Researching and practising sleep techniques with patients has led me to realise that there are a host of practical, highly effective and sustainable strategies that one can adopt, helping avoid a trip to the doctor. And, as any doctor will tell you, sleeping tablets won't work forever anyway. A vital part of my work is to help restore confidence - confidence on the part of the 'sufferer' that they can in fact sleep again and without pharmaceutical assistance.
Here are ten tried and tested strategies that I have been recommending for years, which have helped patients learn how to sleep again:
1. Eat breakfast every day within 30-45 mins of rising - this especially applies if you are having difficulty getting to sleep and getting out of bed in the morning, constantly pressing the snooze button and feeling exhausted. Habitual non-breakfast eaters tend to find it hard to eat breakfast and may even feel nauseous and knotted in the stomach. Anxiety is a common theme in patients that I see; these are people who are exhausted (the snooze button pressers) but their mind is running riot with worry and endless to-do lists. If you struggle to eat breakfast then start small (e.g. half piece of toast and nut butter) and build up to a decent sized breakfast over the course of 21 days (e.g. porridge topped with chopped nuts, seeds and fruit). The only exceptions to this important rule are if you are getting out of bed and exercising straight away or practising meditation first thing.
2. Stay well hydrated - there are conflicting stories about hydration and sleep, which can be confusing. However, in my experience, people who aren't drinking enough water - at least 2 litres per day - often experience noisy, 'tired but wired' sleep.
3. No more than 200-300 mg of caffeine/day - this is the equivalent of 3 strong cups of instant coffee or 4 cups of tea. Most coffee shop grande cappuccinos will contain up to 350mg of caffeine. Avoid caffeine after 3pm.
4. The electronic sundown - switch off all technology an hour before you get into bed to avoid the 'cognitive noise' that many experience as they try to fall asleep sleep. If the idea of doing this horrifies you then start with 20mins and work up to having an hour of technology-free time before bedtime. Leave phones, laptops and other electronic devices out of the bedroom and never check emails or social media notifications during the night.
5. Never check the time if you wake during the night - it is completely normal to wake during the night but if you're a sensitive sleeper then checking the time can send you into a whirl of calculations and worry about how much sleep you will or won't be getting. Ideally use a clock instead of your phone and turn it away from you so you can't see it if you wake during the night.
6. White noise - this is especially good for sensitive sleepers who wake at the slightest noise or if your partner keeps you awake with their snoring. Avoid using white noise apps on your smart phone if you might be tempted to check emails etc. In this hot weather, a fan is the best form of white noise.
7. Learn how to breathe optimally - to sleep well you need to breathe well. This means breathing deeply from the lower part of the lungs in the diaphragm/belly area. If you grind your teeth, yawn or sigh habitually as well as suffering from sleep problems, this could be a sign that your poor breathing patterns are affecting your sleep. Sign up for a Pilates or yoga class where there is an emphasis on breathing techniques.
8. Learn how to power nap - power napping during the day can actually help you to sleep better as you regain confidence in being able to power down mind and body. It also helps to unload the brain's working memory so that there is less 'filing' to be done at night. This in turn leads to deeper, more restorative sleep. A power nap is a relaxation technique of no more than 5 to 20 minutes. It is a near-sleep state as opposed to actual sleeping. It can be done sitting upright or even lying on the floor. The best time to power nap is at some point between 2 and 4pm. Avoid napping later as this might affect your sleep. If you think you might oversleep then set an alarm.
9. If you can't sleep then rest - not being able to sleep is horrible (and bad for your health) but becoming obsessed with it doesn't help either. If you notice the word 'sleep' popping up in your vocabulary far too many times try using the word 'rest' instead. A subtle but effective shift in mind set. If you're lying in bed unable to get to sleep then just say to yourself 'I'm going to use this time to rest'.
10. Go to bed feeling grateful - there are many well-validated studies that show that feeling optimistic and grateful is good for mind, body and spirit. It is also particularly effective for helping you to let go of the day and fall asleep too. So if you're struggling to get to sleep or you've woken during the night, just cast your mind over the day you've had remembering all of the small, positive things that happened and give thanks. Sometimes old fashioned advice - counting your blessings - really is the best.
Practice these techniques for at least 21 days for maximum benefit.
None of these strategies are meant to be substitutes for taking medication but they might help to wean you off sleeping tablets or even stop you needing them in the first place.