How to Sleep Better without Medication
What if I told you that most people could experience significant sleep changes without medication?
Many would dismiss such a claim. The medical field tends to support medication as the go to intervention. But did you know, health insurance companies are now encouraging the use of Cognitive Behavioral Therapy for Insomnia (CBT-I) first before medication is tried? Many of us don't necessarily trust health insurance companies, but we need to consider- Why the emphasis on CBTI-I?
I am a supporter of psychotherapy (aka "talk therapy") and I am conservative with my views of drugs as an intervention. It can be hard to find research that emphasizes psychotherapy over medication, unless we are talking about insomnia or sleep disturbance. Research study after research study not only finds CBT-I effective, they have found this therapeutic approach more successful than medication!
According to research studies: CBT-I, a type of talk therapy, is more effective than medication!
Let that sink in for a second- in a healthcare environment that assumes medication "gets to the root cause" of disorders, it was found less effective than talking to a therapist (and following through with lifestyle changes). It's not every day we find a result like this, so what is it about CBT-I that is so effective? CBT-I is an approach that targets our cognitions and behaviors, or in other words, how we think and what we do as it relates to our sleep. Medication would target our chemistry. So while sleep medication may work, to recognize that psychotherapy is more effective and has longer lasting effects supports the following ideas:
- We have more influence over our sleep than we realize.
- We can all benefit from looking at how we think about sleep and what we do to support our sleep.
- The root cause of insomnia or poor sleep goes deeper than our chemistry.
What if I don't want to go to a therapist?
Maybe you don't have clinical insomnia or maybe you are either unable to afford a therapist or do not want to make the commitment to pursue psychotherapy.
The research on CBT-I shows us that there are many factors that could have an impact on how we sleep and there is often a number of factors we need to address before we experience some relief. We now know that addressing the following factors can significantly improve our sleep:
- Our thoughts and beliefs about our sleep
- Our sleep environment
- Our lifestyle
- Our sleep schedule
- Becoming our own curious scientists and tracking our sleep and gaining an understanding of what is and isn't having a positive effect on our sleep night after night
For additional support or options, there are also sleep improvement workbooks and online apps that could be helpful. One app developed by the Veteran's Health Administration is free: https://mobile.va.gov/app/cbt-i-coach
Preparing for Change
We want a change yet it can be one of the hardest things to start. Preparing may not seem much (and may even feel like procrastination) but may be the most important stage of this important change.
Let's organize ourselves as we prepare for change with a list:
- Educate yourself. Gathering information, reading about how to change, what to change, and why you should change is critical. Research is showing us that how we think has a major impact on our sleep. Reading through the sleep myths may help you buy into the changes you are about to make.
- Identify one thing to change first. Change is hard. Making many changes at once has been proven to not be very effective. Typically, it is recommended to only make one change per week. If this is a particular tough change or one that was hard to stick to, you may work on this one change for a few weeks.
- Map out the time and schedule you need for this new change. New things need their space. We won't do something if we don't know how we can fit it into our days or weeks. It's estimated we need about 30 days to develop a new habit. Allow yourself this time.
- Identify what may be unique to you and allow yourself to embrace potential changes to your original plan. The sleep changes you need to make need to be individualized and are unique to you. If you have medical issues that could interfere with sleep, consultation with the appropriate medical professionals may be the main focus of your change.
- Remind yourself that there is no "magic bullet" when it comes to sleep. Addressing many small factors could translate to a significant impact. Changing thoughts/beliefs and actions/behaviors do not happen overnight. These changes take time and their effects unfold over time. It is not uncommon to hear that someone was successful in making changes to their lifestyle only to truly experience the benefits of the change within 1-2 months of the change.
Medical Issues that Impact Sleep
One of the most significant ways to improve sleep is to improve your health. Everyone benefits from self-care. Identifying and addressing the medical issues issues that impact sleep the most would have significant effects on sleep.
- Sleep apnea (snoring or interrupted breathing while sleeping)
- Cardiovascular problems
- Respiratory problems
- Thyroid problems
- Eating Disorders
- Kidney Disease
- Vitamin Deficiencies such as Vitamin D, B12 and Iron
Many items on this list are common and relatively minor. Taking the time to get a physical, get blood work, and explore current symptoms could really pay off long-term.
As we reflect on this list, we may notice that most of these medical conditions that cause poor sleep are treated or improved by lifestyle changes. We keep making a connection between lifestyle and our sleep.
Causes of Insomnia
What do you think contributes the most to your insomnia?
Technology, Culture and Melatonin
Modern human lifestyles have changed dramatically over the last 100 hundred years. Our lifestyle changes have had more of an effect on our circadian rhythms than we usually recognize. For those who do not know, circadian rhythms are the mental, physical and behavioral changes in an organism that follow a daily cycle. Our circadian rhythms are the reason we tend to get sleepy or wake up around the same time each time. Circadian rhythms are influenced by many things in our environment and light is one of them.
We need melatonin to sleep and we produce this natural. Does it make more sense to take melatonin supplements are avoid what is actually depleting us of our natural supply of melatonin?
Can you image a day without television? Or a smart phone?
There is a reason why people report feeling refreshed after camping. Maybe it's the connection to nature but having a few nights "off the grid" without any artificial lights can allow our bodies to find their natural rhythms once again. The study of circadian rhythms is called chronobiology. As our lifestyles changed and we removed ourselves from nature, we began to understand how much our rhythms and sleep cycle depends on natural cues in our environment. Our circadian rhythms largely depend on daylight to regulate our cycles. Blue light in particular sends messages to our brain to delay or decrease the release of melatonin- a substance that can help us initiate sleep or stay asleep.
So what about our modern lives is unnatural?
Many of us can go about our daily lives without thinking much about nature. We control our light, our temperature, our humidity and come into contact with man-made substances and surfaces throughout our day. We may even have jobs and lifestyles that go against our natural rhythms routinely- night shifts, straining to stay awake and finish a project or task, or longer shifts without breaks. We may find ourselves in offices full of artificial light with regulated temperatures for most of our waking hours. Many of us may even complain we did not experience daylight during the wintertime. Some scientists have argued that sleeping 8 hours and only sleeping when its dark is a modern construct as well. Our average physical exertion has dramatically decreased and our daily chronic stress has dramatically increased.
Interestingly enough, scholars have found evidence of drastically different sleeping patterns in the dark ages. Writings show that sleep varied throughout the seasons and doctors of the time referred to a "second sleep" during the winter months. There is evidence that our natural sleeping pattern during darker, colder months was longer but includes a natural awakening in the wee hours of the morning for an hour or to before returning to sleep. Some would say how we define insomnia today is a social or cultural construct more than a "problem" for many people.
It's hard to sleep in a caffeine and work addicted world.
Culture has reinforced caffeinated beverages at all hours of the night in quantities that far exceed what our bodies can handle. While many may claim caffeine does not affect them, if it does not prevent you from falling asleep and if it does not prevent you from staying asleep, it is disrupting your quality of sleep and causing you to get less restorative sleep.
Overworking ourselves has its own impact on sleep. It creates chronic stress and nighttime worries or difficulty "turning off our brains." Beliefs that we don't need sleep or that sleep is somehow optional or that we may miss out on something if we take time for our own wellness compete with our natural need for sleep and rest.
Sleep Hygiene by Dr. Judy Allen
A Quick Guide to Improving Sleep
Do more of:
Do less of:
Expose yourself to bright light upon wakening and throughout the day.
Avoid bright artificial light after dusk. Avoid blue light from screens (smartphones, computer screens, TV)
Create a relaxing sleeping environment. Avoid being too hot, too cold, consider using a sound machine, and pamper yourself. Technology in our bedrooms can be more disruptive than we think. Black electric tape could be a simple solution for bright digital clocks.
Avoid sleeping on the couch or multiple locations. Avoid a room that is too hot, too cold, too loud, or has an unsoothing element.
Remember to drink water.
Limit caffeine and avoid caffeine after 2pm.
Eat healthy, smaller meals and finish earlier in the day.
Avoid heavy meals close to bedtime
Find a regular routine and keep it even on weekends.
Avoid daytime napping and erratic sleep schedules. Do not force yourself to stay awake or go to sleep.
Using your bed for sleep when you are feeling sleepy.
Using your bed for eating, watching TV, worrying, etc. Instead- use another location for these activities- even if it's in the middle of the night. Avoid just laying in bed and struggling.
Reflecting on your day before it's nighttime. Plan ahead, allow yourself to be in touch with your worries and thoughts- they will be there waiting for you at night anyway.
Avoiding issues and distracting yourself. Worries and anxieties come crashing down on us at night when we finally have the mental space for them.
Activities that unwind and cool the body before bed. Try meditation, soft music, light stretching, etc.
Working out within 2 hours of bedtime or taking a hot shower or hot bath too close to bedtime. These may be things to do before you start to unwind.
Have regular medical check ups and follow recommended regimens and diet.
Going against medical advice without having a conversation with your medical professional. Eating what you cannot process or worsens your condition is an example of how our lifestyle and diet may have a unique impact on our sleep.
Be gentle with yourself. Allow yourself to accept that you are a work in progress. One bad night's sleep is a lesson, it is temporary, and you can change.
Avoid being harsh or judgmental. Don't beat yourself up. Who needs a harsh critic? You got this!
What we learned about our sleep
We have learned a lot about what can have a negative impact on our sleep.
- We can greatly influence our sleep by letting go of negative beliefs about our sleep and by changing our habits to better support our sleep.
- We can make small changes to counteract how technology and our modern lifestyles have negatively impacted our sleep.
- Giving us just a few minutes (10-20 minutes) during the day to plan and relax could save us lots of time tossing and turning later.
- Unwinding before bed could have a significant impact on our sleep.
- Keeping a regular schedule 7 days a week can balance your sleep cycle.
- Everyone's sleep is unique and the key to sleeping better is to explore what is impacting your sleep.
- Some medical issues we may not readily associate with insomnia could be impacting your sleep. Follow up with your medical providers. A recommended lifestyle and diet may solve your sleep issues.
There are Times We Need Help from Professionals
Adopting a lifestyle that supports sleep can benefit everyone but sometimes this is not enough. Sometimes, someone struggling with sleep needs to be evaluated by a medical doctor or a mental heath professional. These professionals can help identify the reasons for your sleep issues and identify the best strategies to address them.
Many times, we may understand what lifestyle we need to adopt to feel better but need support. If you have already started to make changes to improve your sleep, finding additional support may be the next step. Some may seek online support or use sleep-related apps. Others may seek support groups, therapists, or regular engagement with a medical wellness professional.
Whatever sleep recovery path you are taking, I hope this information has helped you along the way.