Improving Sleep

10 Things You Can Do to Start Sleeping Better

Mark Vakkur, MD

Make sleeping a priority.

Go to bed and get up at the same time - don't vary your weekend wake-up time by more than about an hour.

Avoid daytime naps: Try to get all your sleep at one time. If you nap in the afternoon, you may find it harder to sleep at night, or you may wake up earlier, reducing your sleep efficiency (the proportion of time spent in bed that you sleep).

Avoid or limit caffeine, nicotine, and other stimulants after about noon. Don't overlook less obvious sources of caffeine such as chocolate, hot chocolate, coffee ice cream, or iced tea with dinner.

Avoid exercise too close to bed time. Exercise releases catecholamines (adrenaline) that keeps your body in a state of arousal, possibly for hours.

Exercise. Vigorous physical exercise - 20-30" a day or 30-40" every other day - not only helps your heart, but helps you sleep at night. Our bodies were made for a hunting and gathering existence, not for being planted on a couch watching reality television!

Avoid watching television in bed. Get the television out of the bedroom. Your bed should be used for sleeping and sex. Reading in bed or watching television can make it more difficult to cue your body that it is time for bed.

Try to avoid anxiety-provoking conversations or conflicts before going to sleep. Have a cut-off time for anxiety-provoking topics, perhaps 9 or 10 p.m.

Avoid watching television too closely before going to bed. Television activates the part of your brain in charge of alertness and arousal. It is designed to provoke and stimulate and makes it very difficult to "wind down" for some time afterwards.

Develop a bed-time ritual. Reading a book in a quiet room lit only by a lamp or two would be ideal.

Drink warm milk. It is rich in tryptophan, which aids in sleep.

Avoid alcohol. Alcohol may help you go to sleep, but generally leaves your system sometime in the middle of the night, leading to a state of increased arousal and energy. Also, depending on alcohol to help you get to sleep may lead to a dependence and a host of health problems.

If you can't sleep after about 15" lying in bed, get up and resume your ritual. Try not to torture yourself, lying in bed, tossing and turning, looking at the clock, worrying about how tired you'll be the next morning. You are more likely to go to sleep if you get up, read some more in a quiet room, then return to bed in another 5-10". This is especially true if some anxiety-provoking thoughts are keeping you awake.

As much as possible, avoid pharmacological sleep aids until all of the above have been tried and exhausted (no pun intended). A good sleep routine will take several days to a week to take effect. In the meantime, you may feel tired for a few days until your body adjusts (especially if you are used to taking daytime naps or sleeping in very late on weekends). Over the counter sleep aids include generic Benadryl (diphenhydramine) although it may make someone groggy the next day, especially if you are not used to it. Any sleeping medication can generally be taken earlier in the evening to reduce daytime grogginess.

Public service message: avoid preparations containing Tylenol, such as Tylenol PM unless you have pain. Tylenol can be toxic to your liver.

Most sleep aids, such as Ambien or Sonata, should be used short-term. Longer-term requirement of sleeping aids may indicate an underlying medical or psychiatrist disorder that may require treatment. Depression, anxiety, and bipolar disorder may all cause profound disruptions of sleep.