Chapter 10
Potent Solutions for Improving Sleep
In This Chapter
• The importance of improving sleep
• Techniques used to enhance sleep
• High-yield strategies to calming down the stressed-out body
• The role of exercise in improving sleep
Deep in the brain stem are nerve centers that activate the brain. Every waking moment, these nerve centers spritz the brain with chemicals that maintain alertness and keep you awake. In order to fall asleep, you must shut down the activities in these brain-stem centers.
Four factors are known to activate these alerting nerve cells, all of which are directly play a role in preventing sleep:
• Stimulating drugs, such as caffeine.
• The presences of stress hormones in circulation.
• Activation from the body (especially pain and/or muscle tension).
• A busy brain: despite feeling tired, many of us find it very difficult to shut off worries. Often we just can’t stop this thinking over and over again about various problems in our lives.
In this chapter, we will look at specific approaches that together can help you more easily go to sleep and stay asleep.
Preparing the Body and Mind for Sleep
Physicians call it sleep hygiene. Some of the critical factors in sleep hygiene include preparation for sleep that should actually begin about 6 P.M. For the brain to make a shift into a more quiet state, essential for falling asleep, it is important to begin reducing stimulation in the early evening. Most important is to avoid exposure to bright light (such as sunlight) after 6 P.M. Very bright light is an important environmental stimulus that has a profound impact on brain chemistry, the circadian rhythm, and sleep-wake cycles. Bright light enters the eyes, and then nerve impulses go directly from the retina to a part of the brain that is the primary control center for regulating sleep.
def•i•ni•tion
Sleep hygiene refers to a number of specific steps that one can take to improve the quality of sleep.
Other sources of stimulation to avoid include the following:
• Intense exercise for a period of time at least three hours before retiring to bed. As mentioned in the previous chapter, an immediate effect of exercise is to dump some stress hormones into the bloodstream, and it takes two to three hours for these to be eliminated from the body. Exercise needs to be done earlier in the day.
• Loud music and emotionally charged entertainment (such as Monday night football or exciting or intense movies). Coping effectively must include finding a balance in life (see Chapter 17), and, clearly, doing fun activities is a part of this. However, intense entertainment, despite its value in increasing happiness, generates the release of stress hormones, especially adrenaline and cortisol (both of which significantly interfere with the ability to sleep). Thus the key is to plan more exciting activities for earlier in the day. To maximize quality sleep, the evening must be devoted to more calming activities, such as listening to relaxing music or reading that does not generate a lot of emotional intensity.
• Engaging in emotional arguments with others. The evening is not the time to do this. Again, the problem is that these kinds of encounters increase the level of circulating stress hormones. Obviously, lots of times people can’t really schedule arguments. But, you can make some choices about when to bring up certain ongoing problems such as worries about finances or heated discussions with your teenagers.
Keep in mind that any activity (even positive ones) that generates stress hormones require two to three hours for these hormones to be broken down and excreted by the body.
Calming the Body
Oftentimes, muscle tension is very noticeable and even painful. Tension headaches and tight shoulders are common for many of us. However, it’s a surprising fact that even significant muscle tension often becomes so pervasive, chronic, and continuous that people can actually, in a sense, get used to it, and fail to really notice it after a while.
I’ve seen many people who are clearly gritting their teeth, clenching their fists, and have tension written all over their faces, and when asked how they are feeling, they reply “Fine.” The tension has become such a habitual part of daily life that they don’t even notice it. It can be present every minute of the day, even when they’re asleep. Many people constantly clinch their jaws and grind their teeth during the night. This muscle tension is a very common cause of sleep problems (it also can damage teeth). It just keeps pushing the buttons in the brain stem. People may sleep, but only go in to light sleep, getting little deep sleep.
We will now take a look at a very effective muscle relaxation exercise that can quickly reduce bodily tension. However, first a word or two about relaxation.
Many (if not most) people going through very stressful times have been given this form of useless advice: “Just relax.” Such counsel is about as helpful as telling a depressed person to “Just cheer up.” Keep in mind that the approach I am recommending is not about “just relaxing.” This is a technique designed specifically to reduce activation in the brain stem and thus facilitate the ability to fall asleep.
It may be hard to will yourself into a state of relaxation. However, one particular systematic procedure has been shown to be highly effectively in reducing muscle tension, even in highly stressed individuals. The technique accomplishes this largely by mechanically manipulating tense muscles. Here is how it works.
During times of stress, particular muscles and muscle groups tend to become tense automatically. Progressive muscle relaxation techniques are designed to reduce tension in all the body’s major muscle groups.
The relaxation procedure requires a period of time (about 10 minutes), and you need to find a time and a place where you will not be disturbed. Sit in a comfortable chair or recline on a couch, bed, or carpeted floor. Loosen any tight clothing and take off your shoes.
Close your eyes and take two slow, deep breaths. As you exhale slowly, notice the gradual release of tension in your chest and shoulder muscles. Feel the weight of your body against the chair (couch, floor) and the gentle pull of gravity as you settle into the chair. After a few moments, you can begin a series of simple exercises, tensing particular muscles, holding the tension for 10 seconds, and then releasing. Each time you tense and then release, you can enhance the effect by paying special attention to the experience of relaxation and letting go that occurs immediately after release.
Allow 15 to 20 seconds between each muscle group before proceeding to the next. The tensing exercises begin with the feet and progress like this:
1. Feet/toes (like you are making a fist with your feet)
2. Calves/lower legs
3. Thighs
4. Buttocks (squeeze together)
5. Abdomen
6. Lower back (arch)
7. Chest (accomplish this by taking in a deep breath and holding it hold it for a count of three)
8. Hands (make fists)
9. Upper arms
10. Shoulders (shrug)
11. Face (squeeze eyes and purse lips)
12. Face (open eyes and mouth)
Many experts on relaxation techniques recommend 10 to 15 minutes twice a day to go through this exercise, especially when you’re first learning the procedure. It is best to take plenty of time when first learning the procedure. However, after about a week, many people find that they can move through the various muscle groups more quickly, reducing the time it takes to four to five minutes. This simple and effective technique can, of course, be done several times during the day to promote relaxation, but it is right before going to sleep that it is most effective in promoting better-quality sleep.
Another effective way to reduce muscle tension will come as no surprise: soaking in a tub of hot water. This easy way to reduce tension can also be a pleasant way to be good to yourself. However, there is an important point to keep in mind. To enter deep sleep, the human body needs to cool off. Thus getting overheated in a bath or a hot tub should be done 1 to 1½ hours before bed. This allows muscles to begin relaxing, and yet there is plenty of time to cool down before retiring.
Also if you are waking up in the middle of the night and having a hard time going back to sleep, this brief exercise can be very useful in helping you fall back asleep.
Remember, tense muscles keep the brain on alert and interfere with sleep. These techniques are not just about “relaxing”; they have been designed to directly shut off this source of arousal, loosening the muscles and calming the brain.
Calming Bedtime Snacks
Dietary approaches to stress management are discussed in more detail in Chapter 11. Here we’ll take a brief look at evening snacks that can help you relax and, conversely, at snacks that can keep you awake (and thus should be avoided).
In general, carbohydrates (without proteins) are often calming. These include certain fruits: bananas, plums, grapes, cherries, apples, pears, oranges, peaches, high-fiber breakfast cereals, or oatmeal. Simple carbohydrates (simple sugars) such as candy bars, donuts, and ice-cream taste great, but may cause some activation rather than calm. The trouble with simple sugars is that they may in fact soothe and calm rather quickly, but shortly thereafter, have a rebound effect, and can cause increased activation or moodiness. They can also contribute to middle-of-the-night awakening.
Try to avoid snacks that include large amounts of protein (e.g. eggs, meat, nuts, and cheese). It has been clearly demonstrated that protein tends to cause activation.
Think About It
Remember to stay away from things that contain caffeine (not just coffee, tea, and sodas, but also chocolate).
Creating the Right Bedroom Environment
There are five key factors to making your bedroom environment conducive to sleep. Some of these are pretty obvious, but take them seriously. To get good sleep you must pull out all of the stops and tackle sleep problems on several different levels.
• Reducing noise. If you live near a busy street or in an apartment where neighbors are often loud, earplugs or a sound machine (one creating white noise—sometimes a fan can accomplish the same thing) will help to drown out noise.
• Make sure you have a comfortable mattress (not too soft and not too hard).
• Keep the room temperature comfortable, and a bit on the cool side. Cooler temperatures help people get into deeper sleep.
• Use blackout shades to prevent early-morning light from waking you up too early.
• It’s best not to watch TV or read exciting novels in bed. Time spent in bed should be reserved for only two activities: sleep and sex. If you become accustomed to watching intense TV shows in bed, the brain gets programmed to be more activated when getting into bed (as if anticipating excitement). This kind of conditioning really does occur.
Some people have tried to quiet their busy brains by counting sheep. The concept of counting sheep seems sound; after all, what could be more boring than to count sheep? Replacing stressful thoughts with boring ones can reduce arousal, but the sheep-counting approach often just doesn’t work. Why? When people are intensely preoccupied with stressful life events, it can be very difficult to shut off these troublesome thoughts long enough to even imagine a sheep. One British study actually demonstrated this when they found that stressed-out people can’t visually imagine sheep for more than about a minute.
A more effective approach is to read a boring book or watch a boring TV show. These are external stimuli that can, at times, pull one’s thoughts away from worries. If this works, great. However, for many, even this is not terribly effective. Three other approaches hold more promise.
Avoid Evening Conflicts
Not infrequently, worrisome thoughts are sparked by stressful interactions or conflicts with others in the hours prior to bedtime (such as an argument with your children or spouse, or an anxiety-ridden discussion about finances). A first helpful strategy we’ve already considered is to avoid getting into arguments or conflicts later in the evening. This is not just about avoiding activities that can increase stress hormones. It is also designed to reduce provocative situations that stir up both strong emotions and stress hormones.
Communicate Your Stresses
A second approach takes aim at recurring worries, those thoughts that bounce around in your mind, accomplish nothing, and provoke stress. Noted psychologist James Pennebaker has demonstrated that two simple approaches are often surprisingly effective in shutting off worry. The first is this. As soon as you notice that you are into worrying mode, get out of bed, sit down at a table, and write out on a piece of paper exactly what thoughts have been reverberating in your mind. There is something about getting these thoughts out of your head and onto paper that reduces internal worry.
It may seem hard to believe that something this simple could actually work. All you need to do is to experiment. Just do this one or two times and judge for yourself.
Another version of this, recommended by Dr. Pennebaker, is that, instead of writing the worries down, speak into a small hand-held micro-cassette recorder. Again, the intent is to get these troublesome thoughts out of your head. You speak them out loud and record the thoughts. One of Pennebaker’s research subjects referred to his micro-cassette recorder as a “psychic vacuum cleaner” … it is as if the troublesome thoughts were being sucked out of his mind.
The “Eyes Have It”
Another powerful technique has been shown by studies over the past 10 years to be surprisingly effective. The technique involves back-and-forth eye movements. This approach takes two minutes, it’s painless, and it is thought to rapidly reduce stress by disrupting and shutting off repetitive thoughts. I must admit that on first glance this may seem bizarre.
Dr. Stickgold, a researcher from Harvard, has demonstrated that back-and-forth eye movements appear to turn on what’s known as the parasympathetic nervous system (PNS). When the PNS turns on, it reduces physical stress. It is the primary biological mechanism for turning on the relaxation response in the body and in the brain. There is a decrease in heart rate, blood pressure, and muscle tension.
This technique also (for reasons that are not well understood) shuts off repetitive worry. Often without wanting to or choosing to think about stressful things, thoughts automatically whiz through a person’s mind. Some researchers have hypothesized that the brain has neural circuits or loops that get activated and appear to reverberate. The result is repetitive, troublesome thoughts that seem to serve little useful purposes and generate stress and interfere with sleep.
The eye-movement technique described here can often shut off such recurrent thoughts and may do so by some direct effect on these neural brain circuits. Here’s how the technique works:
1. Sit in a comfortable chair or in your bed and take a moment to relax. Then, while holding your neck and head still, begin moving your eyes from side to side (as if watching the ball go back and forth in a ping-pong game), taking about 1 second to shift your eyes from right to left and back to the right.
2. Repeat this back-and-forth movement about 20 times. Then stop, close your eyes, and relax.
3. For a moment, scan through your body and simply be aware of any particular sensations of tension or discomfort. Simply notice it. When you do, you’ll likely notice that there is less tension.
4. Repeat step one; take a calming, deep breath, and then begin back-and-forth eyes movements. When finished, close your eyes and relax. A few seconds later, do it again, a third time. About 75 percent of people will clearly notice a calming of mental activity and a feeling of relaxation.
After going through this exercise a few times, you’ll likely get the hang of it. Thereafter you can do eye movements as you get into bed at night, repeating them two or three times. Some people find that they can eventually achieve the same results by doing the eye movements with their eyes closed.
This approach (especially when combined with the relaxation exercise mentioned previously) is often quite effective in promoting drowsiness and sleep. Additionally, eye movements can also be used during the day to reduce stress and promote tension reduction.
I wouldn’t be surprised if this technique sounds pretty weird to you. It certainly did to me when I first heard about it. However, eye movements (and other repetitive body movements, as previously described) as an anxiety-reduction technique have caught on among many mental-health therapists both in the United States and in Europe and currently are the focus of intense study by neuroscientists.
One thing that is good about this approach is that, when positive results occur, they generally are immediate. Try it even once and see how it works for you.
Possible Meltdown
Those who wear contact lenses are advised to remove contacts before using eye-movement techniques.
Stabilizing Your Circadian Rhythm
The circadian rhythm involves a complex number of biological changes that occur in a highly regular basis during each day. They include the release of a number of hormones at particular times of the day (for example, growth hormone is released at night during deep sleep). Other physical aspects of the circadian rhythm include changes in digestion, the functioning of the immune system, variations in body temperature, and the chemical regulation of the brain.
Optimal sleep and the ability to maintain adaptive emotional control depend heavily on the stability of the circadian rhythm. Two primary factors are responsible for maintaining the appropriate function of the circadian rhythm. And these two activities have a powerful impact on establishing and preserving good-quality sleep.
The first is a highly effective technique, but quite frankly, is something that many people just simply do not want to do. It is to establish very regular bedtimes and regular times for waking up each day. This high degree of regularity helps to stabilize the circadian rhythm. The key to this approach is to decide on a specific half-hour window of time for going to bed and for waking up, let’s say, getting to bed between 10 and 10:30 P.M. and waking up between 6:30 and 7 A.M. For this to be effective, it needs to be the rule of thumb every day—weekdays, weekends, and holidays.
def•i•ni•tion
The term circadian comes from the root words circa (meaning about or approximately) and dies (meaning a day) … thus “about a day.” The circadian rhythm is controlled in the brain by what is known as the “endogenous circadian pacemaker.” This is the internal biological clock that regulates the release of many hormones, influences sleep and awake times, and controls body temperature. All of these fluctuations in the body occur at approximately the same time each day. And the rhythm repeats itself every 24 hours.
Lots of people, understandably, do not want to do this. It interferes with their lifestyle. I can appreciate this, however it is important to emphasize: this approach is extremely effective in enhancing the ability to handle strong emotions. The results are not seen immediately. It generally takes a month of this routine to start to see results.
The second approach is to get at least 10 minutes of bright light exposure early in the morning (preferably during the first half hour after waking up. In order to accomplish this, the light has to be high intensity. This can only be achieved by either going outside (without sunglasses) or by the use of a commercially available light box. Light boxes and what is referred to as high-intensity light therapy for treating stress will be discussed later in Chapter 11.
Exercise in Order to Sleep Better
Although exercising right before bed can interfere with sleep, as noted previously, there is more than 25 years of solid research demonstrating that one of the most powerful ways to improve sleep is to engage in regular exercise. In Chapter 11 we’ll take a closer look at the multitude of benefits from exercise, but for now, just a few comments about exercise and sleep.
The good news is that the type of exercise that works need not be high-intensity aerobic exercise. You don’t have to be a jock to have exercise help with sleep. What is required is some form of exercise each day. Even walking 15 minutes a day can accomplish this. Other types of exercise may also do the trick such as gardening or cleaning the house. If people are very fit, then jogging, swimming, running, and such, of course are beneficial.
The main gain from exercise is that after three months of regular daily exercise, you should see a noticeable increase in the amount of time spent in deep (restorative) sleep and less-frequent middle-of-the-night awakenings.
The Least You Need to Know
• People often dismiss the techniques of sleep hygiene because they seem trivial in the light of current, significant life stresses, yet maintaining good quality sleep is critically dependent on preserving good quality sleep.
• Several things commonly interfere with getting quality sleep. The best approach is to attack this problem on several fronts using a combination of simple, effective strategies.
• Most approaches to improving sleep can have rather immediate benefits.
• Regular exercise (even walking) has been shown to significantly increase the amount of deep, restorative sleep.
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