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.
0 Comments
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. Do you remember Pavlov’s dogs?? If you have ever taken a psychology course you have likely heard of Pavlov’s dogs. Let me give you a basic refresher… Pavlov was a behaviorist who did studies on many different types of animals. He was interested in shaping behavior. One of his experiments involved dogs, a bell, and dog food. He would present food to the dog and at the very same time he would ring a bell. The dog would salivate in response to the food that was being presented to him. After several trials of this pairing of the food with the bell, when Pavlov then just rang the bell and did not present the food, the dog still salivated! So what he discovered was that by pairing the bell with the food eventually the bell became associated with food and the dog salivated to the bell even in the absence of food. Ok, so what in the world does this have to do with sleep? Well when we spend a lot of time in our beds awake, say watching tv, reading, knitting, doing work, we start to associate our beds with being awake. Just like the dog’s associated the bell with food. Over time as we spend a lot of wake time in bed, it starts to become difficult to sleep there because we respond to it as a place for wakefulness. This is referred to as conditioned insomnia. One sure fire sign that you have developed conditioned insomnia is if you find yourself falling asleep or feeling very sleepy on the couch in the living room but as soon as you get into bed you feel wide awake. That is a sign that your bed is a wakefulness cue for you. Another sign is if you tend to sleep better in a hotel versus your bedroom. Something to be mindful of is that people who are tense or anxious may be more susceptible to conditioned insomnia than others. Spending time in bed awake refers to not only spending time in our beds during the day awake, but also during sleepless nights. If someone with insomnia is up in the middle of the night and spending 2-3 hours awake laying in bed, that is an anxious experience. The person may then start to dread going to bed because they anticipate the sleepless night. The bed becomes a cue for the sleeplessness. When I ask my clients with insomnia what they do when they are up in the middle of the night, resoundingly all of them say with pride, “I stay in bed and try to go back to sleep.” There are two things perpetuating the insomnia in that statement. One thing that Dr. Meg Danforth, Ph.D. CBSM, of Duke University Medical Center, stressed in her training was that you cannot “try” to fall asleep. She said sleep is the one thing that does not reward hard work. The more you try to sleep, the more there is no payoff. Sleeping is the one thing that you cannot try to do. The more you try to fall asleep, the more you fail because sleep requires complete relaxation and trying is essentially the opposite of relaxing! She did say that relaxation exercises are beneficial, however, as long as their goal is just to relax, not to fall asleep. Again, as soon as you start to focus on sleep as the goal, the more difficulty you will have reaching that goal. The other thing perpetuating the insomnia in that statement is that the person is staying in bed awake! Again, the more time you spend in bed awake the stronger the association between being awake and your bed. So, what do you do? You create a quiet comfortable place to go to in the middle of the night if you cannot sleep. I often suggest finding a place near a lamp where you can read, watch unexciting television, or do something else, quiet and non-stimulating. You go to this place when you cannot sleep and you stay there doing something non-stimulating until you feel SLEEPY. This is important - it is not until you feel tired, it is until you feel SLEEPY. SLEEPY meaning your eyes are starting to close or your head is nodding. When you feel sleepy you go back to bed and lay down. If you get into bed and you find yourself suddenly feeling awake again, get back out of bed and go to your place until you feel, you guessed it, sleepy again. By getting out of bed when we are awake, the research shows that we can re-associate our bed with sleep in about two weeks. If you find yourself awake in the middle of the night and unable to fall back asleep in about 20 minutes, get out of bed to break the association of wakefulness and your bed! 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. The next aspect of sleep and insomnia I want to share with you is about circadian rhythms. What exactly is a circadian rhythm, you may ask? A circadian rhythm is approximately a 24-hour cycle that governs the physiological processes of living things.
The circadian rhythm, while it influences and is responsible for many things throughout day, is mainly known for it’s influence on the sleep/wake cycle. It regulates our feelings of sleepiness and wakefulness throughout the day. Circadian rhythms are internally driven, however, we rely on environmental cues to keep us on track. I say this because the circadian rhythm actually runs a little longer than 24 hours so things like sunlight, temperature, regular bedtimes/wake times, and meal times help us manage the drift of our circadian rhythm and stick to our schedule. But what if we don’t stick to a regular schedule, meaning regular bedtimes/wake times and meal times? Well, then we can cause ourselves some problems. Some people with insomnia have a habit of varying their sleep and wake times. I hear this all the time in my clinical practice… “Well I couldn’t sleep last night so I let myself sleep-in.” “I was up in the middle of the night so I slept 2 hours later.” “I didn’t sleep well so I took a nap and then I couldn’t fall asleep at night.” Several nights of these types of wacky sleep schedules can throw off your circadian rhythm and make an insomnia problem even worse. So what do we do? Well it isn’t the most popular answer, but we establish a sleep/wake schedule, and we stick to it 7-days a week. Wait. What?? 7-days a week, even on the weekends? Yes even on the weekends. We are all familiar with sleeping in on the weekends, but when we do this we expose ourselves to social jet lag. The feeling is not dissimilar from regular jet lag, however we do not have the fun memories of a great trip to California or Costa Rica. Social jet lag is what occurs when we change our sleep schedules over the weekend. In order to avoid that dragging tired feeling, it is best to stick to your sleep/wake schedule everyday. If you must sleep-in on the weekend make sure it is no more than one hour later than your usual wake time. But how can I establish a regular sleep/wake schedule when I cannot control when I fall asleep?? Good question! We start by establishing a wake time and sticking to it. But what if I can not fall asleep, or I am up for hours in the middle of the night? Well you still get up at the same time in the morning. We cannot control the exact time that you fall asleep, but we can control our wake times by using an alarm clock. You set your alarm clock and get up at the same time every morning regardless of how you slept the night before. Oh and did I mention, NO NAPS!! Again this is to get our circadian rhythm into a good, pun intended, rhythm. Plus if you take a nap you are deflating your balloon!! If you do not know what I mean by “your balloon” visit my previous blog on adenosine. So no naps and wake up at the same time everyday. Eventually you will start to establish a regular sleep time and circadian rhythm. So, what about night owls and morning larks? People are unique in their circadian rhythms and different people reach their peak level of alertness and performance at different times of the day. Night owls function best at night, while morning larks are at their best in the morning. Most of us, however, fall in the “normal” range. Yes, I am talking about the bell curve, true night owls and morning larks are outliers, and most of us fall somewhere in the middle, meaning there is not a whole lot of variability in our peak times of alertness as a people. Again, if we want good/quality sleep, and who doesn’t right? Stick to a regular sleep/wake schedule as nearly to every day as you possibly can. 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. What do sleep and mental health disorders have in common?? Well it turns out more than you might think. First of all, most, if not all, mental health diagnoses impact or demonstrate disruptions in sleep. At one point researchers thought that psychiatric disorders caused the sleep disorders, however more recent studies have indicated that it might be the opposite, that sleep problems may influence mental health problems. This is important information because if we can focus on sleep and getting enough good-quality sleep, than maybe we can also influence how psychiatric disorders present themselves.
If we take a step back and think about this, it makes total sense. How many times have you had a late night, lost some sleep, and the next day find yourself more emotional than usual? Maybe you cry more easily, or lose your temper more readily. Or look at our kids, if our son or daughter is misbehaving or having temper tantrums we often consider - oh he or she is tired, they missed their nap, they went to bed late, etc. Why do we not consider the same for ourselves as adults?? I want to talk a little bit about sleep because it is so important, not just for overall well-being and health, but also for our mental health. I have to confess that sleep is of particular interest to me because for years I lovingly referred to it as my “elusive friend.” My personal interest, along with my professional interest, brought me to a training on CBT-I or Cognitive Behavioral Therapy for Insomnia. I have to give a huge shout out to Meg Danforth, Ph.D. CBSM, Director of the Behavioral Sleep Medicine Program at Duke University Medical Center. She was a fabulous instructor and she made the most seemingly non-lively thing that we do extremely interesting and engaging. Information on sleep that I am sharing in this blog series come mostly from the training I attended with Dr. Danforth, as well as from the book Sleep Right In Five Nights, by James Perl PhD. For me the use of this blog is to help me process and digest information from trainings or books that I have read so that I can better explain and implement the concepts in my clinical practice. If I can learn it, read it, digest it, and write about it, I can teach it. Here we go… The first aspect of sleep that is interesting to know, is that during the day, when we are awake, we build up this chemical in our bodies called adenosine. When we wake up in the morning, we do not have a lot of adenosine in our cells. As the day goes on we build up more adenosine. Dr. Danforth compared it to a balloon. She explained that in the morning our balloon is empty, if we are active and do a lot during the day, we fill our balloon, aka build up adenosine in our cells. Adenosine is responsible for deep sleep drive. So the more adenosine we have the more deep sleep drive we have, meaning more ability to fall into a deep sleep, which is what we want! When it comes to sleep it is very important to be mindful of how you are spending your day. It was stated that most adults need about 16-18 hours of alert time to build enough deep sleep drive for quality sleep, 14-15 hours of alert time may not produce enough. If you are having trouble sleeping and realize that you spent most of your day in bed, on the couch, or sitting down, then scheduling some active activities into your day might be beneficial. The more you can do during the day the better chances of filling your balloon, building up that adenosine, and achieving a good level of deep sleep drive! So that is tip #1 that I want you to know about sleep. It seems so simple right?? Like common sense, yes doing more during the day will help you sleep better, but for some reason I think we forget this. Knowing some science behind it helps make it more meaningful. Get out there, and do some things during the day so you can sleep better at night! 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. |
Archives
May 2019
Categories |