First question: Is the sleep difficulty early or late? Do you have trouble going to sleep? Or do you get to sleep fine and then awaken for hours in the middle of the night? These are usually different type problems and the approaches are somewhat different.

Problem 1: “I have trouble getting to sleep”

Two major things derail getting to sleep at night. Either we have habits and activities that keep our system so wired that it can’t just move down to the relaxation point for sleep, or we have a lot of emotional/mental stress going on and can’t stop thinking about it.

If it’s the first problem, then the focus needs to be on, “What am I doing in the last 2-4 hours before bed?” Some folks can go 100mph with activity and then just crash. Most can’t. We need wind down time. We need to allow our bodies to and physiology to gradually get there, so that when bedtime arrives, our bodies are ready.

Common problems in the last hours before bed:

1. Caffeine
2. Sugar
3. Exercise
4. Activity on computers or devices
5. Work

If any of these are in your habits, commit to 5 days in a row of eliminating them in the hours before bed. For caffeine, make that at least 6 hours before bed; it can have a longer-lasting effect.

Things to do instead:

1. Hot bath one hour before bed. Not right before bed. There has been research to show that as the body temp drops it is more conducive to sleep. The bath serves as a deep relaxation mechanism, time for self, and also elevates the body temp that then falls back down over the next hour, helping induce sleep. Also, pay attention to this as a time for quiet and self-care. Make it darkish in the bathroom. Play soft music. Light candles. Use lavender bath salts or scents. Most importantly, allow yourself to take it in. If you do all the mechanics but your mind is racing with worries or the to-do list, it likely won’t help much. Focus on your body. Focus on the warmth. Focus on the sensation of the water against your skin. Focus on the soreness of any muscles and how they are being soothed. Allow a sense of It’s ok to be good to yourself.
2. Meditation – right before bed can be a great time to meditate. It can allow your body to much more deeply relax and for you to get out of your head.
3. Turn off the stuff – TV, smartphone, iPad, etc. Take in the silence.

If you’ve eliminated all the above “interferences” and practiced the relaxation techniques and you still can’t sleep, there are some natural supplements that can often help a lot. The current formulations of Somnapure and Alteril, easily obtained at local drugstores over-the-counter, are good combinations of natural supplements that can help with getting to sleep. One of the best and most successful is higher doses of the herb Valerian, taking 1300-1800mg one hour before bed. Other commonly tried adjuncts for sleep are magnesium, melatonin, and 5-HTP. Try several. Some people resonate more with one option than the others.

Another huge problem for some folks is ambient noise.  Snoring partner? Cat or dog in the room? Noise outside or in the house?A terrific way to address this is with a white-noise generating sound machine.  It does two key things:

1)  It masks ambient noise very well, and

2) It trains your brain over time that “this is the sound for sleep”.

Turn it on when you crawl into bed and turn it off as soon as you awaken.  The cessation of the white noise in the morning will also help you wake up faster.  The more you use it, the more your brain will become entrained and associate that sound with sleep, helping you sleep much more deeply as well as not being as easily disturbed.

Here is a key to remember:  Get a very good machine.  There are many more lousy sound machines out there than good ones and it makes a difference.  If the white-noise generation is not really pure, then after a while one can begin to hear shifts and changes and even little “tunes” within it, and it can drive you crazy.  You begin to think you’re one of those folks who hear radios in their teeth.  A pure noise-generator stays very stable all the time.  Also, don’t spend the money for all the multiple bells and whistles that some come with, such as 20 different types of sounds.  Listening to jungle sounds, crickets, thunderstorms, crashing waves and such are all really cool and pleasant to listen to, but they’re lousy for sleep.  You want an unchanging blanket of sound that allows the brain to turn inward.  Whenever that sound shifts it signals the brain that a change has occurred, and it wants to pay attention to that, so it stimulates us toward more awakeness.  So, leave off that stuff.  That’s also where a lot of the expense comes in.  I have found through the years that the most reliable brand is Marsona by Marpac.   (I have no connection to the company at all).  Check out their most basic model that sells for about $45.  Works wonders.

Try to avoid prescription sleep meds such as Ambien, Xanax, trazodone, and muscle relaxers, as well as the commonly available Benadryl (diphenhydramine – found in many over-the-counter sleep medications). The majority of these have negative effects on sleep cycles, most particularly on the much-needed Stage IV and REM sleep portions of the night. Normal sleep architecture and substantial time in deep IV sleep is needed for the repair and rejuvenation mechanisms of the body to do their work. It’s a very active time. When those stages are not getting their due night after night after night after night due to chronic sleep medication use, then we become sleep deprived over time due to the med. I’ve yet to meet a patient on chronic, nightly sleep medications who feels rested and great. If you need these meds, use them sparingly and with breaks, not every night.

Problem 2 – “I wake up in the middle of the night and can’t get back to sleep for hours”

This problem is almost always due to stress. There is one significant exception to consider however, and that is the use of wine at night. Wine (much more than other alcohols) can have a well-recognized “kick-back” effect about 6 hours after use. It may give you the illusion of getting you to sleep due to its alcohol effect, but it can produce another effect about 6 hours later of low-grade jitteriness and anxiety. Some folks describe it as a sense of restlessness. If you habitually have that in the middle of the night and are a wine drinker with dinner, consider eliminating that for a week or so and see if it’s the problem. If it’s not, then it’s almost certainly stress.

When we awaken in the middle of the night, we are in a very hazy state, somewhere between dream-world and awake. Our minds tend to have a lot of places they can go and we have no other activities that are taking our focus. It is a very common time for the flood of all that we are worried about in our lives – difficulties in relationships, worries about the future, money, work, fears of all types. They can run quite rampant at 2am. What tends to happen is a rapidly engaged spiral that feeds on itself. Our worries crank up our fight-or-flight system and cortisol and adrenaline. Then those chemicals in our system have a certain half-life – about 5-10 minutes for adrenaline and 45 min or more for cortisol. Now we can’t go back to sleep because our “awake” chemicals are flowing. Now we’re upset because we can’t go back to sleep. If it is a commonly occurring problem, it’s usually not very far into the pattern before our minds are engaged with “Great. Here we go again.” Our distress and tension mechanisms crank. This, in turn, just cranks out more cortisol and adrenaline and we just bought ourselves more chemical time on the clock. And then more frustration. And then more stress chemicals. And then more frustration…….and so it goes. We have to interrupt that spiral.

The primary key to this process is body focus.   We have to get out of the head as quickly as possible. It isn’t possible to get out of the mind by focusing on the mind. We can’t think our way out of not thinking. We can only focus elsewhere. So, first and foremost, we need to allow our focus to be back down in the body. Move your attention to your breathing. Sense the feel of the body as you breathe, the way the belly expands on the in-breath and then comes in as we exhale. When you notice you’re back in thinking, just re-focus on the breathing and the body sensations. This back and forth will happen over and over, that’s just being a human. No judgment of self. It’s just the process.

Another really good technique is called dream remembrance. I am indebted to the great work of Woody Merrell, MD for this nugget. Really works. Basically, if you’re someone who is aware of sometimes awakening from a dream, immediately put yourself back in the dream. Let your mind drift back to what was happening. Also, maintain or resume the same body position you were in at the time, it makes a difference. Explore the landscape and story of the dream like you’re back there again. This helps keep your body/mind connected to dream state and further away from awake state.

The above-mentioned issues of adrenaline and cortisol are important things to remember. If things are to the point that these have begun to engage then realize that there may be a certain amount of time, anywhere from 10-60 minutes where your body is not going to go right back to sleep. The chemicals will need to clear. So, just relax and body focus so that you don’t prolong the process.

Hope this helps! If any of you have any other great tips that have worked for you, please share. Happy Slumber!