Sleep hygiene

Google this and read a few articles on it.  This one by the ME specialist and researcher Dr Sarah Myhill* is particularly useful, though I’m not convinced that we should all be going to bed at half-past nine (Dr Myhill does admit that she’s a natural “lark” herself).  Note the areas you’re not doing well in and think about how you might be able to improve them, even if it’s just partially.  The main thing I had to stop doing was staying on the internet too late, it’s a big sleep-killer.  It’s important to keep yourself in a steady routine as far as possible, including regular mealtimes, if you have any problems with circadian rhythms.

For those of you who aren’t in the mood for hunting around for different articles, here are some sleep hygiene tips.

• Your bed should be blissfully comfortable.  Opinions on exactly what your bed should be like seem to vary, so read up on this if you’re in any doubt, but you probably know what you prefer.  Do remember not to let your mattress get too elderly.
• Reserve your bed for sleep and sex, so that your brain doesn’t associate it with wakefulness.  If there are good reasons why that’s not possible, for instance due to having ME/CFIDS, do think about how the process of association works and consider workarounds, such as switching to the sofa for part of the day, or even a spare bed.
• Generally think about relaxing pre-bedtime routines and how you think about sleep.  Routines can make a surprising difference, and it helps to have a daytime mindset and a bedtime mindset.
• Meditation, visualisation and the like can be very helpful, especially if your mind goes whizzing round in the evenings.  There are lots of different ways you can do this, so keep looking if the first method you find merely irritates you.  I quite like a Zen meditation technique where you repeatedly count to ten, one number with each breath.  Usually I just drift off while daydreaming.
• It’s well-known that caffeine will keep you awake, but few people know that alcohol and nicotine do as as well.  If this applies, you can either change your habits in a big way, or at least remember not to drink/smoke after lunchtime for special occasions, such as when you will have to be up for an early morning appointment or anticipate that something will disrupt your sleep (e.g. travelling on an overnight bus).
• Try to reserve energising activities for earlier in the day.  This can be tricky for natural night owls who feel at their most creative in the evening, or people who only really come to a few hours after they finish work, but it’s worth thinking about if you want to improve your sleep.  Knowing your natural tendencies is a big part of the battle.
• Strenuous exercise is best reserved for earlier in the day, say up to mid-afternoon.
• Computers are lethal for keeping you awake in the evening.  This is partly because they engage your mind, and partly because they emit a lot of blue light which suppresses the sleep hormone, melatonin (keep reading to find out more about this).  Either stay off the computer altogether, or use an orange screen filter, preferably combined with keeping to less energising activities (playing computer solitaire is fine, writing a blog post about something that really excites you is likely to lead to “how did it get to 5 am?” syndrome).
• Televisions pose similar problems to computer screens, both in terms of blue light and getting your brain involved.  I manage as long as I wear my orange glasses to block the blue light, and generally keep to something relatively soporific if it’s just before bed.  This is the time for watching an episode of a not-terribly-exciting TV series, not for starting a two hour horror film.
• Know your bladder!  Some people find that they go to the toilet all night if they so much sip a little water in the evening, in which case set yourself a time after which you won’t drink anything, or at least restrict fluids.  Other people are fine whatever they do, and these folks are good candidates for calming herbal teas, such as chamomile or lemon balm (melissa).  I recommend Dr Stuart’s Valerian Plus, which has a goodly amount of valerian in it, along with passiflora and hops which are both useful for sleep, but it doesn’t taste too bad for a valerian tea, probably because it has lots of linden blossom (lime flowers), which tastes beautiful as well as being calming.  If you find chamomile effective but don’t like the taste, there are some good chamomile blends out there, such as Twinings Chamomile & Limeflower.
• Warm baths help for some people.  You can add Epsom salts (magnesium sulphate), which are meant to relax the muscles, or a few drops of a calming essential oil such as lavender.  If you go for the aromatherapy option, don’t get too hung up on which oils are prescribed for insomnia, as reaction to smell is intensely personal and you just want whatever makes you feel relaxed.  Check whether the oil is listed as sedating (neroli is wonderful, although pricey so buy it diluted for this) or stimulating (rosemary is definitely not a bedtime oil).
• You can also utilise aromatherapy by putting a single drop of a calming oil on a tissue and keeping it near your pillow.  I don’t recommend oil burners which use candles for obvious safety reasons; if you want to use an electric oil burner, plug it into a timer so that it won’t be on all night.  Another pleasant use for aromatherapy is to buy or make up an oil blend with calming essential oils, such as Roman chamomile and bergamot, and either apply it to yourself or, better still, get your partner (if you have one) to give you a gentle massage.
• Some people are kept awake by chilly feet.  If this is the case, there’s the obvious sock option and the marginally less obvious hot water bottle or microwaveable rice bag option.
• Warm bed, cool room, seems to be the advice I’m finding on most sites.  Probably worth following, and fresh air is always good, but as ever, go for what makes you most comfortable, don’t follow something you don’t get on with just because a website suggested it.
• If you’re kept awake by worries or other thoughts, and you are either single or have a very deep-sleeping partner, you can try keeping a notepad by the bed for writing down anything that is keeping your mind on the hamster wheel.  Use a dim light for doing this, preferably one that is yellow, orange or red (see the articles on darkness therapy).
• If you can’t get to sleep, or wake up in the night and can’t get to sleep, give it 20 minutes (this is the usual recommendations; many people would consider 20 minutes fantastically fast to get to sleep, so it may need to be longer for you), and if you still can’t sleep, go and do something relaxing in another room, such as reading or listening to soft music.  Again, use yellow/orange/red light if possible, and dim light at the very least.
• And this applies for getting up to use the toilet in the night too.  It only takes a short exposure to white/blue light to suppress melatonin levels, unfortunately.  Don’t forget to take the hallway light levels into consideration either.
• If your child insists on a nightlight, or you need one for navigating hallways, find something that’s yellow/orange/amber/red.  It is ludicrous how many nightlights are just the right kind of bluish white that will keep you awake.
• On that subject, speak to your doctor if you’re being kept awake by your urinary tract or digestive system.  It is not normal to need to urinate several times during the night, or to be kept awake by gas, and it may be a sign of Overactive Bladder Syndrome, Irritable Bowel Syndrome or a food intolerance (e.g. gluten), amongst other possibilities.
• Ditto for pain: I don’t care if you dislike painkillers, any pain that is disrupting your sleep is serious enough to warrant being discussed with a doctor.  You may need to take medication or alter the medication you’re taking already, and you may also be able to find a non-drug solution.  Remember that poor sleep increases daytime pain levels, so it’s a vicious circle very much worth breaking.
• While I’m marching people off to their doctors, remember that how you sleep reflects your mental health as well.  If you’re up half the night every night worrying, you may have an anxiety disorder, for instance.  Just because you may been experiencing it for as long as you can remember doesn’t mean that it’s healthy!
• Find out what sort of sleep is normal for your age group, rather than following myths.  It is perfectly normal for teenagers to be on a late schedule, though this should improve by 20 or so.  It is not the case that you need less sleep when you’re elderly, however, although many elderly people do sleep less due to, say, pain from arthritis, or other similar problems which – you’ve guessed it – should be discussed with a doctor.
• If an external factor is disrupting your sleep, don’t just assume that everyone has to put up with this, as there may be a solution for it.  Darkness therapy is useful for shift workers and new parents, for instance.  New curtains, if yours are letting the light in, may be unaffordable, but clip-in blackout linings are cheap and very effective.
• If your partner snores, consider the following: earplugs, a white noise generator/tinnitus relaxer (some can be plugged into a pillow), separate bedrooms.  If you haven’t done this already, march them off to the doctor to be checked for sleep apnoea, a very common and rather dangerous condition.  This may mean that you end up having to listen to their CPAP machine instead of their snores, but at least they’ll be a lot healthier.

* Please note that Dr Myhill is now being viewed with caution.  See the Links page for more information.

Get a diagnosis

Work out what’s wrong with your sleep, and if necessary, see a doctor or even a sleep clinic.  Some sleep problems such as sleep apnoea are actually quite dangerous and warrant early investigation.  Note that in the UK at least, sleep clinic waiting lists are long, and if you’re paying for your healthcare then a sleep study is expensive, but it’s generally worth telling your GP what is going on at the very least.  Keeping a sleep diary for a while (a week, a month) can be very useful.  You will want to note down when you sleep, when you doze, when you get up, when you take any meds or treatments that can affect sleep or alertness, and optionally when you eat and get exercise.  If you have sleeping partners, ask what they’ve noticed (e.g. stopping breathing during sleep, waking up with amnesia).  I’m generally going to be talking about circadian rhythm disorders, such as Delayed Sleep Phase Syndrome (when you’re an extreme night owl, e.g. you can’t get to sleep earlier than 4 am no matter how hard you try) and Non-24 Sleep Wake Disorder (when your body clock is running on a 25 hour or 26 hour schedule, so that you will fall asleep an hour or so later every day, which is like living with permanent jet lag), as well as general insomnia and poor sleep quality.  If you have ME, chances are that your sleep will be poor no matter what you do, but it may be possible to improve it to quite an extent.