Corey Biggs, RN

Insomnia is defined by the inability to sleep or to remain asleep over a time period.  It is divided into several classifications and often referred to as short term (acute) or long term (chronic).  In most cases, insomnia is a condition that often coincides with other ailments including, but not limited to; medication usage, stress, and other diseases or conditions such as pain and restless leg syndrome (RLS).  Around 30% of Americans suffer from insomnia or insomnia-like (para-insomnia) symptoms. Treatment models include medical, holistic, psychiatric, and environmental processes that successfully facilitate adequate sleep—there are also many “old timey” remedies to choose from as well (just ask grandma). 

Shift workers, women, and those over the age of 60 are especially at risk for insomnia, thus creating issues such as accidents, lack of productivity, tardiness, and other illnesses—not to mention just plain moodiness.  The lack of sleep can lead to physical problems stemming from fatigue and a weakened immune system.  Psychological problems such as depression, anxiety and poor decision making can also manifest due to insomnia.   

Environmental and Holistic Remedies

Changing the mattress is a good start.  A mattress that is both supportive and comfortable may reduce nighttime tossing and turning that takes away from quality sleep.  Adding plywood under an older mattress may temporarily help its firmness.  Changing your pillows may also help, especially if you are unable to purchase a new mattress.  Here again look for a pillow that offers both comfort and support (Plywood under the pillow does not help its firmness!).  Bedding is also something to consider.  The type of bedding and how much to use may depend on factors such as room and body temperature during your sleep time.  Spreads, sheets and blankets are all items used according to personal preference and time of year.  Sheets come in a variety of material and textures.  Sheets with a higher thread count tend to be more comfortable (and more expensive).  Spreads come in different materials and thicknesses, again it’s all about personal preference and comfort.  My favorite, the goose downs, comes in a variety of styles and can be used with changeable covering to match the décor and to offer more or less warmth.  Pillow Point:  Wash your bedding with baby detergent such as Dreft© to enhance your sleeping experience.  The detergent’s lavender scent coupled with soft sheets is very relaxing causing you to sleep like a baby.  Having all white sheets may achieve a higher level of relaxation than “busy” floral and striped designs.  Outer coverings such as quilts may be colorful and exuberant, but turn back the covers near bedtime to reveal the inviting, clean, baby fresh sheets.  Beds and bedding material will have to be agreed on by your sleeping partner (Providing it’s a living person and not a life sized Marilyn Monroe or Elvis pillow!).  A partner that is not comfortable will toss and turn, keeping you awake.  On the other hand, you could just replace your sleeping partner with a life sized Marilyn Monroe or Elvis pillow!

Two major occurrences that must happen simultaneously to induce the sleep cycle are minimum core body temperature, and a maximum level of the hormone melatonin.  These two occurrences are called circadian markers and are a part of the circadian rhythm; a 24 hour based sleep-wake cycle.  Controlling the room temperature is imperative.  Temperature should be anywhere from 65-72 degrees Fahrenheit.  Body temperature actually drops during sleep, helping to usher in the sleep cycle.  Maintaining a cool environment keeps the sleep cycle consistent.  Most sources quote 68 degrees as optimal.  Statistics show a woman’s feet in bed is on the average negative 10 degrees Fahrenheit (I made that one up—sort of).   Lighting is another big issue (if not the biggest), especially for day-sleepers.  Light tends to disrupt our sleep-wake cycles (circadian rhythms) and decreases our melatonin production that’s necessary for sleep.  Even light from the alarm clock and cracks around the doors can be problematic.  Pillow Point:  An hour prior to sleeping, began to turn down the lights in the house and avoid TV as its light is very intense—especially plasma and high definition TV’s.  Use soft lighting in the bedroom.  We, in our ancient, prehistoric days were not accustomed to being exposed to the quality of light that we are now days—or should I say nights.  Blocking out light and decreasing our pre-sleep exposure time to light is important.  As intelligent and refined as we humans think we are, the part of our brain (the reticular formation) that controls our sleep is very primitive.  Therefore when the sun goes down our bodies need rest so that the next day we can hunt down great woolly mammoths, saber-tooth tigers, or clearance sales.  Our ancient, well rested relatives were very methodical; therefore, try to get in bed at the same time every night and get up at the same time in the mornings.  A good nighttime routine will help to settle you into a relaxing mode. 

A new study found that sleeping within lighted conditions can increase your weight, at least with mice.  The study found that mice that slept in lighted conditions gained 50% more weight than those who slept in the darkness (I promise, Google it).  Both sets of mice consumed the same amount of food and maintained the same activity level.  Research concluded, with further studies, that the light affected brain chemistry and thus their metabolism.  Human studies are underway. [I told you that lighting was a big issue!]

Noise in our environment plays a significant role in our sleep patterns.  Some noises such as radios and TV’s can be controlled while other distractions such as roadways have to be blocked out.  Decreasing exposure to stimulating noise prior to going to bed is crucial.  White noise (a fan blowing e.g.) may help to mask outdoor sounds while instrumental, classical or soft music may facilitate sleep.  Pillow Point:  Iphones (and other smart phones) can be used to download applications specifically for sleep.  Applications may contain relaxing music, meditative chanting, soothing synthesized sounds, or guided relaxation:  “Insomnia—there’s an app for that!”  Many studies state that it’s not necessarily the noise that is the issue, rather one’s response to noise.  For instance, hearing the dog bark next door may be annoying but getting mad or angry is over stimulating—thereby causing you to not sleep.  Hearing the dog bark next door and coming to terms that dogs bark by nature, and dogs are a part of nature, and nature can be relaxing, will—at least—not over stimulate you.  Conversely, thinking of ways not to get over stimulated might just make you sleepy.

Bats sleep 16 hours a day on average.  So let’s take note from them; having a cold, quiet, and dark environment are key elements for good sleep.  If that doesn’t work try sleeping upside down!  If you want to learn how, ask my mother-in-law…I’m sure she could explain it. J

Psychological Remedies

Once we get our bedroom sleep friendly it should be used for sleep and sleep only.  Ok, sex is allowed (watch out Marilyn and Elvis pillows!).  Bedrooms should not contain TV’s or computers—again, bedrooms are for sleep and sex only (we’ll discuss sex in detail later, but don’t skip ahead there’s no pictures).  Eating, working, surfing the web while in the bedroom is counterproductive when it comes to sleep.  Just like we wouldn’t (or shouldn’t) eat while on the toilet; likewise we should not check stock quotes and Facebook pages on computers or phones while in our bed.  Eat in the kitchen and surf the web on the toilet if you must.

Worry is the enemy of sleep.  Making a pre-sleep check list of things that worry you enough to cause you get up shortly after lying down and addressing those issues prior to bed may be necessary—for  example;  worrying if you locked the car or locked up the house, or if you turned the lights out, thinking about if you fed the cat or not.  Using a check list will ease your mind so you can get to sleep faster.  Worrying over bigger issues like health, jobs and money can keep you from sleeping as well.  Speaking with a counselor and addressing the issues can put you at ease—even if the solution is not already reached.  Keeping a journal of your problems and how you plan to deal with them also helps.  

In order to keep your mind from racing, don’t watch TV, or have in-depth conversations prior to going to bed.  Reading is acceptable as long as it actually relaxes you.  Do not read material that will upset you or over stimulate your thoughts—it’s  time to sleep, not solve the world’s economic crisis or prepare a plan for world peace.  If you can’t sleep, get up.  Don’t lay there and get aggravated, however, when you do get up avoid excessive light and TV.  Also stay away from vigorous exercising and large meals.  Instead, listen to soothing music; perform deep breathing or other relaxation techniques.   Pillow Point:  Instead of lying in bed thinking about sleep—lie in bed and think about staying awake or pretend that it is time to get up and that you don’t want to.  This reverse psychology has been said to work in many cases.

Physical Remedies

Now that our environment is suitable and our mind is clear, we can now talk about the physical aspects of sleeping.  Wearing clothing to bed or the lack, thereof, is often taking into account when considering comfortable sleep.  Either way is ok and is up to the individual.  If bed clothes are worn, they should be put on at least an hour before sleeping or immediately after taking a relaxing bath or shower.  Even if you prefer sleeping au Naturél,  getting out of your day or work clothes into something more comfortable such as PJ’s or soft clothes an hour before bed preludes the mind and body to sleep (turning the sheets back or straighten up the bed an hour before sleep makes the sleeping experience more inviting).  Pillow Point:  Wash your robes, slippers, and sleeping clothes with baby detergent to add to the enhancement of your relaxing, bed time experience.  

Speaking of the lack of clothing, the topic of sex often finds its way into insomnia discussions. To do-it or not to do-it before sleeping is the question. The answer is YES, if you want to!  So long that it does not incite pain or in the rare possibility that it rebounds and keeps you awake.  Although physical activity is not recommended prior to sleep, the exception is sexual activity [Those poor, white sheets!].  Sexual intercourse releases endorphins that cause relaxation and sleepiness—especially in men. Other chemical processes also take place after intercourse that further metabolizes serotonin into melatonin which makes you feel relaxed and sleepy.

Massage is beneficial to both the mind and body.  This can be done by a spouse or hand held massager.  Feet baths that massage offer great results, especially if there is no one else around to give you a nice foot rub.  The feet have many reflexology points that incite relaxation and foster good sleep.

Eating a large meal prior to sleep is not recommended.  However, because hunger pains could wake you from a cozy sleep it is recommended that a light (low fat) snack be consumed if necessary.  Eating large meals sets enzymatic processes into motion, which could interfere with the circadian rhythm, and induce nighttime heartburn. 

Many people ask, “What about drinking”?  If its alcohol—absolutely not!  Alcohol may make you feel sleepy at first, but causes you to rebound and wake up…right about the time for last call!  Avoid caffeinated drinks, as caffeine is a stimulant.  Warm milk might do the trick, however studies are inconclusive about is effectiveness.  If nothing else, warm milk is a comforting reminder of grandma’s old remedies.  If you consume a beverage prior to sleep, do so at least one hour before going to bed.  You don’t want to dream of waterfalls, only to get the urge to pee…or worse find yourself swimming in the golden current!

Herbals and Medication

Herbs and herbal teas are helpful to many people suffering from insomnia.  Valerian and chamomile are common herbs found in teas that induce relaxation and sleep.  Melatonin is also popular supplement found in most stores that has become popular for insomniacs.  Many of these herbs come in a pill form that may combine several herbs and minerals.  Although they sound relatively safe, herbs may still have side effects; therefore, it is very important to check with a physician prior to using any herbal therapy if you are currently under a doctor’s care or on any medications.  Other herbs such as lemon balm, passion flower and lavender can induce relaxation and sleepiness in the form of tea or aroma therapy.

Insomnia that is persistent can affect our health and safety—especially if a person is excessively exhausted throughout the day.  We have all heard of unfortunate stories of people falling asleep while driving or injured from lack of paying attention.  Insomnia that lasts for more than a few weeks needs to be further investigated by a physician as it could be symptom of a more serious condition such as sleep apnea, for example.  Medications are often prescribed by physicians to treat insomnia.  Given the mind altering nature of these medications, it is imperative that they are taken exactly as prescribed and not mixed with other drugs (such as pain killers) or alcohol.  It is also important that sleep medication be taken as the person is getting into bed.  Incidences of sleepwalking and sleep-driving have been noted while taking sleep medication—so that reoccurring dream of being at work then realizing you’re naked could become a real-life nightmare!

Conclusion 

Everyone suffers from insomnia at some point in our lives.  Insomnia becomes an eye opening problem when our health and safety, in addition to the safety of those around us, is compromised.  If you feel you are suffering from chronic insomnia consult your physician for further guidance.