As we have seen, poor sleep can be both a cause and a consequence of mental health issues.
Whether it’s a cause or a consequence of your mental health symptoms, it is essential to try to re-establish healthy sleeping patterns to improve your mental health. Below are some techniques which can help.
We can lay the foundations for a good night’s sleep long before bedtime. Make sure that your day reflects the night you want to have and incorporate daily habits which will improve your night time sleep.
- Restrict caffeine from coffee and tea, and don’t have any caffeine after lunch. Espie, C. A. (2010). Overcoming Insomnia and Sleep Problems. London: Robinson, p. 115.
- Some people find that they sleep far better if they eliminate caffeine completely
- Caffeine triggers adrenaline and releases stress hormones
- Caffeine reduces REM sleep and slow-wave sleep Holland, J. (2015). Moody Bitches. New York: Penguin, p. 195.
- Reduce sugar intake, as sugar can be stimulating.
- Despite the immediate feeling of relaxation, alcohol has a negative impact on your quality of sleep
- As the alcohol gets absorbed into your body, mild withdrawal symptoms occur that may be sufficient to wake you, or put you into a lighter sleep Espie, C. A. (2010). Overcoming Insomnia and Sleep Problems. London: Robinson, p. 116.
- Avoid nicotine, as it has a stimulating effect on the nervous system, making it harder to fall asleep and stay asleep Espie, C. A. (2010). Overcoming Insomnia and Sleep Problems. London: Robinson, p. 115.
- Setting aside periods of relaxation during the day can help calm the nervous system, and improve night time sleep
- A short nap (about 20-30 minutes) can also be helpful in helping calm the nervous system, however if the nap is too long and involves deep sleep it can exacerbate insomnia
- Mindfulness meditation has been shown to improve sleep quality and decrease the severity of insomnia. Black, D. S., O’Reilly, G. A. and Olmstead, R. (2015). Mindfulness Meditation and Improvement in Sleep Quality and Daytime Impairment Among Older Adults With Sleep Disturbances. A Randomized Clinical Trial. [online] JAMA Internal Medicine, 175 (4), pp.494-501. Available at: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2110998 [accessed 8 Nov. 2017].
- Meditation of whatever kind can be helpful in rebalancing the nervous system and ensuring better sleep
Exercise can be helpful for sleep
- Establish a regular exercise routine, as it will contribute to deep sleep
- People who are physically fit have a better quality of sleep, so a good way to promote sleep is to get fit by exercising three times a week for 20-30 minutes Espie, C. A. (2010). Overcoming Insomnia and Sleep Problems. London: Robinson, pp. 117-8.
Exercise right for sleep
- Don’t over-exercise as this will lead to higher cortisol levels, leaving you feeling exhausted and wired
- Gentle exercise such as brisk walking, swimming, and yoga can be better for sleep than very intense aerobic exercise, especially if your adrenals are weak
- Yoga, qigong and pilates involves concentration and deep breathing, which can help regulate stress and anxiety
- Cardiovascular exercise is important as it increases endorphins, however it need not be extreme — a brisk walk for over 20 minutes four times a week is enough to raise endorphin levels
- Strength training twice a week can also be helpful for sleep
- Don’t exercise too close to bed-time, as it has a stimulating effect
- Leave at least 4 hours between exercise and bedtime
- Exercise outside
- 20 minutes exposure of daylight, preferably in the morning, will aid deep sleep
- Especially in the morning, as this will help to regulate your circadian rhythms (sleep-wake cycle)
- Without sunscreen or sunglasses, for at least 15-30 minutes between 8 and 11am
- Following a healthy diet and ensuring balanced blood sugar, reduced inflammation, and optimising digestion and absorption of key nutrients are all important for a healthy nervous system and good sleep.
- Eat proteins with every meal, but eat more complex carbohydrates at night, as these can help calm the nervous system Christianson, A. (2014). The Adrenal Reset Diet. New York: Harmony, p. 76.
- Foods impacting the availability of tryptophan, as well as synthesis of serotonin and melatonin may be the most helpful in promoting sleep
- These include nuts, seeds, tofu, cheese, red meat, chicken, turkey, fish, oats, beans, lentils, and eggsPeuhkuri, K., Sihvola, N. and Korpela R. (2012). Diet promotes sleep duration and quality. [online] Nutrition Research, 32 (5), pp. 309-19. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22652369 [accessed 14 Aug. 2017].
Read more about how to correct your nutrition and supplement in order to sleep better by clicking on the links below.
There is increasing evidence to suggest that the use of social media and technology before bed can be disruptive to sleep. Levenson, J. C., Shensa, A., Sidani, J. E., Colditz, J. B. and Primack, B. A. (2017). Social Media Use Before Bed and Sleep Disturbance Among Young Adults in the United States: A Nationally Representative Study. [online] Sleep, 40 (9), p.1. Available at: https://academic.oup.com/sleep/article-abstract/40/9/zsx113/3926043/Social-Media-Use-Before-Bed-and-Sleep-Disturbance [accessed 8 Nov. 2017].
If you were putting a child to bed, you would help them wind down, turn off their lights, and make sure their room was comfortable. As adults, we need to establish our own rituals to calm down and prepare for healing sleep.
Follow the following guidelines for good sleep hygiene and quality sleep:
- Aim to go to bed and turn off your lights at the same time every night
- Get up and turn on your lights at the same time every day
- Try to have lights out a full 8-9 hours before you need to wake up Talbott, S. (2007). The Cortisol Connection. 2nd ed. Alameda, CA: Hunter House, p. 98.
- Being in bed by 9 or 9.30 for lights out by 10 optimizes melatonin production, and can help minimize the second wind of high cortisol
- Lights out by 10pm and waking up at 6am or 7am is ideal to optimise circadian rhythms
- Studies of patients who experience mood-swings show that a regular sleep schedule helps them to keep their moods in balance
Start a wind-down bedtime routine 60-90 minutes before you plan to go to sleep. This will help you wind down, and signal to your body that it’s time for bed. Espie, C. A. (2010). Overcoming Insomnia and Sleep Problems. London: Robinson, p. 124.
You are a creature of habit, and your body will slowly start to fall into the pattern you set it. It takes 21 days to hardwire a habit, so go through the motions for 21 days, and it will become second nature:
- No stimulating physical exercise at least four hours before bedtime
- No computers or screens after 8pm — avoid the computer, electronic games, texting and similar activities before bedtime
- Avoid stimulating discussions or arguments at bedtime
- Write your worries down, one hour before bed, and make plans for what you might do the next day to reduce your anxiety
- This will free up your mind and energy for restful sleep
- Try 30-60 minutes of some/all of these relaxing activities thirty minutes before sleep
- Sleep yoga
- A warm, epsom salt bath
- Put 250-500g of epsom salts (magnesium sulphate) in a warm bath for 20-30 minutes, an hour or two before bedtime
- The magnesium is absorbed through your skin and has a detoxifying effect, and a calming effect on your nervous system
- As your body cools down after a bath, this is a natural signal for your body to sleep
- Have a massage, stretch or do a ten-minute yoga routine before bed
- Use a hot water bottle on your solar plexus- this raises your core temperature to trigger the proper chemistry for sleep
- Brush your teeth, get your PJs on, and climb into bed
- Set the thermostat so that your bedroom is slightly cool through the night, or open a window to get fresh air
- The ideal room temperature for sleep is around 18 degrees celsius Espie, C. A. (2010). Overcoming Insomnia and Sleep Problems. London: Robinson, p. 120.
- Use blackout curtains, get rid of TVs or radios with lights, and otherwise make your bedroom as dark as possible
- Consider wearing a sleep-mask
- Try to ensure that your bedroom is as quiet as possible, and if not, wear earplugs
- Make sure your bed, pillows and bedding are comfortable
- Don’t use the bed for work, watching TV or anything else that causes your brain to associate the bed with other activities
- Sleep experts claim that bed should be reserved for sleep and sex only
- However we are all different, so figure out what works best for you personally
- Allow 30-60 minutes of reading in bed before you aim to have your lights out, although some sleep experts claim that reading in bed is too stimulating
- Again, work out what works best for you personally
- Don’t try and force sleep, if you can’t sleep, get up and do something relaxing such as reorganise your cupboards, have a bath, meditate, do sleep yoga
- After 20 minutes try to go to bed again
Hyman, M. (2009). The UltraMind Solution. New York: Scribner, pp. 319-21. Lake, J. (2009). Integrative Mental Health Care. New York: W.W. Norton & Co., pp. 289-306. Stephens, S. (2010). The Effortless Sleep Method. USA: Effortless Sleep Products. Holland, J. (2015). Moody Bitches. New York: Penguin, p. 206.
A wide variety of electronic devices are now available to help you improve your sleep, from apps to monitor your sleep, to alarm clocks that lull you to sleep and wake you up naturally by simulating sunset and dawn.
Your brain oscillates daily between four different brain waves:
- Delta waves (associated with deep sleep – 0-4 cycles/second)
- Theta waves (light sleep or drowsiness – 4-8 cycles/second)
- Alpha waves (wakeful but relaxed alertness, focused and creative – 8-13 cycles/second)
- Beta waves (fully alert, to stressed – 13-40 cycles/second)
Talbott, S. (2007). The Cortisol Connection. 2nd ed. Alameda, CA: Hunter House, p. 196.
In an ideal world your brain would make a smooth transition from Delta to Theta to Alpha to Beta throughout the day. This would facilitate optimal sleep and cortisol control. Due to stress, people spend too much time in Beta and not enough time in Theta, Alpha or even Delta. This can disrupt sleep patterns as well as hampering focus and creativity.Talbott, S. (2007). The Cortisol Connection. 2nd ed. Alameda, CA: Hunter House, p. 197.
To induce relaxation and aid sleep, try listening to some binaural beats online.
There are also many apps available which help generate the brain waves necessary for sleep. To reduce the amount of time before you fall asleep, try listening to them with earphones.
There are a number of electronic devices and apps which can help monitor our sleep, thereby giving us a better understanding of the quality and quantity of our sleep. We can use this information to tweak our habits to sleep better.
- Allows you to
- Record the duration of your sleep
- Set a silent alarm which wakes you with a gentle vibration
- Understand your sleep quality by tracking light, deep and REM sleep
- Work towards a consistent sleep routine, by giving you reminders to stay on track
Garmin Vivosmart and Garmin Vivoactive
- During sleep mode, the device monitors your rest
- Sleep statistics include:
- Total hours of sleep
- Periods of movement
- Periods of restful sleep
Sleep-monitoring apps for iPhone and Android:
- Choose your wake-up time, and the app will gently stir you from your slumber during your lightest phase of sleep to ensure that you wake up feeling rested, refreshed, and ready for the day ahead
- For iPhone: https://itunes.apple.com/us/app/sleep-cycle-alarm-clock/id320606217
- For Android: https://play.google.com/store/apps/details?id=com.northcube.sleepcycle
- The app monitors your movements over the course of the night and generates customized data of your sleep cycles in easy-to-read graphs and charts
- Wakes you during your lightest sleep phase
- For iPhone: https://itunes.apple.com/us/app/sleep-time-sleep-cycle-smart-alarm-clock-tracker-insights/id555564825
- For Android: https://play.google.com/store/apps/details?id=com.azumio.android.sleeptime
- Through examining clinical studies, Pzizz has developed sound sequences and dynamic dreamscapes that are tailor-made for each portion of the sleep cycle
- For iPhone: https://itunes.apple.com/us/app/pzizz-sleep-at-the-push-of-a-button/id915664862
- For Android: https://play.google.com/store/apps/details?id=com.pzizz.android
Light therapy has been shown to be effective for a number of sleep-related issues, particularly those related to onset of sleep timing. There are dawn and dusk simulators that work in one’s house to fluctuate lighting indoors relating to typical diurnal patterns. Light therapy involves exposure to a light source, typically a specialized fluorescent lamp. The lamp includes the light source, with a diffusing screen and filter, which protects from UV light.
Human beings are hardwired to rise with the morning light. Dawn simulators help you wake up gradually, in keeping with your body’s circadian rhythm. Early morning bright light exposure is highly effective in treating insomnia caused by a disruption in circadian rhythms (e.g. jet-lag).
- The device simulates the appearance and speed of a natural sunrise
- After a few hours of sleep your eyes are so sensitive that they register the change in light through your eyelids — you are programmed, by evolution, to wake up at this cue
- The hypothalamus registers the light and triggers several physiological reactions
- Your brain waves shift state
- Dreams disperse
- Your body temperature rises
- Your cortisol levels rise
- You become increasingly less interested in going back to sleep
- While you are becoming increasingly conscious, the brightness of the light increases
- Light exposure suppresses melatonin production, and improves daytime wakefulness and energy levels
Look for a dawn simulator that allows a minimum of 30 minutes of dawn, have an alarm that can be used as a ‘backup’ for the first few nights, and are also able to simulate dusk as an aid for falling asleep. Schedule the light to turn on 30 or 45 minutes before your appointed wake-up time. You can experiment with the duration that works best for you.
Certain minerals, herbs and amino acids can be beneficial for sleep and promote relaxation.
- A lack of magnesium affects serotonin receptor function and influences the synthesis and release of a variety of neurotransmitters which are essential for sleep
- Good magnesium levels will help with sleep, pain and moods
- Make sure to take at least 400mg daily, and you can go up to 1000mg daily for sleep issues
- That valerian root will give you the relaxation effect gained by benzodiazepines, and may reduce the time it takes to fall asleep and help you sleep better
- Valerian primarily functions as an anxiolytic, which relieve anxiety and have calming, sedative effects
- Several studies indicate that valerian increases levels of neurotransmitter GABA in the brain, which reduces the activity of neurons in the central nervous system. High levels of GABA promote restful sleep
- Butterbur comes from the daisy family, and it’s used to treat allergies and migraines by blocking histamine, which can be a trigger for migraine headaches
- In a randomized control trial in The Journal of European Neurology, they took 33 patients and gave them 25 mg of butterbur per day — more than 50% found a 50% reduction in symptoms Diener, H. C., Rahlfs, V. W. and Danesch, U. (2004). The first placebo-controlled trial of a special butterbur root extract for the prevention of migraine: reanalysis of efficacy criteria. [online] European Neurology, 51 (2), pp. 89-97. Available at: https://www.ncbi.nlm.nih.gov/pubmed/14752215 [accessed 15 Sept. 2017].
- Butterbur can be helpful with sleep https://www.webmd.com/vitamins-supplements/ingredientmono-649-butterbur.aspx?activeingredientid=649&activeingredientname=butterbur
- GABA is the calming neurotransmitter, and can be taken as a supplement to improve relaxation and sleep
- It can also be taken as the supplement glutamine which is an amino acid precursor to GABA
- L-tryptophan is found in low concentrations in some foods. However, the amount of L-tryptophan in these foods is small compared to supplements (2017). L-tryptophan. [online] WebMD. Available at: http://www.webmd.com/vitamins-and-supplements/l-tryptophan-uses-and-risks [accessed 8 Sept. 2017].
- Tryptophan is an essential amino acid precursor to serotonin, the mood boosting neurotransmitter, and can therefore be a great help for insomnia, as well as other mental health issues such as depression and anxiety Holford, P. (2004). Patrick Holford’s New Optimum Nutrition Bible. London: Piatkus, p.51.
- 5-HTP is an amino acid and a precursor to serotonin, which helps modulate your pain as well as your mood and sleep
- 5-HTP also gets converted to melatonin, which helps puts you to sleep, and acts as an antioxidant, which is important for mitochondrial function
Gittleman, L. (2015). The Anxiety Summit – The Parasite/Anxiety Connection. [online] Every Woman Over 29 Blog. Available at: https://www.everywomanover29.com/blog/anxiety-summit-parasite-anxiety/ [accessed 17 Aug. 2017]. Scott, T. and Selhub, E. (May 2015). How to Heal Anxiety with Nature and the Body, not just the Mind. [online] The Anxiety Summit, Season 3. Available at: http://season3.theanxietysummit.com/. Lake, J. (2009). Integrative Mental Health Care. New York: W.W. Norton & Co., pp. 104-5.
- L-theanine is a non-dietary amino acid with properties of being a relaxing agent without sedation
- L-theanine does not appear to induce sleep, but the relaxing properties can aid with sleep and can play a role in attenuating the effect of stimulants The effects of L-theanine (Suntheanine®) on objective sleep quality in boys with attention deficit hyperactivity disorder (ADHD): a randomized, double-blind, placebo-controlled clinical trial. https://www.ncbi.nlm.nih.gov/pubmed/22214254
- Lemon balm is a herb of the mint family that has an ability to promote better sleep and reduce sleep disturbances Pilot trial of Melissa officinalis L. leaf extract in the treatment of volunteers suffering from mild-to-moderate anxiety disorders and sleep disturbances. https://www.ncbi.nlm.nih.gov/pubmed/22207903
- Lemon balm contains phytochemicals that prevent the breakdown of gamma-aminobutyric acid. GABA dampens nerve activity and thus maintained levels helps ensure healthy sleep GABA mechanisms and sleep. https://www.ncbi.nlm.nih.gov/pubmed/11983310
- An additional key ingredient is the natural oily substance, eugenol, which acts a numbing agent
Pilot trial of Melissa officinalis L. leaf extract in the treatment of volunteers suffering from mild-to-moderate anxiety disorders and sleep disturbances. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3230760/
- Passiflora includes more than 500 species of herbs and has been shown to impart sedative effects that may reduce insomnia and enhance general sleep
- Passiflora’s sleep-promoting flavonoids, Apigenin and Chrysin, have demonstrable muscle relaxing and sedative effects due to anxiolytic properties similar to benzodiazepines Possible anxiolytic effects of chrysin, a central benzodiazepine receptor ligand isolated from Passiflora coerulea. https://www.ncbi.nlm.nih.gov/pubmed/7906886
- Skullcap is a flowering plant of the mint family which can aid those experiencing insomnia or other sleeping problems
- Skullcap relaxes the body and dampens the nervous system, and can be used to reduce restlessness, stress and muscle tension
- The main compounds responsible for its properties are flavonoids; several flavonoids bind to the GABA receptor which dampens nerve signals, aiding relaxation and sleep Diagnosis and treatment of chronic insomnia. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2924526/