Sleep Hygiene

Sleep hygiene recommendations for Dr. Ostoja’s patients

I agree to review the following suggestions at my own risk and to apply them using common sense and at my own responsibility. I will not attempt any of the following recommendations if I know of any health conditions or other reasons that would deem them non-beneficial in my specific situation. I will consult with my physician as needed. I will discuss with Dr. Ostoja any difficulties or successes I have using these strategies. Other techniques may be needed, but the more I apply the following strategies, the clearer will be the picture for Dr. Ostoja or my doctor as to the nature of my sleep problems.

I am willing to try as many of the following strategies as possible for at least two weeks (in order of importance):

1. Recognize the value of sleep: If I am the kind of person who tries to get many things done in the evening and robs my body of sleep, I will try these techniques to see if I might become more efficient and productive if I get a more reasonable amount of sleep (most teens and women require 8 to 9 hours of sleep). I will listen to my body when I start to feel fatigued around bedtime. I will not keep pushing past my bedtime, as I may get “second wind,” with stress hormones kicking in and making sleep less likely.
2. Medical advice: I will discuss my sleep problems with my physician. Some sleep problems are caused by medical conditions and should be ruled out by a medical practitioner (e.g., thyroid conditions, hormonal imbalances, iron deficiencies, depression, bipolar disorder, narcolepsy, etc.).
3. Seek help from a mental health professional as appropriate: I will discuss any history of abuse and associated PTSD or anxiety with my medical doctor and my mental health provider. History of trauma can lead to significant sleep problems and should be treated by a professional.
4. Sleep is not a performance: If I already recognize the value of sleep, I will not over-state its importance each and every night. Developing good sleep habits takes time and requires a gentle approach. It is best to view the different strategies described here as pleasant and helpful, rather than oppressive and controlling. I recognize that most people who sleep well use many of these strategies. Because they use them regularly, these strategies have become positive self-soothing and easy habits. I will keep a sleep journal to note any changes in my sleep over time, and as I implement different strategies. I will observe gently and patiently any connections between my actions and my sleep. I will discuss these with Dr. Ostoja.
5. Keep a regular schedule: I will attempt to go to bed and get up roughly at the same time each day. I realize that it is generally recommended to go to bed before midnight, preferably close to 10PM or earlier. If I suffer from significant sleep problems, I will try not to sleep in on weekends. While an occasional late morning may be necessary, especially if I do not feel well, regular shifting of schedule between early and late awakening can create significant sleep problems (this is difficult for teens whose bodies seem programmed for later bedtime and sleeping in).
6. Exercise: After consulting with my doctor, I will try to get some physical exercise at least three to four times a week. This can include walking for 20 minutes or other aerobic exercise. I will try to get my heart rate up (walk briskly, ride a bike).
7. Create a relaxing bedroom environment: I will make my bedroom free of distractions. My bedroom will be a simple and peaceful place where I do not bring my laptop, work, or media. As soon as I enter my bedroom my body will learn to expect rest and peace. I will make my bedroom cool, with multiple blankets, which can be used as needed to keep my body comfortable and cool. Many people find it helpful to have a slightly open window to allow for fresh air. If I have a lot of trouble sleeping I will do nothing else in my bedroom but sleep. I will keep my bedroom quiet and dark. If necessary, I will use a sound machine to create background noise. Many people find it helpful to keep animals out of their bedrooms or at least out of their beds.
8. Avoid naps: Unless otherwise recommended by my physician, or unless I have to be alert that day, I will generally try to refrain from taking naps during the day. Even if I did not sleep well the night before, I will try to make it through the day (remain active, take walks, etc.) until a reasonable bedtime.
9. Abdominal breathing: I will practice abdominal breathing regularly and especially at bedtime (please see Instructions on Abdominal Breathing).
10. Downshift and cocoon: I will start to create an atmosphere of relaxation and feelings of safety for at least one to two hours before my regular bedtime (or as soon as I can). While some people seem able to fall asleep “on a dime,” most brains and bodies shift gradually. I will try to prepare for the following day ahead of the evening hours, so that my mind does not use the bedtime hour to try to problem solve or anticipate the next day. I will “cocoon” by generally choosing not to engage external demands in the form of emails or texts or phone calls, unless absolutely necessary. I will try to deal with “business” earlier in the day.
11. Avoid resting on the couch: If I have trouble falling asleep, I will try to become more and more relaxed through the evening but I will avoid resting or snoozing on the couch before getting into bed. Resting can re-invigorate me, giving me “a second wind.” Getting up from the couch can increase my blood pressure and make me more alert before I get into bed. I may choose to do some gentle stretching or relaxing yoga poses (for those patients who do yoga). I will ask my yoga instructor, which poses are beneficial before bedtime.
12. Worry journal: I will keep a journal where I can note things to do or to think about (or worry about). I will record my concerns and thoughts in that journal throughout the day, but stop before dinner time. I can add a simple thought to the journal if such a need arises, but generally I will train my brain to generate ideas and think hard earlier in the day. Any outstanding items can be handled the following day. This will train my brain to calm down toward the end of each day.
13. Schedule earlier worry and problem solving time: Items that are anxiety provoking or overwhelming can be thought about when I exercise or after I have exercised. I will allow myself some time to reflect on the day earlier in the day and not immediately before bedtime (for example, I could go for a walk with a friend and review my day). I will try to talk to a supportive friend or spouse so I can process my anxieties or insights ahead of my bedtime. I will try to create feelings of closure and safety right before bedtime. I will visualize boundaries during my day. Stressful items should not penetrate the boundary surrounding bedtime.
14. Eating heavier meals earlier in the day: I will try to eat a heavier meal earlier in the day, and only have a light meal in the evening, so that digestion does not disturb my sleep.
15. Exposing myself to bright outdoor light first thing in the morning: Each morning I will get up at a reasonable time and I will try to go outside for at least several minutes if not longer, so that my brain can be exposed to daylight (this strategy is thought to help reset and regulate the circadian rhythms). Going for a brisk walk early in the morning can set a good tone to my day. Many successful people seem to exercise in the mornings.
16. Positive visualization: I will practice positive visualization, relaxation techniques and other methods of relaxing and soothing my brain and body. Some people use positive fantasy as they get into bed. I will develop pleasant or relaxing visualizations but I will try not use intense fantasy as this may actually keep me awake. If I find that I think or process too much at bedtime, I will try to use my Worry Journal and Worry Time in the future (please see above).
17. Organizing thoughts: If positive visualization is not effective, I may experiment with simple mental puzzle solving techniques. Some people find this to organize and focus their thoughts thus making transition into sleep easier.
18. Avoid watching the clock: I will set my alarm ahead of time. Once I turn off the lights, I will try not to check the clock until the alarm goes off. I will accept that I may rest for periods of time without being fully asleep. Watching the clock creates a mindset of performance and stress. Our minds catastrophize the potential consequences of sleeplessness. “Struggling against” insomnia can release stress hormones. Stress hormones interfere with sleep.
19. Allow extra time: I will give myself an extra half hour or longer in bed outside of the hours I want to be asleep. This will help me not worry if I don’t fall asleep immediately or if awaken in the middle of the night. By doing so, I will be less likely to watch the clock or become stressed that I will not get enough sleep. (If I find that my sleep is very erratic and fragmented, with many interruptions and sleepless periods, I will discuss this with Dr. Ostoja or a Sleep Specialist. Under certain circumstances, practitioners specializing in sleep may recommend shortening the overall amount of time spent in bed to consolidate sleep).
20. Accept occasional imperfect sleep: I will develop an attitude of trusting myself to be able to function on slightly less sleep on some nights (unless my job requires me to be highly alert, in which case I will seek help from my physician and/or a Sleep Specialist). I will remind myself that I can be productive and function adequately even when I sleep less but still rest in my bed. I will create an atmosphere of “no big deal” if I cannot sleep, especially if this is only occasional. I will remind myself that if I got more sleep the night before or slept in on the weekend, I may need less rest on Sunday night. I will remind myself that many people have some difficulty sleeping on Sunday nights, as they anticipate shifting to Monday morning.
21. Shift sleep schedules gradually: I understand that Dr. Ostoja generally does not recommend severe sleep deprivation as a means of “getting back on a normal sleep schedule.” Severe sleep deprivation is especially risky for patients suffering from mood disorders and anxiety. I will discuss any plans for keeping myself awake for more than 20 hour periods with Dr. Ostoja or my physician or Sleep Specialist.
22. Avoid screen time before bed: I will avoid watching stimulating TV shows or websites. I will experiment with advice from some authorities who suggests no screen exposure for two hours before bedtime. I will try reading regular books instead of using the electronic format.
23. Avoid caffeine: I will avoid caffeinated drinks after lunch, and preferably altogether. I realize that caffeine can interfere with my natural circadian rhythms, and can contribute to heightened anxiety. Caffeinated drinks include coffee, tea, soda or pop (Mountain Dew, Dr. Pepper), and energy drinks. Ice tea and fancy Starbucks drinks also have caffeine. Chocolate contains caffeine.
24. Night-time brain is not rational: If I worry at night, I will down my worries as they occur (preferably in the dark using a pad of paper ready by my bed) and I will try go back to sleep. I will plan on thinking my worries through when my whole brain is awake the next day. There are times of the night when our bodies release certain hormones, which may cause some unpleasant or agitating sensations. It is unhelpful to over-interpret these as signifying something bad. I will remind myself that if I feel getting stressed, revved up, or anxious, I am not in a good place to try to think the issue through at night. My brain is far less likely to be rational at night. I will label them as worry thoughts. I will focus on my abdominal calming breathing, and I will repeatedly and gently redirect my thoughts to something pleasant. I may have to do that over and over again. I will try not to engage the content of the thoughts, but patiently keep labeling them as irrational. I will try to refocus intensely on something pleasant and relaxing to think about. I will develop pleasant and relaxing topics to think about at night. I will practice meditation and breathing exercises.
25. Bedroom is only for sleeping: Some people find it helpful to get out of bed if they cannot fall asleep for roughly 20 minutes or longer. I I decide to get up, I will not to watch TV or engage in high energy activities. I will try to go to another dark room, where I can stretch, do yoga, or practice breathing exercises. I will return to bed after 20 minutes and try to relax.
26. Keep your bedroom cool. A recent article in the Wall Street Journal (Tuesday, Feb 23, 2016) suggests keeping the temperature close to 65 degrees Farenheit. You can have layers of blankets to cover yourself if you become uncomfortably cold, but keep your room temperature cool.
27. I will discuss any observations I may have about my sleep and the above strategies with Dr. Ostoja.