Sleep Hygiene

So what is insomnia anyway?  Insomnia is when an individual has problems falling asleep, staying asleep, or not feeling rested when they wake up.  Everyone requires a different amount of sleep, so it is less about how much sleep you get, than how you feel when you are sleeping.  Disturbance in your sleep can significantly affect quality of life causing daytime fatigue, forgetfulness, mood symptoms (irritability, anxiety, depression), decreased concentration and motivation, and making frequent mistakes.

Insomnia may be caused by a variety of medical, psychiatric, and neurologic disorders.  However, for most people, causes are much simpler: stress (death of a loved one, divorce, illness, pain, unemployment, etc.); medication or substance use or withdrawal; poor habits around sleep (including diet, exercise and TV/computer use); and changes in the sleep environment (jet lag or night shift work).  The good news is that it is possible to manage common causes without medication or major medical interventions.  The following guidelines are collectively referred to as “sleep hygiene.”  Following these basic principles will significantly improve your quality of life.  The biggest hurdle is adhering to them – although they seem simple, most of us tend to ignore them.

 Go to bed and wake up at the same time!  

If you are having a hard time falling asleep consistently, it is especially important to set a regular wake up time.  If you keep waking up at the same time, eventually the need to fall asleep earlier will catch up with you.

No napping! 

If you can’t sleep at night, avoid daytime naps so that you are tired at bedtime.

 Avoid alcohol 4-6 hours before bed! 

Alcohol may make you feel sleepier, but as your body metabolizes it, and your blood alcohol levels drop, there is a stimulating effect that wakes you up.

 Avoid caffeine 4-6 hours before bedtime!

Some people are more sensitive to caffeine than others, so my general rule of thumb is to limit caffeine intake to the morning only.  Also, don’t forget, chocolate has caffeine in it too!  So – sorry – no chocolate for dessert at dinner.

 Avoid food 2-3 hours before bed, and avoid heavy, spicy, or sugary food 4-6 hours before bed! 

Just as everyone’s sensitivity to caffeine varies, so does their sensitivity to food. If you’re having difficulty sleeping, it might be a time to evaluate your diet in general.

Exercise regularly

Regular exercise helps deepen sleep. But be sure to avoid strenuous activity at least 2 hours before bed as this can keep you up.

 Adjust your sleeping environment:

  •  Make sure your bed is cozy
  • Get the temperature right.  If it’s too hot or too cold you won’t sleep well, a cool (but not cold) temperature is the best for sleep
  • Limit background noise or try wearing earplugs
  • BED IS FOR SLEEP AND SEX ONLY!  Don’t confuse your body by doing other activities such as reading, work, or watching TV in bed.

Getting ready for bed:

  • Warm whole milk before bed is soothing and the fats in the milk slow the body down as it digests
  • Practice relaxation techniques before bed.  Meditate, listen to soothing music or guided visualizations.
  • Don’t take your worries to bed.
  • Complete any tasks or work before bed, so you don’t stay up thinking about them.
  • AVOID YOUR TV, COMPUTER, SMART PHONE, or TABLET before bed!!!!  Studies have shown that the brightness and light wavelength range of these   devices inhibit production of melatonin, an important hormone that initiates sleep. 

Last but not least: What if I wake up in the middle of the night and can’t fall back asleep?

If you can’t fall back asleep within 15-20 minutes, GET UP!  “Trying” to fall back asleep when you can’t doesn’t do you any good.  Get up and do a quiet calming activity.  Meditate, have a snack, read, take a bath (remember – no TV, computer, smart phone, or tablet!).  Most people will get sleepy again within 20 minutes of being out of bed.

Integrative Psychiatry: Why Medications Are Only a Piece of the Puzzle

Integrative medicine is by definition a multidisciplinary approach that combines conventional treatments with alternative therapies.  Integrative psychiatry considers both the mental and physical…the mind as well as the body.  When evaluating psychiatric symptoms it is important to examine biological, psychological, social, and spiritual problems.  This integration is achieved by taking a close look at each aspect of the self, and moving toward a “harmonious whole.”  Understanding the flow and exchange between all of the systems within us is the key to healing; the process is unique to every individual.  Integrative psychiatry develops an individualized health plan through psychopharmacology, psychotherapy, coaching, nutrition, exercise, sleep, and alternative methods such as acupuncture and naturopathic medicine.  It also supports your own resilience and innate healing responses.

How long should I wait before seeking help?

The earlier problems are addressed, the easier it is to treat symptoms into remission and prevent relapse of symptoms in the future. In psychiatry there is a concept called “kindling.”  It is a metaphor that illustrates the reaction of the nervous system in psychiatric disorders. Similar to kindling to a fire, where small twigs can produce a large fire, seemingly insignificant and intermittent mental health disturbances can lead to larger, more persistent problems down the road. 

When should I consider medications?

Many symptoms of depression, anxiety, and other mental health conditions are normal reactions to life circumstances.  Medications should be considered when these symptoms significantly alter your ability to perform daily activities.

For example, you should consult with a health care provider if you find that you are consistently unable to fall asleep at night because you are up late worrying, or that a significant decrease in motivation and concentration is causing problems at work.

Medication will fix everything, right?

Wrong. While medications are a useful tool, they are not the whole picture.  Research has indicated that medication is most effective in combination with other treatments, such as psychotherapy.  Medications can address physiologic causes of symptoms, however they do not target physical, social, environmental, or psychological factors.  This is why an integrative approach to psychiatric care is so important.  Medications are one piece in assisting you in bringing yourself back to your “whole.”