A Good Night’s Sleep — Nature’s Natural Medicine Nurse
When I was a child growing up in Colorado, in order to gain listeners a local disc jockey held a contest to see who could guess how long he could broadcast music without falling asleep.
I must have been fascinated with how a man could put himself through so much torture, since his stunt seemed like one of the worst possible violations of the laws of nature. He lasted about 8 days.
When Shakespeare wrote, “Gentle sleep is nature’s soft nurse,” he invoked the idea that there are few panaceas like a good rest, and restful sleep is the norm of all animals except humans. Even animals that are prey manage to sleep. It is amazing how humankind has manipulated something so natural into something so complicated. Chronic sleep disorders have their roots in poor lifetime sleep habits. The crux of the epidemic began with the invention of the electric light, which permits us to rearrange our circadian rhythms on a whim. Sleep problems happen to one third of us. One of the worst forms, chronic sleep maintenance insomnia, regularly spending long periods awake after initially falling asleep, is the commonest and hardest to treat of sleep disorders, affecting 5% of the population.
The ancient Sanskrit medical textbooks of Ayurveda, the health science of the Vedic civilization, state, “A man sleeps when, with an exhausted mind, his sensory faculties and organs of action detach from their objects.” This implies that as long as one is using the mind, sleep will not come. Sleep is healing, not only because it permits the body to physically rest, but also because it allows the mind to reorganize and digest our experiences and circumstances for understanding our situation and planning future action. Hence, the phrase, “I’ll sleep on that.”
The Vedic textbooks state further, “Sleep brought on by the nature of the night itself is true sleep, called reparative sleep by the wise. Sleep caused by [dullness from foods, drink, medications and activities] is the root of misconduct and should be treated as a disease.” The texts state that sleep caused by imbalances such as heaviness in the body, disease and even fatigue is not true sleep. The ancient physicians understood that the circadian rhythms induced by cycles of light and dark, are the synchronizers for our best sleep, and that we do our most important sleeping when we are actually rested. Just like an athlete or musician will prefer to perform when well rested, our minds and bodies are best healed by sleep undertaken when we are not exhausted.
Unfortunately, we take the same goal-oriented approach to sleep that we use to attack other aspects of our competitive lives. You think, “I’ve got to get a good night’s sleep so I can do well in my meeting tomorrow.” When you find yourself lying awake, thinking about the meeting, you get anxious, further preventing the senses from withdrawing from their objects. Even worse, you start to get angry at things that seem to be preventing you from falling asleep and even more anxious because you haven’t fallen asleep yet. It becomes a vicious cycle.
People with insomnia may have developed the bad habit of using their bed to watch television, read, or plan their schedule for the next day and lying in bed gradually becomes associated with wakefulness rather than sleep.
Sleep is not something we plan or desire to do. It is the by-product of creating specific circumstances and letting nature do the rest. A proper attitude is that we go to bed to rest and not to sleep. We just lie down innocently without any expectations and whatever our nervous system needs, that is what we will get. This attitude prevents us from being disappointed at how we slept and saves our psychology.
In this context it is interesting that in April 2001, Edinger and his group from Duke University found that people who were given cognitive behavioral therapy for treatment of sleep maintenance insomnia, the kind most common in middle-aged and older people. Treatment group subjects were given a program to change the specific thoughts, behaviors, and beliefs that stand between them and a good night’s rest. They were taught to (1) establish a standard wake-up time; (2) get out of bed during extended awakenings; (3) avoid sleep-incompatible behaviors in the bed/bedroom; and (4) eliminate daytime napping. This program essentially tested the ancient Vedic approach to sleep disorders. The treatment group had a reduction of 54% in the time spent awake in the middle of the night, compared with groups getting progressive muscular relaxation or sham, placebo counseling. This is one of the most important studies to address sleep disorders because it showed that dramatic improvements in sleep could be achieved by tackling sleep habits themselves, unlike the superficial effect of sleeping pills, which can be addicting and do not address the problems underlying your sleep disorder.
Most people can change several factors to improve the quality of their rest at night and to prevent age-related sleep disorders. First, change your attitude toward sleep. Stop using the word “sleep” and substitute the word “rest.” You will thus say to your spouse, “I’m going to rest now.” Take the attitude that you are simply going to put yourself in a comfortable, quiet, dark place for six to eight hours, and let go. Whatever happens, fine. Take the outlook that you are just turning yourself over to God, and whatever She or He plans for you for that night is exactly what you need. Dreams, thoughts, and those moments of silence between waking, dreaming and sleeping are all as important as unconscious, dead-to-the-world sleep. Stop judging how good your “sleep” is tonight and how you “slept” the next morning. Adopt the attitude that as long as you passed your time lying down in a quiet, dark room with your eyes closed, that you are ready for your day.
The ideal time for rest according to just about every tradition of wisdom on the planet (except the western one) is from an hour or two after sunset to an hour or two before sunrise, say around 9-10pm to 4-6am. In these six to seven hours, more can be accomplished than from midnight to 9am, and endocrinologists studying the circadian hormonal fluctuations of cortisol and melatonin would agree. When the lights go out, melatonin goes up, cortisol goes down and you sleep. Four a.m. is the onset of the brahmamuhurta, the period of the day when nature is beginning to stir, and the period most conducive to meditation. Take the attitude that you can get up anytime from 3:30am onwards, but at least get up before the sun.
The long-term health consequences of not sleeping well are currently being documented, and include depression, anxiety, poor problem solving and risk of (often fatal) accidents but also heart disease and premature death. So it is important to learn to sleep again if you have never been properly taught.
But you needn’t lose sleep over a little missed sleep. Many people do fine on as little as four to five hours. Some men of great achievement (and admirable longevity) including George Bernard Shaw, Churchill, and Darwin slept very little indeed. Thomas Edison, who lived to 84, was famous for staying up for days working in his lab, taking short naps on a cot. In case your mother never taught you, here’s a primer in how to get your forty winks:
- Establish a regular time to rise. Get up and at ’em at the same time every day, whether or not you think you slept well. Studies have shown that almost everyone functions just fine the next day, even if they have the perception they have not slept a wink. Make that time of the day early — by at least 6am. Then go to bed early enough to
- You don’t need to abandon your old bedtime immediately. Many people with chronic sleep disorders end up retiring at 2am because they are afraid to go to bed and just lie there. They call themselves night owls and have learned that retiring early just creates anxiety and is counter-productive. They may stay up and wait until they know sleep is coming. But two hours later, at 4am — brahmamuhurta for the blue jays — their eyes pop open and they are wide awake, superficially refreshed after 2 hours of sleep. After lying awake for a couple more hours, they need to sleep in to 10am.
- If this describes you, start moving your arising and retiring time earlier by ten to fifteen minutes per day. In a couple of weeks, you will have painlessly reset your biological clock to a healthier pattern. After all, you’re basically just on jet lag, a disorder from which we can recover at the rate of about one hour per day. The issue is not just your inner clock, but also a lifetime of lousy habits, including most importantly the habit of staying up doing things and taking in information, usually of little consequence, in compensation for a day that was less than satisfying. I call it “behavioral bulimia,” ingesting perceptions of little nutritive value from a screen or book. Call it a day, and go to bed with the intention of making tomorrow more fulfilling.
- Arise at the same time, but avoid using alarm clocks. Keep your curtains wide open to let the morning sunshine turn off your melatonin. Or find someone to arouse you gently, or just set a radio alarm to awaken you gently. After a few weeks, you will be waking up without assistance at your proper time. You can have coffee or tea for breakfast, but don’t take any more the rest of the day. Your late afternoon cup o’ joe is still in your brain when you want to be retiring that night.
- If you spend 3 hours up in the night, do not sleep in. Get up and get going. Above all, do not indulge in daytime sleep to make up for missed time. Stay up, but avoid using caffeine. The next night you will fall asleep more easily and awake less often. It may take some time to culture this habit, but persistence will pay off.
- If you find yourself lying awake, avoid giving in to anxiety or anger, or to succumb to the worst mirage of lying awake: “This is boring.” Your nature, after all, is cosmic, and your physiology is a reflection of the nature of the Divine. (Spiritual texts from every tradition, I am told, say man is made in the image of God.) So allow your mind to innocently experience a part of the divine by interfacing with your body. Let the mind go where it will go. Sometimes it will be aware of your breathing, sometimes of your heart, your limbs or your digestion, etc. Enjoy the feeling of your body resting. If you find yourself wandering to anxiety-provoking thoughts, come back to the body.
- Establish another room in the house for resting during the night when you find that the body is not in a mood to sleep. Adopt the attitude that time spent in this room is just as valuable as time spent in bed. This room should have a comfortable chair for meditating and listening to music, ideally a recliner that will allow you to change positions. It could also have a yoga mat where you can go through a set of slow, soothing (versus invigorating) poses.
- If you have been awake in the middle of the night for a prolonged period and feel restless, get up for a brief period. Avoid turning on the light, which stimulates arousal by blocking the sedative melatonin secretion from your pineal gland. Put up a few night lamps so you can take a walk around the house. Sit in a chair in a different room and meditate. Miskiman at the University of Alberta in the early ’70s showed that the Transcendental Meditation technique practiced before breakfast and supper significantly reduced sleep onset from over an hour in people with insomnia to fifteen minutes. TM also reduced time spent awake at night. Or just sit in the chair and go back to your routine of bringing the awareness in the body. You can do the same technique sitting up in bed, and when sleepiness seems to be coming, slide down in bed and continue.
- Cultivate routines that are conducive to this attitude. Get plenty of exercise during the day. After a good afternoon workout you should be ready to collapse for the whole night by ten. Use the evening hours for light, enjoyable activities with family and friends and not for exercise, work, or TV. Listen to or play soothing music. Establish a bedtime routine: take a cup of hot milk (with a teaspoon of soaked poppy seeds), perhaps a hot bath or shower. Read a few verses of spiritual texts. Never take sleeping pills, especially the benzodiazapene category that can quickly become addicting. Use natural fibers such as cotton for your bed linens and bedclothes. Avoid associating the bedroom with anything but sleep, including TV, reading or working. The bedroom should be for sleep or sex and nothing else. If you have a TV in your bedroom, move it out. Your great, great grandmother, who didn’t burn electric lights or watch late night TV, would call these recommendations common sense. Chronobiologists call them “good sleep hygiene.” If you take the trouble to have good hygiene by showering, brushing and wearing clean clothes, make the same effort to turn your routine of resting over to nature. It’s your only ticket to get the rest you need without pills.
Jay Glaser, MD is a board certified internist in Massachusetts.
