Mental Health Matters—A Monthly Column


James L. Fleming, M.D.

What activity works best with minimal effort, starts easier when we’re tired, causes you to be totally unaware or makes you believe (temporarily) in strange, wonderful or scary things and takes up a third or more of our time? Of course I’m talking about sleep. We all know we need it, function well when we get enough of it and feel just plain rotten if we don’t. But it also has become clear to medical science that not getting sufficient sleep increases the risk of a variety of disorders including high blood pressure, heart disease and diabetes, as well as depression, anxiety and other psychiatric disorders.

Insomnia can also be a warning sign of a serious medical or psychiatric problem so seeing a medical professional is recommended. But there are some things we can all safely do which will increases our chances of getting a better night’s sleep. Here is a list of general principles and specific strategies of what is referred to as “sleep hygiene”:

  1. First we should eliminate or reduce anything known to interfere with sleep such as excess caffeine or nicotine. Even after the acute effects of these substances wear off they can cause a fragmentation of sleep, making it light or interrupted. Alcohol, on the other hand can be initially sedating but after a few hours can result in a “mini withdrawal” causing us to wake earlier than we want to. 
  2. The sleep-wake cycle is regulated by the brain hormone melatonin which is made in the dark. Getting at least 30 minutes of sunlight in the morning will help set the “melatonin clock”, i.e. it gives the brain the message that melatonin synthesis should be shut off now but start up again 12-15 hours later and synthesis of melatonin is most vigorous in the dark. We can give this natural synthesis a boost by taking 1 to 3 mg of melatonin in the evening. One can buy this over the counter without a prescription
  3. Try to avoid stimulating movies or TV programs at night, keep the lights low to avoid shutting off your natural melatonin production and also avoid a lot of time on the computer; reading is better and some people find reading in bed works like a great “sleeping pill”.
  4. If your sleep seems too light, i.e. you “toss and turn” a lot, try going to bed later to increase “sleep efficiency”. Think of this like the greater momentum you build up from starting a wagon ride from a high hill vs a small one: likewise, when you start your time in bed more tired and fatigued, you have more momentum for a deeper sleep.
  5. If you wake up and can’t fall back asleep in 20 minutes or so, try getting up and---while keeping the lights low---walk or stretch easily or do something else of a gentle physical nature until you feel sleepy again. The idea is to not associate bed with insomnia which can be frustrating and create a vicious cycle. Also, waking up may be your brain’s way of releasing stress and getting up and doing some gentle physical activity can help facilitate the release of stress and allow the sleep cycle to continue.
  6. Another cause of waking up too early is food: too much will cause our physiology to be focused on digestion instead of sleep and too little food may cause us to wake up hungry. If possible eat your main meal midday rather than in the evening and avoid fried or fatty foods at night which take a long time to digest. Before bed, chamomile or other non-caffeine herb tea can help us fall asleep easier, and warm milk and/or a light carbohydrate snack can help us stay asleep. 

Whatever we do, worrying about not sleeping will not help. Realize that even if you don’t sleep as much or as long as you’d like every night, just resting will be beneficial and the “sleep debt” we build up will eventually “get paid”, i.e. will get more sleep eventually. Just try to avoid daytime sleep as much as possible, use the sleep hygiene strategies mentioned above and if your sleep still suffers, seek professional help.

Dr Fleming is the Medical Director for Senior Life Solutions, an intensive outpatient program for seniors at Putnam County Memorial Hospital