SLEEP HYGIENE & BEHAVIOURAL MEASURES FOR INSOMNIA
KNOW YOUR SLEEP REQUIREMENT: Most adults function best with approximately 8 hours of sleep. Some need 10 hours a night and others need only 5. Your requirement for sleep is unique. What is right for your spouse or friends may not be what you need. If you need only 5 hours of sleep a night, do not worry about it, or try to force longer sleeping hours. Instead, learn to use your extra waking hours for something you would like to do or get done.
SLEEP AND AGE: The amount and quality of sleep varies in the course of each person’s life.
- The infants may require 16-18 hours of sleep each day.
- An elderly person may sleep for lesser number hours at night (compared to his/her usual amount of night time sleep during adult life) and have frequent naps during the day.
- Teenagers need about 9-10 hours per night.
NOISE / LIGHT / BED SURFACE / ROOM TEMPERATURE:
- Noise from snoring spouse, aircrafts, streets or highways disturbs sleep even in people who do not awaken and who cannot remember the noise in the morning. These sleep disturbances can reduce restful sleep. People who sleep near excessive noise should try heavy curtains in their bedrooms or earplugs to protect the amount of restful sleep they get.
- Make your bedroom pitch dark.
- Make a judgment if your mattress is adding to insomnia.
- The room should be comfortably cool.
HUNGER / FOOD: Hunger may disturb sleep. A light snack, especially warm milk, seems to help people get to sleep. Avoid late heavy meals. Heavy protein meal at night may worsen sleep.
CAFFEINE: Avoid coffee, tea, cola drinks and chocolate. Stop caffeine altogether if you have any type of insomnia. Some people are more sensitive to caffeine and may have insomnia even if they take a very small amount (such as a cup of tea or a piece of chocolate) during the previous morning. The usual half-life of caffeine in heathy adults is about 6 hours. The term half-life means the amount of time it takes for your body to eliminate half the amount of caffeine. For example, if you consume 200 mg of caffeine at noon you will still have 100 mg in your system at 6pm and 50 mg at midnight and 25 mg at 6am and so on. There are medical reports that show that half-life of caffeine may increase with oral contraceptives (to 12 hours) and antidepressant fluvoxamine (56 hours). It may increase during pregnancy (15 hours) and with liver disease. The half-life is 65-130 hours in newborns.
ALCOHOL: Alcohol can cause sleep apnea. It can fragment sleep especially during second part of the night. It alters your sleep stages. Although it may help to induce sleep, the chronic use of larger quantities of alcohol causes disturbed sleep and dependency.
EXERCISE: Regular exercise can be an effective aid to sleep. It also releases mental tension. It is better not to do heavy exercise within 6 hours of bedtime as that can cause insomnia by raising your body temperature.
IF HAVING TROUBLE FALLING AND STAYING ASLEEP:
- Get up at the same time every morning. This is one of the best things to do to regulate your internal sleep clock in the brain.
- Keep clock face turned away, and do not check the time when you wake up during the night.
- Go to bed only when sleepy. People with insomnia often have a tendency to spend long hours in bed to rest even when they can’t sleep. Spending too much time in bed further adds to insomnia.
- Use the bedroom and bed for sleep only. Get out of bed if you estimate that you have been awake for more than 20 minutes. Trying harder to fall asleep will make the insomnia worse.
- Don’t nap during the day.
INSOMNIA AS A SYMPTOM OF MEDICAL PROBLEMS: Sleeping problems may signal a medical condition such as anxiety, depression, and other disorders. It is important to get a proper diagnosis and treatment for the underlying cause of your sleep problems.
- An occasional sleeping pill may be of some benefit, but chronic (nightly) use of sleeping pills may actually hinder good sleep. Sleeping medications should be used with caution and only upon the advice of a physician by the elderly, pregnant women, people with respiratory disease, kidney disease, or a liver impairment.
- Some sleeping pills have a prolonged effect, and can impair your coordination and driving skill the following day.
- Some sleeping pills make the sleep apnea worse.
- Sleep medications should be used only for the short term management of a sleep complaint. Do not self-medicate or increase the dosage yourself. If you feel that your medication is losing its effect, report this to your doctor.
- Many people who need sleeping pills chronically are advised to use sedating antidepressants, which may be very helpful and are not addictive.
Recommended reading: No More Sleepless Nights, Revised Edition (1996) – by Peter Hauri and Shirley Linde
Recommended dose of SAD light for delayed brain clock: 10.000 LUX full spectrum light (white light) for 30-90 minutes after waking up in the morning
Recommended dose of Melatonin for delayed brain clock: Use only 0.25 to 0.5 mg and take it 5-7 hours before intended bedtime.
For progressive muscle relaxation: Download an audio file for mp3 player or IPOD etc. from www.comh.ca
Information compiled by Dr. A. S. Minhas, Sleep Medicine Specialist www.surreysleepclinic.com