Sleeping Well : Sleep Promotion

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How do I establish a routine that promotes sleep?

A bedtime routine is part of sleep hygiene and helps you prepare psychologically and physically for sleep. A routine is a way of ordering simple daily tasks and behavioral patterns into a meaningful sequence. If you have difficulty establishing such a routine, it is best to seek help. In addition to assisting you in establishing a routine, a health professional may try a number of different treatments including stimulus control, sleep restriction, and cognitive-behavioral therapy.

What are the best ways to relax before going to bed?

Relaxation is an important part of preparing for sleep, but there is no best way–you must choose what suits you. There are many forms of relaxation therapy and most are easy for you to do yourself. Progressive muscle relaxation is one useful technique, where you tense and then relax different muscle groups in turn . Autogenic training also decreases bodily arousal. This involves mental exercises that switch off stress responses and help relax the body’s muscles. Some people find listening to soothing music or relaxation tapes helpful. No single relaxation technique has been shown to be more effective than any other.

Q:	How can I stop my mind racing when I’m trying to go to sleep?
A:	People who are plagued by a continuous stream of thoughts near bedtime can try methods which decrease cognitive arousal, such as imagery training or meditation. Sometimes writing all your worries for the day on a piece of paper and leaving it in a room other than your bedroom can help.

Is it all right to nap during the day?

First, ask yourself why you need to have a nap during the day. Are you excessively sleepy, despite spending enough time in bed? Do you have disrupted sleep at night? How often do you nap–after Sunday lunch, once a week, or regularly during the week and at different times? If you do have to have a nap, don’t sleep for longer than an hour, because it will affect your level of sleepiness in the evening, and don’t nap after 3pm in the afternoon. If you are napping because you find it really hard to keep awake, including at work or while driving, you should discuss this with your doctor.

Does regular physical exercise promote a good night’s sleep?

In addition to the other health benefits that regular exercise brings to the body, it can also help to improve sleep. Physical exercise tires us out and results in the release of chemicals and hormones in the body that produce better-quality sleep, including the proportion of slow wave sleep that we experience. Exercising in the late afternoon may help you to sleep better; however, vigorous exercise within 3–4 hours of bedtime can interfere with your sleep.

Will a bath before bedtime help me to sleep better?

In addition to environmental temperature, variations in our body temperature also play an important role in determining the quality of sleep we have during the night. Our body temperature falls naturally as part of the circadian rhythm toward the end of the day as we prepare to sleep. Having a bath in hot water, at least an hour before going to bed, can help raise the core body temperature and then let it drop more quickly, decreasing the transition time to sleep. Water can also have a relaxing effect on us that also enhances sleepiness.

How close to bedtime can I eat?

Regular and scheduled meals throughout the day are important to sustain our energy and provide us with the nutrition our body needs. However, it is best not to go to bed with a full stomach. This disrupts sleep because the body has to work overtime to metabolize the food. A full stomach can also exacerbate heartburn. Conversely, going to bed hungry can also disrupt sleep. Complete your last heavy meal of the day at least 2 hours before going to bed, and if you feel hungry just before retiring, have a light snack.

Q:	How does drinking water before bedtime affect my sleep?
A:	Many people experience disturbed sleep due to frequent nocturnal urination (nocturia). To minimize this, restrict fluid intake after your last heavy meal of the day, and try not to drink water about an hour before you go to bed. If nocturia persists, seek medical advice.

What drugs can help me sleep?

If you have persistent difficulty sleeping, which leads to impaired daytime performance, it is best to seek medical advice. Drugs prescribed for short-term sleep disturbances include benzodiazepines, such as temazepam, and non-benzodiazepines, such as zolpidem and zopiclone. However, these hypnotics may have side effects and may impair the quality of your sleep. They shouldn’t be used for more than 2–4 weeks at a time unless recommended by your doctor. Other drugs that are sometimes prescribed for coping with sleep disturbances and promoting sleep include antidepressants, melatonin, and antihistamines .

What “natural” preparations can help me sleep?

Unfortunately, there is very little scientific data on either the safety or efficacy of herbal preparations and the many over-the-counter insomnia medications that are available. A glass of warm milk (because it contains high amounts of tryptophan, an amino acid) is obviously safe to try, as are the numerous herbal teas that are now commonly marketed. The best medical and scientific evidence available to date for improving sleep and sleep quality in mild insomnia supports the use of valerian or a combination of valerian and hops. See the table in Some natural preparations considered conducive to sleep for more information on natural preparations that are potentially conducive to sleep.

Is it true that tryptophan supplements can help me sleep if I have insomnia?

Possibly, but evidence is limited. Serotonin, a brain chemical that helps promote sleep, is made in the body from the amino acid tryptophan. Low levels of tryptophan have been linked with insomnia. Although supplements are unavailable in the US because of deaths caused by a particular manufacturer, you can try adding foods that contain tryptophan–such as peanuts, almonds, tofu, and meat–to your diet.

Q:	Can I drink a kava beverage to help me sleep?
A:	Kava (Piper methysticum) is definitely not recommended because of its interaction with benzodiazepines. In addition to this, studies of kava were not completed because it showed clear evidence of being toxic to the liver.

Can I use melatonin as a “natural” sleeping pill?

There is currently no reliable scientific evidence for the use of melatonin as a sleeping pill. It may be useful in people who have an intrinsic reduction in melatonin production. However, its precise composition, as well as the best way to administer it and the appropriate dose, are still open to debate. Some evidence does exist that it may be useful in the elderly who have nocturnal melatonin deficiency, and may lead to an improvement in sleep efficiency as well as reducing the time it takes to fall asleep (sleep onset time).

Are there any vitamin or mineral supplements that help me sleep?

Currently, there is no proven evidence that a particular vitamin preparation will assist with sleep. However, there are a few case reports in which people have responded to vitamin B compounds, especially if they are deficient in these. There is a lack of consistent evidence for the efficacy of calcium, magnesium, copper, iron, or zinc supplements in improving sleep, especially if you are not deficient in these minerals or have a sleep disorder.

Do alternative therapies help with sleep problems?

This depends on the type of sleep problem you have. There is anecdotal evidence that therapies such as accupuncture, massage, and homeopathic remedies may be useful in dealing with sleep problems related to lifestyle if they help reduce stress and allow you to focus on yourself. As long as treatment is not harmful, it may be worth trying. However, there are few properly conducted scientific trials to test whether treatments are safe and effective for everyone.

How important is it to match sleep patterns with a partner?

If your partner has exactly the same sleep patterns and habits, then you are one of the lucky few. Dealing with differences in sleep patterns always requires some negotiation, compromise, and consideration. If you prefer a cold environment and your partner is a heat-seeker, your partner might have to compromise and consider bed socks and heavier pajamas. If you are a night owl and your partner an early bird , you might have to discuss ways of sharing the bedroom to prevent disruption of your sleep patterns. Separate bedrooms can solve extreme differences, but as with many aspects of a relationship, talking openly and constructively about the problem might lead to the solutions that suit you both.

Does having sex lead to a better night’s sleep?

Very little research has been done to answer this difficult question. For most people, orgasm leads to a release of neurotransmitters, which affect the sleep centers in the brain. However, the effectiveness of sex in inducing sleep depends on how it makes you feel. If it makes you feel peaceful and relaxed, it could help you sleep. If it is a performance, an activity indulged in to prove yourself, or leaves you with high anxiety levels, then it can be the prelude to a night of tossing and turning in bed.

Myth or truth?

Myth

“If you cannot get to sleep, it is best to stay in bed and try harder to sleep”

Truth

Wrong. If you can’t get to sleep within 15–20 minutes, you should get out of bed, leave the bedroom, and do something quiet and unstimulating (like reading a book or knitting) until you feel sleepy again. The longer you toss and turn in bed, the more frustrated and anxious you become and the longer it takes you to get to sleep. If this occurs regularly you’ll start associating your bed with sleeplessness rather than sleep.

Sleep hygiene habits

Try to establish sleep hygiene habits that suit you and your needs. The following tips may help:

Avoid caffeine, nicotine, and alcohol late in the day.
Complete the last meal of the day at least 2 hours before bedtime.
Cut down or avoid fluids at least an hour before bedtime.
Avoid stimulating environments 2 hours prior to bedtime.
Engage in exercise but avoid vigorous activity too close to bedtime.
Use your bed for sleep (and sex) only.
Don’t watch television in bed.
Establish a bedtime routine.
Give yourself time to relax before retiring and use relaxation techniques.
Create a bedroom environment that enhances sleep.
Think about your concerns and write them down before getting into bed.
Go to bed only if you are sleepy.
If you can’t get to sleep within 15–20 minutes, get out of bed and do a quiet activity until you’re sleepy; repeat if necessary until you’re sleepy.
Get up at the same time every day.
Avoid daytime naps.

Some natural preparations considered conducive to sleep

The table lists a number of natural preparations that are often used alone or in combination to aid sleep. If you take conventional medicine for any disorder you must tell your doctor you are using herbal preparations because some of them can have dangerous and potentially life-threatening interactions. It is best to obtain herbal teas, pills, or preparations from a licensed herbalist, and many can be purchased in supermarkets and pharmacies.

Table
Common name	Botanical name	Formulation
Mint	Mentha spp.	Tea; capsules; potpourri
Chamomile	Matricaria chamomilla	Tea; potpourri
Lavender	Lavendula spp.	Oil; fragrance; tea; potpourri
Hops	Humulus lupulus	Capsules; tea mixtures
Lettuce	Lactuca sativa	Fresh leaves
Valerian^[]	Valeriana officinalis	Capsules; tea
Purple passionflower	Passiflora incarnata	Tea; tea mixtures; pills
Lemon balm	Melissa officinalis	Tea; potpourri
Clary sage	Salvia sclarea	Tea; tea mixtures
Vervain	Verbena spp.	Tea; tea mixtures; potpourri
Oats	Avena sativa	Grain; tea