No more counting sheep: Proven behaviors to help you sleep

As humans, we spend about one-third of our lives asleep. Though science has taught us about the human brain's exquisite control of our daily sleep and wake patterns, tens of millions of Americans still don't get the sleep they need. Nearly 20% of American adults report using a sleep medication to help them sleep, despite known side effects and information about how well they really work. Some people turn to alcohol for relief. And many have tried everything without relief.

Whether your problem is experiencing lack of quality sleep, feeling sleepy during the day, or not being able to get the seven to nine hours of sleep each night that most people need, first ask yourself, "What habits can I change to improve my sleep?"

Do you have good sleep hygiene? In general, sleep hygiene refers to practicing behaviors that promote sleep and stopping behaviors that are bad for sleep:

Nighttime tips to help with sleep

• Get up at the same time every day, even on the weekends. A regular wake time helps to set your body's natural clock (circadian rhythm) by making sure you do not oversleep. Sleeping in too much can impact your ability to fall and stay asleep the next night, or the night after that.
• Go to bed when you are sleepy, not just tired. Listen to your body. There are certain times at night that your body will be able to sleep better than others. Going to bed before you are sleepy, or before your body is ready to sleep, will frustrate you. If you feel sleepy, but your brain is busy thinking, it can't shut off and go to sleep. It may be helpful to sit down with a pen and paper in the evening and write down the things that worry you, or perform some relaxation techniques, such as slow breathing or yoga.
• Put away ALL electronics two hours before bedtime. Put away ALL electronics two hours before bedtime. (Yes, it's so important, I am saying this twice!) Cell phones, tablets, and all electronic devices make it harder for your brain to turn off, and also may interfere with your body clock. If you must use your device, use a program that reduces blue light exposure, such as Night Shift in Apple products or f.lux for Android devices.
• Create a comfortable sleep environment: a place that is cool, dark, and quiet.
• Use your bed for sleep and sex only. Doing other activities in bed will train your brain into thinking that activities other than sleep are appropriate in bed.

Daytime tips to help with sleep

• Avoid or limit caffeine. Caffeine can make you more alert during the day, but many people are sensitive to its effects. Even one or two cups in the early part of the day can disrupt your sleep at night.
• Avoid or limit alcohol. While alcohol can help people fall asleep, it leads to more sleep problems at night. Alcohol can also cause more trips to the bathroom in the middle of the night.
• Have a regular schedule for meals, exercise, and other activities, as this is often helpful for helping to set your body's circadian rhythm. In addition, exercise during the day can help improve your sleep quality at night.
• Treat medical problems that may interfere with sleep, such as chronic pain, or mental health issues, such as depression and anxiety. If you have any of these problems, you should discuss them with your doctor.
• Don't smoke. If you are having trouble quitting smoking, there are many good resources to help you quit, and your doctor can help you here, too.

What if I work multiple jobs or do shift work?

Sometimes there are factors that impact our sleep that we can't control. If you work shifts, strategies such as taking naps before evening shifts, and minimizing light exposure when coming off evening shifts and planning to sleep, may help.

I'm doing all these things and I still can't sleep!

This may be a sign that you have a clinical sleep problem, such as insomnia disorder or sleep apnea. If you are doing all the right things and practicing good sleep hygiene, and still have trouble falling or staying asleep, you may need to see a sleep specialist. It is important to know that sleep hygiene can help some people sleep better, but behavioral treatment of insomnia is much more than just sleep hygiene; it is a proven, nondrug method to treat insomnia. Behavioral treatments for insomnia provide each person with their own "prescription" to change their sleep behaviors, which resets your brain to achieve healthy sleep.

Below are a few trusted resources that can get you familiar with behavioral treatments for insomnia:

Getting the Sleep You Need, Harvard Medical School Division of Sleep Medicine

Insomnia Treatment, American Association of Sleep Medicine

Society of Behavioral Sleep Medicine

Dr. Bertisch will present "Understanding the Role of Non-Pharmacologic Treatments in Insomnia" at the Osher Center for Integrative Medicine Grand Rounds at Brigham and Women's Hospital on November 6, 2018, from 8 to 9 AM. Members of the public are welcome to attend her talk.