Improving Your Sleep: A Psychiatrist's Guide to a Restful Night

By Layne A. Gritti, DO

Adult, addiction, and reproductive specialized psychiatrist, Sweetgrass Psychiatry

Sleep plays a vital role in our physical and mental health, and no one is more aware of that role than those who struggle with sleep. The thought of insomnia can even become anxiety-provoking. Everyone experiences insomnia from time to time, but if this persists for more than one month, we call this “chronic insomnia.”

Are you struggling with chronic insomnia?

If you’ve had difficulty achieving refreshing sleep, I’m here to offer straightforward, evidence-based guidance. We were all born knowing how to sleep. It may sound unlikely, but more often than not, those who struggle with insomnia often learn how not to sleep. The good news is that we can all re-learn how to sleep again. Even for those who say they’ve already “tried everything,” with more digging, I usually find that most people who struggle with sleep have at least one thing they can work on.

Lowering expectations

An emphasis on the importance of sleep causes and worsens stress about getting enough sleep. That worry ultimately prevents so many people from getting good sleep. Let’s lower expectations about how much sleep we need. The ideal amount of sleep is about 8-9 hours for most people (but this can vary from person to person). Still, the core amount of sleep we need each night is about 75% of our normal sleep or about 5.5 hours. The good news is that you can function the next day with that amount of sleep. The downside is that you’ll probably feel tired and may notice your mood isn’t as great the next day. However, I hope it is comforting to know that you can do all you need to do the next day with less-than-perfect sleep.

The first-line approach to insomnia

At this point, you may be thinking that the best thing is to take medication to make you sleep. While a sleeping pill is suitable for some situations, it is certainly not the best option for most. The gold standard, first-line treatment for insomnia is called cognitive behavioral therapy for insomnia (CBT-i). CBT-i is a therapeutic approach for understanding how one’s thoughts, feelings, and behaviors affect sleep.

If CBT-i is so great, why haven’t you heard of it? Therapists qualified to do CBT-i with patients can be challenging to find, but it is worth the search to do so. They usually do 4-6 sessions and ask you to keep a sleep diary. There is also a fantastic free app, CBT-i Coach, with a digital diary version and loads of evidence-based content. CBT-i helps people learn how to sleep again so they are not stuck taking medication to sleep every single night and dealing with side effects like feeling overly tired the following day.

Consistency is key

If you take one thing from this blog, please take that the most effective way to improve your sleep is to maintain a consistent sleep schedule. Try going to bed and waking up at the same time every day, even on weekends, and even if you were up for hours trying to fall asleep. Sleeping in the next morning will confuse your body’s internal clock for the next day, perpetuating the cycle. Waking up at the same time each day and going to bed at a similar time will make it easier for you to fall asleep and wake up feeling refreshed.

Let’s talk about your daily routine

Caffeine and nicotine—Caffeine and nicotine are stimulants that can interfere with your ability to fall asleep. Try to avoid consuming them in the hours leading up to bedtime. You should skip out on caffeine any time after noon. Instead, use non-caffeinated herbal teas or water to stay hydrated without disrupting sleep.  

Are you watching TV, scrolling, working, reading, etc., in your bed (at any time of day)?  Doing other activities in bed makes you unconsciously associate the bed with those other activities. You may have heard that you should only use your bed “for sleep and sex,” and it’s entirely true. 

Regular physical activity can positively impact your sleep. However, avoid exercising close to bedtime, as it can be stimulating and make it harder to fall asleep. Aim to complete your workouts at least a few hours before bedtime.

What is your nighttime wind down like?

Developing a bedtime routine with calming activities can signal your body that it’s time to wind down. Consider incorporating relaxing activities like meditation, a warm bath, reading a book (not in bed), or practicing light stretching exercises. These activities help prepare your mind and body for a restful night’s sleep.

Electronic devices emit blue light, interfering with your body’s natural sleep cycle. Avoid using phones, tablets, and laptops at least an hour before bedtime. Instead, unwind with a relaxing activity like reading or calming music.

Although both alcohol and cannabis of these substances can make you feel sleepy (and people often use them for that), they have similar effects on sleep, decreasing the quality of your sleep. These substances do this by reducing the amount of REM sleep you get. So even though you feel like these substances are helping you fall asleep, their effect on sleep makes you sleep more poorly. If you choose to drink or use, try to do so in moderation and avoid them close to bedtime.

Eating right before bedtime can disrupt your sleep. It’s best to avoid heavy meals, especially high-sugar foods, within 3-4 hours of going to bed.  

Lastly, it’s essential to minimize stress before bedtime. Avoid engaging in stressful conversations or activities that may keep your mind racing as you try to fall asleep. Instead, try relaxation techniques like deep breathing or meditation to calm your mind.

Let’s talk more about the setting of your bedroom

Is your room somewhat cold (but not too cold)? Do you keep your room very dark? The environment in which you sleep can significantly influence your rest. Make sure your bedroom is cool, dark, and quiet. Investing in a comfortable mattress and pillows can also make a world of difference in how well you sleep.

“I wake up in the middle of the night.”

Another patient concern I often hear is reporting waking up in the middle of the night. This is another area where learning more about normal sleep can be helpful. Our sleep occurs in cycles that can range from 90 to 110 minutes. At the end of every cycle during the night, we wake up. Most times, we do not remember that we woke up. Sometimes, we remember that we woke up. If you get back to sleep within 30 minutes, this is normal and happens at the end of every sleep cycle. 

Is your alarm clock impacting your sleep?

Please note that I do not say fall back asleep “within 30 minutes” to promote clockwatching. Watching the minutes tick by will only stress you out, so turn that clock around. Stress wakes your body up and makes it harder to fall back asleep. Even though time is relative, you’ll just want to estimate if you’ve been up too long. Light from an alarm clock can impact your sleep-wake cycle by tricking your brain into thinking it is daytime. In fact, it may be best to ditch your alarm clock altogether.

Patience

Remember, improving your sleep might take time and some experimentation. Don’t be discouraged if you don’t see immediate results. If all these tips overwhelm you, start with just one and take it from there. Implement these tips gradually, and soon enough, you’ll notice a positive change in your sleep quality.

 Suppose sleep troubles persist despite trying these tips. In that case, it’s always a good idea to consult a healthcare professional for personalized guidance. Here at Sweetgrass Psychiatry, we are always ready to support you on your journey to better sleep and overall mental well-being.

Wishing you sweet dreams and a well-rested future ahead!

If you are located in South Carolina and struggling with sleep, we encourage you to see support from your primary care physician and we are also happy to see you at Sweetgrass Psychiatry. We have locations in Mount Pleasant, SC and Isle of Palms, SC.