Self-help Articles

by Robin August, Ph.D.

I have to say that I have a terrible time with my sleep, always have. I do have to take medication every night which includes large doses of melatonin (my melatonin levels are reversed, high in the morning and low at night) and ambien cr. This seems to work well for me and of course, I follow the tips that I list below, especially sleep hygiene.

Here are the latest, hot off the press, tips for dealing with sleep problems.

1. Go to bed at approximately the same time each night and get up at about the same time; even on the weekends. Don't build up a sleep debt, i.e. missing some sleep for a night or two and then sleeping much longer other nights to "make up for missed sleep".
2. Slow down before you go to sleep. Do calming things like listening to mellow music, reading something that is not going to rev you up. Don't let your to-do list for the day move into this time. Let it go for tomorrow.
3. Don't consume alcohol, nicotine, or caffeine before you go to sleep (a couple of hours before you go to sleep). They actually interfere with a good night's sleep because they are stimulants.
4. Don't have a big meal 2 hours or less before you go to bed. If you have heartburn, avoid eating foods for dinner that can cause heartburn. Limit how much you drink before you go to bed as it may cause you to have to get up in the middle of the night to go to the bathroom, thereby disturbing your sleep.
5. Make sure that you have a comfortable bed and pillow. Well, to be honest, I actually sleep with three pillows so go for whatever you need to make you comfortable! Some people suggest memory foam or magnet mattresses. Check them out thoroughly.
6. Make your bedroom a place to sleep and do not watch T.V., work on your computer or other activities. Keep the room at a comfortable temperature and limit the light coming in with shades. Also make sure that it is quiet. If not, consider getting a white noise machine. Turn your clock face away from you so that you don't have the temptation to look at the time. That can make you more upset and thus, disturb your sleep.
7. Take a short nap in the middle of the day (20 to 30 minutes but no more than that) only if you are totally wiped out. It will refresh you without keeping you awake at night and give you a little more energy during the afternoon. If I am going to take a nap, I set my kitchen alarm to wake me in 20 minutes. But it seems like the best thing for most people is to rest a few times a day without actually sleeping.
8. Have a ritual before you go to sleep that you follow every night. You might take a warm bath, light some candles, meditate, or try progressive muscle relaxation. Progressive muscle relaxation involves relaxing your muscles by tightening and then relaxing a group of muscles such as the muscles in your face, your neck, your arms, your chest, and so on. Scan your whole body for tension when you are done to see if any area remains tense, then work on relaxing that particular area. When I write my pain blog, I'll go into more details on Progressive Muscle Relaxation.
9. If you absolutely can't get to sleep after about 15 minutes, get out of bed and watch some T.V. or listen to some music in a low light room, or read. Then try going back to sleep again only when you feel tired. Staying in bed and agonizing over your lack of sleep only makes you anxious and it then becomes less likely that you'll be able to sleep.
10. If all fails over time, consult with your physician about medication to be used occasionally. First you can try over the counter such as valerian, chamomile tea, tryptophan, Tylenol PM, melatonin (3-9mg two hours before sleep), or prescription sleep medication such as Ambien CR or Lunesta, but first check with your health care provider before starting any of these. If all else fails, ask your doctor about the possibly of a sleep study, if it is bad enough. with a physician who has worked with CFIDS or Fibromyalgia. You may have restless leg syndrome or sleep apnea which can usually be picked up in a sleep study and can usually be treated. Cognitive Behavioral Therapy, as discussed in previous blogs, may also help with insomnia that is caused by psycho-physiologic factors.
11. Most people need 7 to 9 hours of sleep per night although fibro and cfids patients may need a little more. I need about 10 hours of sleep per night. Find out what is right for you and then try to build that into your schedule. Don't fight getting the amount of sleep that you need.
12. Try to exercise on a regular basis. It can help you fall asleep faster and make your sleep more restful. But don't do it three hours before you go to sleep otherwise it can act as a stimulant.
13. You might try meditation, deep-breathing exercises, and guided imagery. Guided imagery means that you have some images, like a peaceful walk in the woods that you either imagine or put on tape. You can imagine the temperature, the smells of the forest, the beauty of the forest, and how good it feels to walk.
14. If you are having nightmares or wake up worrying about something, try putting pen and paper near your bed and write out what you are worried about. You can also try to mentally change the outcome of your nightmare to something pleasant.
15. If you are really worried about something, try writing about it before you go to sleep so you don't end up processing it while you are trying to sleep.

And as always, please send in any tips that work for you.

About the author:

Robin August, Ph.D., LCSW. obtained her Master’s in Social Work and her Ph.D. in Psychology from major Universities. She has also studied Life Coaching. She has been in private practice since 1987. She specializes in working with survivors of child abuse, coping with chronic illness, depressive and anxiety disorders, life coaching and general psychotherapy. She lives in the beautiful Smoky Mountains where she enjoys the outdoors. Dr. August also lives with Fibromyalgia and Systemic Lupus so she brings a unique personal understanding to her work.