Avoid Alcohol as a Hypnotic
Although alcohol use
before bedtime can help some people to fall asleep more easily, it has been
shown that use of alcohol to promote sleep (i.e., larger quantities than is
typical for the individual) results in more fragmented sleep, more awakenings
during the night, and/or early morning awakenings.
Caveats/considerations:
While some may tolerate a glass or two of wine at dinner, others may find that
this makes their sleep more fitful, while still others may find that this
promotes the occurrence of early morning awakenings. Quite apart from its
effect on sleep maintenance, another possible reason to curtail or eliminate
alcohol consumption is that while in active behavioral treatment, one of the
greatest difficulties that patients have is to remain awake until the
prescribed bedtime. Drinking alcohol will only serve to make this task more
difficult. So the patient may be encouraged to temporarily suspend alcohol
consumption during active treatment so that they can stay awake at night.
Avoid Nicotine
Nicotine is a stimulant,
and it has been demonstrated that chronic cigarette smokers have experienced
significantly improved sleep when they quit.
Caveats/considerations: It
is possible that during the early stages nicotine withdrawal may actually
exacerbate sleep disruption,especially in the patients who are most addicted.
Patients should therefore be educated about the effects of nicotine on sleep,
and then encouraged to work on sleep and smoking cessation at different times.
One thing that could be tried during active sleep treatment would be to have
patients experiment with changing the times of smoking to see what changes
might benefit sleep. For example, patients could be encouraged not to smoke in
the middle of the night when they can’t sleep, as such smoking might be
training them to wake at night to smoke. A consistent change in this regard
might at least alter that pattern without having to go through full smoking
cessation. Further, smoking cessation techniques might aide in this process
(e.g., the use of a icotine patch) and represent a reasonable first step in
smoking cessation.
Avoid Caffeinated Products within 6 Hours of Bedtime
Rationale: Caffeine works
as a stimulant in your body and can keep you awake.
Caveats/considerations: It
is unlikely that caffeine in the morning is going to have much if any impact on
night-time sleep, even in the most sensitive of patients. In addition, there is
some evidence that stimulants, used judiciously in the earlier part of the day,
may actually provide some benefit, especially to those patients engaged in
sleep restriction therapy, in that it can help them to remain more awake and
alert during the day. Permission to use caffeine may actually serve to decrease
patients’ anxiety about not sleeping at night, and this may aid in promoting
better sleep. On the other hand, the length of time before bed that caffeine
should be curtailed before it is an issue will vary from patient to patient,
and this is one rule that will require tailoring. Although decaffeinated
products contain much less caffeine than their caffeinated counterparts, it is
possible that small amounts of caffeine in the evening, especially in the most
sensitive individuals, may still serve to be an irritant to sleep onset. This
is an example of how a modest infraction may serve as a predisposing factor to
sleep problems even if it is not a direct cause. Patients should be encouraged
to read product labels and make sure that they are not inadvertently consuming
caffeine late in the day. It can be illustrative to point out that many
lighter-colored sodas and some aspirin brands contain caffeine.
Avoid Liquids Before Bedtime
Some drugs or substances have
a negative influence on the sleeping pattern due to a central stimulant effect
on the brain. Some of these substances are medical drugs that have been
prescribed by doctors. But sometimes even medical experts are not fully aware
of these possible side effects of the medicine.
Liquids close to bedtime
will fill your bladder and result in discomfort while you sleep, causing you to
wake more frequently.
Caveats/considerations:
Patients who wish to drink small amounts of liquid may do so by restricting
intake to less than 6–7 ounces in the 4 hours prior to bedtime, and by making
sure they void before going to bed. As stated earlier, there may be medical
problems or conditions that require patients to be better hydrated, and this
should supersede any sleep habit instruction. There should also be awareness of
the fact that some conditions (e.g.,enlarged prostate) and some medications
(e.g., diuretics) may necessitate middle of the night voiding regardless of how
much liquid restriction takes place. Some patients, such as those on continuous
positive airway pressure (CPAP), report waking in the night with a dry mouth.These
patients should be encouraged to take a few sips of water in the middle of the
night, perhaps even to have a small cup ready next to their bed to avoid having
to get up. However, they should be dissuaded from drinking large amounts.If
patients do wake in the night with even a mild sense of bladder distension,
they should be encouraged to get up and void. Attempts to go back to sleep with
bladder distension are likely to fail or will result in repeated arousals.
Avoid Benzodiazepines and other substances
The most relevant drugs
that can cause severe sleeping problems are SLEEPING PILLS. Sedative substances
used for short term therapy of insomnia or anxiety disorders (benzodiazepines)
are the most common cause of chronic disturbances of normal sleep. These drugs
are highly effective in promoting sleep during a limited period, but will cause
a disruption of the normal sleep pattern within a couple of weeks. Due to
tolerance effects the patients usually will need more of the drug to achieve
the same effect. This can cause addiction and disturbed sleep.
Other possible drugs with
a negative influence on your sleep:
- Anti-hypertensive drugs
- Asthma medication (theophylline, beta-sympathomimetics)
- thyroid hormones or other hormones (thryroxin, steroid medication) diuretic
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