• Have your ceiling flaws memorized from lying awake at night staring at them.
• Wake up too early and then can’t go back to sleep?
• Wake up already exhausted?
Most of us need seven to eight hours of sleep each night for optimal daytime functioning, but at least 50 percent of Americans struggle with sleep problems—and these problems tend to get worse as we get older.
As a physician, I am no stranger to sleep problems. Medical residency was a life filled with chronic caffeine stimulation, an endless to-do list, long hours in front of a computer screen, stress and late work hours with little (or no) sleep. During those years, even when I had time to sleep, I couldn’t. I felt miserable and was all too familiar with the effects of poor sleep on my performance, memory and mood—which was really scary as I was handling life-and-death matters at work. After medical training ended, it took me about eight months of concerted effort to regain normal sleep.
Poor-Quality Sleep, Poor Quality of Life
Poor-quality sleep is no joke. Not only is the nighttime miserable; daytime can be, too. Fatigue can lead to depression, irritability, headaches, concentration problems, gastrointestinal symptoms, increased susceptibility to colds and infections, increased mistakes at work, and an increased risk of car accidents. As if this isn’t bad enough, poor sleep can also increase weight gain, high blood pressure and risk of diabetes and heart attacks.
New patients have told me they are so anxious they won’t be able to sleep that they lie in bed worrying about how lack of sleep is going to affect their performance the next day. It’s a double whammy—worry about sleep worsens their ability to sleep. Sleep problems can seriously hinder our quality of life—and our health. Here’s the good news: I can tell you from 30 years of clinical practice that there are solutions.
Prioritize Your Relationship with Sleep
Good sleep is a lifestyle habit. You have to make it a priority, not just at bedtime, but in the hours before bed. If sleep eludes you, you are going to have to woo it back by working on your sleep habits every day. It may take months before you see results, but it will be well worth it: Better sleep makes us happier, healthier and more relaxed in every way. And the evidence is really there that when you are happier and more relaxed, you are better for everyone and at everything you do. The following seven steps, practiced daily, will eventually help you sleep like a dream.
7 Steps to Great Sleep
1. Turn Your Lights Down Low. While some lucky people can fall asleep with a jackhammer going outside their bedroom window, the rest of us need a peaceful ambience. Unfortunately, if you have sleep problems you may have begun to see your bedroom as a place of misery rather than rest. Here’s how to create a sleep-promoting environment:
• Use your bed for sleep (and sex) only.
• Keep your bedroom temperature comfortable or slightly on the cooler side.
• Make your bedroom an electronics-free zone: no TV, computers or other electronics.
• Reduce ambient noise and light; a flax seed eye pillow or an eye mask and earplugs can help.
• Paint and decorate your bedroom in restful colors—neutrals, earth tones, and blue and green are often recommended, but whatever you find soothing is best.
• Make sure your bed is outfitted with a comfortable mattress, pillows and bedding.
• If you’re having trouble falling asleep, get up and read something relaxing (and not on a screen) on your sofa; don’t lie in bed tossing and turning as that will only increase your negative association with your bedroom.
2. Get Started Early. Good sleep starts long before you hit the pillow. In fact, your daytime and evening habits can have a major effect on your ability to get to sleep at night. Start planning for a good night’s sleep hours before heading to bed with these tips:
• Avoid caffeinated beverages after lunch (if you’re supersensitive, this includes green tea and chocolate).
• Avoid alcohol, especially near bedtime.
• Avoid smoking or other nicotine intake, especially during the evening.
• Avoid naps.
• Exercise regularly for at least 20 minutes daily, preferably more than four hours prior to bedtime.
• Eat no later than three hours before bed and avoid any foods that cause acid reflux (heartburn) if you suffer from the condition.
• Get into bed only when you are sleepy.
3. Power Down. Many of us live “tired and wired”—we’re dragging all day but then can’t sleep at night. This is the result of a modern lifestyle that keeps us literally wired—on email, cell phones and TV—until we go to bed. While “plugged in,” not only are we exposed to electromagnetic waves and bright light that might interfere with sleep, but we are exposed to stressors and “to-dos” that prevent us from ever turning it all off and getting rest. This tired and wired phenomenon puts stress on our adrenal glands, the hormone centers that pump out stress hormones, leading to some of the medical problems associated with insomnia.
To improve your sleep, power down for two designated stress-free hours before bed during which you avoid electronics. Instead, pass the time with a bath, reading, talking, board games or puzzles. Once you get into bed, practicing relaxation skills can increase your chances of sleeping restfully. Two such stress-reduction techniques are progressive relaxation (see instructions in the section "Progressive Relaxation") and eliciting the relaxation response, a combination of muscle relaxation and breathing exercises that can help pave the way to sleep (visit relaxationresponse.org for full instructions). You can make an exception to the no-electronics-in-the-bedroom rule for relaxation, meditation and guided visualization audio materials; many are available for free online and on mobile apps.
Additionally, aromatherapy and stretching can help ease the transition into sleep. A number of yoga sequences can help unwind body and mind prior to bed. Yogaglo.com offers a wealth of recorded yoga sessions led by well-known instructors. Do a class specifically designed for relaxation an hour before bed, then take an aromatherapy bath (read more about this in item six on this list) to help you decompress before you sleep.
4. Fall into the Rhythm. Human beings evolved with natural light cycles that coincide with day and night called circadian rhythms. These rhythms control the hormones that influence our sleep-wake cycles, such as melatonin. Disruption of these hormones can lead to insomnia. Experts recommend a completely dark environment for sleep. Consistent waking at the same time in the morning followed by physical activity with exposure to outdoor light (e.g., a walk outside) may be beneficial, even on cloudy days. Some individuals benefit from daily exposure to a light box for 30 to 40 minutes upon waking. Benefits usually take two to three weeks to become apparent and the practice may need to be maintained indefinitely.
5. Do Your Worrying Before Bed. I often have my patients start a pro-sleep journal—any blank notebook will do. One hour before bed, they write out all of their worries and concerns, including their to-do list for the next day. Doing this allows you to go to sleep with a clearer head. My patients tell me this practice works wonders. Just don’t do it in your bedroom!
6. Soak It Up. A hot aromatherapy bath before bed can relax your mind and your muscles. Add a cup of Epsom salts and five to seven drops of pure lavender essential oil to your tub of hot water. Lavender promotes relaxation and sleep. This can be done nightly and is safe for pregnant and nursing mothers, too.
7. Try Herbs and Supplements. The following botanical and herbal medicines are gentle, nonaddictive alternatives to sleep medications. I use them, along with several nutritional supplements, in my practice to help my patients sleep with excellent results. As a rule, I recommend not combining herbs and medications without the supervision of a physician skilled in the use of botanicals.
Lavela (lavender oil): Fast becoming my favorite product for sleep and anxiety, Lavela is a proprietary lavender oil product from Integrative Therapeutics. It’s easy to take: one pill an hour before bedtime. Using this, I’ve had patients come off long-term use of the pharmaceutical anxiety and insomnia drugs known as benzodiazepines (work with your doctor to taper off).
Chamomile: Peter Rabbit’s mama knew how to help Peter sleep. Sip up to two cups of a strong tea (use two teabags or two tablespoons of loose herb per cup and steep, lidded, for 10 minutes) throughout the evening. Alternatively, try a tincture: 40 drops one hour and again 30 minutes prior to sleep.
Passionflower: Used traditionally to promote sleep, some evidence shows this herb can help you stay asleep and feel more rested. It is also useful to treat anxiety. A typical dose is 40 to 60 drops of tincture (or 320 milligrams in a capsule) up to three times daily. Take it an hour before and again right before sleep at this dose. Limited data suggests it is safe during pregnancy, but I would avoid it during the first trimester and not use it for extended periods while pregnant.
California poppy: California poppy is widely used for its sedative effects. It is strong and should not be taken during the day or before driving. It is also a gentle analgesic and muscle relaxant. A typical dose is 20 to 30 drops before bed.
Hops: With a long history as a sleep herb, this mildly estrogenic plant is wonderful for promoting deep sleep. I recommend tincture in doses of 30 drops one hour and 30 minutes before sleep. It’s too strong for daytime use, should not be combined with alcohol, and should not be used if you suffer from depression or have a history of breast cancer.
Ashwagandha: With roots in the ancient Indian medicinal system Ayurveda, this herb is specific for the “tired and wired.” It not only helps with sleep in the short run, but also helps relieve adrenal fatigue when taken for three to six months and longer. It improves cognitive function, immunity and stress resilience, as well. Take 1 to 6 grams daily of whole herb in capsules. Alternatively, prepare a tea by boiling roots in water for 15 minutes or by adding 1 teaspoon powder to hot water or warm whole milk and steeping for 10 minutes, and drink three cups daily. Tincture dose is 40 to 60 drops three times daily. There is no known safety data in pregnancy; I recommend it as safe during breastfeeding.
Melatonin: While not effective for everyone, those with sleep latency syndrome—characterized by later-than-normal sleep and wake times—and those with melatonin deficiency may get moderate improvement by taking 1 to 3 mg an hour before bed. Women with menopausal hot flashes may also find relief. This dose is considered safe for up to several months at a time. Not recommended during pregnancy.
5-HTP: A product of the amino acid tryptophan, 5-Hydroxytryptophan is converted to serotonin in the brain. Serotonin helps initiate sleep and reduce nighttime awakenings. A typical dose is 100 to 300 mg three times daily. Not recommended during pregnancy.
Calcium and Magnesium: A calcium (800 mg) and magnesium (400 mg) supplement, or magnesium alone if you avoid calcium supplements due to cardiac disease, can promote relaxation and sleep. They can also help if restless leg syndrome or muscle cramps interfere with sleep, and can be helpful during pregnancy. Relaxing Sleep Tonic by Herb Pharm and Sleep & Relax Tea by Gaia Herbs are reliable products you can find in most stores. Muscle Cramp/Tension formula by Pure Encapsulations is another excellent product that combines herbs with calcium and magnesium.
When to See a Doctor
If sleep troubles persist after three months of trying these tips, or if you have other medical symptoms, you should be evaluated by your physician for sleep disorders, sleep apnea, and medical problems that can interfere with sleep such as depression and fibromyalgia. A number of medications can be used to treat insomnia, but many are addictive or have significant side effects. As long as there are no associated medical problems, trying a natural approach first is a healthy choice.
Sleep Easy Tea
The herbs in this tea are classics from time immemorial for promoting relaxation and rest. Sipping tea in the evening is in itself a restful act. However, drinking a cup of tea too close to bedtime could lead to a late-night trip to the bathroom—counterproductive if you are trying to stay asleep—so drink at least an hour before bed.
1 ounce each dry, loose lemon balm leaf, lavender flowers and chamomile blossoms
Steep 1 tablespoon of combined herbs for 10 minutes in a cup of boiling water. Drink hot, inhaling the vapors as you drink to benefit from the medicinal tea and the aromatherapy effects. This is safe to drink daily, and is safe for pregnant and breastfeeding moms. Store the remainder in an airtight, dry container.
Progressive relaxation is a technique in which you direct your thoughts away from stress and worries, and instead focus your attention on progressively relaxing your muscles. Beginning with the muscles in your feet, contract each set of muscles gently for one to two seconds, then release. Repeat this several times with each of your major muscle groups, progressing from your feet up to your calves, thighs, buttocks, abdomen, lower and upper back, arms, hands, fingers, neck, shoulders, and then face and head. The entire practice takes about 30 minutes.
Rest Easy Tips
“Sleep hygiene behaviors” are recommended by physicians and therapists to improve and maintain good sleep. The practice is really a way of life and includes the following recommendations:
■ Sleep only long enough to feel rested and then get out of bed.
■ Aim to go to bed and get up at the same time every day.
■ Do not try to force yourself to sleep. If you can’t sleep, get out of bed and try again later.
■ Have coffee, tea, and other caffeinated foods and beverages only in the morning.
■ Avoid alcohol, especially in the evening.
■ Avoid smoking, especially in the evening.
■ Keep your bedroom dark, cool, quiet and free of reminders of work or other things that cause you stress.
■ Troubleshoot any problems before you go to bed that may keep you awake, reminding yourself the problem is resolved for the moment and you will be better able to attack the situation after a full night of rest.
Aviva Romm is a Yale-trained physician, a midwife, and an award-winning herbalist and author who has spent nearly 30 years as a health-care practitioner. She is a leader in the health-care revolution to transform the current medical system that over-medicalizes life, from birth to death, into a model that respects the intrinsic healing capacities of the body and nature. Read more at avivaromm.com.