1. Sleep Hygiene Body Recommendations

Obtain regular exercise

Regular cardiovascular exercise is essential to obtaining healthy, deep sleep. However, exercise should be avoided at least 3 – 4 hours prior to bed because it raises core body temperature, which can interfere with sleep.

Quell the body before bed

Intentionally quelling the body before bed can help reduce somatic tension, which is commonly looped with anxiety. Gentle yoga, stretching and massage can be helpful in promoting somatic relaxation. A warm bath or shower can also sooth tense muscles and trigger a reciprocal drop in body temperature to promote sleep.

Stay well nourished

The complex connection between good nutrition and healthy sleep is beginning to receive attention. An anti-inflammatory diet likely supports healthy sleep and dreams, while high glycemic foods can disrupt normal energy rhythms.

Have a healthy bedtime snack

Avoid sugary and harder to digest foods as bedtime snacks. As an alternative, consider complex carbohydrates that may help transport tryptophan, a precursor to melatonin, across the blood-brain barrier.

Limit the consumption of stimulating substances.

Be cognizant of the impact of various stimulating substances that can potentially interfere with sleep, especially caffeine. Given its relatively long half-life, standard cautions about caffeine use may not be sufficient for everyone.

Carefully manage alcohol consumption

Because alcohol promotes sleepiness, it can readily become a nightly crutch. Alcohol can disrupt circadian rhythms, interfere with quality sleep, suppress REM sleep and cause middle of the night awakenings. Drinking less, earlier, and with food is best.

Know the sleep side effects of all medications

Always check for possible sleep or dream interfering side effects of all medications used, both prescription and over the counter, including “natural” alternatives. Check with your healthcare provider or pharmacist regarding possible alternatives if necessary.

Consider natural alternatives for occasional sleeplessness

For transient sleep difficulties associated with acute stress, consider short-term supplementation with botanicals like lavender, jasmine, valerian or hops. Chamomile may help but can also act as a diuretic.

Be mindful of melatonin

Maintain healthy endogenous levels of melatonin by avoiding substances and behaviors that suppress it. Consider melatonin replacement therapy if indicated by circadian rhythm irregularities or advancing age.

Address primary snoring

Aside from its literal noisiness, primary snoring (not associated with apnea) can be viewed as a kind of body noise. Once thought to be innocuous, it is now seen as a possible early sign of an inflammatory process and, unless it is clearly associated with an acute illness, pregnancy or an anatomical anomaly, should be addressed as such.

2. Sleep Hygiene Mind Recommendations

Establish a daily relaxation or rest practice

Engage in a pleasant relaxation practice on a daily basis. Possibilities include meditation, breathing exercises or self-hypnosis. Because rest is the bridge to sleep, it is essential to be familiar and comfortable with it.

Make bedtime a ritual

Ordinary routines become meaningful rituals when engaged in mindfully. Create a sweet and soothing bedtime ritual that incorporates all of your sleep preparatory activities. Approaching sleep ritually helps maintain a sense of its value and mystery.

Laugh before bed

Laughter is a potent and fast-acting relaxant. Whether it is watching a sitcom, doing some lighthearted reading or getting playful with someone or a pet, consider doing something that makes you laugh in the hour before bed.

Journal your waking day to rest

Keeping a daily journal or diary can be most helpful in integrating that day’s experiences and laying them to rest in preparation for sleep. Looking at the day as a page in the great book of one’s life is an effective way of emotionally deescalating and reframing even challenging experiences.

Keep the peace with bed partners

Even though we are not conscious in the ordinary sense of the word during sleep, sharing a bed is a very intimate experience. Maintaining a positive connection with one’s bed partner by sharing and being sensitive to one another’s needs promotes good sleep. Bed partners should support one another in managing loud snoring.

Go down gradually like the sun

Despite common language, we cannot literally “go to sleep.” The intention to do so simply tethers us to waking consciousness. Getting to sleep is more about letting go of waking–of learning to surrender. This process can be approached as a personal spiritual practice since it raises a fundamental question about where we place our faith.

Fall back in love with sleep

Understanding the numerous health benefits of sleep can encourage good sleep hygiene. But having a direct relationship with sleep can also be inspiring. Instead of slipping into bed with thoughts about tomorrow, focus on and indulge in the actual experience of sleep and dreams tonight. Good sleepers don’t just do it for the perks, they truly love sleep. (Listen to Dr. Naiman’s Falling in Love with Sleep Again)

Arise gradually like the sun

In contrast to the common practice of getting jolted out of sleep by an alarm clock, consider a slower, gradual awakening. Use a dawn simulator or timed alarm apps to help with this. And bask for a few moments in your grogginess–that exquisite hybrid state of waking, sleep and dreams.

Engage your dreams

A gradual awakening allows us to be more mindful of our dreams. Bridge your dreams to your waking life by journaling, thinking and talking about them. Dreaming supports emotional health, learning and memory. Dreaming is healing and can re-enchant lives entrenched in the mundane. Even occasional bad dreams are a part of good dreaming.

3. Sleep Hygiene Bed Recommendations

Bed recommendations are about optimizing one’s sleep environment’s space and time, that is, creating a sense of sanctuary and living in tune with natural rhythms.

Get rhythmic

Support your circadian health by maintaining a regular bed and rising time, even on weekends and holidays, if possible. Without becoming compulsive about it, is also helpful to maintain fairly regular meal and exercise times.

See the light

Obtain as much safe outdoor light exposure as you are able on a daily basis. When feasible, obtain 20-30 minutes of exposure to outdoor morning light shortly after arising.

Simulate dusk

During the hour or two before bedtime, dim household lights and/or use blue blocker light bulbs or goggles to promote endogenous melatonin. Always use blue blocker technology when watching television or using computers.

Sleep in the dark

Sleep in total darkness throughout the night or use a quality sleep mask to block out light. If nightlights are necessary, use a motion detector variety.

Awaken gently

Whenever possible, awaken naturally without an alarm clock. As an alternative to a standard alarm, consider a dawn simulator, which awakens one with gradually increasing light or smartphone apps that can be programmed for more gradual and gentle awakenings.

Green the bedroom

Gradually move toward a “green” bedroom by evaluating and diminishing exposure to bedroom toxins. Use a bed and bedding made with natural or organic fabrics and minimize outgassing from furnishings, floors, walls, or carpeting. Make sure the bedroom air is clean by using HEPA filtration or houseplants that refresh the air. Avoid exposure to electromagnetic fields during sleep.

Create a safe space

Do all you can to feel completely psychologically safe in your bedroom during the night. This may involve installing a security system or getting a watchdog. Some people find spiritual symbols or images comforting.

Keep the bedroom cool

Keep bedroom temperatures at about 68° Fahrenheit or lower during sleep. Ideally, use a programmable thermostat that allows programming temperatures to gradually decrease by a few degrees through the night and then climb back up in the morning.

Avoid clock watching at night

Checking the time while in bed draws one back to the world of waking. Use a non-illuminated battery operated clock to minimize light and EMF exposure.

Make your bedroom a personal sanctuary

Design your bedroom to be inviting, serene and free of negative associations. Consider using the principles of Feng Shui as guidelines. Avoid reading or watching overly stimulating material in bed. Try to keep relationship conflict out of the bedroom.

Ten Insomnia Prevention Tips

Recognize the value and joy of sleep.
Pay attention to and journal your dreams.
Engage in relaxation practices daily.
Obtain adequate regular exercise.
Obtain daily exposure to morning light.
Limit the use of stimulants and sedatives.
Maintain a regular sleep-wake schedule.
Dim the lights or use blue blocker tools for 1 – 2 hours prior to sleep.
Sleep in total darkness or use a sleep mask.
Consider low-dose melatonin replacement therapy.

Melatonin

Melatonin plays a key role in initiating and maintaining sleep, higher night-time melatonin concentrations may also have an anti-inflammatory effect, immune-modulating effects, free-radical scavenging effects, and influences on bone growth and osteoporosis (Reiter, 2007).

The significance of suppressed nocturnal melatonin levels may be significant. Factors contributing to melatonin suppression include exposure to light at night (LAN) (Reiter, 2006; Evans, 2007; Blask, 2002), advancing age (Mahlberg, 2006), and common medications (e.g. beta blockers (Brismar, 1988), caffeine, alcohol, 8-methoxypsoralen).

Valerian (Valeriana officinalis) root

Valerian is a non-addictive and safe botanical with mild anxiolytic and hypnotic effects, that does not impair psychomotor or cognitive performance (Gutierrez, 2004; Hallam, 2003). Research on the effectiveness of valerian is mixed, though many clinicians find it useful for many patients when used in sufficient dosage, in combination with other botanicals and behavioral measures.

Valerian does not foster dependence and there are no withdrawal syndrome upon discontinuation. Valerian usually requires 2-3 weeks of nightly use before seeing a significant effect (Wheatley, 2005). Therefore, this botanical is more useful in treating chronic insomnia. The recommended adult dosage is 1-3 grams crude root or a 800-1200 mg of an extract standardized to 0.8-1.0% valerenic acid taken 30-60 minutes prior to bedtime.

Adapted from Arizona Center for Integrative Medicine – IMR – Family Medicine 2018