How to Sleep Better

When Maria came to see me, fatigue was her primary concern. She felt exhausted all the time, she said, and had no real energy or passion for life. She was also experiencing fuzzy thinking, irritability, headaches, and achiness. Doctors tested her for thyroid disease, anemia, chronic fatigue syndrome, and early menopause -- but concluded that she was probably "just" depressed. After starting an antidepressant, Maria came to Duke Integrative Medicine. "I just don't think I'm depressed," she said.

I had my doubts, too, so I started with an obvious culprit, asking her to describe her typical sleep pattern to me. "I usually have no trouble at all falling asleep," she said. "But then, sometime between 2 and 4 a.m., I wake up, and then I have a hard time getting back to sleep."

"Well, that's certainly a factor in your fatigue, and the rest of your symptoms," I said. She looked dubious. Her reluctance to recognize this connection would have surprised me if I hadn't seen it so often in other patients. But Maria's symptoms and sleep pattern are consistent with many women I see, as was her lack of awareness that her quantity and quality of sleep were even an issue.

Sleep is an essential bodily function, like eating and breathing. But more and more, we minimize its importance, and the health effects can be devastating. Besides affecting how we feel and function day to day, a chronic lack of sleep can set us up for diseases such as diabetes and heart disease. And the effects on our emotional and spiritual well-being add up, too.

Getting to the root of sleep issues, and making shut-eye a priority, is one of the best steps you can take for optimal health. Here's how.

All animals, humans included, are programmed to have cycles of activity and rest. Even fetuses in the uterus, protected from outside stimulus and needing to do "nothing," have sleep and wake cycles. Our very cells have active cycles and rest cycles.

Besides allowing our bodies and brains to refuel, sleep allows for our souls to recharge. When our conscious mind is in sleep mode, our unconscious mind goes to work (and play), processing intense experiences -- positive and negative -- during dreams. The symbols and feelings that linger from our dreams can provide crucial guidance for our waking lives. Whenever I have a patient who doesn't remember her dreams, it's a sign to me that she may be running on empty.

There are, of course, medical causes for subpar sleep, such as sleep apnea and hormone imbalances, and it's a good idea to talk with your doctor to rule these out. But the vast majority of cases have more to do with stress and, increasingly, our 24/7 lifestyle. These days we are "plugged in" almost constantly and often never unplug before going to sleep.

Women in particular tend to keep going all day, until our heads hit the pillow, and then most often are so exhausted that sleep comes quickly. But as soon as the body has a bare minimum of shut-eye, we awaken, and it feels as if the mind never stopped. And often, it hasn't. Women are typically great at multitasking, but if we don't consciously unplug, it's almost as if we continue this pattern in our sleep. As soon as we are even slightly conscious, our minds go right back to problem-solving, making to-do lists, planning. I also believe women are programmed to "sleep with one ear open," as if listening for a baby to cry, whether or not there's an actual baby.

The good news? Once you're aware of this dynamic, you can take some simple steps to change it.

1. Use a mind-body technique. Doing a bedtime relaxation exercise, such as the following, can help you fall asleep or get better, deeper sleep. Paced breathing Inhale through your nose for a count of four. Hold for a count of seven. Exhale through your mouth for a count of eight. As you breathe, rest the tip of your tongue on the ridge behind your front teeth. When you exhale, it should create a shooshing sound. Repeat four times.

Mental Muscle Relaxation 
Lying down or sitting comfortably, close your eyes and take a few deep breaths. Starting at the top of your head, notice whether there's tension in your scalp and forehead. If there is, let it go. Progress all the way down your body, assessing each muscle group and mentally releasing any tension.

Alternatively, work with a therapist who's been trained in medical hypnosis. Have the therapist do a session focused on deep sleep and record it. Listen to it before you go to bed, and if you wake in the night, listen to it again to fall back to sleep.

2. Offload stress. If you're worried about something that you can't seem to "unplug" from, turn into it, rather than away from it. Get out a journal or your laptop and write. Offloading will often allow your mind to rest.

3. Pay attention to your diet. Caffeine and sugar are obvious insomnia triggers, but there may be other foods that bother you, so observe your diet and note how well you sleep. Even a small amount of alcohol -- a glass of wine -- can disrupt your sleep cycles. If you suspect this may be a factor, go a week without alcohol and see if your sleep improves. It doesn't mean you have to abstain, but knowing the pattern lets you make conscious choices.

4. Get regular exercise. If your mind is busy all day but your body is not, quality sleep can be hard to come by. The body hasn't been active enough to want or need to lie down and rest. Exercising for at least a half-hour a day helps set the stage for ample sleep.

5. Mine your dreams. Once you're getting enough sleep and reaching deep sleep, try tapping into your dreams. Start by jotting down a few notes in the morning -- even if all you can remember is an image, feeling, or thought. Once your unconscious self knows you're paying attention, it will serve up dreams more regularly and with greater depth. With dreamwork, sleep goes beyond being restorative for health and well-being; it becomes a true opportunity for growth.

Text by Tracy Gaudet, M.D.

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