Can I improve my sleep?

Yes! Review the sleep recommendations listed here for optimizing your sleep hygiene. Start by identifying those you are already doing/using and don't change a thing.  

Next, identify those behaviors that could be improved and pick 1-2 to work toward changing at a time. Don't try to change another one until those become habits. Don't worry if your sleep doesn't change dramatically after you implement your first changes, but do keep track of what you are changing and how you are sleeping. Keep going with what seems to have the biggest impact.  Don't hesitate to speak with your therapist, physician, friend, or family member for support in making changes. 

Daytime:​

• Get out of bed at the same time each day, no matter what.
•  Go outside often. Having bright indoor lights during the day can also work.
•  Move your body often. Regular exercise helps people feel more rested after they sleep. Exercise also helps people feel more awake during the day. However, avoid exercise for about an hour before planning to sleep.
• Eat fresh foods. Your brain needs nutrients so that it can make the chemicals and hormones that help you sleep well.
•  Find ways to lower stress in your life. When the stress hormone (cortisol) is high, it keeps the sleep hormone (melatonin) low. The more you can find ways to relax, the more balanced these hormones will be.

​Nightime

• A few hours before you want to go to sleep, stay away from bright lights. This includes overhead lights, TVs, smart phones, tablets, and computer screens.
• Create a relaxing routine to do each night before you go to bed. Maybe this includes body and muscle relaxation, music, imagery, self massage, a warm bath, etc. Find a relaxing routine that works for you!
• Go to bed at the same time every day, no matter what.
• Keep the bedroom dark. This lets your brain make more melatonin.
• Keep the temperature in your bedroom comfortable. Many people sleep better if the bedroom is on the cool side.
• Keep the bedroom quiet when sleeping. Some people also sleep better with a constant noise, like a fan, TV, or "white noise" machine. If you use noise to help you sleep, make sure there is not too much light in your room. For example, keep the TV screen dark, even if you feel the noise helps you sleep.
• Use your bed only for sleep and sex. Do not do work or other stressful activities in your bed or bedroom. Keep electrical devices away from your head when you sleep. The bright light from a phone or tablet can lower sleep hormones. Having these devices near you, when you are close to bedtime, can make you more stressed, which also makes it harder to sleep!
• If you find you aren't easily able to fall asleep or return to sleep upon waking in the middle of the night, get out of bed and engage in a low-impact/low-sensory activity until yo feel you could quickly return to sleep (e.g. reading in low light, listening to music, engaging in yoga or prayer). The goal is to avoid associating your bed with worrying about whether or not you are sleep.
• Keep your feet and hands warm overnight. Wear warm socks and/or mittens or gloves to bed if you need to.
• Turn the clock around so you cannot see it. Some people get anxious if they are awake, which can make it harder to fall asleep. 

What is still keeping me up?
 Many activities, medicines, foods, and drinks can make it difficult for a person to sleep well. Working to change these habits can make it easier to get a good night’s sleep.(Keep in mind that some of these habits are very hard to overcome. Some people may need to work with a health care professional).

The following are some examples of things to try:

• Avoid activities close to bedtime that make you feel more awake, nervous, or stressed. This may be different for different people, but usually includes watching TV, playing a competitive game, or having an important discussion with a loved one. • Don’t have caffeine after 3 p.m. (Coffee, many teas, energy drinks, chocolate, and many sodas all have caffeine).
  
•  Don’t read, watch TV, or use your electronic device in bed. This can make you more stressed, and the bright screen light can lower your melatonin.
  
• Steer clear of using alcohol to help you sleep. It can make you drowsy, but you can't get the deep, restful type of sleep when alcohol is in your system. Alcohol may also wake you up too early.
  
• Avoid going to bed too hungry or too full.
  
• Ditch daytime naps. These help some people but can keep many people from sleeping well overnight.
  
• Don’t command yourself to go to sleep. This only makes your mind and body more alert and awake (and often upset). • Try to steer clear of medicines, supplements, and substances that can make it difficult to get good sleep.

​

Medications, supplements, & other substances that can make it more difficult to sleep:

• Amphetamines (methylphenidate, dextroamphetamine)
• Antidepressants (many classes – ask your health care team.)
•  Asthma “rescue” inhalers (albuterol)
•  Beta Blockers (atenolol, bisoprolol, carvedilol, labetalol, metoprolol, propranolol)
•  Decongestants (phenylephrine, ephedrine)
•  Diuretics (also called “water pills,” especially if taken at night: furosemide, torsemide, bumetanide, metolazone, chlorthalidone, hydrochlorothiazide, spironolactone, triamterene) • Histamine blockers (ranitidine, famotidine) and antihistamines (loratadine, fexofenadine, cetirizine) • Steroids (prednisone, prednisolone, betamethasone, cortisone, dexamethasone, fluticasone, mometasone)
•  Some thyroid replacement medicines (liothyronine, natural and other thyroid supplements containing T3/tri-iodothyronine)
• Alcohol
  
• Caffeine (including coffee, green/black tea, energy drinks)
  
•  Ginseng
  
• Nicotine
  
• SAMe • Tobacco
  
• Weight loss supplements (Ma huang/ephedra, bitter orange)
• 
  

Please consult with your medical provider before stopping or changing use of any prescribed medications or supplements

This page is adapted from ​https://www.va.gov/wholehealth/veteran-handouts/docs/ChangeHabitsSleepBetter-508Final-10-25-2018.pdf