Sleep Tips for Insomnia

Sleep tips for insomnia are the things you read about in the press most often: Don’t drink coffee after 2 pm, make your bedroom dark, avoid screens and bright lights at night and so forth. 

There are 2 reasons CBTi puts a low emphasis on this advice.  I will let Michael Swartz explain the 1^st: < Michael 15 – sleep hygiene 1:30 – 2:30 – relates to dental hygiene>

Ironically, these least effective methods are the things you have probably heard about and acted on with little success.  When you came to this podcast, you probably thought that you had tried everything to tackle your insomnia.  But what you really meant was that you had read about and tried a lot of sleep tips.  You likely had never even heard of CBTi or Cognitive Behavioral Therapy for Insomnia, until now. 

The 2^nd reason CBTi shy’s away from tips for better sleep is that they can be a slippery slope that ends up causing insomnia.  They must be approached with caution.

As has been repeated many times in this course, stress and anxiety are the #1 cause of insomnia.  Unfortunately, taking sleep tips too seriously can cause sleep anxiety, where you come to believe that unless you follow certain routines or methods with precision, that you will not sleep well.  Solving the problem can easily become the problem. 

So don’t take sleep tips for insomnia too seriously.  Don’t worry about optimizing the sleep tips, or any other aspect of your sleep – it will only lead to anxiety which will more than counteract any benefits you may trying to achieve.  As we learned in lesson 5 on Sleep Buddy, your connection to sleep is more like a connection to a person.  You don’t try to optimize your relationships.  It is more of a give and take situation where you respect the relationship by showing empathy and recognizing your sleep needs.

My recent surgery experience: <2 transition>

I would like to use a recent experience of mine as to how flexible our sleep can be even if we believe it is inflexible and requires vigilance.

I recently underwent a minor surgery at a local hospital which included an overnight stay. 

Over the years I have come to adopt many sleep routines and crutches, many of which I was somewhat unaware of until this experience.  For instance – I have a favorite pillow that I often bring when we stay overnight away from our home, I have a large comfortable bed with a down quilt, I sleep on my side, my bed is flat and I have a bedtime routine which includes reading before bed and dimming the lights, I wear the same pajamas each night, we keep the window open overnight and so forth.  I am not fanatic about these things, but together they form my preferred sleep routine and environment.  At some level I believe that these are important to sleep well, otherwise I would do something else.

With 14 staples in the side of my head, a drain tube out my ear, wearing a hospital gown with a thin cotton blanket, my head elevated all night and all the trappings of a hospital including no fresh air, this should have been a recipe for insomnia.  Even after getting home, I still had many of my sleep habits disrupted as the drain tube remained in place and I used a thick foam wedge to elevate my upper body.  I took almost no pain killers, just an occasional Tylenol and no sleep medications, so there was nothing to artificially put me to sleep.

But instead of insomnia, I marveled at how well I slept.  Certainly sleep was not perfect, but it was good enough.  I felt fine and functioned well during the day, which is our goal of sleeping well anyway, isn’t it? 

If you think about it, comfortable and safe sleep environments are a very recent phenomenon.  Historically, we humans have slept in all sorts of uncomfortable and unsafe conditions.  Bugs crawling over us, snakes slithering nearby, rain seeping through imperfect roofs, uncontrollable temperatures, smoke, aches and pains from untreated diseases and injuries, multiple bodies of various ages in the same room or cave etc, etc.  If we needed perfect conditions to sleep, our species would have died out long ago. 

What I realized in my situation after the surgery, was that I only needed to worry about 2 things, things  that we have learned in previous lessons: Let my sleep pressure build up until I feel sleepy, then relax and let sleep happen.  When I let go of my need to control my sleep and environment, then indeed sleep happened.

<2 transition> 9:00

The thing that makes sleep tips so dangerous, is that they are generally done specifically for sleep whereas much of the other CBTi advice is helpful regardless of your sleep situation.

For instance in Lesson #7 on Sleep Myths where we learned to challenge our beliefs to stop stress from building up.  Preventing stress is a good thing regardless of whether we sleep better or not. 

And in the last lesson on relaxation, triggering the relaxation response has many health benefits and is helpful for its own sake, regardless of whether we sleep better or not.

Because we are facing our sleep myths and learning to relax to feel and function better, and not directly to improve our sleep, developing sleep anxiety is much less likely.  By treating sleep as a fringe benefit of stress reduction, we disconnect the exercise from sleep and thus avoid getting stressed at bedtime.

But with tips for better sleep, about the only reason you would dim the lights 1 hour before bedtime is to help induce sleep.  So you can start to believe that it is essential and feel panic when the lights are not dimmed on time.  This is counter productive.  So I would like to give some context to help you avoid getting stressed about sleep tips.

Context for Sleep Tips for Insomnia

1^st is learned from my experience with surgery.  You can sleep adequately under a wide variety of conditions.  Your ancestors didn’t need perfect sleep conditions to survive, and neither do you.  You can be flexible and adapt to different events and imperfect execution of your sleep tips.  In fact, I encourage you to mess around with the sleep tips to prove to yourself that sometimes you will have a poor nights sleep despite following everything to a tee, and other times sleep well despite exercising some bad judgement.  The correlation between following sleep tips precisely and sleeping well just isn’t very strong.  Sleep tips are just one factor of many impacting your sleep.

2^nd is that you cannot optimize sleep.  The brain has 10 billion neurons and 1,000 trillion neural connections.  Life is complex.  At the same time, your neural sleep circuitry is robust.  A given sleep tip is not going to make or break your sleep. 

And 3^rd, you are sensitive and insensitive to different stimuli and events, and this changes over time and with different circumstances such as whether you have young children in your home.  You may be able to sleep after consuming coffee, or not.  You may need 2 hours to wind down tonight, or maybe 20 minutes works well.  You may be unable to sleep after watching the news, or you might zonk out while you are still watching it. 

So don’t take any of the tips for better sleep too personally.  Find out what is important to you and then try to be somewhat consistent.  Not every sleep tip will make a measurable difference in your sleep.

That being said, if you are still suffering from chronic insomnia, at least at the beginning, you may want to start following as many of the tips as is practical and then start experimenting and relaxing the ones that don’t seem to affect you much.

Sleep tips: <2 transition>  12:32

So let’s get down to it and go over the sleep tips.  These sleep tips are things that your should or should not be doing in preparation for sleep.  It starts with choices and activities during the day and leads up to and includes the time while you are sleeping.  I will go through them in chronological order as that makes them easier to remember.

Wake up at same time:

<plop or sonar> So let’s start with waking up.  The time you wake up and especially first expose to light, sets your circadian rhythm’s clock. It is more important to wake up at the same time than it is to go to sleep at the same time. 

Waking up means getting out of bed and starting your day, it does not mean staying horizontal and lounging in bed. 

You can give yourself some slack, say 15 minutes most days and 30 minutes on weekends, but try to keep your wake up time as consistent as practical.    

Exposure to Sunlight:

<plop or sonar> As early as is practical, get outside and expose yourself to some good old daylight, without sunglasses.  This is important because our brains are tuned to detect daylight and use it to signal to the brain that night has ended and day has started.  In fact, about 1 out of every 100 light sensing neurons in your eye do not help you with your vision.  1% of your light detectors are devoted to sensing light strictly to trigger the start of the day for your circadian rhythm and are connected directly to the hypothalamus.  This is how critical setting your circadian rhythm is, not just for sleep but for your general health and well being.

You may think that bright indoor lights would be enough, but outdoor light levels and 10 to 100 times as bright as typical light levels in houses and offices.  Indoor lighting is not enough to send a clear signal to the brain’s sleep center to set yourself up for a great day and a good night’s sleep.

This can be a problem if you live in the extreme north or south where morning daylight can be scarce in winter, or if you can’t get outside for some reason.  In this case you may want to consider a therapy lamp specifically for that purpose which you can buy at a drug store or online.  I will put a link to a therapy light on my website, sleeptohealthy.com, so you can have an example to go by.

Exposure to morning daylight does not need to take a lot of time.  I used to walk around the block before getting into my car to go to work in the morning. 

<steps> When you are walking, try to keep your eyes up high looking into the branches of trees if you can.  You may find the upward gaze stimulates a positive outlook and seeing nature in the tree branches may have a calming effect for you. But watch where you are walking. 

Exercise:  15:30

<plop or sonar> Getting exercise during the day is good for your sleep.  One of the main reasons is that it raises your core body temperature which is another signal to the brain that it is daytime and all is well and good.  Excercise also improves your mood and reduces stress which are also good for sleep.  You get bonus points if you can combine daylight and exercise into one.  Try to avoid vigorous exercise within 3 hours of bed, but do what seems to work well for you. 

Here is Michael Schwatz’s take on exercise: <Michael, 10:30 – Do activities, not necessarily exercise>

Caffeine: 

<plop or sonar> The next tip is to avoid caffeine after 12 o’clock noon.  Caffeine has a half life of about  6 hours.  This means that it takes about 6 hours for half the caffeine to get out of your system and another 6 hours, or 12 hours in total, for your caffeine level to drop to ¼.  So it takes a while to get it out of your system.  Caffeine counteracts your sleep drive, so any caffeine left in your system will leave you less sleepy at bedtime and lowers your sleep drive during the night.  Even if you can get to sleep after a recent dose of caffeine, it will disrupt your sleep cycles and you won’t sleep as well.

As an aside, caffeine disrupts sleep in an interesting way.  Your sleep drive is created by a gradual build up of a chemical called adenosine in your brain.  Adenosine attaches to receptors than trigger to the brain how long you have been up.  Caffeine blocks the receptors so that even though you have built up adenosine, your brain doesn’t know it and so is tricked into thinking that you have not been up very long and so keeps you alert.

Completely eliminate caffeine if you can, but certainly don’t drink any after noon.  Also watch for hidden sources of caffeine such as in chocolate, medicines and energy drinks.

Nicotine: 

<plop or sonar> Next on the list is nicotine which is also a stimulant that hinders sleep.  Smoking can feel relaxing, but the nicotine will hinder your sleep.  Reduce smoking 4 hours before bedtime and avoid altogether 45 minutes before bed.

Alcohol:

<plop or sonar> Since we are talking about chemi cals that interfere with sleep, I might as well bring up alcohol.  Alcohol is a depressant and so it is a natural choice to help you get to sleep especially when you are wound up or agitated.  While it may help you to start sleep, it upsets your normal sleep patterns and wakes you up as you go through withdrawal in the middle of the night, not to mention extra trips to the bathroom.  You already have trouble staying asleep, so you don’t need alcohol on top if everything else.

Here is Michael Schwartz’s advice on alcohol: <#15 – 5:10> 19:40

Hour before bed wind down. 

<plop or sonar> Now we are nearing bedtime, and the magical hour before bed.  Many of these tips are somewhat negotiable, but this tip is very important for nearly everyone. 

Avoid stressful and stimulating activities within an hour of bed.  Otherwise your brain will be on high alert which, as we learned last lesson, prevents you from approaching the initial sleep state.

The problem is I can’t tell you what these are activities are for you.  Talking to my spouse about tomorrows schedule might be stressful to me, whereas you find it relaxing and helps you feel less stressed.  Pay very close attention to what you do for the hour before bed and figure out what helps you to feel relaxed and what causes your brain to be stimulated, stressed or anxious.  Avoid problem solving as solving problems implies that there is a danger or threat that needs attention. 

Some examples of things to do include:

<ding> Read a book, as long as it’s not stress inducing and doesn’t get you worked up.  You may want to try learning something new as what you read about at the end of the day may be better put into long term memory at night while you sleep.

<ding> Some people find watching TV relaxing, for others it’s too stimulating.

<ding> Do some stretching or yoga or gentle exercises.  If safe, go for an evening stroll.

<ding> Have a bath or shower.  Enjoy the activity, don’t just rush through it.  If you have a bath, allow some time for the body to cool down before bedtime.

<ding> Do a jigsaw puzzle or other hobby that you enjoy.  Doing something that you enjoy doing before bed can really set the stage for a good night’s sleep.

<ding> Listen to some music that relaxes you, or play a musical instrument.  Generating music on a computer, tablet or phone is usually NOT a good idea due to the backlit screen and the problem-solving nature of creating music on a computer.

<ding> Call someone you enjoy chatting with.  Just don’t get into any emotional topics.

<ding> Have a cup of warm milk or herbal tea.

Your tendency might be to consider this hour before bed a waste of time when you have so much to do.  But think for a moment.  Why are you so busy?  What are you trying to achieve?  Usually we are trying to get ahead in the world so we can finally relax and enjoy life.  Guess what – that moment has already arrived and it is your wind down time before bed.  Use this time to treat yourself to what you enjoy doing.  Savor the moment.  You don’t need to wait for some uncertain point in the future, you can enjoy life right now.  And as a bonus, you are likely to sleep better and feel and function better tomorrow.  How good is that?

Lights levels down:    24:36

<plop or sonar> Just as bright sunlight triggers your brain to wake up and be alert, dim lighting at night, about an hour before bed, triggers your brain that sleep is soon to follow.  This is not just psychological conditioning.  In fact, reduced light levels trigger the release of melatonin.  Melatonin’s job it is to convert the brain from awake mode to sleep mode.  So turn off any bright lights or install dimmer switches or dimmable lights to trigger your melatonin production and thus the transition from wakefulness to sleep.

I have converted several our lights to dimmable switches and you can even buy smart light bu  lbs that you can dim down on a schedule thorough your smart phone.

In the morning, you can use the programable lights to come on before your alarm clock.  I have given a few of these smart lights away as gifts and the recipients have said that waking up with the light on has been a game changer, especially if it is dark outside when the alarm goes off.   Smart lights are available at most hardware stores.

Backlit Screens

The other light source that interferes with sleep are backlit screens such as smart phones, tablets, computers and TVs.  These screens emit strongly in the blue light spectrum which stops melatonin production which hinders the brains ability to enter and stay in the sleep state. 

Most smart phones, tablets and computers now have blue light filters that can come on automatically.  Use these.  For TV watching you can buy orange colored glasses.  I have put a link in the show notes at Sleeptohealthy.com as an example. 

Many people find screen time emotionally stimulating which works against your requirement to settle down to prepare for sleep.  So in general it is better to avoid screen time within an hour of bed anyway. 

If you read using a tablet or phone, you can use the blue light filter and also turn the light intensity way down.  Most reading apps allow you to reverse the screen and have a black background with white text which, along with blocking out the blue light and turning down the light intensity allows you to read with a minimum of light.

Bedtime snack: 27:07

<plop or sonar> You might benefit from a light snack before bed.  You don’t need to go to bed hungry.  Something with some protein and fat which tends to give a longer energy release versus sugary snacks work best.  Bread with peanut butter or a glass of warm milk can work well.  You may have heard that turkey helps you sleep, because it contains tryptophan, but the amount is too small to be of any benefit and is similar to other meats, so you can take it or leave it. 

Don’t clock watch: 

<plop or sonar> As I have emphasized several time, we want to avoid mixing stress or anxiety and sleep.  Something that can trigger anxiety towards bedtime and during the night is clock watching.  Seeing the time before bed can cause you to anticipate the start of a bad night’s sleep.  During the night, seeing the time can lead you to worry about how much time there is before you wake up and worry about how little sleep you might get before then.  This makes you try to force sleep, which is a bad idea.

The solution is simple: Cover up all the clocks an hour before bed and don’t uncover them until you are up again in the morning.  Once you get used to doing this, you will be pleasantly surprised at how much it reduces sleep stress.

You want to avoid clock watching about an hour before bedtime. This will help you to pay attention to your brain’s sleep signals rather than giving authority and priority to an artificial electronic device arbitrarily telling you what to do and when.  Your natural sleep system is much more important than a digital display, so pay attention to the right cues for bedtime.

Sleep is a natural process ruled by our minds and bodies, not ruled by digital clocks.  So give it a chance to work this way.  By covering your clocks about an hour before bed, you judge your bedtime by how tired you are, not by the clock.  It is more important to wake at the same time than it is to go to sleep at the same time, so a variation in bed time is not so important.  We all know the frustration of wanting to get to sleep early but not being able to sleep because our minds and bodies are not ready yet.  This avoids this frustration. 

You also know how nice if feels to go to bed when you are tired and, how good it feels to crawl into bed when sleepy and how satisfying it is to get to sleep quickly.  Covering your clocks, and I mean ALL your clocks, and letting your mind lead you to sleep makes it much more likely that this will happen.  It also helps you notice what activities make you relaxed and which stimulate the mind, so you can fine tune your bedtime routine more quickly.

The other part of clock watching should be even more obvious.  What happens when you look at the clock in the middle of the night?  You stress out as you calculate the time until the alarm will go off and you try to figure ways to get to sleep faster which causes stress.  Stress is the #1 enemy of sleep, so this doesn’t help, but hinder. 

What if you didn’t know what time is was?  Then you might just listen to your body, do something relaxing while your mind got sleepy again and then went to bed and slept.  Wouldn’t that be nice? 

Michael Swartz is a big believer of avoiding the clock at night.  <Michael <#16 – 13:20>  31:05

Give it a try for a couple of weeks to get used to because it will probably be a bit unsettling at first.  But this is the way we handled sleep for about a zillion years, so why not let ancient wisdom prevail.  You have nothing to lose and a lot to gain.

Good sleep environment:  32:00

<plop or sonar> A good sleep environment can help you get to and stay asleep.  A dark, cool, quiet, comfortable room and bed are best.  These are pretty much common sense other than the temperature. 

Our body temperature plays an important role in controlling the sleep cycle.  Some people with insomnia have been shown to have shallower temperature rises and dips than good sleepers.  Your body temperature naturally dips during sleep and you want to help that along by having a cool room temperature, but not so cool that you have trouble feeling comfortable below the covers.

You might want to consider ear plugs to reduce noise and good heavy blinds or an eye mask to eliminate light.  The main thing is to see what you are sensitive to and make sure that is taken care of.

Listen to your mind: 

<plop or sonar> With all these sleep tips, pay attention to how your mind responds.  Almost any advice designed to help sleep can easily backfire and make sleep worse.  This is because our minds can put meaning and have associations with actions and thoughts that can cause us to react with fear and anxiety to an action or thought that another person finds relaxing and calming.  Also, our bodies react differently to different environmental and chemicals such as caffeine.

For instance, covering the clock at night might work great for me, but you might find yourself constantly trying to guess the correct time and get even more stressed than if you had the clock visible.  In that case you may want to find creative ways of avoiding clock watching that don’t cause stress, or you may find it less stressful to watch the clock.  But, give yourself time to adapt to the new routine, perhaps 2 weeks, before drawing any conclusions.

I keep my clocks covered, but if I happen to glimpse the time in the middle of the night, it is no big deal.  I just do what I would have done if I hadn’t seen to time.  It becomes information, not a trigger for stress and inappropriate actions or thoughts.

And that’s about it for sleep tips for insomnia or tips for better sleep.  In CBTi parlance, Sleep Tips is called Sleep Hygiene.

Alternatives to CBT: <2 Transition>

Since this is the last element of CBTi or Cognitive Behavioral Therapy for Insomnia, I would like to recognize that CBTi is not for everyone.  For some reason, you may find that the advice and assignments just don’t seem to help you.  You may be resistant to the methods for some reason.  Like any method or advice, success is not 100%.  If that’s the case, I would like to tell you about some alternative methods that you may find helpful.

At the same time you need to be aware that CBTi can take some time to kick in, as much as 6 weeks or more.  It is more like a physiotherapy session than a quick fix with a pill.  You have spent a long time developing your behaviors and beliefs that lead you to insomnia.  Reversing these habits takes time and effort.  Give CBTi an honest effort, at least 6 weeks of hard work, before giving up on it.  It is very common for CBTi to take several weeks before you see any results, but the results will last a lifetime and are well worth it.  Also, consider using a sleep professional as the transition can be difficult and likely needs personal guidance.  I will have the links to Michael Schwartz and Dr. Daniel Erichsen at sleeptohealthy.com.

With that caveat, here are some alternatives you should be aware of:

ACT

<plop or sonar> The first is ACT or Acceptance and Commitment Therapy.  I will put a link in the show notes at SleeptoHealthy.com to a book on ACT and Insomnia.  ACT is like CBT or Cognitive Behavioral Therapy in that it focuses on reducing levels of stress.  But rather than changing core beliefs, it focuses on setting strong life goals – which is the Commitment part of Acceptance and Commitment Therapy – and accepting your insomnia rather than trying to fight it.

By realizing that you can achieve what is important to you despite your insomnia, and not allowing insomnia to prevent you from your life goals, insomnia loses its dominance, you relax, and as a natural consequence, you sleep better.

ACT does not include the behavior aspects of CBTi.  It does not include compacting your sleep or sleep buddy.

Stoicism

<plop or sonar> Another approach is Stoicism.  This may seem like an odd suggestion, but stoicism, like ACT, gets your attention off sleep and onto what it means to live a good life.  Stoicism does not deal with insomnia directly, there is no part of stoicism that tells you how to sleep better.

But stoicism teaches that living a good and fulfilling life is about living a virtuous life and focusing on the things you can control, not the things you can’t control.  Since you can’t control sleep, it could help you reduce your sleep stress.

I have put a link to a well written book on stoicism that I am reading right now on my sleeptohealthy.com website.

The Work

<plop or sonar> You may notice a common theme in my non-CBTi recommendations, which is to reduce stress thus improving sleep.  A method I have used for years and attribute my climb from anger and depression to calmness and acceptance is something called “The Work” by Byron Katie. 

I call it CBT on steroids because it drills down so quickly at correcting your mistaken beliefs.  This is not a scientifically proven method and has a bit of a new age feel to it that some people might not be comfortable with, but it doesn’t contain anything that should clash with your religious or other belief systems.

This method is best experienced and learned through Byron Katie’s audiobook called “Loving What Is”.  There is a link to this at sleeptohealthy.com. 

With The Work, you write out your stressful thought and then gives 4 simple questions which you answer.  The answers to the questions are all you need to completely erase the stress in the situation.

It is like CBT or Cognitive Behavioral Therapy in that you must write out issues and your responses.  It takes a lot of work but can completely wipe away stresses from your life that you thought were insurmountable.

The Myth of Stress

<plop or sonar>  Andrew Bernstein worked with Byron Katie but realized that some people found her methods difficult to relate to.  So he developed a more pragmatic, less abstract system based on The Work and wrote a book called The Myth of Stress.

The great thing about The Myth of Stress is that it is really a workbook that starts with very low stress situations and slowly works you up to more stressful life issues.  The Audio book is narrated by the author and you may find it even more impactful than the book.  Both links are at my sleeptohealhy.com website.

All these alternatives can be used to compliment CBTi, as I do, so you might want to check them out even if you are having success with the CBTi method.  Anything that helps reduce stress so you can be more effective at the things that are important to you, whether that is relationships or projects, is a worthwhile life skill to develop.  40:49

Disclaimer

And here is the disclaimer spoken in one breath….

This podcast is not a substitute for advice from a qualified healthcare professional.  The sole purpose of this podcast is to educate and entertain.  As we do not know your particulars, we cannot and do not provide professional or medical advice or services.  We strongly encourage you to consult a healthcare professional before incorporating any ideas in this podcast.  Listeners who use the information in this podcast do so at their own risk.

Outro:

By structuring this as a course on curing insomnia, it keeps you focused on the core skills you need to improve your sleep. You don’t need tons of sleep trivia and people’s opinions about sleep.  You just need to know proven instructions on what you can do today, to sleep better tonight, so you can feel and function better tomorrow. This allows you to repeat lessons as it’s hard to absorb all the knowledge the first time through, and the information will make more sense after you have the context of the whole course.

You, like most people, will likely benefit from repeated listening.  The lessons will be updated based on student feedback. So the next time you listen to the same lesson, it may be improved since last time.  And that’s about it. Thanks for joining my in my sleep class.

I look forward to seeing you again on the next episode of the sleep to healthy podcast. See you then.