Beyond Counting Sheep

Who has trouble staying or falling asleep? Since the pandemic, I’ve heard of more and more people struggling with shut eye.  I feel your pain.

In this article, I hope to outline strategies- beyond counting sheep – to hopefully demystify this activity and erase some of the dread you may experience.

I’m a quasi-expert in this area, having struggled on and off with sleep issues the last 20 years. As a leader of a sleep support group for one year, ironically called AWAKE, I learned a lot about sleep. And I can recite sleep articles verbatim: They all sound mind-numbingly similar and overly simplistic.

Keep the same wake up and bedtime. Make the room dark and cool. Avoid exercise and screen time too soon before bed. Use your bed only for sleeping- and sex. But avoid too much exercise before bed! Avoid caffeine, do not eat too close before bedtime, try mediation and deep breathing. Get up if you’ve been awake for 20 minutes. But don’t look at the clock! Take a warm bath. I’ve heard it all before. Like that Johnny Cash song: “I’ve been everywhere…”

From valerien to lavender, chamomile to kava roots, darkening shades to HEPA filters, steroid sprays to nasal strips, melatonin to meditation. I’ve tried everything. And then there are the heavy hitters – the prescribed sleep aides like Ambien. These used to be handed out like candy: “Just make it part of your routine, like brushing your teeth,” a nurse once advised me. Now they are a controlled substance, due to the potential for over-dependence and hazardous side effects, like sleep walking.

CBT for Insomnia

After trying the sleep aide route, you can call on the professionals- the sleep doctors. The gold standard prescription is Cognitive Behavioral Therapy For Insomnia (CBTI). Sleep practitioners will scrutinize your sleep “hygiene” habits and how your behavior influences your sleep efficacy. The goal is quality over quantity. You will be asked to document endless details about your sleep habits- When you go to bed, fall asleep, wake up, return to sleep, wake up, get up. Like with new parents trying to coax their colicky baby to sleep through the night, every hour of sleep is cause for celebration.

The focus in sleep medicine now is on making your sleep more productive, so ironically sleep specialists may recommend that you acquire a sleep deficit. If you are a night owl, they will have you stay up later and later in 15-minute increments. Or, if you are a morning person, you will have to wake up earlier and earlier. And then gradually you will move back to a more reasonable schedule.

This worked well when I suddenly became an adoptive mother. I was naturally kept up late and woken up early and soon my sleep problems improved! Generally, I don’t recommend having babies as an insomnia solution- especially since they eventually become teenagers.

Overnight Sleep Studies

A next thing to do after analyzing your sleep hygiene habits, is to have a sleep study to rule out any obvious physiological or anatomical challenges. Melatonin and chamomile and CBT oil will only get you so far! And there are new concerns about the overuse of melatonin. After looking at any obvious challenges with your breathing patterns and ear nose throat structure, sleep doctors will subject you to an overnight sleep test to rule out any obvious medical problems.

When my husband woke up one night gasping for air, he finally agreed to a sleep study. In an overnight sleep study, you will be strapped to wires strapped to your head and heart, and various limbs, to measure your pulse, brain activity and periodic movements. Every snore and reflex will be captured on camera, which is typically perched from the ceiling in the corner of the room.

A tech will be waiting for you to nod off from the other side of the room. Just when you think you cannot possibly sleep a wink, they shut out the lights and begin recording you. And the pressure to doze begins! Or, mercifully, you will have a home study which is far less intrusive.

Sleep Apnea and CPAP

Don’t brush off snoring as an annoying or amusing habit. You may have sleep apnea. It’s normal to stop breathing for up to a minute 5 times an hour- 15 times is considered severe. My husband had 38 episodes per hour. Now he sleeps with a CPAP machine (Continuous Positive Airway Pressure).

When I discovered it wasn’t normal to fall asleep in hot tubs, conversations, or thriller movies, I had my first of numerous sleep studies. Due to upper airway restricted breathing issues, I finally surrendered to using a BiPAP machine, which helps control the inhale and exhale. Now my husband I resemble a pair of unicorns with hoses coming out the tops of our heads like a pair of unicorns. It may not help your sex life, but it will improve your sleep! If you wish to avoid such drastic measures, I have a few other tips to offer.

Resting and Relaxing

First, invest in a decent mattress. Or as they are now called, sleeping systems. Water beds, Memory foam, latex, spring coil: I’ve tried them all. It may end up costing more than your first car, but it will probably help your sleep. A latex foam mattress has been the most effective for me. Comfy bedding helps too. Enjoy the sensation of cuddling in bed and practice the art of lying still.

Take it one day at a time- try not to assume this insomnia phase or relapse will last forever. Don’t panic about how you will possibly drag yourself out of bed in the morning, and trust you will have had enough sleep to get through the day. Build buffers or natural pauses to give your nervous system a break, and give yourself grace to be less productive.

Unless you are Albert Einstein – he was reported to have snoozed with 2 tennis balls in his hand. So that if they fell out while going into deeper sleep, he would wake up and be more likely to remember his creative ideas.

It’s normal to frequently waken during sleep, but most of the time we are hardly aware of it. What is more detrimental is the hyper-arousal state where you become more aware and anxious about your awakenings. Slow breathing and mediation can help kick you out of the stressed fight flight nervous system, and back to the relaxed one, used for resting and digesting. But we need to practice feeling relaxed during the day time, in order to feel relaxed at night. Sleep experts say it’s not always what we do at nighttime that affects sleep!

Sleep Interrupted

Fragmented sleep was sleep was common in historical times. People did all kinds of things in the middle of the night, besides jotting down their theories of relativity. Have you heard of this two-sleep trend? This mediaeval habit has been making the news lately. Sleep researchers have seen it referenced across cultures and countries, from the Middle East to South Asia and Latin America, Europe and Africa up, all the way to the industrial age.

Sleep at one time was like a two-part performance with an intermission in between, where people conversed together, had sex, did their taxes, read prayer manuals. Or visited their neighbors. Don’t try that today if you want to keep the peace! This nocturnal activity all started to change with the increase of light- first the glass candle holders in Paris, then gas powered light in Amsterdam, and finally electricity in the Industrial Revolution. (Ironically the City of Light, Paris, is now trying to mandate more darkness by having businesses shut off lights after 2 am). 

Sleeping through the night became more in vogue with the advent of electricity and the surge of coffee houses, according to historian Roger Ekirch, who first researched segmented sleep twenty years ago. Suddenly medical journals were touting the efficiency of sleeping through the night in one phase instead of the bi-phase approach typical for most mammals. The one constant that most experts agree on for optimal sleep is a routine or schedule to help maintain your optimal circadian rhythm.

Routines and Rituals

What works for toddlers, works for adults too! Try to develop a routine. If that means reading for a few moments in bed before nodding down, then read. Or write a worry journal to clear your head. But maybe avoid riveting thriller with a murder happening in every page. A car manual, doctoral dissertation, or law briefs might be more sleep-inducing.

Browsing on your phone may be relaxing for a few seconds. But don’t scroll through your phone trying to find the bottom of the internet or keep hitting next episode on the endless stream of Netflix series. Too much light from the screen or lamp can disrupt your melatonin levels. And too much stimulus may put your brain into overdrive, though light filters help to some degree. Some glasses now have blue light features.

Whatever your routine, avoid dozing off before completing your nighttime rituals. Or your body’s circadian rhythm will be confused about what the real bedtime is and have trouble returning to sleep.

We all have our own unique rhythm, so don’t be pressured into thinking we all need that magical 8 hours. Maybe your sweet spot is 7 hours. People may boast with bravado about only 4 hours of sleep to sleep, but that is a genetic fluke. Sleep –or lack thereof- need not be a sign of weakness or of strength. Sleep scientist Matthew Walker says we are the only species that deliberately resists going to sleep, for no apparent gain. We often act like snoozes are for sissies, but a quick 10-minute power nap has been shown to provide great benefit.

Sleep Cycle

To reduce your nighttime anxiety, it is helpful to know that there are 5 stages of sleep in the sleep cycle. Each stage lasts 5-15 minutes and you cycle through them all night long, alternating between REM and non-REM sleep, according to National Sleep Foundation.

The first stage is light– it is normal here to drift in and out of sleep. In fact, the first 4 stages of sleep are all non-REM sleep, and account for 75% of your sleep. Stage 3, where you shift from light to deep sleep, can also leave you disoriented when you awaken. This stage provides the most restorative sleep, and has the most brain activity.

Deep REM sleep, Stage 5, accounts for about 25%. And if you wake up at this time, it can feel like you haven’t slept at all- which explains why those early alarms or phone calls can leave you groggy. This is the dreaming stage, and the stage which impacts you the most physiologically (rendering muscles immobile, so we don’t act out our dreams).

Remember, you may be dozing more than you think. You could be in a state of fragmented sleep, where you feel half-awake, but this still counts as sleep. This was confirmed in my sleep studies. They call this the twilight zone. If you have chronic insomnia and get up every time you feel like you’ve been awake for 20 minutes, as sleep docs recommend, you may never get any rest.

Know What’s Normal

Taking 20 minutes to fall asleep is typical. Whatever your reason for wakefulness is at night, try to bring intentionality to your sleep habits. When we historically had multiple wake and sleep times in the night, for rest and relaxation, people naturally learned to self-regulate stress.

Perhaps that is why stress, anxiety and drinking are on the rise. But alcohol and sleep aids do not cause normal sleep rhythms, even if they bring temporary quick relief. The next time you wake up and feel anxious- try to relax and trust the process. A little bit of awake time is normal and may even be good for you!

So when you have that occasional bout of insomnia, think of what works for toddlers:

• Be consistent

• Take time to rest and play in the daytime.

• Transition before going to sleep

• Make your bed inviting and comfy

• Listen to something calming before bed

And don’t panic over occasional sleep woes. If you struggle, remember to breathe slowly and deeply. One thing I have learned through sleep struggles is surrender. You can also try my strategy: I don’t count sheep, but I pray for different countries or people around the world, starting from A-Z or Z-A. Right now I am especially praying for Ukraine. There is certainly no shortage of topics to pray for these days!

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