How To Get Back to Sleep

If you sometimes wake up in the night and can't get back to sleep, you're in good company.  Approximate one-third of Americans wake in the night, and about half of those have trouble falling back asleep.  Sleep experts tell us it's normal to wake sometimes during sleep.  If you wake, roll over, and go back to sleep, you don't have a problem.  But if you are awake for 20 minutes (or longer), you  might need some help.*  What can you do when you want to go back to sleep?  Here's a couple ideas:

1.  Body Scan:  Starting at your toes, finger, or head, scan through your whole body, noticing each part and asking it it relax.  Here's a link to a body scan you can use:  http://www.mindfulmomentsinsc.com/files/Exercises/BodyScan.mp3
2. Noticing texture:  Put your hands on two different textures in your bed (e.g. sheet and blanket or skin and cloth).  Notice the difference between your two palms (rough, smooth, cool, warm, soft, hard...).  Then move your hands slightly and notice the difference.  Then be still again and notice the difference. Move one hand to another object with a different texture and notice the difference again.  This exercise helps pull you into the current moment helping you appreciate your bed and perhaps taking away your thoughts from worry or racing thoughts.
3.  Counting your breath:  Count your exhale length and inhale length. (Ideally the exhale should be as long as or longer than the inhale.)  Then add a number to each inhale and exhale making the breath longer and deeper.  Keep adding numbers until your breath is quite deep, perhaps reaching 10.  Don't go so deep that it hurts.  Then make the breath shorter again, going down in length from 10 to 9 to ... to 2 to 1.  Now breathe normally again, enjoying each inhale and exhale.  Or try this meditation:  http://www.mindfulmomentsinsc.com/files/Exercises/ObservingYourBreath.mp3
4. Neuromuscular Relaxation:  Tighten your fist and hold it tight for 10 seconds.  Notice how tight it gets and perhaps even notice how your arm and shoulder feels tense.  Now relax it and notice the difference.  Repeat twice.  Leave arm still as relaxed as you tighten your other fist.  Relax.  Repeat.  Now tighten your foot, or forehead, or upper arm.  Always holding contraction for 10 seconds, then releasing and noticing the difference.  When you move to a new area, keep the other parts of your body still.  Relax your whole body this way until you fall asleep.
5. Going to a relaxing place:  In your mind go to a place that is very relaxing for you (the beach, forest, a special bedroom, with a loved person...).  Describe to yourself all you see there.  Then describe the sounds, touch, taste and smell.  Really go there and relax.  Breath out tension and breathe in peace.
6.  If you've tried these and other ideas and still can't sleep after about 20 minutes get up and do something else.  It might even be good to have a sofa or comfy chair all set up (with an extra blanket and pillow?) before going to bed.  Go and do something relaxing in another room (ideas below).  And if you fall asleep there, allow that.  Or once you feel sleepy go back to your bed.

Staying in bed when you can't sleep and worrying about not being able to sleep is unlikely to lead to sleep (and gets into the habit of not sleeping when in bed).  So get out of bed to do something else to stop the worry and the tension associated with worry.

Ideas of what to do when you get out of bed in the night because you can't sleep:
1.  Drink chamomile tea which is soothing and can make you sleepy.  Avoid caffeinated teas.
2.  Have warm milk or hot chocolate.  Milk has tryptophan which can help you sleep.
3.  Read something boring (textbook?).  Exciting stories can have the opposite effect.
4.  Listen to quiet soothing music.
5.  Pet your dog or cat.
6.  Think about something you like to do that's relaxing.
7.  Watch someone else sleep.
8.  Develop a relaxing ritual to use before you want to sleep.

Everyone has some nights when it's hard to sleep or stay asleep.  If this is just occasional, there's no need to seek further medical assistance.  But if you regularly find you can't sleep more than 2 hours at a time, you probably should consult a sleep doctor to determine what you could do to get more sleep.



*As we grow older, waking in the night becomes more common for lots of reasons like needing to go the the bathroom, pain in joints, and seniors tend to sleep lighter than younger folks.  As long as you're getting enough sleep (7-8 hours in normal), it's ok if part of you sleep is during the day).

Recent research on improving sleep

Summarized below are three new studies that help us understand more about sleep.  Summaries below are draw from WebMed (www.webmd.com) research summaries and articles on sleep written by Dr. Micheal Breus, PhD, ABSM.

1.  The National Science foundation interviewed 1000 adults (ages 23-60) to determine the effects of exercise on sleep.  Respondents reported their physical activity for the week (vigorous, moderate, light, and no activity).  All respondents reported the same amount of sleep, but the more people exercised in the day time, the higher the quality of sleep (i.e. they felt more rested and refreshed when waking).  61% of the non-exercisers reported bad sleep (e.g. difficulty falling and staying asleep, difficulty falling back asleep, sleeping too little), and were more likely to report feeling sleepy during the day.  But perhaps most significant is that even those who only reported light exercise (e.g. 10 minute walk a day), reported better sleep than those who did no exercise.  Participants who exercised more reported improved sleep regardless of when during they day they exercised.

2.  A new study conducted by the University of California Berkeley suggests poor sleep may contribute to the lack of appreciation in couples.  Researchers studied 60 heterosexual couples between ages 18 and 56, asking them to record amount of sleep and their feelings of gratitude.  Results suggest that people tend to feel less appreciated by their partners if they slept poorly. In fact, when just one member of the couple slept poorly, both partners are negatively effected emotionally and have a lower level of appreciation felt in the relationship.  This may explain why more couples are sleeping separately (25% and rising).  Poor or insufficient sleep leads to crankiness and less ability to adapt to changes.  So it's no wonder that we are less appreciative when we have slept poorly.

3.  Modest sleep improvement appears to increase tolerance for pain.  Researchers at the North Shore-Long Island Jewish Sleep Disorders Center extended the sleep of half the participants (ages 21-35) to 10 hours a night and then tested both groups for pain tolerance (how long it took them to remove hands from a heat source).  The extended sleep group had a 25% increase in pain tolerance, the equivalent of taking a pain killer.  Findings are found in the December 2012 issue of Sleep.  Although this small study cannot conclude that increased sleep causes higher pain tolerance, it does suggest that those 
expecting to have surgery or suffering from chronic pain would benefit from increased sleep.


So what can we conclude?

1.  Arrange your schedule so that you can get 7-10 hours of sleep each night.
2.  If you, your partner, boss, or best friend is experiencing sleep problems, get or encourage them to get some help improving their sleep habits.
3.  Exercise everyday, even on busy days.
4.  If you're experiencing chronic pain, consider other causes of pain beyond the initial diagnosis such as sleeping more.

Need help with sleeping better.  See the last blog post (from May 8, 2013, below). 

Tips for Getting Better Sleep

Here's some tips to sleep better tonight:

1.     Have a bedtime ritual:

a.  Self-care:  teeth, bath, hair, etc.

b.  Relaxation:  warm bath, quiet music, gratitude list, tea,…

2.    Go to bed and get up at the same time every night/morning.

3.    Make a comfortable sleep area:

a.  Mattress less than 10 years old

b.  Consider darkening shades to prevent light

c.  Consider earplugs or white noise machines

d.  Pillows to support lower back and neck

What encourages sleep

1.    Daily exercise (esp. aerobic).

2.    Making relaxation a habit (e.g. meditation, neuromuscular relaxation, yoga, mindfulness, spiritual practices, etc.)

3.    Healthy encouraging relationships.

4.    Processing (vs. ignoring) stress (therapy, talk to friend, worry list, setting smaller goals, decreasing expectations, etc.).

5.    Some foods:  warm milk,* bananas, almonds, cherries (only natural source of melatonin), oatmeal,* small portion of protein (cheese, cottage cheese, meat, hard boiled egg), and some herbal teas.*   (*Remember to avoid high sugar additives.)

Things to Avoid:

1.     Exercise and heavy eating right before bed (esp. high fat meals).

2.     Naps more than 20 minutes in the afternoon.

3.     Looking at electronic screens before bed.

4.     Stress and arguments, especially before bed.

5.     Alcohol, caffeine, sugar, and nicotine within 3-5 hours of bedtime.

6.     Using bed for other things (reading, chatting, working, TV, …)

7.     Suspenseful books, shows, etc. that are hard to stop.

8.     Turning the light on when you get up for the bathroom, kids,…

9.     Staying in bed and worrying that you aren’t sleeping.

10. Distractions (e.g. pets, kids, snoring, neighborhood noise…).