New York Neurology & Sleep Medicine

Allen Towfigh, MD

Sleep Hygiene

The Path to Sleep Health: Relaxation

Stress Management

If you are not sleeping because you are worrying about something that iS happening in your life, the best thing to do is to do something about the problem. Perhaps you can't remove the problem but you can do some constructive things like",

  • During the day, talk to someone about the problem. Seek support from friends or a professional counselor.
  • Most of the thinking and worrying that we do in bed needs to be done - it just does not need to be done in bed. If you are lying in bed and not being able to get off to sleep because you are worrying, sit up and write about the problem. Keep a journal of your thoughts and feelings which you write in your journal when you feel the urge.
  • Try an imagery , of storing your worries away for a night. This works very effectively when used in conjunction with some physical relaxation exercises.
  • Devote some time during the day (5-60 minutes) for thinking and worrying. This should end at least a couple of hours before going to bed. Then, when the thoughts come when you are in bed, say gently: "Stop, I thought about this today. I will think about it again tomorrow. Now is the time to sleep".

Relaxation: A Guide

There are many approaches to learning to relax. None is "right" for everyone - it is , more a matter of finding an approach that makes sense and works for you. Learning to relax muscle groups physically, learning mental relaxation, meditation, yoga, prayer, biofeedback - all are possible approaches. As our body is not disconnected from our mind and our emotions, it is possible to use any of these starting points to benefit our entire being.

*Like exercising in order to get fit, doing relaxation exercises once will not make you "fit": learning to relax takes time and practice in order for you to become proficient.

Learning to Breathe

When we become STRESSED for any reason, our bodies activate the natural, genetic `;fight-or flight" response leading to very shallow and quick breathing patterns. Most often we do not acknowledge this type.of breathing — but we feel it as anxiety. Once we think about our anxiety, we often become more anxious thinking about how anxious we are?!? Deep Breathing breaks this cycle by intentionally slowing our breaths, providing more oxygen to our bodies, and energizing and rejuvenating every organ and cell in our bodies. ,Lie on your back.

Deep Breathing

  1. Priming: Slowly relax your body, starting with your feet and moving through every part of your body until you have reached -- and relaxed -- your face and scalp. Wiggling ONLY your toes for 10 seconds is a great first step.
  2. Noticing: Slowly begin to inhale throughyour nose - first filling your lower belly, then your stomachaTiin, and then your chest and the top of your lungs almost up to your shoulders. Hold for a second or two, and then begin to exhale through your mouth nntil you are completely empty. Continue this breathing for a few minutes — paying close attention to how the breath fills your lungs and how tense spots on your body begin to decompress.
  3. Intention: After a few minutes, begin to inhale through your nose while slowly counting from 0 to 5. Once you reach 5, hold your breath and count backwards slowly from 5 to 0. Once you reach 0, exhale through your mouth while counting slowly from 0 to 5.
  4. Letting Go: What you will find is that your breathing will naturally become slower and more regular. Remember, don't force your breathing;- it's not a contest!
  5. Accepting: After a while, imagine that you are resting on a warm, gentle ocean. The sun is shining peacefully on your body. Imagine that you rise on the gentle swells of the water as you inhale, and that you slowly descend as you exhale.
  6. Continue this relaxing breathing as long as you wish (hopefully until you fall asleep).

Note: The results of this breathing technique are immediate. You will feel your shoulders and arms relaxing. Your chest will feel less constricted and you will feel less stress and tension.

Practice this breathing technique on a daily basis so that it becomes a natural routine for you and helps to induce natural sleep.

Visualize Something Peaceful

Just lie there with your eyes closed and imagine you're in your very favorite, most peaceful place. It may be on a sunny beach, swinging in a hammock in the mountains or your back yard, or all alone in a cave in the Himalayas.

Wherever it is, imagine you are there. You can see your surroundings, hear the peaceful sounds, smell the fragrance of the flowers, and feel the warmth of the sun or whatever sensations are there. Just relax and enjoy it -- and drift off to sleep.

Once you've found a place that's especially peaceful and effective, you'll find that the more you use it, the more you can count on it to help you relax and get to sleep. Its comfort and familiarity will make it more and more effective.

Progressive Muscle Relaxation

Try the following relaxation exercise before you get into bed:,

  1. Lay on your back on the bed/floor with your feet slightly apart, your hands by your sides, and your palms turned upward.
  2. Close your eyes airekoncentrate on every part of your body.
  3. Remember to breathe! (See above)
  4. Begin at the top of your head and work your way down to your toes.
  5. Start by feeling your forehead tense, then your eyes, then your jaw, finally your entire face — almost like your 'scrunching your face' from sour lemons.
  6. Squeeze and tense each individual muscle group, hold for 5 seconds, and then release. Try to tense ONLY one select muscle group at a time — this can be tricky to start, but you will soon master this ability.
  7. Move down from your head, to your neck, through yo -ur shoulders and arms. Continue down through the trunk of your body, down through your thighs, into your calves, through the arch of your feet, and ending at the tip of your toes. Wiggle
  8. Give attention to each area of your body from the top of your head, down through the trunk of your body, down along your legs, and ending at the tip of your toes. Wiggling ONLY your toes for 10 seconds is a great final step.
  9. As you become more aware of your body parts, concentrate on your breathing and let all your worry and stress dissipate from your mind and body as you tense and release.
  10. Through practice, this exercise will tell your body and mind that it is okay to settle down, leaving behind thoughts of worry,- fear, and stress. Performing this exercise regularly, you will notice that it becomes much easier to reach a state of complete relaxation — almost at the mere thought!

Drink Herbal Teas

If a glass of warm milk just does not do it for you - or you avoid dairy products - try a qup of hot chamomile, catnip, anise or fennel tea. All contain natural ingredients which will help you sleep. Most health food stores (Whole Food's is exceptional for this) will also have special blends of herb tea designed to soothe you and help you get to sleep.

Sleep Hygiene

The most common cause of insomnia is a change in your daily routine. For example, traveling, change in work hours, disruption of other behaviors (eating, exercise, leisure, etc.), and relationship conflicts can all cause sleep problems. Paying attention to good sleep hygiene is the most important thing you can do to maintain good sleep.

Do:

  1. Go to bed at the same time each day.
  2. Get up from bed at the same time each day.
  3. Get regular exercise each day, preferably in the morning. There is good evidence that regular exercise improves restful sleep. This includes stretching and aerobic exercise.
  4. Get regular exposure to outdoor or bright lights, especially in the late afternoon.
  5. Keep the temperature in your bedroom comfortable.
  6. Keep the bedroom quiet when sleeping.
  7. Keep the bedroom dark enough to facilitate sleep.
  8. Use your bed only for sleep and sex.
  9. Take medications as directed. It is helpful to take prescribed sleeping pills 1 hour before bedtime, so they are causing drowsiness when you lie down, or 10 hours before getting up, to avoid daytime drowsiness.
  10. Use a relaxation exercise just before going to sleep. o Muscle relaxation, imagery, massage, warm bath, etc.
  11. Keep your feet and hands warm. Wear warm socks and/or mittens or gloves to bed.

Don't:

  1. Exercise just before going to bed.
  2. Engage in stimulating activity just before bed, such as playing a competitive game, watching an exciting program on television or movie, or having an important discussion with a loved one.
  3. Have caffeine-in the evening (coffee, many teas, chocolate, sodas, etc.)
  4. Read or watch television in bed.
  5. Use alcohol to help you sleep.
  6. Go to bed too hungry or too full.
  7. Take another person's sleeping pills.
  8. Take over-the-counter sleeping pills, without your doctor's knowledge. Tolerance can develop rapidly with these medications. Diphenhydramine (an ingredient commonly found in over-the-counter sleep meds) can have serious side effects for elderly patients.
  9. Take daytime naps. /#
  10. Command yourself to go to sleep. This only makes your Mind and body More alert.

If you lie in bed awake for more than 20-30 minutes, get up, go to a different room (or different part of the bedroom), ilarticipate in a quiet activity (e.g-non-excitable reading of -television), and then return to bed when you feel sleepy. Do this as many times during the night as needed.

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