Sleeping problems effect somewhere between 10 – 18% of the adult population. Sleeping problems include the following: insomnia, sleep apnea, movement syndromes and in rare cases, narcolepsy. This article will focus on the various types of insomnia, what causes & aggravates it, and 32 suggestions to combat it. I’ll touch upon some unique ways colleges are dealing with sleep issues.
Insomnia is a too-oft ignored mental health and medical issue. Dr. Dan Blazer of the Duke University Medical Center, said, “Insomnia may predispose people to anxiety and depression, just as anxiety and depression may predispose people to insomnia.” Additionally, people with insomnia are more likely to have medical issues, and people with medical issues are more likely to suffer from insomnia. The four major types of insomnia are:
(a) Can’t fall asleep (initiation)
(b) Wake up in middle of the night (maintenance)
(c) Sleep isn’t restful or restorative (quality)
(d) Can’t get enough sleep (duration)
Just having one of these symptoms means that one has insomnia; if someone has two or more of these symptoms, then their insomnia is more pervasive and debilitating. Insomnia effects people in three different time categories: transient (lasts less than a week); short term (one to four weeks); and chronic (more than a month). Transient and short term insomnia are often caused by temporary sickness, stress, jet lag or a schedule change. They tend to work themselves out. The major concern here is chronic insomnia. Chronic insomnia can be caused by the following:
(1) Adjustmental insomnia (triggered by current stress). There are many kinds of adjustmental stressors that can cause insomnia. Work, academic, familial, financial, romantic and medical concerns can all lead to difficulties in falling asleep (initiation) or staying asleep (duration).
(2) Due to substance use/withdrawal (alcohol, nicotine, caffeine, marijuana, stimulants, prescription drugs and opiates). Use of caffeine, nicotine or stimulants will cause people to stay up later and have a difficult time falling asleep. Alcohol, stimulant, opiate and other prescription drug use/abuse can cause sleep problems that last for years. People who use/abuse alcohol may have no problem falling asleep, but they may find that they wake up in the middle of the night (maintenance) or that they don’t sleep long enough (duration). One of the major signs of marijuana dependence is that people need it to fall asleep, or that they have trouble sleeping if they attempt to cut down or quit. Completely quitting caffeine or nicotine can effect sleep for up to two weeks (it will be longer if one just cuts down). Quitting any of the other substances (stimulants, prescription drugs, opiates, marijuana, alcohol) can cause or exacerbate insomnia for two months or more.
(3) Due to medical condition. They include, but are not limited to: heart problems, cancer, dementia, heartburn, diabetes, prostate problems, dental problems, gastrointestinal problems, allergies, colds and/or the flu. Medical problems and insomnia often exist together and serve to make the other worse over time. It is a vicious, downward cycle.
(4) Due to psychiatric disorder (especially anxiety, PTSD, depression and bio-polar disorder). Chronic insomnia effects at least: 25% of kids with ADHD, 50% of people with generalized anxiety disorder, 65% of adults with depression and 70% of adults with bi-polar disorder. The major findings on the Harvard Medical School’s website regarding sleep and psychiatric issues are:
- Sleep problems are more likely to affect patients with psychiatric disorders than people in the general population.
- Sleep problems may increase risk for developing particular mental illnesses, as well as result from such disorders.
- Treating the sleep disorder may help alleviate symptoms of the mental health problems.
(5) Inadequate sleep hygiene (poor habits before sleep). More on this later.
Strategies to Fight Insomnia and Improve Sleep
There are a number of changes, interventions and actions that one can take to combat insomnia. They include therapy, exercise, lifestyle changes, relaxation techniques, medical treatment and improving sleep hygiene. Here are 32 suggestions:
(1) Work with a therapist to improve coping skills, develop stress management techniques and consider making some minor (or major) life changes.
(2) Work with a therapist to address mental health or substance abuse disorders.
(3) Weight training (but you should stop at least 3 hours before bed, otherwise you will be too stimulated to fall asleep). You will be more tired at night and will fall asleep quicker.
(4) Endurance training (running, biking, swimming – again, not within 3 hours before going to sleep).
(5) Lose weight. Changing exercise and/or eating habits can lead to weight loss. Usually, losing weight improves one’s health. Healthier people tend to have less problems falling asleep and staying asleep.
(6) Do not nap during the day. Napping breaks up one’s natural body rhythm. If one naps during the day, she is less likely to be tired at night and thus have more difficulty falling asleep.
(7) Eat healthier food.
(8) Meditation will help reduce anxiety and/or stress.
(9) Deep breathing exercises will also help reduce anxiety and/or stress. Breathing in for a count of 3 and out for a count of 6 will clear one’s mind, lower the heart rate and lower the blood pressure.
(11) Use breathing strips if you have sleep apnea (one should also see a doctor for this).
(12) Get medical conditions treated and checked up on regularly. Inform medical provider of sleep problems.
(13) Engage in preventative care. Get regular medical, dental and gynecological check-ups to prevent problems from developing or to avoid letting problems get worse.
(14) Set a regular sleep schedule. This means going to sleep at the same time and waking up at the same time each day. If you wake up before the alarm goes off each day, you are probably getting into a good routine.
(15) Therefore, don’t sleep in on weekends or holidays.
(16) Increase exposure to natural light, especially early in the morning. You should get at least 20 minutes of sunlight each day.
(17) Turn off light when you get into bed. Light signals our bodies to wake up. Humans evolved into a rhythm of being awake in the day and asleep at night. Lights simulate the sun and cause our bodies to energize, making it hard to fall or stay asleep.
(18) Do not watch TV in bed, work on your laptop or browse through your phone. All of those technologies use lighted screens, which again, simulate sunlight.
(19) Minimize sound, or go with a fan or white noise machine.
(20) Your bedroom should only be for sleeping and sex. We are conditioned to do certain activities in different environments. You may not be hungry, but if you go into your kitchen, you might start looking at food. Working out at the gym is not the hard part; it’s getting there (because once you are there, you are used to working out). The more things you do in your bedroom, the more stimuli you have when you are in there. If you eat, read, study, work, fight or do other things in there, it is hard to send a signal to your body to just shut down and go to sleep.
(21) Do not think of yesterday, today or tomorrow while in bed.
(22) Have a comfortable environment
a. Noise can a problem (get a white noise machine, fan, etc…
b. If it is too hot, you’ll wake up
c. If it is too cold, you’re sleep won’t be very restorative
d. Slightly cool is best. Studies have shown that people tend to sleep the best in rooms a temperature around 66 degrees fahrenheit. There is some variation within our species as to what constitutes a cool sleeping temperature, so you might want to experiment.
(23) Do not use sleeping pills (more on this in a separate post later this week). If you must use sleeping pills, you should be aware that they can cause a number of other problems and that many of them are addictive.
(24) Drinking warm milk actually works (without sugary syrup).
(25) Develop a bed time routine. Just as you have a morning routine, you should have a nighttime routine. Do the same things for the 5 to 25 minutes before you go to sleep every night. Your body will learn the routine and will send a signal to itself that it is time to go to sleep.
(26) Unless you want to wake up in the middle of the night to urinate, watch your fluid intake in the evening. If you are someone who is determined to drink a lot of water throughout the day, concentrate your water intake in the first half of your day.
(27) Do not take in sugar within 3 hours of sleeping. It’s a stimulant.
(28) Do not take in caffeine within 6 hours of sleeping. It’s a stronger stimulant.
(29) Do not use tobacco within 2 hours of sleeping. It’s a stimulant.
(30) Do not eat heavily within 3 hours of sleeping. Your body will begin digesting just as you are sleeping and you might wake up with energy after a short time of rest.
(31) If you can’t fall asleep within 30 minutes, get up for a bit and go to another room. Remember, you don’t want to condition yourself to be awake in your bedroom.
(32) If you sleep with someone that has medical problems, snores or has insomnia themselves, you might want to consider sleeping in separate rooms.
I don’t expect someone to initiate all 32 into their new sleep protocol, but I strongly suggest talking to a therapist or doctor who understands sleeping problems (quick quiz, ask them what sleep hygiene is) and coming up with a plan that incorporates a number of them.
Insomnia on the College Campus
Insomnia is a problem on college campuses. A recent study reported that 63% of college students don’t get enough sleep (one aspect that contributes to that high percentage is students who work full time and go to school). I’m comfortable with the posit that students that don’t get enough sleep have a lower academic performance than students that are well rested. A number of schools have instituted a variety of different plans in order to assist students in improving their sleep. Some of them are sound and others less so:
(1) Duke University cancelled all of its 8 am classes, and most courses are scheduled between the more reasonable times of 10 am to 2 pm
(2) (from that article) “Cornell University takes a scientific approach to promoting sleep on campus, sharing a sleep-focused version of introductory psychology. In this class, students are confronted with photos, hard data, and experiments that show the effect of sleep deprivation on college students. They’ve found that it’s been their most effective way to change behavior.”
(3) The University of Cincinnati has a stress management course that teaches people about the importance of proper sleep.
(4) The University of Delaware offers a class on napping (I hope it is not a full 3 credit class, but rather a 1 hour seminar…and most sleep experts state that naps are actually a bad idea).
(5) The College of the Holy Cross teaches their students about sleep hygiene and then takes the novel approach of sending those students into the community to talk to school children about the importance of proper rest.
Colleges are addressing sleep because it leads to a healthier, better performing student body. It’s good for both academics and the business of higher education. It makes a great deal of sense to address sleeping problems on both the micro and macro level. The over-medication of the American public is something that I have talked and written about at great length, so it should not come as a surprise that I also think that we are over-medicating sleeping problems. The effects of over-medicating have the potential to be disastrous. Later on this week, I’ll publish an article on The Problem with Sleep Medication.