Living with and managing insomnia

1. Sleep education and lifestyle adjustments

Good sleep hygiene needs to be understood and practiced by a person with insomnia as daily habits, behaviours and activities, however insignificant these may seem, can have an impact on overall sleep quality. Practicing good sleep hygiene is beneficial for acute insomnia sufferers as well as those dealing with more persistent / chronic conditions.

Adjustments to sleep hygiene practices can almost certainly benefit patients with more transient variations of insomnia, helping to ease trouble with both falling and staying sleep. If anxiety is a factor, CBT is highly beneficial, providing a patient with tools to address the triggers of stimuli which aggravate sleep disturbances. Pharmacological treatment can help to re-establish a more regular sleep pattern or schedule. A combination of these components often makes for the most effective treatment plan, especially when an insomnia sufferer practices better sleep hygiene on a daily basis.

In order to help curb the activities or habits which contribute to hindering sleep, and better promote more quality sleep, a person can take note of the following as is relevant to their condition:

Start and maintain consistent sleep and waking times

• Working with a treating doctor, an insomnia sufferer can work out just how much sleep they actually require in order to maintain a healthier and more functional existence. A doctor will discourage a person from developing any habits of staying in bed longer than is actually necessary in order to achieve restorative sleep.
• Slowing down in the evenings and engaging in healthy activities which help a person to unwind should form part of a daily habit. Reading before bedtime (not in bed) or listening to music can be helpful. Some also find that taking a hot bath at least 2 hours before a scheduled bedtime helps them to unwind and stimulates better opportunity for sleep. ⁽²⁶⁾ 

Refrain from ‘catching up on sleep’

• Either the morning after a night of non-restorative sleep or during off days, such as weekends when a normal sleep-wake routine is typically more relaxed for most people. This includes the taking of naps, unless a doctor has made allowances for this in one’s treatment plan (a treating doctor may allow short daytime naps for between 20 and 40 minutes at a time and not usually after 3pm in the afternoon). ⁽²⁷⁾ 

Get into good daytime habits.

• By having regular meal times and developing a more habitual schedule for the taking of medications or performing certain activities such as household chores or exercise routines, an insomnia sufferer can help to create a reliable ‘inner body clock’ that does not encounter too much overall disruption. In this way, the less room there is for erratic and irregular lifestyle, the easier it will be for one to adopt healthier habits for the benefit of their condition.
• Regular late afternoon sun exposure can also help to stimulate natural melatonin secretion in the body, which can benefit normal circadian rhythm function. Taking the dog for a short walk or relaxing in the park each day can become a regular helping hand in this regard.

Remove distractions unrelated to sleep from the bedroom.

• Activities or behaviours, such as reading, writing, watching television, talking on the phone or eating, which one may get into the habit of doing in the bedroom can be counteractive when trying to achieve better quality sleep. It is best to dedicate such activities to other appropriate household rooms or living areas. A person should take care not to fall asleep on the couch or sofa while watching television or reading and then try and retire to bed.

Avoid stimulants which counteract the ability to sleep and sleep quality

• This includes the consumption of caffeinated beverages or products after lunch (in the afternoon) as this stimulates hyperarousal, alcoholic beverages 6 hours before retiring to bed ⁽²⁸⁾, and the use of nicotine products during the evenings. Alcohol consumption may help a person to fall sleep, but it does tend to contribute to frequent awakenings during the night, which disrupts sleep.
• Vigorous exercise, or engaging in mentally stimulating activities or conversation, as well as self-rumination just before bedtime should also be avoided. Exercise is best completed well before 6 / 7 pm in the evenings. A healthy guideline for exercise is to engage in activity at least 5 days a week for a minimum of 30 minutes.
• Unless recommended by a doctor, one should avoid taking sleeping tablets or other over-the-counter remedies, including herbal varieties.

Refrain from skipping evening meals or eating large ones close to bedtime.

• Large meals consumed too close to bedtime can be particularly disruptive for those prone to GERD (gastroesophageal reflux disease) or problems with delayed gastric emptying.

Make adjustments to a bedroom which promote restorative and quality sleep.

• Factors which help including keeping the sleep environment dark, at a comfortable temperature, well-ventilated and quiet. It is also helpful to ensure that the mattress or bed is comfortable for sleep, and that loose clothing is worn.
• If noise control near the sleep environment is not entirely within a person’s control, it can be drowned out by other monotonous sounds, such as a fan or audio recording of ocean waves etc.

Get into the habit of not forcing sleep.

• If a person is unable to achieve a sleep state within 15 to 30 minutes of getting into bed, laying there will not likely be helpful. It is best to get up and do something which is deemed relaxing and non-stimulating until sleepiness is achieved. Reading in another dimly lit room or watching a non-stimulating television programme can be more helpful than lying in bed and watching the minutes tick by on the bedside clock. Such allowances promote worry and anxiety and further disrupt opportunity for sleep.

2. Nutrition factors

Healthy nutrition may also have a hand in either promoting or disrupting sleep patterns. It is wise to discuss overall eating habits with a treating doctor during a consultation to determine whether or not there are foodstuffs in one’s diet which could be having an impact on symptoms.

The following factors may be beneficial to take note of when it comes to managing insomnia at home and taking the best care of the body:

Avoid:

• Foods which the body is known to have a sensitivity to, such as wheat, soy, dairy or specific additives and preservatives.
• Refined food products, such as those containing sugar, or pastas and white bread.
• Stimulants, like tea, coffee and alcohol.

Incorporate:

• More antioxidant-rich foods into daily meals, such as leafy vegetables, blueberries, cherries and pomegranates.
• Healthy proteins, such as cold-water fish (rich in omega-3 fatty acids) including salmon, tuna, sardines and mackerel; lean meat and beans.
• Enough water consumption on a daily basis (at least 6 to 8 glasses).
• Carbohydrate-rich snacks, including crackers, unsweetened cereals or granola, can be consumed before bedtime. The high carbohydrate / low protein and fat ratio of a snack can help to boost serotonin and melatonin production, aiding in sleep.
• Dietary supplements containing vitamin A, C, E and B-complex, magnesium, zinc, calcium and selenium, which can all be found in a daily multivitamin. Omega-3 fatty acid (fish oils) supplements can also be beneficial for reducing inflammation in the body, and promoting mental balance. Mood stabilisation and improved sleep may be achieved with the incorporation of the amino acid, 5-HTP (5-hydroxytryptophan), but should not be used without the express recommendation of a treating doctor. Another amino acid, L-theanine can also provide support to the nervous system. Any supplements of interest should be discussed with a treating doctor before being taken to assess level of benefit.

References:

^{26. UNSW Sydney. Sleep Hygiene: https://student.unsw.edu.au/sites/all/files/uploads/CAPS/Info-sleep%20hygiene.pdf [Accessed 04.08.2018]}

^{27. Harvard Health Publishing - Harvard Medical School. February 2009. Insomnia: Restoring restful sleep: https://www.health.harvard.edu/staying-healthy/insomnia-restoring-restful-sleep [Accessed 04.08.2018]}

^{28.US National Library of Medicine - National Institutes of Health. March 2005. Disturbed Sleep and Its Relationship to Alcohol Use: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775419/ [Accessed 04.08.2018]}