Betty W. Phillips, Ph.D., Psychology
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Sleep for Health, Part II

SLEEP FOR HEALTH, PART II

The first step in maximizing quality sleep will be structuring activities during the day. Most people do not realize that activities in both the sleep and wake cycles are directly related to each other. Exposure to bright light in the morning will help program the body clock. This is of course more difficult during the winter months, and individuals with winter blues or seasonal depressions should take special steps to expose themselves to bright light. Normal winter sunlight exposure is helpful but not sufficient. Exercise during the day has also been shown to contribute directly to quality sleep at night as long as there is sufficient time between the end of the workout and bedtime. Three hours is often suggested. In many cases, though, a non-strenuous, relaxing walk after dinner will not hinder sleep as long as there is an adequate sleep routine.

Unresolved stress, tension or emotional disruptions during the day can also contribute to sleep disturbances. Many times we feel that our early evening escape activities will help us de-stress and cope with life problems. However, while temporary escapes can be useful as distractions, unresolved problems will reemerge during the time usually reserved for sleeping. You will often return to unresolved problems during the night at the time when your mind is least alert and least capable of rational problem-solving. This is when worry and frustration cycles of insomnia begin. The best approach is to structure active problem-solving activities, even "worry times," during the day to be resolved or at least concluded before the sleep routine begins. Our rational minds are our greatest problem-solving resource, and therefore we should reserve problem-solving for the time when our minds are most alert and decisive, not for semi conscious or dreaming mind states which are more easily disrupted by emotionality. It will be helpful to take some time before the end of the day to "download" life issues and possible solutions to clear the mind for the rest of the night. Many people find it helpful to jot down their thoughts or issues, while others perform this function mentally. People are often advised to journal their thoughts and feelings, but the journaling should take place before the night and sleep routine begins, otherwise sleep may be disrupted by a continuation of the processing. Obviously all problems cannot be resolved during this thinking or writing time. The notebook should be closed and put away, and the problem should be assigned to a time and space during the next day or other time in the future.

Unresolved or unacknowledged anger is a problematic issue which does not easily lend itself to rational problem-solving and often reemerges at night causing sleep disruption and insomnia. Journaling or talking to friends may be helpful as long as these steps do not lead to rumination or reinforcement of unresolved anger. If these supportive interventions are not helpful, assistance of a therapist may be productive in helping resolve these issues and restore uninterrupted sleep.

Positive end peaceful mind states are conducive to quality sleep. In addition to clearing the mind by following the problem-solving methods described above, you can take other steps to create a more relaxed mindset. Realizing that worry and depression are composed of negative thoughts, these can be replaced with positive thinking. Choose positive or soothing activities which counterbalance stress and negativity. For example, properly chosen music, spirituality, humor, meditation, playing with pets, cuddling with a spouse, all can help infuse us with a sense of positive well-being. Research has shown that feelings of happiness increase when we schedule a daily time to think about three things which make us feel grateful.

A specific resource helpful in developing a positive and peaceful mindset is the use of hemi-sync tapes or CDs. The hemi-sync technology was developed as a way to alter brain states to facilitate meditation. The technology involves placing binaural beats underneath the music or narrative of a tape or CD. While the conscious mind does not hear the binaural beats fed into the brain through stereo headphones, the hemi-sync technology changes brain waves from the faster or more agitated brain waves (beta) to peaceful, creative (alpha or theta) or sleep-like brain waves (delta). I have found that the hemi-sync technology can be effective even while the listener is walking around and is not necessarily restricted to sitting or lying down. Of course, since it does induce an altered state of mind, you would not use this technology while you are operating a motor vehicle. Sites accessible on your computer sell hemi-sync tapes or CDs at reasonable prices. Several sites allow you to preview the music before purchase.

The information above describes daily activities productive to quality sleep. As described in the first article, adults, not just children, need predictable sleep routines. Just getting into bed is not enough of a signal to induce sleep. Planned and predictable activities will be a programmed stimulus for sleep, and these activities should be chosen to maximize the physiological states preparatory to sleep. In other words, avoid any actions which are stimulating or stress inducing and substitute retained, peaceful and predictable relaxation activities which induce the sleep state. Information which follows will describe some positive and productive components of sleep routines.

Light and dark cycles are the single most powerful influence on sleep. Your body is programmed to prepare for sleep when night falls and then to wake up in the morning light. The invention of electricity, while obviously positive in many ways, had an unintended side effect of causing sleep disruption. The early part of your sleep routine should involve reducing light levels around you. Lights can be dimmed, and flickering or irregular lights such as TV can be turned off. One book even recommends wearing rose-colored glasses at night to reduce light levels. While reducing illumination is helpful preparatory to sleep, the sleeping environment should be completely dark. Research has shown that all parts of the body can be stimulated in response to light, reducing hormones necessary for sleep. Even when light switches are turned off, the room can still be illuminated. Most people don't think about the light that comes from clocks and light sensors on thermostats and other electronic instruments. Covering all of these light sources will be extremely helpful in promoting sleep and preventing sleep disruption. Often people read or listen to music as a part of their sleep routine. It is important to keep the light as low as possible. For example, reading can be done in bed with a flashlight to avoid the stimulation of a brighter light. Don't turn on the lights to go to the bathroom at night. Be sure to have enough illumination to ensure safety, for example using a flashlight, but keeping the light low enough to avoid stimulating the awakening response. Whenever possible, scheduling your sleep-wake cycles according to the natural light and dark cycles will promote quality sleep. Consistency in night and waking times will help encourage sleep regularity and is especially important in helping regulate insomnia.

Body temperature is an important factor in sleep time, varying about 1 1/2F during the daily cycle. Lowered body temperature is characteristic of sleep. Increased body temperatures earlier in the day have been found to be helpful in lowering temperature at night. A hot bath or shower preparatory to bed will then cause the body temperature to fall at the onset of sleep. One of the effects of exercise earlier in the day has been found to increase body temperature which will then be more likely to decrease later in the day to facilitate sleep. The sleep environment should be cool enough to facilitate sleep. Blankets can provide a comfortable environment so that the room temperature can be lowered. One medical adviser suggests wearing socks to bed due to the fact that the feet have the poorest circulation in the body. Research has shown that this may help reduce night wakings.

Other senses can be utilized in inducing or maintaining sleep. Warm non-caffeinated herbal teas or warm milk can be helpful. A protein snack earlier in the night can be useful, while sweets or carbohydrates should be avoided due to the insulin spikes which can interrupt sleep. Essential oils, especially lavender, can be very useful in inducing sleep states. Herbal tea, lavender oils or mineral salts can be added to your bathwater. Lavender can be sprinkled on your pillow to facilitate or maintain sleep. Supplements can be a useful components your sleep routine, although it would be beyond the scope of this article to suggest which supplements are best for your particular situation. Some individuals have found that melatonin supplements are helpful in dealing with jet lag or insomnia. It should be noted that melatonin does increase dreaming which can be either helpful or disruptive depending upon the quality of your dreams. Trauma survivors may have a lot of bad dreams and nightmares, and melatonin should be avoided in this situation.

Intermittent or unexpected noises are obviously disruptive of sleep. A white noise machine can help mask these noises and may itself be a calming influence and a conditioned stimulus for sleep. While some may worry that the white noise will block essential information as you sleep, parents will find they can program their brain to wake up when their children cry despite the background noise.

The bed and sleeping environment should obviously be chosen and maintained to be conducive to sleep. The bed should be comfortable and pillows should be available to keep all body parts comfortable. The bed and linen should be maintained so as to avoid allergic responses. The room should be as free as possible from clutter, especially work related clutter which can stimulate conscious thinking or worry. Avoid using the bed and bedroom for worrisome activities such as work or paying bills which will create associations intrusive to sleep.

As previously mentioned, techniques should be used to empty the mind of problems and promote a positive and peaceful mindset. Some reading activities or use of music or hemi-sync may keep negative thoughts at bay to help you slip into a dream state. Your bedtime routine activities should be chosen to be non-stimulating and unrelated to daily life activities: easy reading or listening so that the conscious mind does not override the calming effect of the sleep routine. Counting sheep and other mental gymnastics should be avoided if they require focused conscious thinking.

What should you do if you do awaken during the night before morning? If possible, attempt to keep your mind in the dream state to block conscious thinking. Unless you're having a bad dream, return to the dream thoughts and images and continue the dream reverie even if you need to get up and go to the bathroom. Avoid looking at the clock or thinking about daily activities which will inevitably return your mind to the conscious state. If you cannot return to the dream, you can put a little lavender on your pillow and try to maintain dreamlike images. If you find yourself unable to return to sleep, you can slip on some headphones for a tape or CD specifically purchased to induce sleep states. If you find yourself with a racing mind, tossing and turning with increasing frustration, you may need to get out of bed for awhile. If possible, avoid turning on the light. Listening to calming music and/or walking around another room in the dark may interrupt the insomnia and let you to return to sleep.

Examine your daily activities and habits in order to avoid sleep disrupters. Check your medications to ascertain if they could cause any sleep problems. Avoid diet pills, decongestants and caffeine-based products especially toward the end of the day. As previously mentioned, avoid bright lights and stimulating activities. Although some people do go to sleep in front of the TV, the programs and especially the advertisements are designed to attract your attention, and the changing sound levels and flickering lights interrupt sleep. Smoking habits are disruptive to sleep, partially due to nicotine withdrawal and also due to inhibition of deep sleep states. Some researchers feel that electro-magnetic fields may cause sleep problems, and they recommend that alarm clocks and electrical devices be kept away from the bed. There are other conditions such as sleep apnea, restless leg syndrome, trauma reactions, pain or other physical conditions which disrupt sleep and require specialized treatment. Local sleep centers are available to measure your brain waves and physiological states during an overnight sleep assessment in the facility. This type of evaluation is helpful in assessing physiological barriers to sleep but is not designed for psychological interventions. There are many emotional and situational factors which contribute to sleep problems which will benefit from mental health assistance.

Please note that it is possible to sleep too much, especially if you find yourself sleeping due to depression or in an attempt to avoid problems. There are more direct and hence more effective approaches to solving these problems. Good quality sleep will give you more energy and happiness to get up and deal with life issues instead of hanging around too long with the covers drawn to block out the light of day.

I hope these ideas and suggestions will help you better understand the sleep state and ways to maximize the quality of your sleep. I would be happy to consult with you about your sleep situation and help you develop an individualized plan to improve your sleep and peace of mind.