effects. The usual dose is approx. 3mg-6mg at bedtime. There is even a new time-release form available by prescription called Rozerem. (Always check with your doctor before starting any new medication, even those that you can buy over the counter.)
And, if sleep is still elusive it is time to see your doctor. There could be an underlying medical problem interfering with your sleep, or other issues such as an undiagnosed depressive or anxiety disorder. Prescription sleep medications (such as Lunesta, Sonata, or Ambien) could also be indicated, although they should not be the starting point or considered as a long-term solution.
The Rev. Suzanne Watson, M.D. came to medicine as a second career after 10+ years of ordained ministry in the Episcopal Church where she served in congregations in California, New Zealand, and Connecticut, as well as on the staff of the Presiding Bishop in New York. She was also a candidate for Bishop of Alaska.
She attended medical school in her 20s, but left to devote time to raising her family. However, her dream of practicing medicine never died, and at the age of 50 she embarked on this vocational change. Part of her motivation was the loss of her physician husband to suicide. She is strongly committed to mental health advocacy, the reduction of stigma, and suicide prevention
She is currently in her last year of residency in Psychiatry at the University of Nevada, Reno. She is returning to San Diego this Summer and will be working at the VA hospital in La Jolla.