SLEEP BASICS – With Love from Dr. G
It’s not uncommon to experience some type of sleep disturbance following a traumatic experience. But sleep is all about habits, and now would be a good time to take a closer look at your own routines and rituals surrounding sleep. We can get into habits of sleeping after an energy drink or cigarette, on the couch, and in front of the TV. But that does not necessarily mean that we will be getting good quality sleep. So here are some basic tips:
The bed is for 2 things: Sleep and Sex. Essentially, we want the bed to cue us for sleep. If we do too many other things in bed, then our brains do not know that it’s time to sleep.
No napping. If you’re having trouble sleeping, napping is not a good idea because it adversely impacts our sleep cycle. There’s a “sleepiness” chemical we produce (called adenosine) that builds up as we wake up and go through our day. More adenosine = more sleepy. Napping lowers adenosine levels and then we are not as sleepy at nighttime. Fun fact: Caffeine is also an adenosine-blocker.
Get out of bed if you’re not asleep by 15 minutes. When we stay in bed not sleeping, then we are teaching our brains that it is okay to not sleep in bed. Again, this is all about conditioned learning and associations.
Get up at the same time every morning. That means EVERY morning, even weekends. Always anchor your sleep to the morning wake-up time, not evening get-in-bed time. If you do the latter, you will likely find yourself feeling agitated and counting sheep.
Reduce stimulant use: Stimulants like caffeine and nicotine (or any substance that has stimulant properties) adversely impacts your sleep. Half-life of these types of chemical substances is approximately 5-6 hours. Therefore, it takes 10-12 hours for the chemical to be completely eliminated from your bloodstream/body. Drinking a lot of water can help improve the elimination of these substances from your body. If you are going to drink coffee, cut yourself off by noon or early afternoon (depending on when you typically go to bed).
Stay away from alcohol/drugs: Alcohol and marijuana can seem like they’re helping us fall asleep more easily (and that’s because they do! They can hasten sleep onset), however, they also disrupt our sleep architecture. REM (i.e., Rapid Eye Movement, stage 4 sleep in which we experience the majority of our dreaming) phase is delayed and then rebounds, often with increased bad or weird dreams. Alcohol abuse overtime may permanently damage our “deep sleep” stages (stage 3 sleep), and marijuana over time also decreases the body’s ability to get slow wave deep sleep. Deep sleep (stage 3) is extremely important for us because this is when the body repairs, hormones are regulated, etc. Sleep-deprivation over time has been correlated to a host of undesired health outcomes, including weight-gain, decreased concentration/focus (and memory problems), and negative effects on cardiovascular, endocrine, and immune functioning.
Exercise daily. This is generally healthy regardless of whether or not you are trying to recover from trauma. Many different beneficial chemicals are produced when we exercise, such as endorphins (our own body’s natural “pain” killer), dopamine (another happy chemical), and norepinephrine (noradrenaline). But try not to exercise intensely within a 2-3 hours of bedtime because unless you’re an Olympic athlete, it takes a little longer for your heart rate to come back down.
Food. Try not to go to bed too hungry, but also try not to eat a really heavy, salty, greasy meal before you sleep. When we eat, a significant amount of blood flow moves into our gastrointestinal system. Your stomach working that hard late at night might make it difficult to sleep.
Try more relaxing activities before sleep. This means the hour before you sleep is probably not when you want to work on taxes, get into an argument with your significant other, or watch an intense scary movie. Try meditating (there are great apps on your phone, e.g., Headspace, Calm, Breathe2relax), or engaging in an abdominal/diaphragmatic breathing exercise for 5-10 minutes. Try taking a hot Epsom salts bath or listening to relaxing music.
Turn off electronics and light sources. Bright light and certain types of light (e.g., blue light spectrum) can trigger awakening. Research is still pretty green in this area, but it’s probably not a bad idea to keep even small electronics away from your brain/head region.
NOTE: Sleep disturbance can occur for many reasons. Make sure to check for sleep apnea (as a rule out) if you tend to snore and it awakens you or your partner at night. Right now, many of you are probably having nightmares or bad dreams (hopefully not every night). Remember, dreams are a manifestation of whatever is in your head before you sleep. The cortex (in our brain) normally organizes information, but it’s not as effective while we sleep so nightmares are essentially whatever is lying around. If you are having a recurring dream, and it always ends a certain (catastrophic) way, then try thinking it out with an alternative (better ending) before you go to sleep. [This is a real therapy, by the way, called Imaginal Rescripting Therapy.] If you try all of the above things, and you are still having significant sleep disturbance, it may be helpful for you to take a medication for a brief period of time, and currently, the first-line medication for nightmares is Prazosin (Minipress).
Goodnight and sleep well. – Dr. G