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Getting a good night's sleep

A stepped approach

This page created 25th August 2014

By Belinda (ADAVIC Volunteer)


Sleep is a wonderful thing.  Historically, sleep has been used to cure the ill.  In an ancient Greek tradition, the sick were first purified by fasting and bathing, then asked to sleep in a sacred precinct.  During this period of sleep, Asclepius, the god of medicine and healing, would apparently appear in the sick individual’s dreams and provide advice, which would be interpreted by the priests. Beyond healing, sleep has been associated with genius and   intellectual break-through.  For example, Fredrich August von Kekule, one of the most prominent European chemists of the 1800’s, was said to have discovered the Benzene ring (an organic chemical compound) during a dream.  It took him 2-3 years of research in his waking state to provide evidence for his finding.  Then, of course, beyond the tales of almost mystical healing and ingenious discovery, adequate sleep is associated with everyday cognitive function such as memory and decision-making, hormonal stability, reflexes and normal appetite.  
 
Reading a list of benefits associated with sleep can be somewhat anxiety-provoking for those of us who struggle a getting good night’s slumber.  Really, you just don’t need the added concern that between 11pm and 7am, you might be missing the opportunity to make the next scientific discovery via a dream that you don’t have.  But the importance of sleep – or rather, how to achieve a restorative sleep – is something worth discussing.
 
“Sleep difficulties” is a general term that covers both acute and chronic deficits experienced in the quality, duration, or timing of sleep.  From a clinical perspective, sleep difficulties might be symptomatic of a sleep-wake disorder, including insomnia, narcolepsy or breathing-related disorders.  Notably, sleep difficulties and sleep-wake disorders are commonly experienced by individuals with anxiety and mood-related disorders – a challenge given that the two complaints can mutually aggravate one another.  The following is a stepped approach to achieve a good night’s sleep.  While the suggestions do not stand as a substitute for clinical treatment, it may be worthwhile truly implementing the first three, before looking into available therapies (Step 4 below).   
 
Step 1.  Embrace rhythm and routine
Human bodies work on a circadian rhythm, a biological cycle that is centered around daylight.  For this reason,   we thrive on rhythm and routine in our daily lives.  At a basic level, we can achieve this by committing to a consistent bedtime and wake-time every single day.  But this principle also extends to the routine that you implement in your day: when you move, when you eat each meal, and how you structure your day with activities such as work, parenting, and social activities.
Fine-tuning your morning and bed-preparation routines are key ingredients in achieving optimal sleep. Specifically, getting as much sunlight upon waking is important to activate melatonin receptors, which control our sleep-wake cycles.  Melatonin is created in our pineal gland (a small hormonal gland in the brain), and the pineal gland can only be activated by light hitting our retinas (eyes).  In the darkness of night, melatonin production decreases, causing drowsiness and lowering our body temperature.  In the morning, we want to see as much light as possible to activate melatonin production and kick-start the “wake” part of our circadian rhythm.  Conversely, at night, we are best to steer clear of harsh lights, such as those in televisions and back-lit devices (e.g. iPhones, iPads), which might continue to stimulate melatonin production.  Rather, it is best to create a calming routine at night, such as taking a bath, and dimming the lights, in order to promote restfulness.

Step 2.  Move your body everyday.

Human bodies were made to move.  Our hunter-gatherer forebears would be frankly quite perplexed by our sedentary lifestyles.  While they engaged in bursts of energy all day in order to survive, we often drive to work, plonk ourselves on a chair at work, drive home, then sit on the couch after dinner.  It is simply not how our bodies were designed, and by denying ourselves the opportunity to move, as a race, we are experiencing an epidemic of health issues that might be traced (in part) back to this very fact.    Movement is not necessarily prescribed “exercise”. 

“Exercise” is now associated for many with dogma, and that icky feeling associated with something that they “should” do.  For example, “I should go to the gym and run on the treadmill”.  If this is the case for you, banish “exercise” from your vocabulary and embrace “movement”.  Movement induces a feeling of freedom and joy.  It comprises absolutely anything that you enjoy doing with your body in motion.  This could be walking, dancing, yoga, or scurrying though bushland.  It could be done in the comfort of your own home, walking to the supermarket, or within the beauty of a local park.  Whatever that movement is for you, commit to doing some of it each day.  Your night-self might thank you for the improved quality of sleep that it affords.


Step 3. Nourish your body.

Eating a diet full of wholefoods (unprocessed foods) is important to ensure adequate sleep.  On the one hand, there are specific substances that you are best to reduce, or avoid, such as caffeine and artificial sugar.  For example, caffeine stimulates the secretion of adrenalin and cortisol, our fight-or-flight hormones, getting us ready for action.  However, while caffeine gives us the buzz in the day, it also takes around 6 hours for our bodies to completely metabolize it.  So, if you have 200mg of caffeine at 4 p.m.  (a standard coffee), you will still have approximately 100mg in your body at 10 p.m., and 50mg floating around at 4 a.m.  Obviously, the presence of caffeine in your body is not conducive to sleep. 

Similarly, artificial sugar does not aid sleep as it depletes vitamin B, which causes exhaustion, and spikes insulin levels.  The spike in insulin gives an immediate high in energy and mood, which is quickly replaced by a low, causing the urge to reach for the next sugary treat.  Thus, not only are you leeching your body of vitamins and minerals, but are likely to be left with an artificial “wired” feeling come nighttime.

 
On the other hand, some foods have been identified as friends of sleep.  For example, almonds contain magnesium, which promotes sleep and muscle relaxation, and helps maintain blood sugar levels while sleeping.  Similarly, bananas contain magnesium and potassium, which relaxes overstressed muscles, as well as tryptophan, which converts to the brain’s calming hormones.  Dairy also contains tryptophan, in addition to calcium, which   has been associated with stress reduction and stabilization of nerve fibers.  That said, don’t get hung up on eating specific sleep-aiding foods.  If you eat an array of wholefoods, including a variety of colourful vegetables and fruits, you will be providing yourself with ideal energy in the day, and setting yourself up for sleep at night.

Step 4.  Talking to a healthcare professional

Sometimes, breaking a dysfunctional sleep pattern is best done by speaking with a professional.  A Western-trained professional (e.g. General Practitioner, Psychologist, Psychiatrist) may present several options, including medication, a sleep based cognitive behavoural therapy for insomnia (CBTI), or a mindfulness-based-cognitive behavioural-therapy (MBCT).
There are several types of medications available, although most work by promoting drowsiness. For example, the commonly prescribed Temazepam is a benzodiazepine, a type of drug that causes the release of gamma amino butyric acid (GABA), a neurotransmitter that has a ‘nerve-calming’ effect.  Medications usually require a prescription and should be taken in close consultation with a doctor.  Each is associated with numerous side-effects, are usually only prescribed for a short period of time, and can result in drug dependency or addiction.  Interestingly, several studies which compare sleeping tablets with CBTI or MBCT, the therapy has the same (or greater) efficacy as compared to the drugs over the short term (6-10 weeks) and greater efficacy over a longer period (12 months).  That is, CBT or MBCT provides better results in terms of sleep quality as compared with medication – and it does not come with strings attached in terms of side effects.
 
To provide a quick overview of the two therapies, CBT aims to challenge the content of your thoughts.  For example, dysfunctional thoughts around sleep might be “There’s something wrong with me and I cannot ever sleep.” CBT would look at the validity of these thoughts (i.e. “Is it true that I cannot ever sleep, or can I sleep better on some nights each week?”).  Overtime, CBT aims to alter the dysfunctional sleep-related thoughts in order to promote better sleep.  MBCT is a meditation program based on an integration of CBT and Mindfulness-based stress reduction.  That is, rather than just challenging the content of your thoughts, it also changes your relationship with your thoughts regardless of the content.  The aim of mindfulness is to relate with your thoughts in a more accepting, non-judgmental, non-reactive manner.  For example, if you were to have the thought “There’s something wrong with me and I cannot ever sleep,” rather than labeling it a “bad” thought, you would just observe it without judgment.  This ability to consciously observe your thoughts promotes non-reactivity – it’s difficult to have an anxious reaction to a thought that is neither good nor bad!  


The steps above provide some initial ideas on how to promote a better night’s sleep.  That said, they are not exhaustive and it is always best to speak with your doctor as they can take your medical history and personal circumstances into account.

It is also worthwhile noting that the forth step provides options from a Western-medical perspective: options also exist within the field of complementary therapies.   



 

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