Common substances such as caffeine, alcohol, and nicotine can have a major impact on our sleep. After thinking over the information I have shared so far on sleep I do not feel complete without doing a short post on these substances so that you are informed of how these substances can impact your sleep. Caffeine is a stimulant. Remember our balloons from my first post on sleep? We know that we have to fill our cells (balloons) with adenosine during the day in order to build up deep sleep drive for better quality sleep at night, right? Caffeine is an adenosine blocker. This means that when we ingest caffeine it stops adenosine from building up in our cells. So this is the reason why we do not want to have caffeine too late in the day because it not only keeps us awake due to it’s stimulant effects but it also stops the build up of our deep sleep drive. My general rule is no caffeine past about 2pm. Alcohol is a trap I see a lot of clients fall into. Nightcap if you will? Alcohol is a relaxant so people often think that it helps with sleep, which, it does. It helps you drift off to sleep but the problem is, it is a shallow sleep and once our bodies process the alcohol we often wake up and have disrupted sleep. Alcohol also has an impact on anxiety. If your insomnia is anxiety related alcohol can have a rebound anxiety effect, meaning that while it helps with the anxiety in the moment once your body processes the alcohol you may not only wake up but wake up feeling more anxious because the relaxant and inhibitory effects of the alcohol have also worn off. General rule, do not use alcohol to treat your insomnia. Nicotine is a stimulant that impacts your heart, nervous system, and blood vessels. When you smoke it increases your heart rate, raises blood pressure, and increases brain wave activity. People who smoke tend to have both major types of insomnia. Difficulty falling asleep and difficulty staying asleep. The reason for this is due to nicotines stimulating effects. If you smoke too near to bedtime the effects of the nicotine keep you awake. During the night you may have difficulty staying asleep due to the withdrawal from the nicotine waking you up. Nicotine has a nasty tendency to perpetuate insomnia that is very difficult to remedy due to the highly addictive nature of the substance. Unfortunately it is difficult to truly treat the insomnia if it is related to nicotine use. With alcohol and caffeine we are able to adjust our use in order to improve sleep, however with nicotine the most effective option is to quit the substance all together in order to improve sleep. Due to the effects of the nicotine and the quick withdrawal associated with it, smokers tend to have fragmented, less restorative sleep. Quick recap! Limit caffeine later in the day. Do not drink alcohol to treat your insomnia. And if you are a smoker with insomnia consider how nicotine is impacting your sleep and decide if more restorative sleep is a motivator to quit. I think it is!! Until next time… Dr. B References Perl, J. (1993). Sleep Right in Five Nights: A clear and effective guide for conquering insomnia. New York, NY: William Morrow and Company, Inc. Danforth, M. (2018). Treating Insomnia: Evidence-based strategies to help your clients sleep. Presentation, New Jersey.
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I want to share 3 risks of using sleeping pills. Sleeping pills are meant to help us sleep, however, they are really only meant to be used on a very short term basis. There are a few different kinds of sleeping pills and how they act on the body differ. For the purposes of this blog, I am going to be addressing how sleeping pills impact your sleep overall if you take them on a consistent basis. The types of drugs I am generally referring to are sedatives, benzodiazepines, and antihistamines, which are found in most over the counter sleep aids. Zolpidem, or Ambien, also has risks that I will discuss with the exception of the first risk addressed.
Risk #1 Sleeping pills taken over time actually result in poorer quality sleep. When taking a sleeping pill you actually tend to sleep more shallow and get more stage 2 sleep vs. the deeper more restorative sleep of stages 3 and 4. When you are not getting as much sleep in the deeper stages of sleep, you wake up feeling less refreshed than if you were getting a natural nights sleep without the drug. The shallow sleep caused by sleeping pills can also lead to more awakenings during the night. While they help you sleep it is the quality of sleep that suffers. Ambien does not seem to have this effect on deep sleep, however, it could lead to other undesirable outcomes… such as the infamous night eating that some experience. Risk #2 Another risk of sleeping pills is their impact on you the next day. After taking a sleeping pill a portion of the medication continues to be present in your body. The hang over feeling you get from a sleeping pill is evidence of this. Research looking at performance the day after taking a sleeping pill show that performance on mental and motor tasks are poorer the day after taking a sleeping pill vs. a day after insomnia. The reason for this is that the drug impacts these systems and how you respond. This effect can be experienced with natural sleep aids as well. Risk #3 Dependence is also a risk factor of sleeping pills. As stated earlier the use of sleeping pills is really only meant to be for a short period of time. Extended use of these drugs can lead to both tolerance and withdrawal. Tolerance meaning you need more of the drug to have the same effect. Withdrawal meaning you feel an effect when you no longer use the drug and if you start using the drug again that effect is diminished. For sleeping pills the withdrawal is called rebound insomnia. Rebound insomnia is what happens when someone who has been taking sleeping pills to treat their insomnia stops taking the pills and finds that their insomnia is much worse than it was before they started taking the pills. This is devastating for those who unknowingly start taking sleeping pills thinking they are doing the right thing for their insomnia then come to find out that it has made it worse. Safe sleeping pill use is taking them infrequently and on an as needed basis. A particularly stressful event such as the death of a loved one, divorce, or trauma may warrant sleeping pill use, but again the use should be no longer than 2 weeks. Even better is taking them only once in a while if you feel the need. Sleeping pills should not be taken every night as they do involve risks, with one major risk being the development of even worse insomnia! Just a tid bit about sleeping pills. Until next time… Dr. B References Perl, J. (1993). Sleep Right in Five Nights: A clear and effective guide for conquering insomnia. New York, NY: William Morrow and Company, Inc. Danforth, M. (2018). Treating Insomnia: Evidence-based strategies to help your clients sleep. Presentation, New Jersey. This post cover topics related to sleep including sunlight, exercise, how to manage worries, and establishing a bedtime routine.
Sunlight Just like plants, people need sunlight! Sunlight serves as a powerful cue in setting a regular circadian rhythm that will help us get more quality sleep at night. Approximately 90% of people who are blind report having sleep problems. 90%! The reason for this is because they are unable to use sunlight to set or reset their circadian rhythms. Sleep problems are also more common in people who spend the majority of their time inside. Get outside as often, and for as long as possible during the day! The exposure to sunlight will help you establish a regular circadian rhythm and sleep better at night. Exercise Exercise is beneficial for sleep because it helps you fall asleep more easily, and sleep more deeply. The time of day that you exercise matters when it comes to sleep. It is best to exercise in the late afternoon or early evening if you want it to help with your sleep. The reason for this is because when you exercise it raises your body’s temperature which then subsequently drops four to six hours after your exercise. This drop in temperature a few hours after you exercise is what helps with sleep. What if you cannot exercise due to medical problems or physical limitations? Well you can actually trick your body by taking a hot bath two to four hours before bed. The hot, and we are talking at least 102 degrees Fahrenheit, bath can increase your body temperature in a similar manner as exercising and you will then have the body temperature drop that can help facilitate sleep. Worries Have you ever had the experience when you go to bed that your mind seems to fill with worries that keep you awake? This experience is not uncommon especially when we are faced with a stressful situation. If this experience, however, becomes a habit then we need to consider how to break this habit. One way to break bedtime worrying is by scheduling a specific worry time during the day. Scheduling this worry time helps you get the worries out of the way before you go to bed. You can set aside anywhere from 5 minutes to 30 minutes depending on how much worry you have. Setting aside this time allows you to control when you worry and also moves that worry time from your bed to another setting. Whenever you decide to worry, make sure it is not in your bed as you do not want to set up conditioned insomnia. Choose another room where you can worry to your hearts desire. As you worry it is also beneficial to write your worries down, possibly put them into categories, and start to identify one or two solutions for each. I recommend this frequently to my clients. By writing down your worries they somehow become more manageable. When they are running free in our minds they tend to ruminate over and over with no end in site. Writing them down helps to make them finite, concrete and sometimes more solvable. Another idea is to keep a journal or paper by your bedside so that if you do wake up in the middle of the night worrying, write it down. I do this myself and it helps to just get the worries out of my head and someplace else. Then, in the morning my worries are there and often feel more manageable once I am alert and thinking more clearly. Bedtime Routine In the evening, before our formal bedtime routine, there should be some downtime before bed. This downtime should be used to relax, watch television, read, do anything you like to do to unwind. This winding down time is important because it cues to our bodies that sleep is coming soon. Stressful experiences during the evening can disrupt nighttime sleep so it is helpful to think of the evening as a time for calm. Get family conflicts or evening work done as early as possible as to not let those stressors impinge on your sleep. Often in the evening we are less apt at coping with stress so better to leave these things for the morning and focus your attention to the transition from alertness to sleep. When you actually start to get ready for bed it is beneficial to have a bedtime routine. As parents we set these types of routines up for our children. We give them baths, read them stories, and kiss them goodnight. These routines that we establish for our children provide environmental cues that it is time for sleep. Often times, we as adults, need these routines even more than our kids! For some reason we do not think of this, however, and then wonder why we cannot go from sixty mph to sleep in 4 seconds flat! At bedtime we need to have environmental cues as well. Think about your bedtime routine, does it help you relax and get ready for sleep or you do you often find yourself having different routines each night, or falling asleep on the couch, waking, and then laying sleepless for two hours before you can return to that state of sleep? If this is your experience think more about how to adjust your bedtime routine in order to establish the environmental cues that will help you ease into sleep. Repeating a regular bedtime routine helps you adjust your thoughts, emotions, and level of arousal so that you are better prepared for sleep. In addition, a bedtime routine in which you are mindful of your actions, versus thinking about other things, helps you further relax and get into the mindset for sleep. Get some sunshine like a plant, exercise in the evening (or take a hot bath), move worry time out of your bed, and develop a bedtime routine! We will all be getting better sleep and managing our mental health more effectively in no time! Until next time… Dr. B References Perl, J. (1993). Sleep Right in Five Nights: A clear and effective guide for conquering insomnia. New York, NY: William Morrow and Company, Inc. Danforth, M. (2018). Treating Insomnia: Evidence-based strategies to help your clients sleep. Presentation, New Jersey. I want to write a little bit about naps, since I have found in my clinical practice, that this can be a point of contention. Most insomnia sufferers sleep better at night by avoiding daytime naps. When I say most, it is about 80%. Twenty percent, however, report sleeping better at night when they have a nap.
How could this be when we know that more active alert time helps us build up our deep sleep drive? Well, for those insomnia sufferers who are particularly anxious, sometimes a daytime nap can help ease some of the anxiety. Their anxiety is eased because, for them, knowing that they already had some sleep that day, or that they will be able to nap the next day, makes them feel calmer. If you are one that feels less anxious when you have a nap, then keep your nap, but lets go over some guidelines for napping.
Be mindful of naps if you do need them! Until next time… Dr. B References Perl, J. (1993). Sleep Right in Five Nights: A clear and effective guide for conquering insomnia. New York, NY: William Morrow and Company, Inc. Danforth, M. (2018). Treating Insomnia: Evidence-based strategies to help your clients sleep. Presentation, New Jersey. |
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