Thursday, 15 June 2023

Insomnia: How To Manage It Safely

From forbes.com

Hey, Health Coach,

I have what I would call intermittent insomnia. I have a hard time sleeping for a few days, and then I’m fine for a few days or weeks. It doesn’t make any sense. I never know when it’s going to happen, and it’s so painful to be wide awake when everyone else in the house is fast asleep. How can I manage my insomnia?

— Can’t Sleep

Dear Can’t Sleep,

Sleep is nature’s balm, a soothing neurochemical bath that heals our bodies and makes our waking hours so much easier and more productive, and (as you clearly know) not getting enough can be excruciating—especially when you’re exhausted and trying your best.

Sleep is still a mystery in a lot of ways. So much is unknown. There isn’t an exact science to “solving” sleep problems, but there’s a lot you can do to make getting a good night’s sleep easier and more consistent. In fact, I think your word—“manage”—is a supremely healthy way to approach this question and, ultimately, get better sleep. It’s a process with a lot of different options.

Benefits of Sleep

In recent decades, scientists have identified an enormous network of benefits humans get from sleep, says University of California, Berkeley neuroscientist and psychology professor Matthew Walker, Ph.D, in his book Why We Sleep: Unlocking the Power of Sleep and Dreams.

He writes that sleep increases our ability to learn and process information, make healthy decisions, maintain emotional equilibrium, focus and reduce symptoms of depression and anxiety. Physically, it also boosts the immune system and gut microbiome, regulates metabolism, lowers blood pressure and reduces the risk of heart disease, cancer, the common cold and weight gain, among other things.

That’s a long list of perks, but it’s also a long list of things to worry about losing when you just can’t seem to fall asleep.

Dr. Walker dives into the mechanics of sleep, too. He unpacks the differences between wakefulness, non-rapid eye movement (NREM) phases that provide deep, focused recovery and REM sleep, which he gamely describes as “a bizarre, highly associative carnival… that mollifies painful memories… a flagrantly psychotic virtual reality space in which the brain melds past and present knowledge.”

He also explores the crossover of two forces that trigger sleep: circadian rhythms (regulated by genetics, temperature and light exposure) and “sleep pressure,” the product of a fatigue-inducing neurotransmitter called adenosine that builds up all day through physical and psychological activities until we succumb to it. These forces are important to understand because they can both be utilized to help you drift off.

It’s always a good idea to check with your health care provider about any concerns you have, but below, we’ll cover eight takeaways I gathered from Dr. Walker’s book, additional studies and my many years working directly with clients to improve (among other things) when and how much they sleep.

How to Sleep Better

Because our daily routines have a profound impact on the biological functions that help us sleep, we can affect that nightly process in significant ways. You’ve probably heard some (if not all) of them before—the science is well-documented. It can be easy to shrug them off as too simple to matter, but evidence shows playing with these variables could help reduce some of your late-night misery.

Light

Before the invention of the lightbulb, humans went to sleep soon after sundown. Some naturally fell asleep later than others. (According to Dr. Walker, night owls come by their rhythms naturally.) But people didn’t have light pouring in through their corneas after dark like we do now, especially blue LED light. That light exposure delays the natural flow of melatonin and circadian rhythms that would otherwise send us off to sleep.

Try dimming or removing sources of light in the hours before bedtime. Choose warm, dimmable light bulbs for bedside lamps, and stay away from screens if at all possible. I know… easier said than done.

Temperature

To sleep well, your core body temperature needs to drop. Studies show a room temperature of about 65 degrees Fahrenheit is optimal for sleep. If your feet get cold, wearing socks can help pull body heat away from your core and out through your feet. (This easy trick was news to me.)

Exercise

Sleep is recovery, and it can be hard to sleep if there isn’t anything from which your body needs to recover. Thirty minutes of exercise a day helps build sleep pressure and can boost your ability to drift off. If you can exercise outside, you also get exposure to daylight, which helps regulate your circadian rhythm. Everyone’s body is different, but experts recommend avoiding exercise two hours before bed to prevent increasing your core temperature.

Food

Being too full or too hungry can make sleep difficult. Dr. Walker reports severe calorie restriction makes it harder to fall asleep and reduces NREM sleep. Eating a large meal before bed doesn’t help, either, as it can cause indigestion and reduce the same deep sleep. (On the other hand, small, low-sugar snacks can be helpful if you’re genuinely hungry.) Caffeine and high-sugar diets, especially late in the day, cause more sleep interruptions as well.

Note to drinkers: Alcohol functions more like a sedative than a sleep aid and can cause wakefulness and reduced REM sleep similar to the effects of sugar.

Stress

Stress is my wheelhouse as a coach. When you’re stressed, your nervous system is wound up. To ease tension before bed, you can try the usual suspects like taking a bath or meditating, or create a small ritual after brushing your teeth—like a specific series of stretches or unloading your thoughts on paper, not a device—before turning out the light.

Sleeping Pills

Dr. Walker rips into sleeping pills like a Rottweiler tears into a steak. The bottom line: The effect of sleep medicine is more akin to anesthesia than restful sleep. The pills don’t allow for natural brainwave activity to cement learning and restore equilibrium overnight. They can also cause rebound insomnia, which can make sleep more difficult on subsequent nights after taking the pills.

Melatonin

Melatonin occurs naturally in most people’s bodies. It signals the brain that it’s time for sleep, but the other factors I mentioned above (circadian rhythms and sleep pressure) are what make sleep actually begin. Dr. Walker proposes that melatonin supplements have a placebo effect for many people, adding that initial signal function can be useful for getting on a healthy schedule while traveling through time zones.

A 2022 report in the Journal of the American Medical Association supports these findings, showing that melatonin use in U.S. adults rose dramatically over the past 20 years, but there’s little evidence that it helps people sleep. Also, some people report mild side effects from melatonin supplements, including daytime sleepiness, headaches and mood swings.

Routine

The most important thing researchers say can improve sleep is waking up and falling asleep at the same time each day. I wrote in my book The Habit Trip that I find this advice “mildly infuriating” because it’s difficult to achieve in real life. As a bona fide night person with a job and a child at home, my natural sleep cycle is not an option for me, and adhering to a weekday schedule on weekends feels like a special kind of torture. However, according to Dr. Walker, adjusting by even a few minutes can have a profound biological impact, as it allows for more complete sleep cycles throughout the night.

Working with my own sleep patterns, I discovered I can nudge my weeknights to get to bed just a little earlier and, on weekend mornings, wake up a little earlier than I might naturally. Regardless of timing, sticking with a ritualized routine before bed (like you might for a child) is one of the most effective things you can do to signal your brain that it’s time to drift off.

Build Your Routine

We are complex creatures with finely-attuned physiology. We respond to our surroundings—often without even knowing it. Sometimes these responses work in our favor. Other times, not so much. The good news is there are so many ways to improve your sleep—you just may need to experiment a bit to see what works for you.

As your schedule shifts, see if you can identify any recurring triggers for your insomnia and ways to build a personalized, relaxing ritual at night.

I hope this response helps you get some consistent z’s!

“Hey, Health Coach” is for informational purposes only and should not substitute for professional psychological or medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions about your personal situation, health or medical condition.

https://www.forbes.com/health/conditions/sleep-insomnia/

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