Insomnia

 

 

 

 

 

I planned to regale my readers with news from the big annual American Society of Addiction Medicine conference, held earlier this month. But it was not to be. The day before I was to depart, I woke up with pink eye.

I woke up with the kind of pink eye that caused fluid to sprout from my eye like an overfull bathtub. Of course, this material in highly infectious, and very messy. I dabbed my eye and face with a tissue, discarded it and washed my hands, only to have to repeat the whole process a minute later. In good conscience I couldn’t get on a plane and go to a meeting of hundreds of people and risk infecting them, so I stayed home, feeling grumpy.

I’ll still go to the sessions, online. ASAM has a wonderful online program, where you can hear sessions at conferences you’ve registered for. So as soon as they are posted, I’ll listen to them at home, and then pass new information on to my readers.

In the meantime, here’s a re-run on insomnia. I get so many patients with insomnia. It’s a common problem for people in recovery, who are waiting for their brain chemistries to calm down. Nearly every week, I recite the main points of good sleep hygiene to patients in need of a good night’s sleep.

For someone who has grown accustomed to taking some sort of substance to fix every problem, hearing that the solution isn’t another pill can be hard to accept, but I’m convinced most sleep issues can be cured or improved with the following principles of sleep hygiene:

Many U.S. citizens, and not only addicts, have become “chemical copers.” We have the idea that every problem can and should be fixed with medication. But with insomnia, sleep hygiene is the best first option, and medication can be used if sleep hygiene doesn’t work.

Sleep hygiene, which sounds it means washing behind your ears at bedtime, really refers to habits that help us get satisfactory sleep. Most are common sense ideas, and they can really make a big difference. Here are some of these ideas:

Go to bed at the same time and wake at the same time every day, even on weekends.

If it’s at all possible, don’t go to bed later or sleep later on weekend days. Get your body into the habit of keeping a regular sleep/wake cycle. You will fall asleep more easily with a fixed bed time.

Besides making your feel better because you’ll get more regular sleep, this practice has other benefits. For example, people with migraine and tension headaches have fewer pain episodes with regular sleep/wake times. Keeping regular sleeping hours is also highly recommended for patients with bipolar disorder, as it can help with mood swings.

Avoid caffeine late in the day. For some people, drinking caffeine in the late afternoon can affect them up to six hours later. To be sure, cut off caffeine at least eight hours before you want to sleep. Caffeine doesn’t affect everyone to this degree, but unless you know for sure, try to limit late-day caffeine. If you consume energy drinks, consider cutting back or stopping them.

Make sure your bed is comfortable and your room as free from distractions as possible. Pets and rowdy bed partners may need to sleep in other areas. Make sure the room temperature is conducive to sleep and there’s no noise or light that may interrupt sleep. Keeping the television on for background noise isn’t a good idea and can prevent you from getting to the deeper levels of sleep.

Don’t set your alarm for earlier than you need to. Many of us like to do this so we can hit snooze a few times. However, the most beneficial sleep, REM sleep, comes at the end of the night, and we are depriving ourselves of REM sleep by hitting the snooze button a few times before getting out of bed for good.

Have a bedtime ritual. Have things you do each night before going to bed that relax you and put you in a mindset to sleep. This could be a series of ablutions like brushing your teeth, flossing, or taking a warm bath. Other people may prefer doing prayer or meditation to quiet the mind, or reading.

Don’t nap during the day to catch up on sleep. More than anything else, napping will keep you from sleeping at night.

This is a tough one for me, since napping has long been one of my hobbies. Because I think of a good nap as one of life’s great joys, on some days I’m willing to risk not being able to get to sleep at night and take the nap anyway.

Don’t use alcohol to help you sleep. While alcohol does cause faster sleep onset, it also shortens the sleep cycle, causing us to wake earlier, and robs us of the important REM sleep. Over long term, alcohol can greatly interfere with your sleep cycle.

Only use your bed for sleep. OK, for sex too. But don’t live in your bed so that you become accustomed to eating, watching television, and working on the computer in bed. Your mind should associate bed with sleep, and not these waking activities.

Exercise each day. More than most other suggestions, this one can help you more than you expect. Even a small amount of exercise can have surprisingly good benefits. Don’t exercise too close to bedtime, since exercise can have a stimulating effect.

Sometimes people in early recovery find they want to sleep more than usual. This can be part of your physical recovery, and I think it’s best to listen to your body and allow yourself extra sleep time without feeling guilty. However, some mood disorders also make people want to “take to the bed” during times of stress and negative emotion. This latter situation may need medication if it continues or interferes with your life.

If you try all these sleep hygiene measures and you still can’t sleep, talk to your doctor about a safe medication for sleep. I’ll write more about medications in a later blog.

 

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2 responses to this post.

  1. Posted by Mary Anne Hughes on April 24, 2019 at 1:24 am

    Hi Jana! Great column, as usual. I still share them all with patients, their families and staff and you have many fans among them. . If I may, I wanted to add a few things I learned along the way, since I have my fair share of insomniacs too.Many of our patients who can’t sleep and are smokers, get up and have a cig or vape to relax. I remind them that nicotine, although relaxing, acts like a stimulant, much like caffeine and can stay in their bodies up to 14 hours, according to one article I read. Also, keeping the room cool enhances sleep. I keep my room temp around 69 degrees, which is within the recommended range ( yes, they even researched THOSE parameters) . And lastly, there is some wisdom to getting up with the sun and going to bed, or at least settling in at dark. Light and dark play an important part in our circadian rhythms. So on that note, I’d just like to quote from my grandson’s night time ritual. He says ” Sleep tight and don’t let the bed bugs bite”. I guess there is some wisdom in that too!

    Reply

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