Bedtime Blues: What to do when you can't sleep

It's 3 a.m. You're scheduled to give a big presentation at eleven, only eight hours away. You desperately need to sleep so you will be rested and alert when your big moment comes, but here you are staring wide eyed at the bedroom ceiling. Your mind is agitated and your body won't relax. The harder you work at getting to sleep, the wider awake you are. You've already tried counting sheep, watching the late show, and making yourself a snack-all to no avail. In desperation you reach for a sleeping pill.

This is a common scenario in the United States, where approximately one third of all adults suffer from some type of sleep disorder. Insomnia, the most common type by far, is clinically defined as the inability to fall asleep after lying in bed for thirty minutes or the inability to sustain sleep for more than a few hours without waking. Practically speaking, however, insomnia can be defined as unrestful sleep.

We've all experienced some form of insomnia at particularly stressful times in our lives. It's normal to have trouble sleeping at these times, and it usually passes after a night or two. Insomnia is a problem only when it becomes chronic. Although it is associated with certain physical illnesses-arthritis, heart failure, and chronic lung disease, for example-most experts agree that insomnia is a symptom, not an illness in itself. So what is it a symptom of? There are two answers-the ancient and the modern. At first glance they seem completely different, but a closer look reveals some remarkable similarities.

An Ancient Angle on a Modern Malady

Ayurveda, the healing science associated with yoga, tells us that all disease is caused by indigestion. That is, at some level-either physical, mental, or emotional-we haven't completed extracting what is helpful and eliminating what is indigestible. This is one of the keys to understanding insomnia.

On the physical level, indigestion is caused either by bad food or by weak digestion and leads to conditions like heartburn (a contributor to insomnia), flatulence, and diarrhea. Mental indigestion is the inability to let go of a certain incident or thought-usually an unpleasant experience. This can be a distant tragedy like the earthquake in Kobe, Japan, criticism from someone whose opinion we value, or a work-related problem we're trying to solve. Emotional indigestion is the recurrence of a feeling, often sadness or anger, long after the precipitating event. The emotion has not been sufficiently digested and remains just under the surface, springing up for no apparent reason. Mental and emotional indigestion are the most common causes of insomnia. Some of us even grind our teeth while we sleep in an attempt to chew and digest recurring thoughts and emotions.

The Contemporary Angle

Modern explanations for insomnia range from overstimulation and stress to mucking up our waking-sleeping cycle. Stimulants include caffeine (coffee, tea, chocolate, and some sodas), and sugar, as well as activities such as aerobic exercise, arguing, and watching violent TV shows (or the evening news, for that matter). All these taken (or experienced) too close to bedtime can rev us up so much that it is difficult to fall asleep. This is only another way of saying we are still attempting to digest these substances or events at the same time we are courting sleep.

Stress is another form of indigestion. Most of my patients who suffer from insomnia tell me, "My worries keep me awake," or "My mind won't stop. I don't know how to turn it off." Anxiety, worry, depression, unpleasant memories, and fears are the most common cause of sleeplessness. They seem to take on a life of their own and are determined to stay awake, even though it's way past bedtime.

The third common cause of insomnia, one which has become prevalent only in modern times, is tampering with the normal cycle of sleeping and waking. This is a mechanical problem of sorts. Human beings have a normal sleep rhythm; in general, we are designed to be awake in daylight and asleep at night. People who work the night shift, or travelers who have recently crossed several time zones, may experience insomnia simply because they are trying to sleep when their internal clock is telling their body to be awake.

Our bodies are designed for sleep to come effortlessly. When it doesn't, when we're holding on to the day's stresses and reaching out for tomorrow's too, there are a number of ways of inducing the body and mind to let go and slip gently into a restful sleep.

Create an Environment that Will Help You Sleep

Your bedroom should be tranquil and inviting. Make it comfortable and conducive to sleep. Eliminate ambient light and any noise that could disturb your sleep. If possible, reserve the bedroom for sleep and sex. Conduct other activities-reading work-related material, watching TV, paying bills, and disciplining your children-in another room. In time, this will create the expectation in your body that the bedroom is where it goes to relax and rest.

End the Day with a Calming Routine

Go to bed about the same time every night. Create a routine that prepares you for sleep. You may already have some kind of program you follow before you go to bed-locking the house, brushing your teeth, maybe reading a little. A pre-bed routine is a way of telling your unconscious that it's time to sleep.

Make sure that this routine is relaxing, not stimulating-winding down before bedtime increases the likelihood that your mind will let you rest. If you find the news disturbing, skip the late broadcast. If you live in a safe neighborhood, take a leisurely stroll. Read something pleasant and soothing-save the suspense novel for earlier in the day. Take a hot bath. Sit for a period of meditation. The trick is to calm your mind and quiet your nerves before you get into bed.

And speaking of routines, getting up at the same time every morning will make it easier to fall asleep at night. Attempting to compensate for a night of disturbed sleep by staying in bed longer in the morning will simply further disrupt your sleep cycle. Get up on time, even if you don't feel like you've had enough rest-you'll have a much better chance of falling asleep easily when bedtime rolls around again.

Do a Relaxation Exercise Taking a few minutes to do a short relaxation exercise just before getting into bed is an excellent way of letting go. This doesn't have to be elaborate. Great benefits can be gained by simply lying on your back in the corpse pose (hands at your sides, palms upward, feet slightly apart). Close your eyes, and systematically address every part of your body. Start at your scalp and move toward your toes. Begin by softening your forehead, eyes, face, and jaw. Tensing and then releasing each muscle group help tight muscles loosen, especially those in the neck and shoulders. Continue giving attention to each area of your body-the arms, the trunk, and the legs-until you reach your toes. Surrender to gravity.

Stay in this relaxed state for a few minutes, letting the floor support you. Focus on your breathing, releasing all other concerns. Let your breath come from deep in your abdomen, and let it flow smoothly, slowly, and evenly. This simple exercise is a way of telling your mind and body that it is OK to stop thinking, working, and struggling.

Pay Attention to What You Ingest

It's best to eat a light meal in the evening, especially if you are dining late. You will sleep more deeply if you have finished digesting your food before you go to bed. A rich, heavy meal close to bedtime will interfere with your rest and leave you feeling sluggish in the morning.

Avoid caffeine, especially after midday. This includes coffee, tea, chocolate, and many sodas. Coffee has a half-life of four to six hours. That means it takes that long for half of the coffee to be digested, and another four to six hours for the next quarter of it to be eliminated from your body. In other words, it takes twelve to fourteen hours for 7/8 of the coffee you have ingested to be eliminated. No wonder you still feel wide awake at eleven when you had your last cup after dinner.

Sugar can also cause problems. Consider avoiding refined sugar in the evening because it is absorbed immediately into the bloodstream. That's why it gives you a burst of energy and sometimes makes you feel a little high. Eating sugar near bedtime can make you restless and jittery and can keep you from falling asleep. If you need a treat at bedtime, a glass of warm milk is your best bet.

Alcohol and tobacco taken near bedtime can also interfere with deep sleep. It's true that a nightcap will make you sleepy, but the sleep it induces is light, restless, and shot through with periods of wakefulness. Likewise, you may associate tobacco with relaxation, but it actually increases tension. Tobacco is a stimulant that makes the heart race and blood pressure rise. It's best avoided altogether, but if you choose to smoke, avoiding it in the hour or two before bedtime will make your sleep more restful.

Get Some Exercise

If we polled farmers or anyone else who does manual labor eight to ten hours a day, very few would report a problem with insomnia. But for most of us, hard work is reserved for the mental sphere, so we need to exercise our bodies if we're going to sleep well. Studies of athletes have shown that they do not require more (or less) sleep than sedentary folks, but their ratio of deep to light sleep is higher. Doing some form of aerobic exercise at least three times a week also increases this ratio. Just be sure to avoid strenuous exercise within several hours of bedtime-it can be stimulating. But if you exercise at any other time, you'll sleep better.

It's OK to do long, slow stretches near bedtime, however, for they will release muscular tension and prepare you for sleep. Focus on asanas that you find relaxing. Avoid intense backward bends, such as the wheel, as they may prove to be too invigorating at the end of the day.

Don't Drug Yourself to Sleep

According to a recent article in the Archives of Internal Medicine, approximately 20 million prescriptions are written each year for sleeping aids, a number dwarfed by the quantity of over-the-counter sleep medications sold annually. Although most of these drugs do induce sleep within ten to twenty minutes, they interfere with the deeper stages of sleep. And all of them impair functioning the next day in one way or another. They can be helpful for short-term insomnia resulting from a sudden stressful event, but even the mainstream medi-cal community agrees that sleep medications/sedatives are not helpful in resolving chronic sleep problems.

Experiment with Natural Remedies

Homeopathic remedies and herbs can help with insomnia. Homeopathic medicines are extremely dilute extracts from natural substances, so they don't have the rebound effects drugs do. They are considered to be non-toxic by the FDA, and many lowpotency remedies are sold over the counter. One of the best treatments for insomnia is homeopathic coffee, coffea cruda. Although coffee causes irritability and sleeplessness in physiologic doses, in homeopathic doses it can cure these states.

Valerian root, passionflower, and hops, taken before bedtime in either tablet or tea form, are other alternatives. These gentle, relaxing substances help your body rest, but they don't affect your central nervous system the way prescription sleep medicines do. Both homeopathic remedies and herbal preparations can be purchased at most healthfood stores or through a holistic physician.

Don't Panic!

Insomnia is a huge problem in this fast-paced, sugar and caffeine addicted country. But if we can first identify the habits we have that contribute to our sleeplessness and slowly change them, and at the same time add more relaxation and deep breathing to our pre-sleep routine, we will sleep better.

Above all, don't panic. Insomnia is not life-threatening, although many people respond to it with agitation or fear. The more anxious you make yourself about not sleeping, the more sleep will elude you. So turn the clock to the wall and drop the internal dialogue about what a horrible day you will have tomorrow if you don't get to sleep immediately. The key to sound sleep lies in surrendering, not in trying harder. Once you're in bed, focus on your breath and empty your mind. If you have a mantra, let your mind rest in it. Be kind to yourself. Remember, sleep cannot be forced, but it can be coaxed. It is waiting for you. Allow yourself to come to it, enter it, and let the world spin without you for a while.

ABOUT THE AUTHOR

Lilias Folan has designed a six-week program on audiotape for people who have trouble getting a good night's sleep. If you can't find it in your local bookstore, Rest, Relax and Sleep is available directly from Rudra Press. Call 1-800-876-7798 for more information, or order directly by sending $29.95 + $5.00 shipping to Rudra Press, P.O. Box 13390, Portland, Oregon 97213.
Carrie Angus, M.D. is a yoga student practicing holistic medicine at the Himalayan Institute's Center for Health and Healing in Honesdale, Pennsylvania.

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Bedtime Blues: What to do when you can't sleep

ABOUT THE AUTHOR