Carrot top curls bobbing merrily, Sandy’s worried big blue eyes contradicted her otherwise spunky appearance. “I know I shouldn’t eat French fries and drink beer before I go to sleep but my schedule is so hectic that I can’t follow my own rules. I don’t think I’ve slept more than five hours a night in the last four weeks and I am simply wiped out. I am so tired that I couldn’t even finish finals I love learning business stuff but the program is unforgiving and now I will need another semester to finish. This is terrible!”

Since this was our first meeting I needed to see how motivated she was to change. “Sleep hygiene requires self-discipline. You say that is hard for you.”

“I’m ready. My boyfriend is fed up with how apathetic I am. I don’t want to lose him. The blue eyes teared slightly.
I pulled out an information sheet that we offer clients. “Let’s read this together. See if any information surprises you and stop me when we need to discuss something.”

• Waking Up: Get up at about the same time every day, especially on the morning after you've lost sleep. When you get up go into the light to remind your body that it is time to get active. Your calves get blood circulating, carrying more oxygen to your brain, so walk around a bit.

• Exercise: Be more active during the day to sleep better at night. A good walk in late afternoon and gentle stretching before bed helps. Your need for sleep may decrease and your ability to go to sleep may improve when you are exercising regularly and doing things you enjoy and do easily.

• Nap Not. Do not take any naps the day after you've lost sleep but keep active.

• Set a bedtime schedule. Sleep can become as regular as eating meals at the same time each day. Thirty minutes before sleep do something that's relaxing. Get into a routine which can include a long, hot bath to relax and soothe your muscles, an earlier dinner to create a calm digestive system, gentle stretching and relaxation techniques before bedtime.

• Warm milk and bread? Milk has tryptophan, which stimulates the brain chemical serotonin, believed to play a key role in inducing sleep. A piece of whole wheat bread, or another carbohydrate, enhances the effect.

• Avoid caffeine and fermented foods from late afternoon on: Caffeinated drinks, fermented cheeses and deli meats stimulate the system.

• Cut down on alcohol, which results in shallow and disturbed sleep, abnormal dream periods, and frequent early morning awakening.

• Create a sleep friendly environment. Sleep in a cool room (60 degrees or so). Have the room pleasantly humid. Manage noise through white sound or baroque music, as you prefer.

Sandy looked astonished. “I never knew half of this. I can do lots of it but the worst part is that I worry about not falling asleep which causes me to stay awake…this is a vicious cycle that sets me up night after night. It is the worst of all of it. “

“Yes. This is the hardest part. We enter into a worry cycle that makes the insomnia worse. I can teach you Cognitive Behavior Therapy techniques to get your mind off not sleeping. These include deep breathing and in-bed exercises. Both distract your thoughts. Cognitive skills teach us to redirect the way we think about sleep, which allows us to be less anxious and fall asleep faster.”

“Great, but what if I wake up and can’t get back to sleep?”

“Most people worry about middle of the night waking. If you are in bed and unable to sleep, get out of bed and do a quiet activity that will not involve you enough to wake you up. Make your bed a place to sleep.

Do not eat or you will teach yourself to wake up for treats. And, if you wake early get up and begin the day. If you're rested, you've probably had enough sleep.
Sleep needs vary from person to person but most of us need 6 to 9 hours nightly. Experiment to find the amount of sleep you need.”

I looked at Sandy and was pleased to see that the blue eyes looked less worried. “I feel confident that this is a good path, but I wish I had known all this years ago.”

“Me too,” I replied. And I meant it. So much of living life well is skills based.

To Consider: Which ideas might I implement to help my own sleep? Can I offer ideas to others I love?

To read: The Harvard Medical School Guide to a Good Night's Sleep, L. Epstein and S. Mardon. NY: McGraw Hill.

(Coche of Stone Harbor educates the public in mental health issues. She can be reached at tcctcs@earthlink.net or 215-735- 1908.)