Posted tagged ‘Sleep hygiene’

First discussion!

February 13, 2010

Welcome to all my new readers!  I’d like to open the floor to you here.  Tell me about your sleep, what you’ve tried for it, whether you’ve used light or darkness therapies for sleep or indeed for other purposes such as SAD, and of course you can just introduce yourself.  I’d love you to comment on my articles, reviews and blog posts as well, of course, but these discussion posts are especially for you.  If there’s anything you want me to post about, let me know.

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Dawn simulation

January 26, 2010

Dawn simulation works by gradually turning on a light, generally 40w or 60w, over a period of time, most typically 30 min, in order to simulate a sunrise.  The light goes through your eyelids and moves your sleep stage to the point where it should wake you up naturally, meaning that you wake feeling as refreshed as you’re going to get and that hormones such as cortisol do what they’re meant to.  I find that when it wakes me up, it feels like I blink and I’m awake, rather than being dragged kicking and screaming into consciousness.  They all have backup alarms you can set just in case.  Most people don’t need them, but some do, and can still find that while the light isn’t quite enough to wake them up on its own, they do feel much better when they wake up.

As well as making it easier to get up in the morning, some research has found dawn simulation to be as effective or nearly as effective as bright light therapy for treating SAD, and it may work well for non-seasonal depression too.  This is despite the fact that it doesn’t use such bright light, just an ordinary bedside lamp or equivalent.  It’s thought to be something to do with the gradual increase in light having the effect.  The advantage over bright light therapy is that the treatment is over by the time you get up, you don’t have to tether yourself to a light box in the morning, but the disadvantage is that it may not be as effective.  Companies selling both tend to recommend it for mild SAD and bright light boxes for more severe SAD, I’ve noticed.

Dawn simulators also generally offer dusk simulation as well, where the light fades down gradually to help you get to sleep.  I think there’s some research around showing that it helps a bit with insomnia.  I’ve not really used this setting much as it’s less convenient, though I find it relaxing when I do.  I use dawn simulation because it helps stabilise my sleep pattern even further, and because it helps both myself and my partner to get up in the morning.

One common problem with dawn simulators is that they tend to buzz when the light is ramping up or down.  The best solution is to get one of the new energy-saving halogen bulbs, also called halogen incandescent, which are the same shape as standard incandescent bulbs and can be dimmed.  Not only will they save you at 30% on energy (42w is equivalent to 60w and so on, though I and many other people think they actually seem to be brighter than that) and last longer, but the light is good quality and they don’t buzz.  You can’t use fluorescent bulbs in a dawn simulator (I never recommend them anyway as the light causes problems for so many people), you can’t use the usual halogen bulbs, you can’t use LED bulbs if you’ve managed to find one, you can just use them with standard incandescent or energy-saving halogen.  This is for where you put in the bulb yourself: there are a couple of types of dawn simulator around using fluorescent or LED lights already built in.  If you get the type of dawn simulator which plugs into a lamp, again it has to be the sort of lamp which takes incandescent bulbs, and it can’t be a lamp which already has any sort of dimmer fitted, such as a touch lamp.  Just use an ordinary table, bedside or desk lamp.

There’s a new type of dawn simulator which is combined with a lightbox, such as this one (do read reviews, there are some poor quality ones out there by other manufacturers).  They may be a good solution for people wanting to try both dawn simulation and bright light therapy, but bear a few things in mind.  Firstly, it comes up to full lightbox brightness rather than the brightness of a 40w or 60w bulb, so that you will most likely be awake long before it’s anywhere near fully bright.  One solution could be to set a 90 minute sunrise and assume that you’ll be awake after, say, 30 min.  You need your dawn simulation to be by your bed but are unlikely to want to be using your bright light box by the bed, though if you read in bed in the morning or have your laptop close to your bed you could be OK.  The other point that occurs to me is that since the light is much brighter than is needed for dawn simulation, you could place it further away from the bed (e.g. by your computer, if it’s in the bedroom) and just point it in the right direction.  If I was starting light therapy all over again, I’d probably have gone for one of these and hoped that I’d be able to work something out once I’d fiddled with it enough.

I started off years ago with an all-in-one Bodyclock by Lumie where the lamp is built in, but even though it was a 60w bulb I found that it wasn’t bright enough for a reading lamp, plus Lumie often get slated for poor product build quality.  I sold it on eBay and bought myself a Sunrise System which plugs into a lamp or lamps of your choice, and vastly prefer it.  Mine  eventually became faulty and I sent it in for repair, where they reported that it had been damaged by a power surge (at which point I promptly bought a surge protector) and sent me a replacement which is slightly different from the older model.  They can take a bit of getting used to, and I think the company needs to continue tweaking them (though at the very picky level), but generally they’re excellent.  They have lots of useful features, such as being able to set the time individually for each day of the week.  We have it set to finish at 9 am Mon-Sat and 10.30 on Sunday, when my partner starts work later.  Actually he starts quite a lot later on Sundays, but I want to keep myself in a good routine while having a bit of a lie-in.

One of the great things about dawn simulators of this sort is that you can plug them into more than one lamp as long as you don’t exceed the total wattage, which in the case of the Sunrise System is 200w in the US and 300w in Europe.  That’s enough to hook it up to lights all over the bedroom if you like, though most people like to hook it up to a light on each side of the bed.  We’ve found that I get woken up better than my partner does by light, that he doesn’t like waking up to full light and generally prefers it to be dimmer on his side, that he still needs his alarms as he’s trained himself to respond to those, and that I take longer to get up once I’m awake, so that by the time he’s had a shower and got ready for work it’s about the time that I’ll be getting up.

So on my side of the bed, the dawn simulator is hooked up to my bedside light, which is a 40w equivalent low-energy halogen bulb in an anglepoise lamp that faces the wall, and on my partner’s side there’s a little 25w spotlight hidden behind a vase which points into the corner and is enough for ambient lighting.  My partner’s bedside reading light is independent of the dawn simulator.  The dawn simulation starts at 8 am, which is when the first of his three alarms go off.  He gets up at 8.30 when the light is up to half brightness, and I get up at 9 when the light is at full brightness.  As there are alarms going off from 8, I can be anywhere from awake to dozing to having fallen asleep again while the light is increasing, but it doesn’t seem to prevent it from being effective.  Occasionally I sleep in later than 9, but it’s probably only once a week, which for me is fantastic.  This helps keep my sleep stabilised even if I went to bed too late the night before.  I’m getting up earlier than I used to (even when I was using the lightbox), and it’s great being able to get up earlier in the morning and go to bed at the same time as my partner.

Sleep in total darkness and quiet

January 26, 2010

Make your sleeping environment as dark and quiet as you possibly can.  If you have tinnitus or are troubled by background noise, look into getting a white noise generator.  I was given this one on the NHS by my hearing therapist, and it was very useful when I was living in a noisy place and with a landlord who liked to play loud music at interesting hours, not to mention helpful when I was going through a spell of bad tinnitus.  It makes a variety of sounds as well as white noise, which is useful as it’s normal to find that some or most of the sounds annoy you, while there may be only one that you find soothing.  I personally liked the rain one.  It can also be plugged into a special pillow if you have a partner.

The rule for how dark your bedroom should be at night is that you should not be able to see your hand in front of your face.  I used to sleep with an eye mask on, but while my one was also good for dry eyes it was not a particularly friendly thing if you have a partner (he used to call me Bug Lady ,and would yelp if the bulbous shape of the eye mask hit him during sleepy cuddles), plus I decided that I wanted to try dawn simulation again.  There is some research suggesting that light is taken in by the skin as well as by the eyes, so some people think an eye mask won’t do if the room isn’t dark enough.  There are several views on the subject, though, and personally I wouldn’t worry about it.  If an eye mask suits you and doesn’t fall off during the night, then go for it, it’s a nice easy solution.

Once I stopped using the eye mask, I had to go to quite a lot of effort and a certain amount of expense to get the room as dark as possible.  There’s a borrowed light above the bedroom door which lets in light from the hall (which itself lets in light from the stairwell through a borrowed light above the front door), and I taped a piece of blackout fabric onto that shortly after I originally moved in years ago. The curtains are beige and glow nicely when the light comes through, even when I have my not-terribly-efficient blackout blind down, so I bought blackout curtain linings and they improved matters quite a lot.  Lots of light still came in around the sides and top, so I bought self-adhesive velcro and stuck one side to the window surround and stapled the other side to the blackout linings, thus blocking off the light at the sides.  I did spend a while still being woken by the small amount of dawn light coming over the top of the curtain rail, but this settled after a while.  I don’t know whether it was an adjustment period or whether it was because winter set in and it was still dark when my alarm went off.   I found that it took me a while to get used to not having the eye mask on any more, for some reason, but I now sleep absolutely fine without it.

All of this would have been considerably simpler if I did not have 10′ high ceilings, which meant that my original curtains had to be custom-made, the only affordable blackout blind available was a cheap and nasty thing from Ikea which was still a few inches too short, and I had to buy extra pieces of blackout fabric and sew extensions onto the blackout curtain linings.  If I ever have to start over with a similar type of flat, I think I’ll look into the cost of having shutters made instead.

Sleep hygiene

January 26, 2010

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.