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I can't sleep - should I get up or stay in bed? Add to ...

The question: When I can’t sleep, is it better to get up and try to take my mind off things or stay in bed?

The answer: One of my favourite quotes is from writer Edgar Watson Howe: “There is only one thing people like that is good for them; a good night’s sleep.”

Sleep is a core need that we have – just like water, oxygen or food. Yet about one-third of Canadians struggle with chronic sleep difficulties.

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We all know when we have a solid, deep sleep that we feel golden: mood is positive, energy is high, we are much more focused and attentive, and generally more resilient to day-to-day stressors. Conversely, when we are lacking in sleep, multiple areas of function are affected. We are more likely to feel irritable or annoyed, experience changes in appetite and be much more distracted.

One of the most common sleep problems is insomnia – characterized by difficulty falling asleep, not being able to stay asleep and/or early-morning awakenings. The most effective treatment for insomnia is cognitive-behavioural therapy that focuses on behavioural sleep patterns, thoughts and worries – including worries about sleep.

If you can’t fall asleep within 15-20 minutes, get out of bed and do not go back until you are sleepy (not just tired).

Anxiety is a normal part of life, but also one of the strongest factors that influences sleep. If you find that worries are preventing you from sleeping, it can be helpful to keep a “worry log” – get out of bed, write down your concerns and ask yourself three key questions:

1. What is the evidence for this worry?

2. What is the problem to be solved?

3. What can I do right now?

Although this can feel difficult to do, it is highly important as staying in bed and worrying associates anxious thoughts with sleep time – and over time, your bed becomes linked with worries and can evoke these thoughts as soon as you get into bed.

If you are having trouble identifying the root of your sleep problems, keep a diary for one to two weeks (e.g., track your diet, work and leisure activities, level of stress and bed/wake times). This can help identify patterns and factors that are affecting sleep that you may not be aware of.

Here are some tips to improve your sleep:

• Have a consistent, fixed wake-up time – even on weekends – to build a steady sleep pattern.

• Expose yourself to outside light (e.g., open blinds) upon waking.

• If you are having sleep problems, do not nap! Naps interfere with the restorative value of sleep later at night. The best strategy is to get into bed earlier that evening.

• Do not have caffeine after noon to 1 p.m. (the half-life of caffeine is five hours – which means that five hours after having caffeine, 50 per cent is still left in your body; it takes another five hours for the caffeine to be reduced in half again to 25 per cent).

• Do not smoke or exercise two to three hours before bedtime.

• Reduce or eliminate alcohol use. Even one drink interferes with sleep quality and makes sleep less restorative.

• Create a bedtime routine that is relaxing; have decaffeinated tea, warm milk or a warm bath. Make a clear distinction between daytime (alert) activities and bedtime (relaxing) ones.

• Make your bedroom environment comfortable and conducive to sleep. Get comfortable pillows and bedding, darken the room and keep the temperature moderate.

• Restrict your bed for two activities: sleep and sex. Do not watch TV, eat, talk on the phone, argue or use your computer while in bed.

Send psychologist Joti Samra your questions at psychologist@globeandmail.com. She will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail web site. Your name will not be published if your question is chosen.

Read more Q&As from Dr. Samra.

Click here to see Q&As from all of our health experts.

The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.



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