Sleep Hygiene

By Nasreen Shah, LMHC

With our busy schedules, it is no surprise many Americans feel behind on sleep. It can be difficult to find time for rest and relaxation as it is not part of our daily activities. In other countries, such as Finland, and Canada, breaks are scheduled during the work day. In Spain, India, Italy, and China, workers come home from work in the middle of the day for a 1-2 hour break. People use this time to eat a meal with the family and to take an afternoon nap, offering more opportunities for resting and self-care.  Unlike other countries which engage in fewer work hours and create routines prioritizing rest, for most Americans, the evening hours offer the only window of opportunity for sleep in a 24 hour day.  

With fewer opportunities for rest, we need to be mindful and intentional with how we use our time in the evenings and create routines that help us have our best sleep.  Lack of sleep is associated with poor concentration, low energy, and difficulty with alertness and memory. Many people experience disruptive sleep, however, you can develop habits to increase your quality of sleep.  

Tips for getting to sleep:
1. Set up the routine: One of the best things you can do to improve sleep is to set a consistent sleep and waking time. Waking up at the same time, within 30 minutes or so of your regular time, helps your body regulate to a schedule. Upon waking, get outside, or stand in front of a window for natural light. Turning on the lights, and moving first thing in the morning, helps your body adjust to waking early.  You might consider doing light stretches or a short walk in the morning. 
2. During the day, strive for 10- 15 minutes (or more if you can) of movement. Exercise greatly improves quality of sleep.  Cardio can be effective in decreasing anxiety and allowing the body to be tired enough to sleep. Additionally, weight training utilizes energy, allowing you to be tired enough to fall asleep at night. The more movement you can incorporate in your day, the more likely you will be tired enough to sleep at night. 
3. Prepare for sleep: Our brains and bodies respond well to consistency and healthy sleep habits. Once you have set a ‘going to bed time’ keep in mind the following:

• Limit caffeine, and other substances, including alcohol, within 3 hours of bed time. While substances may help you feel relaxed, they disturb the depth and quality of sleep. 
• 1 hour to 30 minutes before your bed time, create a bed time routine which includes turning down the lights, limiting electronic use, and incorporates relaxation techniques such as mindfulness exercises, journaling, reading a book, or taking a warm shower. Regularly incorporating relaxation into your routine helps signal to your brain and body that it is time to prepare to sleep. 
  • Note: consistency with your routine is important for conditioning your body and brain to prepare for sleep
• Keep your daytime routine consistent-resist the urge to sleep in or change your plans for the following day, because you did not get enough sleep the night before.  Try to avoid naps or limit them to 30 minutes a day or less.

Restless sleep:
1. Waking up in the middle of the night can be due to a variety of factors. Here are some common reasons:

• Temperature: You may be waking up because you are too warm. Try turning down the thermostat, or using less bedding. Also, certain medications and health conditions can create fluxuations in temperature which could be interfering with your sleep.
• Full bladder: If you wake frequently to use the restroom in the middle of the night you might consider limiting liquids before bed time, and if you do get up, do not turn on the lights. Use a soft night light in the hall or bathroom as turning on bright lights can signal your brain to start waking up.
• Anxiety/stress: When your mind is alert, or you are feeling anxious and stressed, it can be difficult to fall asleep and stay asleep. It may be helpful to utilize relaxation exercises before going to bed, which could include journaling to get your worries on paper and out of your mind. If you find yourself ruminating on stressors or feeling anxious in the middle of the night, you might find it helpful to engage in autogenics exercises. These can be listened to on tape, or can be done with a partner voicing the script. Autogenics exercises focus on imaging your limbs as warm and heavy, and can be very valuable in helping the body relax. Scripts for autogenics can be found in books or online.
• Keeping your clock away from your view will help with not frequently checking time, which can increase anxiety and make it even more difficult to get to sleep.
• Acceptance of restless sleep: There may be factors due to family, work, or environmental circumstances which are creating barriers in sound sleep. It is normal to be anxious the night before a presentation or job interview. It is expected you might not sleep well if you have young children or pets who are needing care during the night, and, if you have roommates or others who’s sleep needs are different than yours, there can be additional barriers to getting what you need out of your sleep routine. If wakefulness during the night is occurring more nights than not, you might consider working to identify what concerns are present for you, to create a plan for managing these stressors.  If your concern is excessive light and noise, for example, your plan might include using ear plugs, a noise machine, sleep mask, and light reducing curtains. 
• Asses level of chronic stressors: If you are under a considerable amount of stress due to life circumstances, job, personal reasons, it may be a culprit for sleep interference. Simplifying your routine/responsibilities, or putting extra supports in place (arranging to nap on weekends or for 20-30 minutes on weekdays) might be important for sleep hygiene during periods of high stress. This can also apply to acute stressors such as the loss of a loved one, depression, and other mental health concerns.
• Medications, mental health, physical health, and your environment are all components that can impact sleep. Discuss your needs with your physician or therapist to create a plan that is right for you. 

References: National Sleep Foundation, 2018