If you find yourself tossing and turning every night or waking up before the birds, you may want to try this list of recommendations for overcoming insomnia and achieving a great night’s sleep. Insomnia is caused by a vast array of physical and emotional components, so no single recommendation helps every person. Overcoming stubborn cases of insomnia may require combining a number of treatments at once to achieve results. I suggest working your way through this list and sticking with anything that appears to help.
1. Medical Causes
There are many different causes of insomnia. Find and work with a professional who can help you identify the cause(s) of your sleep problems. A few considerations:
- If your partner hears gasping noises during the night, and/or you have two or more of the following issues: snoring, high blood pressure, unrestful sleep, large neck circumference, are overweight and a family history of sleep apnea; then ask your doctor to consider evaluating you for sleep apnea. Sleep apnea is 2-3 x more common in males. Risks increases with age and family history.
- If you experience one or more of the following: kick sheets around, partner notices your restlessness, or you feel jumpy and uncomfortable while resting at night; ask your doctor to consider evaluate you for restless leg syndrome (RLS). RLS can usually be treated effectively by nutritional means.
If symptoms persist ask your doctor for a referral to a sleep medicine specialist.
Exercise is a great tool to improve sleep, although to be effective it can’t just be any type or amount of exercise. In my experience, the most effective program of exercise to improve sleep is as follows:
Exercise should ideally be done 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 every day.
- 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. For most people there is a tipping point they hit which suddenly starts helping. So even if you’ve you given up previously on exercise as a fix for your sleep problems, give this program a go.
3. Temperature Reduction and Optimization
A slight lowering of body temperature, which occurs at night time, plays a very important role in modulating the chemical signals which induce sleep. In one study a group of insomniacs was instructed to have a hot shower approximately three hours before bed. Many reported this had a dramatic effect on improving their sleep. If this doesn’t help you, try combining it with a cold shower right before going to bed. When trying to fall asleep in bed, always take steps to achieve a comfortable temperature. Feeling too hot or too cold can inhibit sleep.
4. Dietary Salt Intake
In a long forgotten study from the Journal of the American Medical Association on Sept. 22, 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.
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 also avoiding packaged food and cooking your 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 adrenal problems should not attempt a low salt diet.
5. Bright Light Therapy and Night Light Minimization
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 utilized to improve sleep in the following ways:
- Try sitting in the sun first thing every morning (or obtain a Bright Light Box )and sit in front of it, looking directly into it at times, for 30 minutes each morning. You must do this at the exact same time every morning, as this process is resetting your body clock.
- At the same time try avoiding bright light for an hour before going to bed.
- Avoid as much light exposure (use an eye mask if necessary) as possible while in bed.
- Some people may be photosensitive. Try avoiding computers/televisions/phone screens for two hours before going to bed and see if this helps.
There is often a connection between the type and size of the meal you eat prior to going to bed, and your sleep. Everyone responds differently to different meals with some people reporting a high whole grain meal helps them fall asleep, and others report high protein or high fat meals help them sleep. Try experimenting with the following:
- For a week try making the meal you have before bed high in protein and low in carbohydrates. For example a vegetable and meat/fish dish.
- Another week try making the meal you have before bed high in unrefined carbohydrates (e.g. whole grain rice, vegetables) and low in protein (meat, eggs, dairy products).
- 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.
The following are general dietary recommendations that everyone trying to improve their sleep should follow:
- Avoid caffeine (caffeine is in some medications), other stimulants, soft drinks and alcohol after lunch.
- Avoid tyramine containing foods (bananas, avocado, cheese, sour cream, pizza, fermented dairy products, beer, wine, MSG, fermented soy products, pickled salamis, liver, caviar, beans) in the evening as tyramine can alter 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.
- Balance blood sugar (avoid refined grains/sugar [including fruit juice]).
- Don’t drink any fluids within 1.5-2 hours of going to bed to avoid or minimise night urination.
- Avoid excessively low calorie diets as they can interfere with sleep patterns.
- 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.
7. Emotional Freedom Techniques
A very large subset of those suffering with insomnia respond very well to Emotional Freedom Techniques (EFT). The techniques are based on the same principles as acupuncture, although involve tapping on selected points rather than using needles. EFT is particularly effective if insomnia is related to any stress/depression/anxiety however, if there is no emotional cause, using EFT focusing purely on the insomnia itself is still often very effective.
8. Meditation Audio Tracks
Relaxing meditation or hypnosis audio tracks work very effectively for some people. Listen to them while lying in bed trying to go to sleep. The The Silva UltraMind Centering Exercise is one example of an available track free online. You can also download Interactive Self-Hypnosis Sessions to use. YouTube, Spotify and App stores are other places to search for sleep meditations and relaxation music.
9. Basic Sleep Hygiene
These steps are basic sleep hygiene recommendations. These alone are rarely enough to cure serious insomnia, but should be followed as part of a basic foundation towards achieving better sleep quality.
- Have consistently regular sleeping times. (e.g. 10 pm-7 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.
- 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.
- Try reading a book/magazine while lying down in bed until you have trouble staying awake.
- Do not watch the clock while trying to get to sleep. Remove your clock from view.
- If possible, avoid/minimize napping during the day (particularly after 2 pm) and never nap for more than an hour during the day.
- If possible, mainly use your bedroom for sleep (rather than for TV, computer use, study, etc.).
- Do not smoke for two hours before going to bed.
- If you are bothered by cold feet in the night, or wake up in the night feeling cold, wear socks to bed.
- Breathe through your nose as much as possible while in bed. This improves respiratory function and hormone balance contributing to more refreshing sleep.
Sexual activity directly before bed helps some people nod off easily.
There are many nutritional and herbal supplements that can help people sleep better. Unfortunately, no single supplement universally helps everyone. Among the most effective, in my opinion, include melatonin (which is a supplement of the sleep inducing hormone produced by the pineal gland) and 5-hydroxy tryptophan (5-HTP – a precursor of serotonin).
Supplements should be individualised and guided by a knowledgeable professional. Avoid any potentially stimulating supplements/herbs (e.g. many B-vitamins, fish oil, tyrosine, phenylalanine, glutamine, ginseng, DHEA, licorice, etc.) in the evening or late afternoon.
As a general rule, if you have insomnia take the bulk or all of your supplements with breakfast.
12. Electromagnetic Fields and Chemical Avoidance
Some people are sensitive to electromagnetic fields (EMF’s) to a point where it can inhibit sleep. Try minimising all EMF’s near your sleep area for a week or so and see if it makes a difference.
Consider sources near your bed and keep them as far as possible from your body: power boxes [other side of wall], clock radios, mobile phones, electric blankets, coils of cable, waterbed heater, phone charger, etc. 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 make a difference.
Some individuals are also sensitive to environmental chemicals, molds, dust mites, cat/dog hair, etc. which can potentially impair sleep. Keep your bedroom very clean from dirt, dust, mold, etc. Follow the guidelines below to minimise synthetic chemical exposures in your bedroom:
- Never smoke or allow anyone to smoke in your house.
- Ensure good ventilation in bedroom. Keep windows open as much as possible.
- Don’t spray insecticides or other chemical sprays inside or outside your home or workplace.
- Avoid all the following products in our bedroom as they pollute the air you breath: hair sprays, mothballs, 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.
- Use 100% cotton pyjamas, sheets and pillow cases. These should be washed weekly using a synthetic chemical free washing powder.
- Hang newly dry-cleaned clothes outside until they lose that chemical smell and don’t store in your bedroom.
- Keep computers and printers out of your bedroom as they release volatile organic compounds (VOC’s).
13. Other Therapies to Consider
- Massage. Massage raises endorphin levels.
- Subliminal messaging. Informal research by Dr. Phil Bate reports that subliminal messaging is effective in treating insomnia.
- Acupressure points have been studied in the treatment of insomnia.
- Try sleeping with a bag of lavender in your pillow. Inhale the lavender scent deeply through your nose.
Blake Graham, BSc (Honours), AACNEM
Perth, Western Australia