“Sleep is that golden chain that ties health and our bodies together.”
– Thomas Dekker

After several months of experimenting with sleep practices and routines, you have undoubtedly increased the amount of shut-eye you get on a regular basis. But it’s easy to fall back into old habits, let others interrupt good intentions, or simply forget the tools we use to manage our chronic illness. Let’s visit some principles and review practices that can improve our sleep.

Principles

• Know what makes you tick—the physical, emotional, mental, and spiritual. Each of us is unique in each of these areas, so knowing how things affect us and finding ways to create balance is a skill that complements every strategy in chronic illness management.
• Focus on what gives you pleasure and peace, not on what creates fear or dissatisfaction.
• Sleep is our soft spot, so a gentle approach is more effective than disciplined inflexibility. A plan to fit the season, temperature, and environmental factors heightens the likelihood of a good night’s sleep.

Practices

• Day in, day out. Adopt a consistent schedule for bedtime and waking. Your body and mind can’t create regularity out of chaos.
• Exercise your right to sleep. OK, it’s a pun, but exercising early in the day will produce better sleep at night. That said, anything that requires the body or mind to work hard—eating, drinking cold beverages, environmental chaos, fear, or anxiety—prevents the body from going into sleep mode; so it’s a good idea to protect the two-hour zone prior to bedtime.
• Slowly but surely. Adopt routines and rituals that support restfulness. For one person, it might be a cup of herbal tea and a good book. For someone else in a warm climate, it could be a leisurely walk through the park. It’s easier to stop a vehicle that’s moving slowly than one that’s speeding. There’s a lesson in that for us.
• Go out like a light. Darkness is essential for the natural production of melatonin, the sleep hormone. Dim the lights and turn off TVs and computers 30-60 minutes before hitting the hay. Chickens tuck their heads under a wing at dusk and are clucking with first light the next morning. While it might not work for us to function with that schedule in the winter, when darkness takes up to 14 hours of the 24 hours in a day, it’s important to recognize how sleep is impacted by environmental elements.
• Rest assured. Thinking about things in the past or future can produce anxiety or guilt in the middle of the night. Have you noticed that what we fret about are often things we fear we’ll forget? Consider a nightly ritual of writing down concerns and problems before bedtime. If you wake in the middle of the night, add insomnia-producing thoughts to the list so you can let go of them. Focusing on gratitudes and breathing can calm the mental roar and allow you to fall asleep again.

Do electronic readers interfere with sleep?

New research supports older studies, which have found that screen time before bedtime can affect sleep. In the latest study, iPad readers took longer to fall asleep, felt less sleepy at bedtime, and had shorter REM sleep compared to those who read a print book. Those reading an electronic device also secreted less melatonin and felt more tired the following day, even if they got a full eight hours of sleep. Sleep deficiency—not getting enough sleep or obtaining poor quality sleep—has been linked to a plethora of serious health problems.

If you MUST use an electronic reader before bedtime, several devices offer a blue-light blocker app, and filter screen protectors can be found for other products by typing “blue light screen filter for [device]” into your internet browser.

Medication

There are times when life produces new challenges or extra anxiety, and your physician may suggest the use of medications. Here’s a short wrap-up on how the most common prescriptions and over-the-counter meds work:

Most sleeping pills are “sedative hypnotics” and include benzodiazepines, barbiturates, and various hypnotics. Xanax, Valium, Ativan, and Librium are anti-anxiety medications. While these drugs may be useful in the short term, all benzodiazepines are potentially addictive. Halcion is an older sedative-hypnotic that has largely been replaced by newer medications. Barbiturates depress the central nervous system and are usually limited to anesthesia.

Newer medications (Lunesta, Sonata, and Ambien) help reduce the time it takes to fall asleep and are less likely than benzodiazepines to be habit-forming.

Sleeping pills have side effects like most medications, but individual response varies. Some medical conditions, such as asthma and COPD, require careful oversight because sleeping pills slow breathing. When taking medications, any changes in digestion, headaches or heartburn, shaking or weakness should be reported to your physician immediately.

Most over-the-counter sleep aids are antihistamines. They can induce sleepiness, but can also cause next-day drowsiness. Care should be taken not to take them with other drugs containing antihistamines (like cold or allergy meds).
Any sleep aid should be taken only when 7-8 hours of sleep time is ensured because they can cause significant drowsiness. Over time, some medications cause dependence, where sleeping becomes difficult or impossible without the drug. As with any medication, discuss dosage and use with the doctor or pharmacist, and utilize your knowledge of sleep practices to minimize your need for drugs. Read more.

Natural Remedies

The use of natural sleep aids is helpful to some. Be aware that these are not regulated by the FDA and our bodies all respond to supplements in different ways. The following guidelines are published by WebMD.

Melatonin is a hormone produced in the pineal gland in the center of your brain. Some people may not produce enough, and most of us get in the way of production. If used, 0.1-0.3 milligrams may be sufficient to promote sleep. Some users report going to sleep faster, but waking in the middle of the night; others feel groggy or depressed. Supplements can be used to jump-start a better routine, but there is a lack of data to support taking melatonin “forever.” In fact, some medical scientists wonder if long-term use may interfere with the body’s production of melatonin.

Valerian is an herbal extract, and one of the leading natural supplements for managing anxiety and insomnia. Some studies show that valerian may reduce the time it takes to fall asleep and may improve sleep quality (but some experience the opposite effect of wide-awakeness or nervousness). Unlike benzodiazepines, most people feel no morning grogginess after taking valerian. Using valerian over a long period of time (four weeks or more) may be more effective than taking the supplement now and then.

Poor sleepers seem to report more benefit than those who are normally good sleepers.

Chamomile is a popular herbal sleep remedy that’s been used for centuries. It also has anti-inflammatory and anti-bacterial properties. Sipping chamomile tea an hour before bedtime can produce a calming effect for many people.

Kava, also known as kava kava, is an herb that may relieve stress, anxiety, and insomnia. Kava affects the brain and central nervous system. While it has some relaxing and sedative properties, it is considered unsafe to use on an ongoing basis due to its link to cirrhosis, hepatitis, and liver failure, and is even banned in several countries.

Tryptophan is a precursor in the synthesis of serotonin in the brain, meaning it’s a biochemical substance that is necessary for the formation of serotonin, a neurotransmitter linked to sleep induction.
Tryptophan is present in milk, and warm milk helps some people feel drowsy. While this amino acid is not available as a natural dietary supplement or sleep remedy, food sources such as turkey, cheese, nuts, beans, eggs, and milk may increase its supply to help us feel calm and sleepy.
5-hydroxytryptophan (5-HTP) is a derivative of the amino acid tryptophan. It is used to boost serotonin in the body. 5-HTP is also the precursor of melatonin, which regulates sleep cycles. Some findings show that 5-HTP may ease symptoms of depression, anxiety, and insomnia. Other studies show that 5-HTP may be useful in controlling appetite and pain; however, a few studies show no benefit with supplementation of 5-HTP.

Chasing sleep can become a full-time job that interferes with strategies to manage chronic illness or pain, so it’s wise to incorporate healthy, sleep-inducing practices as a first line of defense against insomnia before popping a bunch of pills to reach a state of sleepiness.

In order for the nervous system to work properly, it needs to be restored each night. When we get too little sleep, we are less equipped to deal with stress. Irritability, daytime drowsiness, lack of concentration, forgetfulness, and loss of physical coordination are only the visible effects of sleep deprivation. If sleep deprivation goes on long enough, it can cause wild mood swings and even hallucinations.