Suggestions for better sleep

The following is based on personal experience, my dealings with doctors,
and considerable research over the years (books, web pages, a sleep study, a seminar ...).
You are not me, and some of this may not work for you.
If you don't like my suggestions, or they fail, keep looking and experimenting.
Problems with sleep are not to be taken lightly, and can take considerable time and effort to mitigate.

If you donít improve after trying the tips given below, consult a doctor or other specialist.
Be prepared to invest time, effort, discipline, and possibly money.
You may need a sleep study and/or cognitive behavioral therapy.
Keep at it, and don't get discouraged. The effort is worth it, in the end.
I've had to work for years to get better sleep.
It ain't perfect, and never will be, but it's much better.
When I describe my sleep routine to people, they always think it takes too long.
It doesn't, because my waking hours are so much easier and so much more productive.
Sleep is necessary; that's why denying it is a favorite technique of torturers.
Do yourself a favor, and get the sleep you need.

Further information can be found here and here and here and here.

Preparation; habits; environment.

The bedroom is for sleep, sex, and changing your clothes only.
Try to get your body and mind to associate bed and bedroom with sleep.
Associating a lot of other things with bed will make falling asleep more difficult.
If you have to use the bedroom for other purposes (e.g., if you're in a studio apartment,
or it's the only quiet place for your home office) find a way to treat the bed as a separate space --
maybe cover it during the day, so that removing the cover signals the approach of sleep.

Get on a schedule.
Go to sleep and get up at the same times every day.
Find the best time. For me 10 p.m. works better than midnight.
Part of a schedule should be rising quickly in the morning.
Get up as if you have to be somewhere in five minutes.

Follow a ritual.
I sit in a chair and read for an hour with my dog in my lap, while listening to a
recording of crickets and flowing water. After that, I use my massage chair,
do yoga, meditate, take 1.5 mg of melatonin, and go straight to bed.
I put on my sleep mask, and do the Zen trick (see below).
Then I do a Qi Gong breathing ritual; maybe half the time, I fall asleep in the middle of it.
I should then visualize a peaceful scene, except that I always seem to forget that step.

Wind down.
This is a crucial part of the ritual. In my armchair I do Sudoku or read,
because these are calming activities. Usually, my dog sleeps in my lap while I do.
You may not be able to spare an hour for your bedtime ritual, but invest what time you can.

Keep the room like a cave: dark, quiet, and cool.
And I do mean dark. Try to eliminate all light.
If your alarm clock emits light, turn it away from the bed. Etc.
As for quiet, if there's external sound you can't block out, use a noise generator.
Dohm, Sound Oasis, and Sharper Image all make them.

Sleep cool, not warm.
This sounds counterintuitive, but all the experts recommend it, and keeping a cool room and bed seems to help me.
Lowering the temperature on your thermostat for the evening suggests to your mind and body that it's nighttime.
Splashing water on your face cools it and helps put you on the path to sleep.
Body temperature control can also involve seemingly paradoxical actions,
such as wearing your socks to bed, or taking a hot bath shortly before bedtime.

Consider sleeping separately.
If your partner snores or kicks in their sleep,
or you're a light sleeper, separate rooms may be in order.
If you lack sufficient space, invest some thought:
a bigger bed, sleep on the floor, sleep on the sofa in the living room, ...

Keep a sleep log.
Log your sleep. Look for patterns: are there particular days you sleep
better or worse? Why? Do exercise, diet, stress correlate with worse sleep?
Does coffee after a particular time of day disrupt your sleep?
You can find a sample sleep diary here.

Quality bedding and bed.
You don't want a lumpy, too-hard/soft mattress. It will only keep you awake.

Cooling pillow and cooling sheets?
I haven't tried this, but some people recommend it. They're expensive, I hear.

Turn on a noise machine or quiet, calming music.
This is useful, and it also helps block out external noise.

Light, sound, and the body in general.

Avoid screens for at least an hour before bed.
This means no TV, computer, or cell phone.
Not only do they distract and excite you, but their light is enough like
sunlight that they fool the mind into thinking it's not time for bed yet.

Avoid evening napping.
It's taken me a long time to realize that falling asleep in my armchair
in the evening is a major cause of sleep disruption. From now on, I'll
do everything I can to avoid this. The phrase "evening napping" refers
to those micro-naps that sneak up on me when I'm tired.

Avoid bright light before bed.
Your brain interprets dimmer light as the approach of night.

Blue blockers.
Use blue-blocker glasses for an hour or two before going to bed.
Uvex, Ra Optics, and other companies make them.
If you wear glasses and don't want a prescription pair,
there are kinds that will fit over your specs.
Be sure to get the amber-colored ones that block all blue light.

No TV, radio, or books in bedroom. No phones.
Especially no phones -- if someone wants to text you at 3 a.m., that's their problem.
They can't reasonably expect a reply until you're awake.

Full-spectrum light.
When you wake up, get some sunlight. Also get some during the day.
If you can't get it outside, use a full-spectrum light for a while instead.
The idea is that you're serving notice to your body and mind that
it's now daytime, so wake up and stay awake.

Exercise daily.
This may not be possible for everyone, but try to exercise as often as you can.
You may be able to sneak it in -- say by running up the stairs at work, instead of taking the elevator.
Tire yourself out.
I've found that more exercise is better than less. 3 hours a day is ideal.
Yes, this is not realistic for people who are not retired.
But it shows the importance of physical movement in managing sleep.
Avoid exercising too close to bedtime.

Do yoga and/or meditate before bed.
This one is optional, for those who are physically capable and interested.
If you are, I suggest making one or both of these part of your bedtime ritual.
They have other benefits besides improving your sleep.
Timing is important.

Eat meals, at the same times every day.
This one surprised me, but it made a clear difference. Don't just graze.
Eat actual meals and avoid snacking.

Avoid caffeine, alcohol, and nicotine.
Here some will cry out "but beer helps me sleep!". No. Alcohol disrupts your sleep cycle.
The other two harm sleep in their own inimitable fashions.
Sensitivity to caffeine seems to vary; I used to have a sign above my desk "No coffee after 10:30 a.m.".
I'm not suggesting you become a total teetotaler. Use common sense with these things.
For instance, I metabolize caffeine slowly, so I don't drink coffee past noon, and usually mid-morning.
But I find that a cup early in the day helps prevent napping, and thus helps nighttime sleep.
(Your mileage may vary. See the paragraph on naps, below.)
Now that I think of it, also avoid psychoactive drugs.
You know what I mean, you recreational drug users.

Cut out the sugar.
Stop eating sugar. This isn't easy, because it's ubiquitous in our food.
But when I had a recurrence, and I'd read an article by someone who'd stopped eating sugar,
I thought it was worth a try. And cutting out sugar did seem to improve my sleep.
I'm still experimenting, going on and off it, but it does seem to help.

Control salt intake.
I eat a lot of salty food, sometimes including a bedtime snack. (I have a sodium deficiency.)
But I read that salt is slow to get flushed out, and can trigger multiple awakenings.
Since I fail to get back to sleep after a third awakening to urinate,
I'm restricting my salt intake to mornings. I hope this helps.

Cold showers?
This is a tough one, but I think they can help.
By abolishing sleepiness, you "bank" any sleep debt.
You're more alert.
Having said that, I repeat: this is a tough one.
This is, of course, not for evening, because it will wake you.
First thing in the morning is probably best.

Hot, or at least warm, showers
If you have a problem with rigidity or muscular tension, a hot or warm shower before bed may help.

Tart cherries.
I used to drink dark tart cherry juice before going to bed.
This sounded to me like new-age B.S. from a hippie dietician,
but I tried it and it seemed to help. Maybe it will help you.
Really should get back to doing this.
Later, I stumbled on research that says that tart cherry juice increases melatonin.
I also eat dried tart cherries, either a few handfuls, or on my breakfast cereal.

Falling asleep, and getting back to sleep.

Overview of falling asleep.
You may prefer something else, but my routine is:
- Preparation:
--- Read for an hour with the dog in my lap, while listening to crickets and water
--- 20 minutes in the massage chair
--- 20 minutes of yoga and stretching
--- 20 minutes of meditation
- Urinate
- Take half a 3-mg melatonin
- In bed:
--- The Zen trick
--- Qi Gong breathing
--- Imagery, if still awake (e.g., conjure images of faces or flowers)
Yes, this routine takes a lot of time. (But most of the practices are good for reasons besides sleep.)
Mileage may vary. Season to taste.

Focus on your breath as you fall asleep.
You can do box breathing, or count the breaths. Whatever works.
It's better than counting sheep, because it's right there with you, all the time.
See "Zen trick", below, for a suggestion about a specific kind of breathing I've discovered.
These days, though, I've combined that with Qi Gong breathing.

Relaxation, and mantra.
Youtube suggests relaxing your body from your face downwards (including forehead and mouth),
tensing each section if necessary, holding, then relaxing it.
One interesting thing about this is the importance of relaxing your facial muscles.
This is essential, at least for me.
You can successively tighten and relax all the muscles in your body,
I do them all together, including the face (see "The Zen trick").
I've found it's especially important that your face be relaxed.
This means forehead, jaw -- all of it.
After physically relaxing, repeat a mantra in your mind.
Experiment with the speed, from fast to slow, to find out what works.
One effective mantra is to repeat to yourself "Don't think, don't think, ..." .
This is supposed to be what Navy fliers say to themselves.
I was surprised to find that this is a highly effective mantra.
Thank you, Uncle Sam.

The Zen trick.
In a memoir about living in a Japanese Zen monastery,
a Westerner recalls a trick he learned from one of the monks:
tense all the muscles in your body and keep them tense;
then, when you're ready, relax them while simultaneously coughing.
I've discovered that it helps to take a very long inbreath afterward,
preferably through the nose, then expel every last bit of air,
preferably through the mouth, with lips flat and wide (not rounded).
The exhale should sound harsh.
Pay attention to your body: it should feel like a balloon inflating and deflating.
Pat attention to the muscles: they should relax with the out breaths.
Repeat until satisfied.
Note: it's crucial that your face and jaw be relaxed.
After this, continue with imagery (see below).

Imagine a scene.
The picture should be static and peaceful. Neither you nor anyone nor anything should be in motion.
I like to picture myself lying in the mountains, looking up at the stars.
Sometimes I imagine sitting next to a stream, my dog next to me.
Or I'm lying on a raft in the middle of a body of water, looking up at the stars.
The image may work better if it's associated with a happy memory.
If you're one of the tiny per centage of people who can't visualize, I sympathize.
After imagery, you can add SWAN (see below).

SWAN (sigh with a noise).
Use this in combination with imagery:
Take a deep breath, then let it out with sound, like an audible sigh.
Focus on the breath.

Wear a sleep mask.
These are cheap, and easy to find. I've seen them at Walgreens.
I use a mask from Alaska Bear, which blocks more light than others I've tried.
If there's much light, sometimes I'll wear two masks, one on top of the other.

I keep intending to learn and practice this, but haven't got around to it yet.

Mouth taping?
This can't be serious, so I pass it along for the humor: Rivers Cuomo says
"Somebody told me if you tape your mouth shut with athletic tape, you'll get
much deeper sleep. I tried it, and it works great. At night, I say good night
to my wife and then tape my mouth shut." Yes, you're supposed to breathe
through your nose, but isn't this a bit extreme? Besides, he has a mustache.

Lavender is said to work well.
You can even buy lavender-scented sleep masks.
Other lavender sleep help is easily found with a web search.

Night awakenings.
If you wake up, donít open your eyes. Stay as if asleep.
If you have a problem with needing to urinate during the night, get up right away and go to the toilet.
Staying in bed and fighting it will put you in a state of wakefulness, which will make it harder to get back to sleep.
If possible, feel your way to the bathroom without opening your eyes.
(Opening your eyes promotes wakefulness.)
In any case, minimize your movement, and your exposure to light.
If you woke up during a dream, make a mental note. When you come back to bed, remember the dream. This helps me get back to sleep.
Also, consider not drinking liquid after a certain time of evening.
(However, avoid dehydration, which can worsen sleep.
I front-load my fluids, drinking them in the morning and afternoon, but not in the evening.)
You will have to experiment to find what time works for you.
Pelvic floor exercises supposedly can help with bladder control, even for men. (I take tamsulosin instead.)
If you canít get back to sleep with any of the tricks described on this page, get up and do something peaceful,
somewhere other than the bedroom. Sometimes I read a math book.
My most recent favorite is Thinking and Being, by Irad Kimhi, a philosophy book that's incomprehensible.
Reading it is soporific in the extreme.
A high school teacher of mine swore that reading Marx's Kapital in the original German never failed
to put him back to sleep. Of course, you need a reading knowledge of that language.
But you get the idea.

I've noticed that there are three things that must work for me to get back to sleep:
    Muscular tension must be absent. See Zen trick, or use cognitive behavioral therapy techniques.
    Breathing must be regular. Focus on it.
    Mind must not be preoccupied. Learn meditative focus, and visualize a peaceful scene. Nothing in the scene should move
(waving grass or a brook is okay, but no animals, people, or transportation in motion).

One last technique I've found: if you remember a dream, think about it.
Try to re-enter (re-run) the dream. This works especially well for me.
Of course I mean a dream you just had, or were having, when you woke.

A lot of people have apnea and don't know it. You may want to read up on it, and have a sleep study done.
I had what was supposedly too mild to be a real case, but I would wake up unable to breathe.
I found that rolling out of bed onto all fours got me started again.
Eventually, I got a CPAP, and that, though annoying, solved the problem.
I no longer have to use it (I lost weight), and gave it away, but if you have the signs of apnea, investigate it and get treatment.

Chemical and physical assists.

Weighted blankets.
This is quite the rage recently (early 2020). You can find reviews in various places,
which seem to be the usual: pushing products, instead of objective reviews.
Be sure to get the right length for your height, and weight for your body weight.
Get one with a cover, so you don't have to wash it instead of the blanket, which might break the beads.
I bought one. It seemed to improve my sleep a bit, and I used it for perhaps a year.
It seemed to eliminate my leg cramps, too.
On the other hand, it made getting in and out of bed, and changing position, considerably more difficult.
In the end, I concluded that it was a placebo, and abandoned it.
I noticed no change in my sleep afterward.

This works for some people, and not for others.
I used to think that routine use might be unwise.
I take it before bed, on the recommendation of my neurologist.
Also, for when I wake in the middle of the night, I keep a pill on the bedside table.
I use half a 3 mg pill, in case more might affect the body's melatonin processing.

Cannabidiol (either oil, or water-soluble) taken sublingually may get you to sleep, or back to sleep, more quickly.
For me, this was a placebo that failed, and I no longer use it,
but many people swear by it. "Your mileage may vary," as they say.
And yes, this is now legal in all states, or nearly all. Do your research.
For instance, in Kansas, THC content must be zero per cent, not the usual 0.3%,
so if you live there, you may want to be careful what you order on the Internet.
(Personally, I wouldn't worry. You're unlikely to get busted.)
Routine use, as with any sleep drug, may be inadvisable.
CBD is not like weed. It will not get you high.
Lastly, solid and consistent as user reports seem to be, they're all anecdotal.
There's very little real research, so you'll have to decide for yourself.

If you can't sleep, or you wake up, and your significant other is agreeable, have sex. The time is certainly well spent.
If s/he doesn't want to, or doesn't like being awakened, or you're alone, the alternative is masturbation.
The problem with sex, of course, is that you'll likely have to get up an extra time to urinate.

Prescription drugs to put you to sleep.
These should be strictly temporary.
They can affect you in subtle ways you may not realize for a while.
I know this from personal experience, but the medical research supports it, too.
Also, if you stay on long and then stop, expect to have brutal rebound insomnia,
which may go on for many months. Trust me on this.

Prescription drugs to wake you up.
If you've had a poor night of sleep, you might consider taking a small dose of a stimulant such as Ritalin in the morning.
This is like drinking coffee, or taking that cold shower.
It helps you get through the day more easily, and when evening comes, your body should fall asleep more easily because of the sleep debt.
That said, be sure not to become reliant on it, and be sure to ask your doctor's advice before you start.

Ferrous sulfate for your ferritin levels.
If your ferritin levels are low, and you have a certain medical condition, this can affect your sleep.
Unfortunately, testing ferritin is nonstandard and costs in the low three figures.
I had the test combined with a regularly scheduled standard blood test, found that my levels were low,
and started taking ferrous sulfate every other day, which has helped my sleep.
Please do not take my advice alone. Consult your doctor on this.

Massage chair.
These are fantastically relaxing. On the occasions I used them, I had great sleep afterwards.
So I bought one, and it helps.
Using it is an essential part of my sleep ritual now.
The main drawback is the cost, which is considerable (four figures).
If you decide to buy one, do your comparison shopping, try some out,
check the features, and consider reliability and warranty.
As with any expensive purchase, buyer beware.
Alternatively, consider regular massage from a masseuse or masseur.

Floating in an isolation tank.
Like massage chairs, this is fantastically relaxing.
Unless you have a lot of money and time, though, this won't be practical,
except on a very occasional basis.

Somewhat like massage chairs and isolation tanks, but I don't think it's quite as effective, at least for me.

There are now products that measure your sleep with mats under your sheets, so they're non-intrusive.
There are also wearable devices, like Fitbits.
Try this link for reviews.


To nap, or not to nap?
You'll have to figure this one out for yourself. Some researchers favor naps, and some reject them.
Experiment, and find whether you can make naps work for you, or not.
My own experience with them has been mixed.
Tip: don't let naps be too long, or much after noon.
While it's hard to stay awake, if you take a late nap, it will mess up your next night's sleep.

I wish you well. Good sleep is necessary to your long-term health and longevity.

Rev 30, 20220914