ASK DR. BAUGHAN October 1, 1999
PRECIOUS SLEEP
A new sleeping pill hits the market this month, so expect some direct-to-consumer advertising, as has become the custom in our society. It is called Sonata. It is chemically similar to the existing prescription pill Ambien. It may help some people who have not benefited from other sleeping aides, but I do not expect it to solve everyone’s sleep problems. It is nice to have another option to treat insomnia, but I thought it would be timely to review the other ways we know can help establish and maintain sleep without drugs – “sleep hygiene,” as it is called in the sleep business.
We spend one-third of our lives asleep, and we go crazy or die if we do not get enough sleep. But surprisingly, we rarely teach ourselves how to sleep. Somewhere around age 7 or 8, we stop reading stories or singing lullabies to our children and expect them to simply “fall” asleep. For millions of people, though, it is not so simple. One of the first steps toward better sleep is to establish a good “sleep ritual.”
Try to go to bed around the same time every night. Your body’s internal clocks need a predictable rhythm. Going to bed at 9 o’clock one night and 12 o’clock another is like changing time zones. This is particularly difficult for people who work different time shifts. For people who work the night shift during the week, it is better for the body if they maintain the same schedule on their days off. Admittedly, this is hard on social and family lives. For those who change from day to evening to night shifts, the body needs an adjustment period. This has been studied well enough to document that changing shifts every 3 weeks is much healthier than weekly. Not only is sleep better, but concentration, judgment and reflexes suffer if shifts are changed more frequently than that. Surprisingly, some occupations that require these abilities, such as health care and state troopers, ignore this knowledge.
Prepare for sleep the same way each night. If you shower in the evening, do it consistently. Give yourself some sleep preparation time. If you have trouble getting to sleep, avoid television for an hour before bedtime. Even non-violent shows are stimulating to the brain by the nature of the medium. Read in a chair until drowsy rather than in bed. Don’t take the problems of the day to bed for discussion. Deal with them earlier. Avoid any alcohol for several hours before bedtime. Those who say a nightcap helps them get to sleep often find themselves waking in the middle of the night when the alcohol wears off. Certainly avoid caffeine; some cannot tolerate caffeine even much earlier in the day. Likewise, exercise and meditation earlier in the day is beneficial, but too close to bedtime can be too stimulating. Ensure the mattress is comfortable and supportive. Warm milk or even warm water can be helpful. There are many herbal approaches to insomnia, but today I will only focus on sleeping without any chemicals, natural or synthetic. One of the most frequent causes of insomnia is the chemical that one-fifth of our country is addicted to, nicotine. Soft noise may help, such as a humidifier or air cleaner.
If you cannot get to sleep in 30 minutes or so, do not remain in bed tossing and turning. Get up and do some quiet, non-stimulating activity. Read a technical or dull book, not a suspense novel. Knitting is good, housework or weaving is too physical. Do not watch television. Keep the lights low. When you feel drowsy, go back to bed. This applies for waking up during the night as well.
If you did not sleep well last night, try not to sleep late or take a nap to catch up. Remember, this is for people with chronic sleep disturbances. You may need to suffer some daytime discomfort to re-establish your nighttime rhythm. Admittedly, easier said than done, but breaking an insomnia cycle is very important and often requires careful structure. If all this fails to help, then there are a variety of medicines that may help, so consult your health care provider.