Getting to Sleep and Staying There

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I’m writing this at 3:30 AM. I really should be sleeping, but my body doesn’t want to. Losing sleep is not good for health, as I detailed last week. What can I or any of us do to sleep better?

Some people have problems falling asleep (“sleep-onset insomnia”). Sleep experts think this problem is usually due to stress or to bad sleep habits. If falling asleep is difficult for you, here are ideas.

Peter Hauri, PhD, former Codirector of the Mayo Clinic Sleep Disorders Center, recommends the following:

• Reduce caffeine (none in the evening)

• Limit alcohol

• Stop smoking

• Have a sleep-inducing environment — dark, quiet, and a comfortable temperature with a comfy mattress.

Sleep rituals
Some of us need to prepare for sleep. We can’t go from work or an argument or an exciting TV show straight to bed and expect to drop off. We should have a “bedtime ritual.” It should be about the same most nights, and done at about the same time each night, and it might include some of the following:

• Dim the lights 20 minutes or so before bedtime (to simulate sunset).

• Take a warm bath.

• Have a snack. Most typical bedtime snacks will work, but avoid spicy food. Warm milk, herbal tea, and turkey are especially good for many people.

• Do some gentle stretching, but not vigorous exercise.

• Pray or meditate.

• Repeat an affirmation such as, “I have done all I needed to do today.”

• Listen to restful music or nature sounds or a relaxation tape.

• Put on socks or down booties so that cold feet don’t keep you awake.

• Sex can also be a good sleep-inducer.

Staying asleep
All those suggestions for falling asleep are good, but, like many of us, I fall asleep just fine. The problem is I wake up after three or four hours and can’t get back to sleep.

Unwanted waking has many causes, and is very common in diabetes. Nocturia (having to urinate at night) is the most commonly cited reason for awakening by men and women alike, but that may be misleading. People may wake for other reasons and assume it was because they had to urinate.

Diabetes can cause broken sleep in two ways. High blood glucose leads to increased urination, while low blood glucose causes people to wake up from hunger. They may think they woke to urinate, when it was really the low blood glucose levels.

People with sleep apnea often think they are waking to urinate, when actually they are fighting for air. Having jumpy legs or “restless leg syndrome” is a neurological problem that can cause waking, which may be mistaken for nocturia.

There are other reasons for waking. The website Stop Being Tired lists the following causes and possible solutions for nighttime awakenings:

Sound. If there’s too much noise in your environment, get a white noise machine to block the sound, wear earplugs, or tell whoever is making the noise to cut it out. You need your sleep.

Medicines. Ask your doctor or pharmacist if your meds could be waking you up.

Low blood glucose. If you suspect this may be waking you up, (for example, if you have dawn phenomenon), figure out what you can do to avoid it. Perhaps changing evening snacks or medicines will stop these mild hypoglycemic episodes.

Deficiencies of magnesium, iron, tryptophan, or vitamin B6. You can get these from foods or in supplements.

Stress. Here are some tips on reducing stress or coping with it through relaxation.

Lack of daytime exercise. I think this might be the most common cause. Bodies won’t sleep if they’re not tired.

Two things that can wake you up that might need professional help are depression and gastroesophageal reflux disorder or GERD (also known as heartburn).

It’s a habit
Good sleep and bad sleep are usually habits. “Conditioned insomnia” means not sleeping because you associate certain things (like your bed) with not sleeping. So you might need to change some things, just to break the insomnia habit.

In the last two nights, I have tried a few of these ideas. I started eating a snack and taking magnesium at bedtime, and I changed beds to have more private space. I’ve had a couple of good nights since then, so maybe it’s working. We’ll see.

One last note: Dr. Hauri (who has recently died) once said, “The harder you try to sleep, the longer you will stay awake.” If you can’t get to sleep, or you wake up and can’t get back to sleep, don’t fight it. Give it ten minutes or so, then get up and do something gentle for a little while. Preferably something boring. Then go back to bed.

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