Can’t Sleep? Here’s Everything To Do Short of Meds
Creating the Perfect Bed Room
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The first step is to make your room cold and dark - like a bear finding a nice cave to hibernate in. This might sound intuitive, but what surprises most people is how important this is, as well as how cold and dark we should try to make it.
COLD - Research shows most people sleep far better on the colder side, specifically 60 to 67° F.If turning up the AC or getting a fan isn’t an option, then splashing yourself with cold water or investing in more breathable blankets can help.
DARK - Light is a key signal to our body’s sleep/wake cycle. So one of the first solutions we should pursue is making your sleeping space as dark as possible.Invest in block out curtains, a sleep mask, and/or door sweeps. Tape over small lights if you notice any.
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Humidity and noise can both be significant issues, and in seemingly contradictory ways. It’s not about maximizing or minimizing them, but about finding the right level and kind of each.
HUMIDITY - For most, the issue is high humidity, which is related to cold/heat above. Make sure you have breathable sleep wear and get a de-humidifier if needed.However, if it’s too dry this can cause breathing issues. If you’re having issues here, a humidifier might help.
NOISE - Similarly, we want to aim to reduce noise while we sleep. If you’re stuck near a train, then sometimes the best we can do is buy good ear plugs or headphones, and practice acceptance.
Noise machines can be great investments, whether there’s traffic you want to drown out or just plain can’t get to sleep. For a cheap option, you can simply search YouTube on your phone (see the video to the right).
Familiarity can also be important. Sometimes we just need to do our best to recreate what we usually hear when sleeping. This might mean calling someone from home before you nod off. With parents and kids, a recording of you singing can work wonders. -
During the pandemic this one became a big issue. We all started using our bed for, well, everything. It became a bed / reading nook / work desk / dinner table.
It may not seem important, but this can cause a lot of issues. Our bodies aren’t rational but emotional and our habits often become strongly associated with place.
Our beds need to be associated with sleep. Our limbic system needs the cue, “oh, we’re in the sleep space, better do the sleep thing now”. If most of what we do in our bed isn’t sleep, then it simply won’t get that cue.
**Note: The exception for this is sex. However, if you’re having as much sex or more than you sleep, you should find somewhere else than your bed. At least diversify a little. -
Sometimes, it’s better to sleep alone. This one can be difficult, but important. Ultimately, there’s no simple answer. You’ll have to weigh the options and talk with those involved.
PARENTS - While sleeping with children under 1yr old increases risk of SIDS, co-sleeping with children can be really important. It can help with their sleep and develop a stronger attachment relationship.However, and I speak from experience, a kick in the gut can make sleeping difficult. Even if you’re solely focused on your kids wellbeing, all things considered it might be better to sleep separately. After all, you’ll be a better parent if you get good sleep.
LOVERS - Similarly, sharing a bed is an important form of intimacy with our partner. But whether it’s because of snoring, tossing and turning, different sleep schedules, or simply a tiny twin mattress, we sometimes need to prioritize our sleep. Whatever you decide, make sure you decide it together.If you decide the closeness matters too much to give up, make sure to remember that! It’s hard, but possible to reframe kicks or snores as a good thing in your life. It’ll help to listen to this granny’s wisdom.
Do’s & Don’ts Before Sleep
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Our circadian rhythm is run largely in response to light. And I don’t think I need to explain why. Specifically, dimmer light triggers the suprachiasmatic nucleus (SCN) to cue melatonin production.
About 1-2 hours before you go to sleep, it can help to turn off or dim the lights in your house.
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This one has been written about everywhere, and relates to the advice above about light. So I’ll keep it brief.
FIRST, no, your scrolling social media does NOT help you get to sleep.
SECOND, no screens 1-2 hours before bed. Minimum 30 minutes.
THIRD, darker, amber/orange lenses do seem to help with sleep.
But for other reasons than light - anxiety inducing news, dopamine addiction, procrastination with sleep time - you should still put the phone away completely.
FOURTH, there are lots of great apps, such Brick, to help with decreased phone use. Check them out!
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This is another one that requires you to walk a middle path.
FIRST, you very likely need to exercise more. I say this only because, the CDC says that 24% of Americans exercise the min recommended amount.
Exercise helps with sleep in a wide variety of ways.
SECOND, do NOT exercise before bed. Especially aerobic exercise that increases your heart rate. Make sure to do so, but at least 1-2 before bed, and ideally 4 hours for vigorous exercise.
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I’m sure this is obvious in itself, but what people are often unaware of is how long caffeine sticks in your system.
The half life of caffeine varies person to person, but average at about 5 hours, but ranges as wide as 1.5 to 9 hours.
This means if you drink two cups at 12pm noon and go to sleep at 10pm, it’s as if you drank half a cup of coffee, or one cup of black tea, right before bed.
Oh, and if you’re someone who‘s fine with a late night coffee after dinner, that probably isn’t quite true. While it might not be interring with getting to sleep, it can impair your sleep quality while asleep.
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Unfortunately, there’s a popular myth that alcohol helps people sleep. And it’s obvious how this one started. Alcohol is a chemical depressant. So if you drink you get lethargic and drowsy. And if you drink too much, you’ll even pass out.
However, getting to sleep and sleeping well are two very different things (see caffeine too).
Alcohol impairs critical REM sleep that we need to recuperate and feel rested. Additionally, since it relaxes our throat muscles, it can make snoring and sleep apnea worse.
Try to limit your last drink to 3-4 hours before bed.
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It may seem forced or irrelevant, but designing and sticking with a rigid routine of what you do before bed can be incredibly helpful.
Our bodies simply aren’t rational. They respond to cues in our behaviors and environment. So a sleep ritual sends messages on a physical level that prepares us to get to sleep.
Here are some ideas for your sleep ritual:
1) Showering, brushing teeth, washing your face
2) Changing into pajamas, making your bed
3) Journaling, updating a habit tracker, creating To Do lists
4) Reading, crossword or sudoku puzzles, doodling
5) Saying goodnight to loved ones, either in person or a quick text
6) Some of the items above, like bricking your phone, turning on a noise machine
Biohacks
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This type of pragmatic evidence based meditation that can help us relax and destress.
The video on the side can walk you through it. But once you get the hang of it you can practice this in a way that works for you, whether you’re in your chair at the office during the day or laying sleepless in your bed at night.
A large meta-analysis (study reviewing all relevant studies) showed that PMR “significantly reduces anxiety” and “markedly improves overall sleep quality
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This one’s actually quite fascinating. All mammals show a similar response when their face suddenly comes into contact cold water called the Mammalian Dive Reflex.
Ideally you should submerge your face in cold water. But a cold washcloth or ice pack on your cheeks, forehead, or back of your neck can help too.
This technique is especially important when you’d like to bring down your anxiety or heart rate is high.
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The core idea is to intentionally blink and count each one to 60.
It combines the traditional “counting sheep” method, which can help interrupt our thoughts, with an additional hypothesis that repeated blinking tires out our eye muscles. This then contributes to feelings of sleepiness.
This technique does not have as much concrete empirical evidence behind it, but is commonly used and many people feel it helps. So feel free to try it out.
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Warmth, light, dryness, and a lot of other sensory issues are often talked about, but we don’t really think about “pressure” very much. However, we have specialized nerve endings just for pressure. This includes Pacinian corpuscles deeper within our skin that focus on deep pressure and Ruffini endings for sustained pressure.
A systematic review of research on weighted blankets “showed that weighted blankets could effectively improve sleep quality and alleviate negative emotions and daytime symptoms in patients with sleep disorders.“
What to Do with Anxiety?
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Ever stay awake in bed, just lying there for what feels like hour after hour? Of course! That’s probably why you’re here!
An important rule to remember is to get out of bed and do something if you can’t get to sleep in 20-30 minutes. This can sometimes be hard to do, since it feels like the last thing we should be doing when we’re trying to sleep. But this is often necessary.
Here are some tips:
1) Don’t turn on bright lights or do anything that beams lots of light directly into your eyes.
2) No exercise or other things that get your heart rate up for long.
3) Reading, sudoku, puzzles, and writing are common. Something interesting, boring even, but not exciting.
4) When you start to feel sleepy again, it’s time to get back into bed.
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A lot of times we stay up because our mind is swirling in anxious or angry thoughts, slowly shifting to more exaggerated and extreme beliefs.
“Everyone hates me” or “I’m the worst” or “I’m definitely going to fail tomorrow and get fired”.
One thing that can help is to stop this spiral in it’s track and get back to a narrative of what you actually believe.
“Ok, yeah I do have a few friends” and “Well, I’ve bombed presentations like this before and not gotten fired, plus most of the time I do pretty well.“
Write down the emotional beliefs coming up. Get them down on paper. And then look for counter evidence to find a more balanced belief. Our emotional reasoning usually swings to extremes and ignores a lot of reality.
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Sometimes, before we can challenge our thoughts, and subsequently bring down the emotions keeping us up, we need to change how we see and relate to them. We need to create some perspective and distance from them.
In my article on mindfulness, I discuss this kind of meditation as a workout for two important cognitive muscles. But practicing this meditation, especially defusion, can dramatically bring down our anxiety and other emotions on its own.
When we recognize our out of control anxiety as just that, an emotion disconnected from reality, instead of getting swept up in world it paints, we can take a lot of its power away.
This technique can also work with snoring, chronic pain, headaches, and other sensory or pain issues. You can read more by searching for articles on Mindfulness Based Stress Reduction.
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I already mentioned one kind of late night journaling that might help: writing out your ABC’s. Here are a few more. When our thoughts are swirling around, we can often deal with them effectively by simply getting them out of our heads and onto some paper (or phone/comp screen).
1) STREAM OF CONSCIOUSNESS - Write out the mess of thoughts that are coming up and just keep going. Eventually you’ll exhaust them.
2) LETTERS TO OTHERS - Having an anxious or angry conversation in your head? or reliving an embarrassing or otherwise painful moment you had with someone? Get it out. Write a message to them. Don’t send it now! You can read it (and likely delete it) tomorrow. But all the same, get it out.
3) TO DO LISTS & IDEAS - Have a bunch of things you need to do or an awesome idea? Instead of staying up thinking about it, take some quick notes so you can get to it when you actually have some time and energy to do so.
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The last item on any and every therapy list is acceptance.
It’s often hard to gauge what our options are and what we can do. But once we’ve thought it through and tried what we can, we’re left with whatever reality were living in.
If you can do something, do it. But once you have, you just need to practice acceptance with what’s left.
Oddly, accepting things like “I guess I’m not getting any sleep tonight” and dropping the rope on this tug of war with reality can be the thing we actually need.
Our acceptance can sometimes calm us down enough to put us to sleep on its own.
If you’re struggling with this one, check out Dr. Harris’s talk on the Struggle Switch to the right.
