By Dr. Aviva Romm
If you’ve got your ceiling memorized from lying awake staring at it night
after night, if you’ve got a spare tire you just can’t get rid of, you wake up
and can’t get back to sleep, you wake up already exhausted, or if you need a
nap by noon (or coffee, or chocolate, or…) then this article is for you!
The Importance of Sleep
Most of us need seven to eight hours of sleep each night for optimal daytime
functioning, but at least 50 percent of Americans struggle with sleep problems-
and these problems tend to get worse as we get older.
As a physician, I am no stranger to sleep problems. Medical residency was a
life filled with chronic caffeine stimulation, an endless to-do list, long
hours in front of a computer screen, stress and late work hours with little (or
no) sleep. During those years, even when I had time to sleep, I couldn’t. I
felt miserable and was all too familiar with the effects of poor sleep on my
performance, memory and mood-which was really scary as I was handling
life-and-death matters at work. After medical training ended, it took me a
few months of concerted effort to regain normal sleep…but I was able to,
and here are tips you can us to get your sleep back on track, too.
When Your Sleep is Miserable, So is
Everything Else…
Poor quality sleep is no joke. Not only is the night time miserable, daytime
can be, too. When we’re tired we’re more irritable, depressed, our hormones are
a wreck, we can’t lose weight, we can’t concentrate, our digestion is a mess,
we get more zits, we get sick more often, make mistakes at our jobs…. We even
get into more accidents. Seriously. And who hasn’t bitched (ok, telling’ it
like it is, here!) at someone they love or a co-worker out of sheer fatigue?
(When I was in medical residency? Ooh…guilty as charged!).
Oh right, and then there’s the old DOUBLE WHAMMY: Laying there awake (yup,
memorizing the ceiling), worrying about how lack of sleep is going to wreck
your day tomorrow – and BAM – that makes it even harder to fall asleep!
As if all of this wasn’t bad enough, the really bad news is that poor sleep
increases your risk of diabetes, high blood pressure, and heart attack! In
fact, if you’re having trouble shedding pounds, fixing your sleep may be all
you need to do!
But there’s good news! (Would I ever just bum you out? Of course
not!!!)
I can tell you from 30 years of clinical experience – there are
solutions!
Prioritize Your Relationship With Sleep
To win back your sleep, you have to invite it back into your bed! Woo sleep
like s/he’s the love of your life and you’ve been on a break-up! I’m serious,
ladies. Dote on your sleep habits every day. And not just at bedtime.
Good sleep is a lifestyle habit. You have to make it a priority, not just at
bedtime, but in the hours before bed. It may take a month or so before you
see consistent results if your sleep problem is pretty bad, but it will be well
worth it: Better sleep makes us happier, healthier and more relaxed in every
way. And the evidence is really there that when you are happier and more
relaxed, you are better for everyone and at everything you do. The following
seven steps, practiced daily, will eventually help you sleep like a dream.
Regular outdoor exercise can help improve our ability to fall asleep.
The following 7 steps, practiced daily, will, over time, help you to sleep
like a dream. In fact, one patient, who had not slept in years, just recently
told me she is once again “sleepin’ like a baby” – and her whole life has been
transformed as a result! It may take a few months for your body to adjust, so
hang in there and keep at it! With persistence and loving attention, you and
sleep can get back into a great relationship.
7 STEPS TO GREAT ZZZ’S
1. TURN
YOUR LIGHTS DOWN LOW
While some lucky girls can fall asleep with a jackhammer going outside their
bedroom window (actually, it’s mostly the men that can do this, eh?), the rest
of us need a somewhat quieter ambiance. Unfortunately, if you have sleep
problems, you may have begun to equate your bedroom with a place of misery
rather than rest.
Here’s how to create a sleep-promoting environment.
- Make
your bedroom your sanctuary – your place of peace and respite.
- Use your
bed for sleep (and sex) only.
- Keep
your bedroom temperature comfortable or even slightly on the cooler side.
- Make
your bedroom an electronics-free zone: no TV, computers, or other
electronics in there – ever. (Small apartment? Get a room divider to
separate your sleep and desk area.)
- Reduce
ambient noise and light; a flax eye pillow or an eye mask and earplugs can
work wonders!
- Paint
and decorate your bedroom in restful colors (apparently purple and grey
are very bad choices, blue is the best, and neutrals and yellows pretty
good).
- Make
sure you have a comfortable mattress, pillows, and bedding.
If you’re having trouble falling asleep, don’t lay in bed tossing and
turning. That will only make you hate your bedroom! Get up and read something
relaxing on your sofa until you’re ready to try sleep again.
2. GET A HEAD START
Good sleep starts long before you hit the pillow. In fact, your daytime and
evening habits can have a major impact on your ability to get to sleep at
night. Start planning for a good night’s sleep hours before bed by:
- Avoiding
caffeinated beverages after lunch (if you’re super sensitive, this
includes green tea – and chocolate, too)
- Avoiding
alcohol, especially near bedtime
- Avoiding
smoking or other nicotine intake, especially during the evening
- Avoiding
daytime naps
- Exercising
regularly for at least 20 minutes daily, but preferably more than four
hours prior to bedtime
- Eating
no later than three hours before bed and avoid foods that cause acid
reflux (heartburn) if you suffer from it
And don’t go to bed until you are sleepy.
3.
POWER DOWN
Many of us live “tired and wired” – we’re dragging all day and then can’t
sleep at night. Being “plugged in” to computers, email, and Iphones all day and
evening exposes us to electromagnetic waves that potentially interfere with
sleep, and also keeps us plugged into our endless “to-do’s” that prevent us
from ever turning it all off and getting rest.
This same tired and wired phenomenon puts stress on our adrenal glands, the
hormones that pump out stress hormones, leading to some of the medical problems
associated with insomnia.
If you are going to improve your sleep, this means powering down for a
designated couple of stress-free hours before bed. Relaxation skills practiced
once you get into bed can increase your chances of getting to sleep – and
having it be restful. Audio materials to support meditation and guided
visualization are available for free on the Internet and on downloadable IPhone
apps (listening to these is the one exception to the ‘no electronics in the
bedroom’ rule).
Additionally, there are a number of yoga sequences that can help you unwind
your body and your mind prior to bed. YogaGlo, a fantastic website with a
wealth of recorded yoga classes with well-known teachers, offers a selection of
yoga classes to help you relax. Do a class an hour before bed, then take an
aromatherapy bath to help you decompress before you sleep.
4.
GOTTA’ HAVE RHYTHM
Human beings evolved with natural day and night cycles – also called
circadian rhythms. These rhythms control the hormones, for example, melatonin,
which influence our sleep-wake cycles. Getting up at the same time each
morning, followed by physical activity with exposure to outdoor light (e.g., a
walk outside) or even just sitting next to a window with the shades and
curtains open, may be beneficial, even on a cloudy day. If you have severe
insomnia, using a light box for 30-40 minutes upon waking each morning might
help. A completely dark environment is recommended at night for sleep. Benefits
usually take 2-3 weeks to become apparent and the practice may need to be
maintained indefinitely.
5.
DO YOUR WORRYING BEFORE BED
I have my patients start a pro-sleep journal – any blank notebook will
do. One hour before bed they write out all of their worries and concerns,
including their to-do list for the next day. Doing this allows you go to sleep
with a clearer head. Oh, and did I say vent in there, too? Never go to sleep
angry. Even if you do sleep you’ll have rough dreams. After you’ve done your
writing, read something inspirational for a few minutes. I highly recommend
Tara Bennet Goleman’s
Mind Whispering as a start. My patients tell me
this whole practice works wonders. [Just don’t do it in your bedroom!]
6.
SOAK IT UP
A hot aromatherapy bath before bed can relax your mind and your muscles. Add
1 cup of Epsom salts and 5-7 drops of pure lavender essential oil to your tub
of hot water. SOAK away your day’s troubles. Lavender promotes relaxation and
sleep. This can be done nightly just prior to going to bed and is safe for
pregnant and nursing mothers, too.
7.
HERBS AND SUPPLEMENTS
Herbs are my first go-to medicines. Botanical – or herbal – medicines are
gentle, non-addictive alternatives to sleep medications. I use them, along with
several nutritional supplements to help my patients sleep and they LOVE the
results! You can combine any (or all) of these safely and the herbal
extracts can be put right into your chamomile tea!
As a rule I recommend not combining herbs and medications without the
supervision of a physician skilled in the use of botanicals.
Lavela (lavender oil)
Fast becoming my favorite product for sleep and anxiety, Lavela is a
proprietary lavender oil product so look for this brand. (I have no conflict of
interest). It’s super easy to take – one pill about an hour before bedtime.
It’s also helpful if you suffer with anxiety that keeps you awake, performance
anxiety, or test anxiety. I’ve even had several patients come off of long-term
benzodiazepines (you have to work with your doctor to taper off of these
medications!).
Chamomile
Peter Rabbit’s mama knew just what to give Peter to help him sleep!
Chamomile tea can be sipped throughout the evening in the hours before sleep –
up to 2 cups of a strong brewed tea (use 2 teabags per cup or 2 TBS of loose
herb) and steep for 10 minutes with a lid on the cup. Just remember to pee
before bed or you’ll be waking up from a sound sleep! Alternatively, you can
use the tincture, 40 drops 1 hour and again 30 minutes prior to sleep.
Passionflower
This herb has been used traditionally to promote sleep, and some evidence
shows that it can actually improve sleep quality – thus it can help you stay
asleep and feel more rested when you wake. It is also useful in the treatment
of anxiety disorders. A typical dose is 40-60 drops of the tincture (or 320 mg
in a capsule) up to 3 times daily. It can be taken an hour before sleep and
again right before sleep at this dose. Limited data suggests safety in
pregnancy but I would avoid it during the first trimester and not use for
extended periods of time during pregnancy.
California poppy
California poppy is widely used by herbalists for its sedative effects. It
is quite strong and should not be taken during the day or before driving. It is
also a gentle analgesic and muscle relaxant. A typical dose is 20-30 drops
before bed.
Hops
With a long traditional history as a sleep herb, this mildly estrogenic herb
is a common beer ingredient and is wonderful for promoting deep sleep. I
recommend the tincture (alcohol extract) to be taken in doses of 30 drops, 1
hour and again 30 minutes before going to sleep. It’s too strong for daytime
use, should not be combined with alcohol, and should not be used if you suffer
from moderate to severe depression or have a history of estrogen receptor
positive breast cancer.
Ashwagandha
An herb with roots in Ayurvedic medicine, this herb is specific for the
“tired and wired,” and as such not only helps sleep in the short run, but helps
relieve “adrenal fatigue” and burnout when taken for at least 3-6 months or
longer. It improves cognitive function, immunity, and stress resilience as
well. The dose is 1 to 6 grams daily of the whole herb in capsule or tea form.
The tea is prepared by boiling ashwagandha roots in water for 15 minutes and
then cooling, or adding 1 tsp. of the powder to hot water or warm whole milk
and steeping for 10 minutes before drinking. The usual dose is 3 cups daily.
Tincture dose is 40-60 drops 3 times daily. There is no known safety data in
pregnancy; I recommend it as safe during breastfeeding.
Melatonin
While not effective for everyone, individuals with sleep latency syndrome
and those with melatonin deficiency may get moderate improvement from taking
1-3 mg in the hour before bed. Menopausal hot flashers may also get some relief
and sleep from this remedy. This dose is considered safe for a duration of up
to several months at a time. Not recommended during pregnancy.
5-HTP
5-Hydroxytryptophan (5-HTP), a product of the amino acid tryptophan, is
converted into serotonin in the brain. Serotonin helps to initiate calm and
sleep and reduces nighttime awakenings. A typical dose is 100-300 mg three
times daily. Not recommended during pregnancy.
Calcium and Magnesium
A combination calcium (800 mg) and magnesium supplement (400 mg), or
magnesium alone if you are avoiding calcium supplementation due to cardiac
disease, can promote relaxation and sleep. They can also help if restless leg
syndrome or muscle cramps interfere with your sleep, and can be helpful during
pregnancy.
Relaxing Sleep Tonic by Herb Pharm, and
Sleep and
Relax Tea by Gaia Herbs are two reliable over-the-counter products you
can find in most stores.
Muscle Cramp/Tension formula by Pure
Encapsulations is another excellent formula that combines the recommended herbs
along with calcium and magnesium.
When to See Your Doctor
If sleep troubles persist after 3 months of trying these tips, or if you
have other medical symptoms, please talk with your primary physician who can
evaluate you for sleep disorders, sleep apnea, and medical problems that can
interfere with sleep, for example, depression and fibromyalgia. There are a
number of medications that can be used to treat insomnia, however, many are
addictive or have significant side effects, and so trying a natural approach
first, if there are no associated medical problems, is a healthy choice. Sleep
apnea must be treated with appropriate medical care in addition to the options
above.
Sleep well,
Dr. Aviva Romm is a
Yale-trained physician specializing in
integrative medicine for women and children, a
midwife,
an
herbalist, an
award-winning author,
and the creator/owner of
WomanWise,
on-line courses dedicated to vitality and optimal health for women and
children.
