Over the years, many of us have likely accumulated a few bad sleep habits like watching television, reading or working on the laptop in bed, and while our natural sleep cycle can accomodate a few of these bad habits, chronic insomnia sets in when these accumulated poor sleep habits hit a threshhold and a precipitating factor (stress in a relationship or job) throws us over the edge.
If you find yourself tossing and turning in bed on most nights and this pattern lasts for more than a month, it is a common preliminary scenario to the development of chronic insomnia. Many people suffer from it for years, and end up using sleep aid medications regularly to induce sleep. Most sufferers aren’t aware that there are practical solutions to break the cycle without using medication.
Tips for Sweet Dreams
Living in Vietnam isn’t the best environment to promote a good night’s sleep, but here are tips to get you more than 40 winks:
1. There are only two activites appropriate for the bed - sleeping and getting intimate. Beds are not for doing work or any other activites. Many of us have transformed the bedroom into a multi-purpose room. All electronics must be removed.
2. Avoid the habit of taking naps during the day time. Get up and go to bed at the same time every day, even on weekends. We really are creatures of habit, and our sleep is no exception. By consistently going to bed and getting up at the same time, we condition our body to follow a regular sleep pattern. This allows our body to stick with its natural cycle, called a circadian rhythm, involved in initiating and maintaining our sleep.
3. Exercise is great for good sleep, but it is best to exercise in the morning if possible. The parks here are great venues for this. Also, try to avoid doing it four hours before bedtime because it may have your body still revved up and energised.
4. Make sure your bedroom is quiet, dark, cool and comfortable. Sometimes the street level noise of honking horns or the funeral wake that suddenly started at 10pm and goes until 6am for the next six days are unavoidable, but do your best to create the proper environment for uninterrupted sleep. Studies show a cool room at 15oC to 20oC, this will seem a bit chilly for most but with the use of layered blankets, can work very well to promote a good sleep. In our tropical city that would mean having the air-con on or a fan that keeps you slightly cooler during the hot Saigon nights.
5. If you are living in an apartment with poor noise insulation or are by a construction project that suddenly got going one month after you rented that house in what you thought was a residential area, ear plugs could help, but moving to a new apartment might be a better long-term solution. A white-out noise generator can work so long as whatever background it generates is monotonous, so whale songs are out, ocean waves are okay, but white or “pink” noises are best. There are companies that sell white noise forms as soothing sounds, and this may be the best compromise between a pleasing sound and the need for it to be monotonous or invariant.
6. Avoid caffeine, chocolate, alcohol and nicotine four to six hours before bedtime. Alcohol may make you drowsy, but it often leads to non-restorative sleep that is fragmented.
7. Develop sleep rituals that include quiet activities from reading (not in bed), listening to relaxing music to even taking a nice bath. We often do this for our children, but even as adults these relaxing, stress-relieving rituals can have their benefits. Watching Ultimate Fighting Championships at night is not a relaxing ritual that promotes sleep initiation.
8. If you are having trouble getting to sleep, do not struggle in bed or you will condition yourself to have difficulties there. Individuals who have difficulty getting to sleep often toss and turn in bed and try to force sleep to come. As this occurs, night after night, this sets up a situation where we associate your bed with the anxiety of not being able to get to sleep. If you are unable to get to sleep within 15 to 20 minutes, get out of the bed and go to another quiet place and lie down until you feel ready to fall asleep, and then return to your bed again.
Alternatively…
Alternative treatments abound for insomnia: valerian, corydalis, lavender, chamomile, passion flower, aromatherapy, and I have seen an Aryurvedic remedy of a cup of warm milk with two strands of saffron or some grated nutmeg. Some of these remedies have been studied and to date seem to fare only as a placebo. I am in no way dismissing herbal, homeopathic or Aryuvedic remedies, they probably are effective, but the lesson here I believe is to incorporate them as a regular quiet and relaxing sleep ritual. Whatever works to relax you is “good medicine.”
Finally if you cannot break the cycle on your own with these measures, there is a comprehensive approach, usually guided by physicians or psychologists (it does incorporate many of the principles above), called Cognitive Behavioral Therapy for Insomnia. It has shown excellent results in leading to a return of a healthy sleep hygiene without the use of medications.
Dr Mark Siefring is an American physician practicing in Internal Medicine and Aesthetic Medicine at the Stamford Medical Centre in Saigon.
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