IV. What are The Choices of Good Sleep Practices?

Ideally, you would want to have 7-8 hours of sleep per night (depending on your age group) so that you can go through enough cycles of dream sleep to recharge your mind for the next day. There are a number of tricks and tools you can use to achieve that. Some of these sleep improvement techniques are simple, easy to change your sleep environment or daily routine, so that you can spend more hours in the dream level. You may find that some of these changes are harder to do, because you may have to prioritise your sleep schedule over a habit of working late or socialising. Just consider the benefits of what a good night’s sleep can bring, and you will find it worthwhile to make the effort.

Sleep Journal

You can use a sleep journal to track your daily activities, eating habits, and pre-sleep habits to find out what may be keeping you from a good night’s sleep. Although a month of entries can pinpoint the cause and what you may need to change, sleep experts suggest that even just one week of journaling will be helpful already to determine patterns that may be keeping you up late at night and robbing you of sleep. When you track your day-to-day activities, you should ask yourself the following questions:

• What did I do today?
• What did I eat today? Did I drink coffee, smoke, or drink alcohol?
• What time did I work out today?
• How many hours of sleep did I get last night?
• How long did it take me to fall asleep?
• Was there anything in the room that kept me from sleeping?
• What did I do before going to bed?

Once you have identified the different patterns in diet or pre-sleep habits that kept you up at night, you can adopt any of the following techniques to improve your chances of getting a good night’s sleep.

Basic Sleep Habits

No matter what your food or daily activity patterns are now, there are some basic rules to be maintained if you are to develop a good sleeping habit:

• Go to bed at the same time every night.
• Wake up at the same time each morning.
• Get 7-8 hours of sleep each night.
• Avoid taking a nap unless you need to stay alert later.
• Sleep in a comfortable, cool, and dark room, and only sleep in your own bed.

Bed Changes and Sleep Environment Changes

It may be that your bedroom is like a cave where you keep a laptop, mobile phone and a stack of work next to the bed, or you may have a monster of a LED alarm clock to ensure you wake up on time in the mornings, or you may find your room to be very hot. If you find any of these things or conditions in your room which could be keeping you awake, try the following:

• Only sleep in your room and in your own bed.
• Keep your room cool to allow your body temperature to drop
• Turn the ringer off on the phone while you sleep or use earplugs to drown out the noise.
• Use a sleep mask to block out the light.

The way you sleep can also affect your sleep quality. For example, where do you put your head when you sleep? You may have pillows or blankets that make you sneeze and you wake up still feeling tired, have a stiff, sore neck and back. Everyone is different but you can always use hypo-allergic bedding or pillows to help you sleep better.

• If you sleep on your side, use a pillow that will support your head and neck, to bridge the gap between the head and the shoulder.
• If you sleep on your back, use flatter, stiffer pillows.
• Try using synthetic blankets and pillows if you are allergic to natural materials.
• If your mattress is no longer comfortable, it may be time to replace it altogether.

Avoiding Sleep-preventing Substances

Drinking too many cups of coffee to get you through the afternoon meeting? Having 2 or 3 alcoholic drinks at ‘happy hour’ after work? Smoking to get rid of your stress?

Not only do caffeine, alcohol, and nicotine negatively affect all your efforts to reduce anxiety, they also prevent you from having a deep and healthy sleep. All these substances should be avoided or limited as much as possible.

There are other vitamins, minerals, and foods that are attributed to help with preventing anxiety. Since these are also related to poor sleep patterns, it may be useful to visit the lesson on Nutrition and Medication to better minimise the anxiety that can contribute to insomnia.

Regular Exercise

After a week of journaling, you may discover that you were getting 6 hours of sleep on the first night, 8 the next, and then only 5 the following night, going up and down even when you were not staying up late to work, party or look after the children.

If that happens, regular exercise can stabilise sleep patterns and help you get to sleep faster and have more phases of deep sleep. Physical exercise is another complementary treatment for anxiety. In order to maximise the effects of exercise to get plenty of sleep, avoid any exercises two hours before your bed time.

Aromatherapy and Herbal Remedies

Lavender is widely hyped by both alternative treatment advocates and researchers to help with deeper sleep. The scent of this herb can be effective to help achieve a deeper sleep.

To help get relaxed before sleeping, you can drink or even bathe in Chamomile, a herb widely accepted for its calming properties. To learn more about other herbs that can help with calming and relaxation, please visit the lesson on Nutrition and Medication.

Make Up for Lost Sleep

Some people say you can’t “catch up” on lost sleep. We often have erratic sleep schedules due to the demands of work, family, school or relationships, and somehow end up sleeping only 5 hours, 2 or 3 nights in a row.

This is partial sleep deprivation and while it can be a short or long term condition it is bad for your mind and body. Although you can make up for a night or two of lost sleep by sleeping longer the next morning, or choosing to go to bed a little earlier the next evening, what is more important is that you do not develop a habit of partial sleep deprivation that can turn into insomnia.

Using Naps Wisely

Naps are often used as a way to make up for lost sleep too. However, depending on when and why you take them, they might negatively affect your sleep patterns.

If you need to take a nap to improve alertness, it should be done earlier in the afternoon, since naps taken later are edging close to normal bedtime and can therefore disrupt your sleep. If you discover in your sleep journal that you are not sleeping enough hours at night, you should probably avoid naps altogether until you can get into a regular pattern of sleep at bedtime.

Alternatives to Waiting to Fall Asleep

Sometimes lying in bed for too long can actually make you less likely to fall asleep or get a good night’s sleep. You may have lain in bed at night, counting sheep and thinking “almost asleep, just a few more sheep.” Thousands of sheep later, you are still hopeful, but not asleep. Sleep experts actually suggest doing the opposite: you should wait no more than 15 minutes to fall asleep, and if not, you should get out of bed and do something relaxing until you feel the urge to sleep. Whatever relaxing activity you do, do it away from your bed, so that you only use your bed for sleeping.

Sleep Lab Evaluations

The referral for a sleep lab testing has to come from your doctor when other sources of sleep problems have been exhausted. Some such sources of sleep problems exhausted could be:

• Your doctor giving you a mild sleep medication to help reduce anxious thoughts while you sleep if you have been diagnosed with a General Anxiety Disorder which often occurs with insomnia.
• You making changes in your room for less light to come in, or acquiring an alarm clock with amber lights.
• You using alternative herbal remedies like lavender aromatherapy or drinking chamomile tea.
• You trying not to work in the evenings or doing energetic activities late at night.

If you still have problems sleeping after exhausted all methods, then that is the time to ask your doctor to refer you to a sleep lab, particularly when he has diagnosed that your sleep problems had nothing to do with anxiety. The sleep lab will use various observation and testing techniques to see if you have parasomnia - a sleep disorder that consists of involuntary or movements, behaviours, or dreams that affect your sleep quality. Parasomnias can include:

• sleep apnea (breathing pauses while asleep)
• sleep bruising (grinding teeth while asleep)
• intense nightmares that lead to sudden wakening throughout the night
• narcolepsy (extreme daytime tiredness) or sleepwalking.

These often occur during sleep, and you may not know exactly what had occurred except that you may just wake up suddenly in the night or wake up in the morning with aches, pains, or terrors related to these disorders.

During a sleep lab evaluation, you may go through the following:

• Overnight sleep tests: In these tests, the lab will mimic your usual home sleeping environment, and you will follow the same routine you normally adopt to go to sleep, but you will be under audio and video observation to detect unconscious behaviours during sleep.
• Polysomnography observation: This involves small electrodes being placed on specific parts of the body to measure blood pressure, eye movement, brain waves, or muscle tension. If the sleep specialist detects a problem during the night, they may be able to prescribe treatment there and then.
• Daytime sleep tests: On the following morning, you may be tested to see how long it takes you to fall asleep at different intervals to test for narcolepsy.

Having a sleep lab evaluation can be expensive and time consuming. In addition to the overnight and daytime testing in the lab, sleep specialists may ask you to change and try out different sleeping behaviours in the weeks before testing to find out if you really need a lab evaluation. Sleep lab evaluation should be used as a “last resort” when sleep problems are not related to insomnia, anxiety, or poor sleep hygiene, or when your doctor believes you to have a serious sleep disorder that can threaten your overall health.

Bringing it all together

You can also combine a number of environmental, scheduling, and food change strategies to form your own sleep improvement plan. The first plan below may be for someone who has difficulty falling asleep. The second plan is for someone that may not have problems falling asleep, but finds it hard to stay asleep or go into deep sleep.

• Set the stage for bedtime: It helps your body to recognize a routine so as to fall asleep better. You may want to set up a ‘sleepy-time habit’ - sleeping at the same time every day so your body knows when it is time to sleep. An example of one such routine is as follows:
• Put on some soothing music
• Take a warm bath
• Make sure your bedroom is cool and dark
• Have a cup of your favourite, non-caffeinated tea (not in the bedroom)
• Read a few pages of your favourite book until your eyes feel heavy (not in the bedroom)
• Wait until you cannot keep your eyes open any longer to then finally go to your bedroom to sleep
• Increasing your chances for staying asleep: Because sleep deprivation may come from what is called ‘sleep maintenance insomnia’, or the inability of a person to remain asleep for a period of time, it is important to take into account certain factors that may affect a person's ability to stay asleep. Some of the things you can do to increase your chances of staying asleep are:
• Avoiding caffeine or foods that may be a stimulant
• Exercising earlier in the day will help to bring about a deeper sleep
• Avoiding alcohol close to bedtime
• Reducing possible noise where you sleep