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Sleepless in Tampa

September 09, 2018 in Self-Care
by Dr. Brian Doane

It’s 2 am and you’re staring at the clock - exhausted, frustrated, and stressed over how much you need
to be sleeping. Maybe you pick up your phone and surf the web or let your mind wander about all the
things you have to do. You’re clinging on to hope that a nap in the afternoon will get you through
tomorrow.

Years ago I struggled with inconsistent sleep. Like most of us, I often took the path of least resistance
when trying to solve the problem. So when I woke up after getting about five fitful hours of what we can
loosely call “sleep”, I relied on several quick fixes to make myself feel better in the moment. I would hit the snooze button over and over until my brain could convince my body that being responsible was
more important than feeling like a normal person. But the body wasn’t done. While making my way out
of bed with the grace of Cosmo Kramer, my body began renegotiations with my brain. Its victory was
evidenced by redirecting me to the kitchen where I could hear the alluring rumble of my automatic
coffee maker. With a slight hopefulness of anticipation, I reached for the mug in my cupboard with a
capacity better suited for hydrating a marathon runner with H2O. I sipped my hazelnut infused
Colombian nectar and slowly began to feel human again. Little did I know, my desperate attempts to
survive a morning routine sabotaged my sleep for the following night.

If you can relate to this experience, you’re not alone. About 20-30% of the population experiences poor
sleep (Bixler, et al., 2002). To make matters worse, insomnia doesn’t just make people tired the next
day, it affects appetite, emotional balance, and over time can negatively impact physical health
(Fernandez-Mendoza, J. & N Vgontzas, 2013). For many people, the solution only requires a few routine
tweaks, so keep reading if you’re ready to take back control of your sleep!

Getting your sleep back on track will take some change. I’ll break down these changes into two types of
interventions: Prevention and Coping in the Moment

Prevention

Let’s start with prevention. We need to begin associating your bed with feelings of peace, calm, and
serenity. Imagine trying to create a sacred sleeping space. Activities like studying, arguing with a partner, or even trying to write a blog (I would never…) while in bed are not going to help. The only time you should be crawling into bed is when you are ready to begin your sleep routine for the night.

Now that you’ve created a sacred sleeping space, let’s work on cutting out behaviors that make it much
more difficult to fall and stay asleep. Some of the biggest sleep saboteurs are substances that change
your body chemistry. The two big ones are alcohol and caffeine. While alcohol can lure you into a sleepy
state, it will ultimately interrupt your sleep cycle and increase the likelihood of waking up a few hours
after falling asleep (Stein, M. D., & Friedmann, P. D. 2005). The more common concern my clients report is caffeine use. The guilty pleasures are often teas (especially black), pop, chocolate, and definitely coffee.

I get it. For some people, coffee is awesome. I love it. But I’m not suggesting you have to cut it out of
your life entirely, simply to be strategic about when and how much you drink. Caffeine has a half-life of
about 5-6 hours in most people. So if you have one cup of coffee at 5pm, half of that caffeine is still in your body around 10 or 11 pm. Caffeine is likely going to increase heart rate, blood pressure, focus and
attention, and even irritability. If you’re someone who is already anxious, I would highly recommend you
reduce caffeine to not only help with sleep but help control the anxiety (Rogers, P., 2007).
Interestingly, birth control significantly slows down the metabolism of caffeine which causes an increase in caffeine sensitivity and the duration of these side effects on your body (Ribeiro-Alves, M. Trugo, L. & Donangelo, C., 2003). Try and limit your caffeine to the morning and only have 1-2 cups per day.

Another significant prevention tool is to wake up at the same time each day and eliminate all naps. This
is another difficult habit to break, especially if you’re getting very little sleep. The problem with naps is that rarely are they structured (“I’m only going to rest for 20 min” almost always turns into two hours…) and they completely disrupt any gains towards a consistent sleep cycle. Going to bed at 11pm would be exceedingly difficult with a nap from 5-7pm. You’ll also want to force yourself to wake up at the time
same time each day. If the goal is to be asleep by 11pm, then you have to be waking up around 6, 7, or
8am each day regardless of when you went to sleep. I can imagine some of you right now telling your
computer screen that you have to take a nap or sleep in on the weekends because you’ll only get a few
hours of sleep each night. Well, that may be true for the first night. Maybe even the second night. But by
the third or forth night of getting 3-4 hours of sleep with no naps, I will be amazed if you aren’t falling asleep on time. The body eventually gives in and you’ll be snoozing through the night.

Lastly, there is an enormous amount of research that suggests exercise helps people fall and stay asleep.
I’ll write another blog about exercise in the future, but try and find an activity you enjoy (don’t force
yourself to run if you hate running) and don’t do it in the evening.

Coping in the Moment

So now we’ve created your sacred sleep space, you’ve cut out naps, limited coffee to the morning, and
worked out in the morning a few days a week. Let’s talk about how to cope when you’re in bed and
sleep feels as likely as a mega-millions jackpot. Below are a few pro-tips that can help reduce the
frustration that comes with insomnia:

1) Create a bedtime routine that begins about 30-60 minutes before you want to fall asleep. This
includes only doing activities that are calming (take a bath, read, light incense, watch Antiques
Roadshow). Avoid anything that is not calming (Horror movies, arguing, exercise, putting your
children to sleep). Once you’re feeling calm, head off to the bedroom.
2) Don’t watch the clock in bed. It only makes you mad. So stop it.
3) Don’t use LED screens in bed. There is recent research coming out that the blue wavelength light
from the LED screens on your phone, laptop, and television trick your body into thinking the sun
is still out so your body stops producing melatonin which essentially helps you fall asleep (Tosini,
G., Ferguson, I., & Tsubota, K., 2016). Some smartphones have a display setting of “Night Shift”
which removes the blue wavelength during preprogrammed hours. I’d recommend using this
option or downloading an app if your phone doesn’t have this feature.
4) If you’ve been in bed for about 20 minutes and still no luck, get out of bed and go back to doing
something relaxing. Read your favorite non-suspenseful book. Light a mellow scented candle
and reflect on a peaceful memory. If your mind wanders to thinking about stressful things like
work, money, or relationships redirect your attention to something else. Maybe try a sleep
meditation app on your phone with Night Shift enabled. After 20 minutes, or if you start feel
calm enough, go back off to the bedroom. Repeat.

Hopefully this information is helpful. I know making changes to your life can be difficult. If you want to
improve your sleep but feel overwhelmed, try picking one or two things from this article and see what
happens. If you feel like you need more support, give me call and we can come up with a plan tailored to
your specific needs and situation.

Disclaimer: It’s strongly encouraged to consult with your physician to rule out any medical conditions
that may be contributing to problems with sleep and get their opinion before making major changes to
diet or routine. The information presented in this article is not intended to be psychological advice or
therapy, but educational in nature.

References

Bixler EO, Vgontzas AN, Lin HM, Vela-Bueno A, Kales A. (2002). Insomnia in central Pennsylvania. Journal
of Psychosom Res., 53(1): 589–92.

Fernandez-Mendoza, J. & N Vgontzas, A. (2013). Insomnia and Its Impact on Physical and Mental Health.
Current Psychiatry Reports, 418(15).

Ribeiro-Alves, M. Trugo, L. & Donangelo, C. (2003). Use of Oral Contraceptives Blunts the Calciuric Effect of Caffeine in Young Adult Women. The Journal of Nutrition, 133(2): 393-398.

Rogers, P. J. (2007), Caffeine, mood and mental performance in everyday life. Nutrition Bulletin, 32: 84-
89.

Stein, M. D., & Friedmann, P. D. (2005). Disturbed Sleep and Its Relationship to Alcohol Use. Substance Abuse : Official Publication of the Association for Medical Education and Research in Substance Abuse, 26(1): 1–13.

Tosini, G., Ferguson, I., & Tsubota, K. (2016). Effects of blue light on the circadian system and eye
physiology. Molecular Vision, 22: 61–72.

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