Thoughts on getting to sleep and a routine to try

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Thoughts on getting to sleep and a routine to try (1/3/06)

Sleep has got to be one of the subjects written about most often. Scientists are starting to understand it so I thought I'd take a crack at summarizing things. I've got the worse insomnia but I've had a lot of luck treating it after reading this:

Kräuchi, K., Cajochen, C., Werth, E. & Wirz-Justice A. (1999)
Warm feet promote the rapid onset of sleep. Nature, 401: 36-37.

Basically it says the body dilates (widens) the blood vessels in the hands and feet before sleep, and that the people who can dilate their blood vessels the most fall asleep faster. They've tracked the reason for this down to a net loss of warmth from the core of the body, which the body interprets as a signal to fall asleep.

The doctors work at the Centre for Chronobiology at the Universitären Psychiatrischen Kliniken (UPK) in Basel, Switzerland. In addition to the vasodilation study above, they've also found the importance of a mess of other factors with "clueing in the body" that it is time to fall asleep. Some of them are:

A. Low light levels
B. Little to no UV or blue light
C. Vasodilatation, mentioned above

Common wisdom also adds to the list:

D. Decreased activity levels
E. Decreased mental activity
G. Absence of life endangering conditions

As is typical of a complex system, there are a lot of sleep-inducing strategies all of which work for some people but not everyone. However, most of them will directly address one or more of the factors above, even if they just shift a person's attention away from "Why can't I sleep? Is there something wrong with me?" to thoughts of how pleasant the person feels, or in the case of meditation, nothing at all. Some, like a hot toddy, actually work against one factor in favor of triggering others. I think these cause sleep, but a low quality sleep because alcohol, caffeine and nicotine constrict the blood vessels, which works against one of the prime factors above: vasodilatation.

The picture that emerges is that once most of these factors are tipped in the right direction, we fall asleep. So what is the optimal method for falling asleep? Can we come up with a routine that will address all of these factors?

Sleep Routine

1. Make sure you are in a place you feel safe and comfortable. The temperature should be a little cold, but not cold (68° - 70°). This will help with vasodilatation. Unfortunately this temperature varies between people. Clean air would also be good since it is easier on the lungs, decreasing activity.

2. Ensure you are wearing something that will keep your limbs warmer than your abdomen, such as a t-shirt and warm pants. You don't want to be cold or too warm though. Sweating is bad.

3. Don't drink alcohol or caffeinated products like coffee and tea, or smoke for at least two hours before bedtime.

4. Eat a small amount of protein. This will keep your blood sugar levels stable during the night and prevent the brain from worrying about them. A little peanut butter on one cracker will do great.

5. Turn off most of the lights, including the TV. For the few lights you have on make sure they aren't very blue ones and are more natural in nature, such as the yellowish lights used traditionally in homes.

6. Do something relaxing, both physically and mentally:

Take a bath.
Read something that makes you genuinely happy.
Get a massage or try massaging yourself (<-- not sexually you gutterheads!).
Eat something really good, really slowly. Savor it. Beware chocolate - it has caffeine. Sugary foods should be consumed in very small quanities, if at all.
Listen to music. Just lay back, listen, and enjoy it.
Meditate. You don't need to be a Buddhist to do this. For ideas try Andy Smith.
Daydream.
Spend time playing with your pet.
Tell a story to someone.
Write in a journal.

7. When you've been at that for 20 or 30 minutes, move to the bed and get in. Keep doing one of the things above that you can do in a bed, such as listen to music, daydreaming, etc. Don't wonder why you are not sleeping, just listen to the music, or whatever you're doing and keep doing it.

Sooner or later sleep will just happen. There will probably signs of it that you can recognize, such as muscles relaxing or a noise like you are standing in a crowd. If so you can use these to reassure yourself that you're almost there.

If you don't fall asleep, you may not be tired enough. Try getting up and returning to step 6 for another half hour. Don't be discouraged - this is quite normal.

Do this regularly and don't stray from the routine. In the same way that the body can be trained for a specific sport the body can be trained to sleep, but the cues to sleep need to be there regularly. This will be easier if you go to bed at the same time everyday, including weekends, as one of the cues your brain will pay attention to is how tired you are and how long ago the light levels went down.

Part of this process is about learning a new way to perceive sleeping and wakefulness, from two separate states to two parts of a spectrum, each on a different side. If you stress the body by shifting the timing too much there is hell to pay. A little bit is certainly okay but too much and the timing will be forced in one direction, one the body isn't used to and will need some time to catch up to, if it even can. That translates into a bad night's rest and a lousy day.

One important note: if this is consistently failing to give you a good night's rest and you can't figure out why, talk to your doctor about it. A lot of people have medical problems which can interfere with sleep, such as sleep apnea, and it is really worth getting these taken care of.

Sleep tight. 'night.