Acadia Touch Points Blog

Acadia Hospital Child and Adolescent
Psychiatrist Julie Balaban, MD

Everyone has trouble with sleep at some time in her or his life. The problem can be trouble falling asleep (initial insomnia), waking up a lot during the night (disrupted sleep), or waking up too early and not being able to get back to sleep (terminal insomnia).

There are many reasons why someone might develop a problem sleeping. Some of these reasons include: Being sick; being nervous or scared; having nightmares; traveling; feeling stressed; feeling excited; or just having too much to think about.

Other things that affect sleep include medication, drugs and alcohol, and caffeine.

Usually sleep problems go on for a few days at a time or up to a week. Although it can be bothersome and make you tired, it just gets better on its own. If the problem continues, or actually gets worse, then you need to try to fix it. Lack of sleep can make it hard to be at your best during the day. It is hard for your brain to function well when it is sleep-deprived, and it can also make you more down, irritable and grouchy. Sleep deprivation can make it harder to concentrate and pay attention. Being overtired sometimes even causes headaches or stomachaches, or other physical symptoms.

When people are having trouble sleeping, they sometimes try to find a medicine that will help them. There are many medicines available at the drugstore that say they help with sleep. Most of those medicines contain a medicine called diphenhydramine, which is an antihistamine that is sometimes prescribed for colds or allergies. Diphenhydramine is not a sleeping medicine; it is a medicine that has the side effect of making people drowsy, and so sometimes it helps people to fall asleep.

It is a bad idea to take any medicine for sleep unless you have talked with your doctor, first. Sometimes medicine you think will help actually has the opposite effect, and will make you “hyper” and alert. Sometimes the medicine does help, but then when you stop taking it your sleep problems return or get even worse.

Sleeping medicine, even prescribed by your doctor, does not always work. When it does work, you are usually not supposed to take it for more than a couple of weeks.  Sometimes you need increasing doses for it to keep working. You have to work very closely with your doctor in order to use sleep medication safely and appropriately.

One of the best ways to fix a sleeping problem is to train yourself back into good sleeping habits. Doing this often means you don’t need to use medication, and if you are using medication you need to be doing this along with the medicine in order for it to work best.

SLEEP HYGIENE

Sleep hygiene (sometimes called Sleep Fitness) includes all the things you do to take good care of your sleeping needs, just like oral or dental hygiene is how you take care of your teeth and gums. When you are sleeping well, you probably don’t need to pay as much attention to following all of the good sleep hygiene techniques, but when you are having trouble sleeping, you need to be very careful to go back to using the techniques, at least until the problem is better.

1 – Schedule

Our bodies help us with falling asleep and waking up by pumping certain chemicals (hormones) into the blood at the right times. This occurs in regular cycles over the course of a day. The body “knows” when to pump each chemical out by using cues from our behavior and our environment. If you keep an irregular schedule, your body gets very confused about when it should be pumping which chemical, and this results in disrupted sleep.

So one of the most important things in fixing sleep is to get on a regular schedule. Every day you should go to bed and wake up at a similar time; do not vary by more than an hour your bedtime or your wake-up time. This can be hard on the week-ends, when you might want to sleep in, but it is very important.

2 – Bedtime Routine

A bedtime routine helps in two ways. First, it helps the mind and body to shift from your busy day, and to start to relax and be ready to fall sleep. Second, it is a way of conditioning your body to get used to falling asleep once you get into bed.

Here are some guidelines for a bedtime routine:

Start your routine at least ½ hour before you plan on getting into bed. It should include quiet, routine activities that won’t get you more alert, excited or upset. Part of the routine will be getting ready for bed (brushing teeth, getting into pajamas). It should also include relaxing activities like listening to quiet music, reading a magazine, having someone read a story to you, talking quietly with someone, taking a relaxing bath or shower, having a massage or back-rub, listening to a tape, etc. For most people these activities should all be done before you get into bed, but for some people it helps them if they relax while they are in the bed. Once you are in bed, lights out, time for sleep.

If you are lying in bed for 15 to 20 minutes, and you are not able to fall asleep, you should get out of bed.  You do not want your bed to be a place where you toss and turn; that makes it harder to be relaxed.  Get out of bed for 10 minutes.  Sit in a chair, or on the floor, and do something very quiet.  Do not play loud music, use the computer or watch TV.  Maybe look at pictures, flip through a magazine, draw, or think.  After about 10 to 15 minutes, get back into bed. 

If you are still up after another 15 minutes, get out of bed, again.  Eventually you will fall asleep.  Even if you have to do this for many days, you will find that the number of times you have to get out of bed will decrease and you will be able to fall asleep more quickly.

3 – Things to Avoid

• Caffeine – do not have caffeine after lunchtime.  This includes soda and coffee, of course, but even decaf coffee has some caffeine in it.  Avoid chocolate or regular tea. 
• Naps – DO NOT NAP!  Although your body may be craving sleep, napping makes the body’s cycle go out of whack, and makes it harder to fix.  If your eyes are closing and you just can’t function, sleep for no more than 45 minutes, and no later than 8 hours before your bedtime.
• Eating – do not eat a heavy meal or snack within two hours of bedtime.  You shouldn’t go to bed hungry, but you don’t want your body to be working on digesting food when it is supposed to be sleeping.  A light snack an hour before bed is OK.
• Electronics – This can be the hardest part for some people.  Using computers, TV, PlayStations, etc. can cause sleep disruption.  First, the activities are stimulating, which makes it harder for the mind and body to relax.  Second, the light from the machines stimulates part of the brain and interferes with sleep regulation.  So stop watching TV or using the electronics at least one hour before bedtime.
• Exercise – do not do any major exercise in the two hours before bedtime.  The physical activity releases chemicals that can make it harder to relax and fall asleep.  On
• Alcohol – although it sometimes seems that alcohol helps with falling asleep, it actually causes sleep disruption. 
• Nicotine – in addition to being unhealthy, it acts as a stimulant and affects sleep

4 – Things that Help

• Exercise -  exercise early in the day will probably improve sleep.  In the evening, things like yoga, deep breathing or meditation, relaxation exercises, etc. can help you unwind and be ready to sleep.
• Sunlight – getting some sunlight during the day helps keep your body’s regulation system in working order
• Light boxes – some people find that using a special light box in the morning helps them to be more alert
• Save your bed for sleep – many people use their bed for doing work.  If you are having trouble with sleep, you need to connect being in bed with being relaxed and resting.  Therefore, if you are having trouble sleeping, you should only be in bed when you are resting or sleeping.  Do your work on the floor, at your desk, or most preferably in another room.

The Acadia Hospital offers rapid access to a wide array of services for youth living with an anxiety disorder. To schedule an evaluation please call 1-800-640-1211 or 973-6100.