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Thirteen tips for a great nights sleep

Insomnia is caused by a vast array of physical and emotional factors so no one of these recommendations helps everyone. Overcoming stubborn cases of insomnia requires combining a number of treatments to achieve desired results. I suggest working your way through this list and sticking with anything that appears to help.

1. Medical and other causes.

The following factors are documented to impair sleep. These factors must be identified and treated appropriately.

Hormonal and neurotransmitter abnormalities
Sleep apnea
Restless leg syndrome
Circadian rhythm disorders
Stress/anxiety/depression
Pain
Medication/drug side effects
Nutrient imbalances
Low blood sugar (hypoglycemia)
Disturbance of intestinal micro-flora
Toxic chemicals (e.g. lead, mercury) and mold
Hypoxia
Electromagnetic field exposure
Smoking
Restless partner
Waking up to go to the toilet
Noise (e.g. traffic, partner, neighbours, baby, etc.)
Temperature regulation problems
Teeth grinding

If symptoms persist ask your doctor for a referral to a ‘sleep medicine specialist’.

2. Exercise.

Exercise is a great tool to improve sleep, although to be effective it can’t just be any type or any amount. In my experience the most effective program of exercise to improve sleep is as follows:

Exercise should ideally be approximately 3-4 hours before going to bed and at roughly the same time every day.
It should be in the form of aerobic exercise (e.g. walking, running, swimming, etc.).
Exercise must be everyday.
The amount of time spent exercising is critical. You may find that 30 minutes/day does nothing for you but 45 minutes/day does wonders. Or you may find 45 minutes/day does nothing for you, but 60 minutes/day works great. In most people there is a time point they hit which suddenly starts helping.

So even if you’ve you given up on exercise fixing your sleep problem, give this program a go.

3. Temperature reduction and optimisation.

A slight lowering of body temperature which occurs at night plays a very important role in modulating the chemical signals which induce sleep. In one study a group of insomniacs were instructed to have a hot shower approximately 3 hours before bed. Many reported this had a dramatic effect on improving their sleep. While trying to fall asleep in bed always take steps to achieve a comfortable temperature as being too hot or too cold can inhibit sleep. If you are bothered by cold feet in the night, or wake up in the night feeling cold, wear socks to bed. The average optimum temperature for quality sleep is 19 degrees, although this may vary from person to person.

4. Bright light therapy and night time light minimisation.

When we wake up in the morning light hits our eyes and sends a signal to the pineal gland in our brain, which is a major regulator of sleep in the body. This signal regulates our circadian rhythm (‘body clock’). This process can be utilised to improve sleep and is especially useful in individuals with abnormal circadian rhythms.

Hire or buy a ‘Bright Light Box’ (www.northernlighttechnologies.com/) and sit in front of it, looking directly into it at times, for 30 minutes first thing each morning. This must be done at the exact same time every morning (e.g. 7:30 AM). The brightness of the light is high, usually 10’000 lux. If you don’t have access to a bright light box try sitting in the sun each morning.
At the same time try avoiding bright light for ~1 hour before going to bed and avoid as much light exposure (use an eye mask if necessary) as possible while in bed. Light inhibits the release of melatonin.
Some people may be photosensitive. Try avoiding computers/TV’s for two hours before going to bed and see if this helps.

5. Basic Sleep hygiene.

These steps are basic ‘sleep hygiene’ recommendations. They are rarely enough alone to cure serious insomnia, but should be followed as part of a basic foundation of sleep guidelines.

Have consistently regular sleeping times. (e.g. 10 PM-7AM) The most restorative sleep, including highest human growth hormone production, is between 9:00 PM and 2:00 AM.
If too much noise or quiet is a problem in your bedroom try leaving a fan on, use a white noise generator, or wear ear plugs.
If possible avoid regularly over-sleeping and do not spend an excess amount of total time in bed.
If your mattress, pillow or items of clothing you wear to bed are not comfortable, replace them.
Do not do anything too stimulating before going to bed. (e.g. Action/Horror films)
Try reading a book/magazine while lying down in bed until you have trouble staying awake.
Do not ‘clock watch’ while trying to get to sleep. Remove your clock from view.
If possible, avoid/minimize napping during the day (particularly after 2 PM).
If possible mainly use your bedroom for sleep (rather than for TV, computer use, study, etc.).
Do not smoke for 2 hours before going to bed and ideally quit altogether.
Breath deeply, diaphragmatically, while in bed. Shallow breathing causes metabolic acidosis which impairs sleep.
If you do any daily exercise, do this at roughly the same time each day and not in the three hours before going to bed.
Breathing through your nose, rather than through your mouth, improves respiratory function and hormone balance contributing to more refreshing sleep, including higher human growth hormone production. The ‘Myofacial Toner’ (www.sleep4health.com.au/prodtoner.shtml) strengthens the orbicular muscle of mouth, allowing nose breathing to be easy and natural.

6. Diet.

6.1. Night time meal size and composition.

There is often a connection between the composition and size of your daily meals, and your sleep. Everyone responds differently to different meals, with some people reporting a high whole grain meal helps them fall asleep, while others report a high protein and/or high fat meals helps them sleep. Try experimenting with the following:

Dr. Sidney Baker, author of 'The Circadian Prescription', cites evidence that specific timing of carbohydrate and protein consumption optimises our circadian rhythm and improves sleep initiation and quality. His basic dietary suggestions include:

1. "Put protein in your morning meal, snacks and lunch. Emphasize fish, eggs, milk products (for those who can handle them), nuts, peanuts, soy, poultry, beans, and meat."
2. "Move most of your carbohydrates from breakfast, lunch, and morning snacks to the evening. After 4:00 p.m., your goal is to cut back on protein and emphasize healthy carbohydrate-rich foods like pasta, potato, sweet potato and other starchy vegetables, whole grain cereals, seeds, sprouts, and fruit."

Try Dr. Baker’s dietary recommendations for a few weeks and observe if any changes occur in your sleep or other aspects of your health. Another time try making the last meal you have before bed high in protein and low in carbohydrates for a few weeks. For example a non-starchy vegetable and meat/fish dish. Also compare the effect of large meals and small meals as your final meal for the day. You may notice a connection between different meals and your sleep.

6.2. General diet.

The following are general dietary recommendations that everyone trying to improve their sleep should follow:

Avoid caffeine (including in some medications), other stimulants, soft drinks and alcohol after 12 PM.
Try a strong cup of relaxing chamomile and/or lemonbalm tea two hours before bed. Brew for 15 minutes before drinking.
Avoid tyramine containing foods (bananas, avocado, cheese, sour cream, pizza, fermented dairy products, beer, wine, MSG, fermented soy products, pickled salamis, liver, caviar, beans) after 5 PM as tyramine alters brain neurotransmitter levels inhibiting sleep.
Avoid excitotoxin rich foods: MSG (monosodium glutamate), glutamic acid or anything that contains the word glutamic or glutamate, aspartame (Nutrasweet), hydrolyzed vegetable protein, red/yellow food dyes.
Adopt regular meal times which helps to establish circadian rhythm.
Balance blood sugar (avoid refined grains/sugar) as hypoglycemia can cause insomnia.
Don’t drink any fluids within 1.5-2 hours of going to bed to minimise night urination.
Avoid excessively low calorie diets as they can interfere with sleep patterns.
Spices consumed in evening meals appear to be disruptive to some people, including exacerbating night time heat intolerance problems which can further disrupt sleep.
Eat a diet rich in fruits, vegetables and other unrefined foods.
Ensure optimum hydration.
Ensure a good balance of essential fatty acids in your diet.

6.3. Dietary salt intake.

In a long forgotten study from the Journal of the American Medical Association in 1945, a group of patients with insomnia were treated with a severely restricted salt intake. After 4-7 days the majority of individuals began to fall asleep easier. A few weeks later most noticed big differences in their ability to fall asleep.

Low Sodium Chloride intake in the treatment of insomnia and tension states. Journal of the American Medical Association. September 22, 1945.

Most people think they follow a low salt intake but in fact are wrong. On average 90% of our salt intake comes from packaged foods, while only 10% comes from the salt shaker. Cutting way back on salt involves not only avoiding the salt shaker but avoiding packaged food and cooking meals from scratch. Check labels of foods to see if they contain salt. NOTE: Some people feel unwell on a very low salt intake, for example feeling fatigued and light headed. People with CFS and adrenal problems should not attempt a low salt diet.

7. Coherent/resonant breathing.

Our breathing rate is a key cue to the autonomic nervous systems need for sympathetic nervous system ('fight or flight' / stress response) activation. While a typical person might have 15-20 breath cycles per minute, slowing our breathing down to five breaths per minute puts our autonomic nervous system (ANS) into a state of coherence, toning down stress-response associated sympathetic activity and increasing the relaxation/rejuvenation associated parasympathetic response. Five breath cycles per minute = one breath cycle per 12 seconds, or inhaling for six seconds and exhaling for 6 seconds. Read the fascinating article ‘The Science of Coherent Breathing’ by Stephen Elliott for a more in depth discussion of this topic. While laying in bed a person can listen to an audio track which has a sound cue every six seconds. You simply inhale or exhale at each interval using the track like a metronome. You can order a CD called Respire I or download the audio tracks as MP3s. I enjoy Respire 1, track 2 which has Tibetan bells as the breath cue.

8. Meditation/hypnosis/relaxation exercises.

Meditation and various relaxation techniques can help improve sleep. One basic relaxation exercise simply involves concentrating on individual muscle groups, e.g. feet à calves à knees à thighs, etc., one at a time, letting all tension fade away and inducing a feeling of tingling, numbness and relaxation. Doing this over your whole body is a very pleasant experience.

Relaxing meditation or hypnosis audio tracks work very effectively for some people. They have the advantage of allowing you to sit back, listen and be guided by the track. Listen to them while lying in bed trying to go to sleep. The following are examples of tracks available online.

The only disadvantages of audio tracks is that our minds tend to gradually pay less attention to them the more times we listen to them and we are not developing the skills we do when doing similar exercises ourselves. If you listen to these tracks long term it may be worth rotating through different ones when they start to lose their effectiveness.

9. Sex.

Sexual activity directly before bed helps some people nod off easily.

10. Nutritional/herbal supplements.

There are many nutritional and herbal supplements that can help people sleep better. Unfortunately no one supplement helps everyone. Among the most effective in my opinion include the following:

Adenosine.
Melatonin.
5-hydroxy tryptophan (5-HTP) or L-tryptophan.
Inositol.
GABA.
Taurine.
L-Theanine.
Magnesium (chelated, glycinate, chloride, aspartate & orotate).
Remotiv (St John’s wort) by Flordis.
ReDormin (valerian root and hops) by Flordis.
Kava by Mediherb.

A wide range of nutrient deficiencies can cause insomnia (B1, B5, B6, magnesium, iron & calcium). Supplements should be individualised and guided by a knowledgeable professional and should typically be taken 30 minutes before bed. A certain amount of trial and error is often required to determine which supplements are most beneficial to you. Avoid any potentially stimulating supplements/herbs (e.g. many B-vitamins, fish oil, tyrosine, phenylalanine, glutamine, ginseng, DHEA, licorice, etc.) in the afternoon or evening. As a general rule take the bulk or all of your supplements and medications with breakfast. Also ask yourself if any medications you are taking could be affecting your sleep.

11. Electromagnetic field avoidance.

Electromagnetic fields (EMF’s) lower levels of melatonin and impair our circadian rhythm. Some people appear to be more sensitive to the effects of EMF’s than others. Consider sources near your bed:

Power boxes [other side of wall]
Clock radios
Mobile phones
Phone charger
Electric blankets
Coils of cable
Waterbed heater
Computers

Keep electrical devices in your bedroom as far away from you as possible and ideally unplugged. Avoid other major sources in the hours before going to bed: operating microwave ovens, operating electric toothbrushes, etc. You may even wish to turn the power off at the mains for a night and see if this makes a difference. Some people may wish to consider hiring a EMR (electromagnetic radiation) meter. (www.acnem.org/miscellaneous/emr_meter_hire.htm)

12. Chemical avoidance.

Some individuals are also sensitive to environmental chemicals, molds and dust mites, which can impair sleep in some cases. Keep your bedroom very clean from dirt, dust, mold, etc. Follow the guidelines below to minimise environmental chemical exposures in your bedroom:

Never smoke or allow anyone to smoke in your house.
Ensure good ventilation in your bedroom. Keep windows open as much as possible.
Don’t spray insecticides or other chemical sprays inside or outside your home.
Avoid all the following products in our bedroom as they pollute the air you breath: mothballs, hair sprays, air fresheners, stain removers, dryer sheets, essential oils, aftershaves, fabric softeners, deodorizing products, scented products, nail polish remover, nail polish, glues, paints (use water-based and the least odorous paints and adhesives), smelly plastics, plastics generally (including furniture), waxes or finishes, degreasers, spot removers, urethanes (e.g. hardwood floor covering), varnish, flea sprays for pets, pest strips, DVD/CD cleaner spray. If you have to use these products use them in another room or ideally outside.
Use 100% cotton bed clothes, sheets and pillow cases. These should be washed regularly using a synthetic chemical free washing powder (e.g. Planet Ark in Australia). Replace your pillow with a 100% cotton pillow. Pillows accumulate large quantities of dust mites and mold spores.
Hang newly dry-cleaned clothes outside until they lose that chemical smell and don’t store in your bedroom.
Keep computers, faxes and printers out of your bedroom as they release volatile organic compounds (VOC’s).

13. Experimental therapies to consider.

Massage. Massage raises endorphin levels.
Some eastern medicine groups claim that having the head of your bed facing north allows your body to be in better sync with the earths electromagnetic fields, allowing you to get a better nights sleep.
Subliminal messaging [www.subliminals-training.com/insomnia.html]. Informal research by Dr. Phil Bate reports that subliminal messaging is effective in treating insomnia.
Acupressure points [see: www.holistichealthtools.com/insomnia.html] have been studied in the treatment of insomnia.
Try sleeping with a bag of lavender in your pillow. Inhale the lavender smell deeply through your nose.

Blake Graham, BSc (Honours), AACNEM
Clinical Nutritionist
Perth, Western Australia
Phone/Email: See Contact page
*Non-Perth residents may enquire about phone consultations.