Many patients complain they do not get enough sleep at night. They either cannot fall asleep, stay asleep, or wake up too much at night. Sometimes a graveyard work schedule disturbs their sleep. Other times they find their sleep disturbed by worries, physical discomfort, or they simply just cannot fall asleep. Sometimes a medical condition like sleep apnea disturbs the person’s rest. Other medical conditions like hormone imbalances and other chronic illnesses can disturb sleep. Finally, mental health conditions like anxiety and depression can adversely affect sleep.

Not getting enough sleep can affect your waking life. People who do not get enough rest at night find themselves feeling drowsy during the day. They do not think as clearly and find it harder to pay attention to things. You become more forgetful. It can increase your appetite and cause carbohydrate cravings. It can reduce your sex drive. Lack of sleep can cause people to become cranky and irritable. Over time, a lack of sleep can contribute to depression.

From our own personal perspective, we experience sleep either as a blackout or dreaming. We go to bed and sometime later we awake, with a blackout in the middle. We cannot account for what happened during the blackout. Knowing we had the blackout tells us we were asleep. The other way we know when we have been sleeping occurs when we realize we are dreaming and wake up from a dream. This is how we psychologically experience sleep.

Research has found our sleep goes through a series of repeating stages through the night. We get our deepest sleep early on, and then our sleep becomes lighter and lighter through the course of the night. The first few hours is when we experience the blackout. Because we experience lighter sleep as the night goes on, that is the reason why we wake up. This is the time when we dream more actively.

The funny thing about sleep is that we can be in a light stage of sleep but think we are awake. If we are lying in bed, have conscious control of our muscles, and are aware of our surroundings, we think we are awake. In fact, research has shown you can be in a light stage of sleep and be in control of you thoughts, muscles, and be aware of our surroundings. You might think you are awake but actually be asleep.

The fear of not functioning adequately the next day is the greatest concern people have when they think they are not getting enough rest. Here is the situation. You wake up in the middle of the night and cannot fall back to sleep. You have a busy workday ahead of you. You begin to think “If I don’t get enough sleep, I won’t be able to do my work. If I can’t get my work done my boss will fire me.” Worrying about not sleeping because the concern, and guess what that does to your sleep. You cannot sleep. Worrying about not sleeping causes you not to sleep.

The fact is you need not worry. Even though you might not get the rest you think you need, you will get enough to function adequately the next day. Whenever I ask patients if they can function the next day after a restless night, they invariably tell me they can. So set your mind at ease. If you lie in bed comfortably with your eyes closed, and stay there, you will get the rest you need.

I want to make some recommendations on how to improve your rest. Let me say this in advance though. There is NO sure cure for insomnia. There is no pill, machine, or technique that will give you a guaranteed eight hours of uninterpreted sleep every night. However, using the techniques I recommend will improve your rest and allow you function adequately during the day.

• Get a medical assessment – As I said at the outset, you might not be sleeping well due to a medical or mental health concern. If you have recurrent insomnia, the first step is to talk with a physician. This might include having a sleep study. If there is a mental health concern the physician might prescribe non-addictive medication that will improve your mood. Some of these medications will also help with sleep. If pain is disturbing your sleep you might need to consult with a pain management specialist.
• Lead an active day – This might seem like common sense, but common sense is not that common. If you lead a sedentary lifestyle and take naps during the day, do not be surprise to find you have trouble sleeping at night. If you are having trouble sleeping at night, avoid taking naps during the day.
• Set aside enough time for sleep – Again this is common sense but often people do not do this. Perhaps they burn the candle at both ends. Graveyard workers typically have this problem. If you work a graveyard shift you must decide when you are going to set aside time to sleep. Will it be shortly after you get off work, or will you stay up and then go to bed in the afternoon. Whatever you decide to do set aside enough time and jealously protect that time from outside disturbances. Do not take calls or set appointments when you are supposed to be in bed sleeping.
• Have a bedtime routine – Go to bed and get up at the same time. Engage in relaxing activities prior to going to bed. Avoid activities that will arouse you just before going to bed. Getting into arguments with family members just before going to bed is a good way to disturb your sleep. Take some time to relax, watch TV, read a book, or engage in other relaxing activities for an hour before going to bed. Then try to stay in bed until it is your usual time to get up.
• Use your bed and bedroom primarily for sleeping. You condition yourself to falling asleep when you primarily use your bed for sleeping. Avoid using your bed to eat, argue, watch TV, or to work.
• Reduce stimulation – We sleep best in a quiet, darken room. If you have to sleep in a noisy, light-filled environment, compensate with earplugs, eye-shades, heavy blinds, or white noise.
• Avoid stimulants prior to bedtime – This includes taking medication that will stimulate you, drinking caffeinated beverages, eating sweets just before bed, playing videogames, watching disturbing television programs, working, reading the mail (that is, looking over your bills and wondering how you are going to pay them), or beginning a discussion about problems.
• Deal with problems during the day – Our daytime lives are filled with distractions to keep our attention away from other problems. When all the distractions have subsided, these problems come to our awareness. This can often occur at night when we are trying to sleep.
• Do constructive problem solving if you are lying awake thinking. I do my best thinking at 3 AM. Sometimes I have a problem in my life that I take to bed with me. I do not choice to take it to bed with me, it just crawls in there next to me and keeps me awake. While lying in bed restfully, relaxed, with my eyes closed I think about the concern and develop a plan of action. I avoid negative thinking like catastrophizing about the problem, making myself angry, and get overwhelmed by the “what ifs.” I also avoid hopeless thinking and self-critical thinking. Negative thinking serves no useful purpose when trying to make a plan of what I am going to do about a problem. After I’ve been mulling over the problem for a while I might get up and jot down some things I plan to do about the problem the next day. After doing that I tell myself, “that’s enough of that, time to go back to sleep.”
• Meditate – Many times I cannot sleep simply because I cannot sleep. There are no problems or physical discomfort keeping me from falling asleep. There are any number of meditative methods you can use. The goal of these techniques is to control what your mind is doing while you are lying in bed ostensibly awake. These meditation or mindful techniques include the following; planning your upcoming vacation, prayer, doing math problems, breath counting, contemplating something that interests you, and mantra meditation. Meditation is an equivalent form of restfulness as sleep. Oh by the way, at some point in your meditation, you will eventually fall back asleep.
• Stretch if you feel restless – You just cannot lie still. You are tossing and turning. Sometimes it helps just to get up and do a little stretching in order to relax your muscles. I am not talking about a full blown workout, just some stretching exercises.
• Get up and do something for a little bit. This is one of my most effective techniques for getting me back to sleep. Let us say I have tried the constructive problem solving. I tried the meditating but I still cannot nod off to sleep. I used to get up and watch some TV for about a half hour. I do not have to do that anymore because I watch something on You-Tube with my smart phone, lying in the comfort of my bed. I like to watch something that holds my interest somewhat but does not captivate me. While I am watching it my eyes will start to close. The next thing I know I am only listening and not watching. At this point I turn off You-Tube, put the phone away, and try to go back to sleep. Generally I am pretty successful at doing that.
• Stay in bed as much as possible – As I mentioned earlier, set a time for sleeping and stick to the schedule as much as possible. Stay in bed.
• Reassure yourself – Again, as mentioned earlier, if you stay in bed, lying restfully, with your eyes closed you will get the rest you need. There is a good chance you will fall back to sleep or be in a light stage of sleep and not realize it. Reassure yourself “If will get the rest I need if I just stay in bed with my eyes closed” if you begin to fret about not being able to function the next day.