The Basics of Sound Sleep

Psychiatric problems can cause insomnia or excessive sleep; however, it is also clear that alterations of sleep can cause psychiatric problems.  Insomnia increases the risk of depression, anxiety, poor concentration, physical pain, and manic episodes.   Paradoxically, too much sleep can also aggravate depression.   If you can create regular, restorative sleep, you are likely to feel much better. 

Here are some of the things you can do:

• Avoid both stimulants (such as caffeine, nicotine, amphetamine, cocaine) and sedatives (such as alcohol, barbiturates); both types of drugs disrupt sleep.
• Avoid heavy meals in the late evening.
• Increase exercise (as long as it is not too close to bedtime.)
• Avoid naps. Most people sleep better at night if they do not nap during the daytime; when the “sleep need” can build up during the daytime, the sleep at night is deeper.  When daytime drowsiness is a problem, it usually occurs for a few hours in the afternoon and then lifts in the late afternoon or evening.  Develop strategies for staying awake for those few hours. If you get drowsy, try to avoid napping by avoiding lying down or sitting, postures that predispose people to sleep.  Planning a walk or physical activity (especially outside) during this times may help you stay awake. Remind yourself that the drowsiness is only temporary and that alertness will be coming soon.  Eventually, once the nighttime sleep is sound, the daytime drowsiness should be minimal or nonexistent.  
• During the 2-3 hours before the desired time of going to sleep, avoid stressful activities (such as disturbing movies or TV news) and keep the light level low.
• Make sure that your bedroom is dark and that the temperature is cool (less than 66 degrees F.) Strive to keep the air around your head cool, and keep the skin temperature of the rest of the body comfortable, not too hot or too cold. The brain needs to cool down at night in order for you to have a restful sleep.
• Use the bed only for sleep and sex.  Avoid watching TV, reading, etc.  
• If you find yourself awake in the middle of the night, relaxation techniques may be helpful.  You can slowly breathe in through the nose and out through the mouth; this may be helpful in cooling the brain and facilitating sleep.  Progressive muscle relaxation may also be helpful.   If the insomnia in the middle of the night lasts for a long time, some people may benefit from getting out of the bedroom and doing something else, such as listening to soothing music.  This may break the association between the anxiety about the insomnia and the bedroom. The activity should not involve exposure to too much light, such as TV or computer screens or bright reading lights; dim nightlights may be important for safety.
• Determine the best sleep duration for you.  When you feel best, how many hours of sleep are you getting?  (Most people require 6-9 hours.) Don't sleep deprive yourself.  Don't sleep too much.
• Go to sleep at the same time and wake up at the same time each day. Set the target times of going to sleep and waking up, making sure that these times will allow you to get your optimal hours of sleep. Wake up at a regular time even on weekends.  Our sleep is controlled by our body clocks (circadian rhythms). The timing of body clocks is controlled by the light-dark cycle.  Therefore, if we can control when we are exposed to light and darkness, we can synchronize our body clock timing with when we want to sleep.  The regular light-dark cycle will lead to more regular (natural) sleep-wake cycle and more efficient and restorative sleep.
• Increase daytime light exposure.  Get outside.  Outdoor light (even on a cloudy day) is much brighter than indoor light.  For most people, outdoor light soon after awakening is especially helpful.  You may also put your bedside lamp on a timer so that the light comes on 15 minutes before your desired time of awakening.
• Decrease late evening and nighttime light exposure: “Dark therapy”.   Decrease evening light exposure 2-3 hours before the desired time of going to sleep, especially if you have difficulty getting to sleep. Minimize exposure to the TV and computer screens and bright kitchen and bathroom lights; these lights are capable of fooling your eyes and brain into thinking that the sun is still up in the late evening and making it difficult to get to sleep.