One of the most common problems we see in primary care is complaints about not getting quality sleep. People can’t fall asleep. Once they’re asleep they keep waking up. They wake up unrested. They’re tired and sleepy during the day.
Sleep disturbances have huge impact on our quality of life. Fatigue and sleepiness decrease our enjoyment of our hobbies and activities with family. In extreme cases, severe fatigue can be fatal in the case of people who fall asleep behind the wheel.
The good news is that sleep problems are very responsive to treatment even without medications. Changes in behavior related to sleep make a huge difference in quality of sleep. Continuing bad sleep habits (called poor sleep hygiene) make it very difficult for even sleeping pills to produce good results.
The absolute first thing to do is to have a consistent wake-up time every morning, 7 days per week. This sets your “biological clock” and helps improve sleep onset. And don’t nap. If you absolutely must nap every once in a while, set an alarm so you only sleep 20-30 minutes, and nap early in the day.
Can’t Fall Asleep
This actually is one of the easier problems to correct. Why can’t you fall asleep? Usually it’s because you’re worrying about something, or because you have trained yourself to be awake in bed.
The first thing to do is to make a commitment that the ONLY things you’re going to do in bed are sleep and have sex. Everything else happens somewhere else. No watching TV, no reading, no eating, no nothing. Often just taking this one step is enough to help gradually improve your ability to fall asleep.
If you are a light sleeper and use the TV to block out outside noise, change to a white-noise machine. TV noise (and light) actually makes it hard to sleep because of the change in pitch and volume from show to show and with commercial breaks.
If you have trouble getting to sleep because you’re worrying about something, take a week and try scheduling time earlier in each day to make a plan for dealing with whatever is worrying you. If you lie down and then remember something, get up and take care of it right away or make yourself a note so you don’t forget to deal with it in the morning. Oh, and don’t check work emails right before bed!
Can’t Stay Asleep
Many people fall asleep just fine but wake up before they need to get up, and then have trouble going back to sleep. This is often stress related and responds to stress reduction, meditation, and exercise.
This may sound weird, but it is important to only sleep as much as you need to feel refreshed the next day. Not everyone needs 8 hours, and spending excess time in bed can increase broken sleep and make it hard to get deep, restful sleep.
One important thing to do is STOP watching the clock. This makes it even harder to go to sleep. Set your alarm for your wake-up time and turn the clock towards the wall. Turn your phone over or plug it in in a place where you can’t reach it without getting out of bed.
Also, make sure you have a comfortable bed and bedroom. Cooler temperatures usually make it easier to sleep. It should be quiet and dark. As I said earlier, a white noise machine and blackout curtains can help if you are a light sleeper.
Substance use can interfere with quality sleep too. Caffeine, alcohol and nicotine all interfere with quality sleep. Caffeine should be avoided after noon, alcohol should be avoided after dinner and nicotine should be avoided altogether 😉
If you have tried these measures and still find yourself unable to fall asleep, unable to stay asleep, and feeling sleepy during the day, it’s time to see the doctor. Sleep trouble is potentially dangerous and treatment can significantly improve your quality of life.