Having trouble sleeping? Perhaps these strategies can help
Why can’t I sleep?
Most depressed people experience poor sleep. This might be:
- Difficulty falling asleep
- Frequent waking overnight, often with difficulty falling asleep again
- Waking far earlier than normal for you
- Daytime tiredness
- Any combination of these
If you normally do not have these difficulties, then the sleep disturbance is most likely due to the depression, and will most likely fully resolve as the depression gets better.
But things other than depression can disrupt sleep. These include:
- Worry or anxiety
This may about a specific problem, or it may be part of an anxiety disorder, in which you would also be having anxiety difficulties in the daytime. Many aspects of your life can cause worry, including difficulties in relationships, at school/study/work, dislocation from your usual routine etc.
- Substances
Many, many substances can disturb sleep. These include:
- Prescribed medications: For example, oral corticosteroids, often needed for inflammatory disorders such as asthma or arthritis.
- Alcohol: Many people say they need a drink to fall asleep, but start to sleep much better when they stop or reduce the alcohol.
- Cigarettes: Nicotine is a stimulant and so keeps you awake, but smokers addicted to nicotine usually can’t fall asleep without a smoke. Sleep disturbances related to smoking can take time to settle after quitting, but they do go away.
- Illicit substances: Many illegal drugs are stimulants (eg cocaine, speed) and cause marked wakefulness. Others can be initially sedating (eg marijuana) but, like alcohol, actually impair the quality of sleep and make it hard to fall asleep without them.
- Caffeine: This is possibly the most widely used stimulating substance in our society. Present, of course, in coffee, caffeine is also found in tea (not in herbal teas), cola drinks and chocolate (not white chocolate).
- Alternative, herbal and over the counter medications: These are variable in their effect on sleep, so it is important to ask the person who has suggested you use them. Many tonics and energy drinks contain stimulating substances that cause wakefulness, such as caffeine. Cough and cold preparations commonly contain stimulants, such as ephedrine, so check the contents list or ask your doctor or your chemist.
- Medical disorders
There are a number of medical disorders that can be associated with poor sleep (eg anaemia). A few commonly occur alongside depression (eg thyroid disturbance).
For these reasons, it is very important to see your doctor and together review the factors that could be contributing to your sleep difficulties. Commonly there is more than one cause, even if you are depressed, which means that more than one type of strategy will be needed to tackle it effectively.
Why can’t this person sleep?
Ondine is a 25 year old woman who has moved out of home to go to a much wanted job interstate. She is working very long hours, her boss is demanding and critical, she has been unable to make new friends, and the flat she is living in is noisy. She no longer has time to exercise, is needing repeated cups of coffee to keep going at work, and feels miserable and lonely much of the time. It is harder and harder to fall asleep at night, even with two glasses of wine. She finds that she wakes repeatedly overnight worrying about work, and is then tired and lethargic the next day.
How many different reasons can you see why Ondine might be sleeping badly? If you were her parent or friend, what would you suggest she do?
What can you do about your sleeping difficulties?
- See your doctor, as suggested above, to check on the role of medications, medical disorders, depression and other factors.
- Get effective treatment for any depression. You may need anti-depressant medication (this varies depending on the type of depression you have, the sort of person you are, the supports and stresses you have etc). You will probably need some sort of talking therapy or counseling (instead of, or as well as, medication), and this will likely include working on strategies for your sleep problems together with your clinician.
- Think about your own situation, the way you did about Ondine’s. What are the different factors that are contributing to your sleep disturbance? This will help guide your choice from the list of strategies below. The doctor treating your depression can help you work on these and will likely know of others, but strategies include the following:
- Minimal or no caffeine, and certainly none after mid afternoon.
- Minimal or no alcohol (or illicit substances).
- Check about the contents of any prescribed, over the counter, herbal or alternative preparations you are taking.
- If you are a smoker who has found difficulty stopping: ask your local doctor for advice and support in quitting.
- Eat dinner at a regular time, a few hours before bed. Avoid large meals and excess liquids close to bedtime.
- A small glass of warm milk at bedtime can help relaxation, ease hunger and promote sleepiness. You can add honey or malted drinks, but not chocolate.
- Do gentle exercise in the early part of the day. Evening exercise is helpful for some, but many people find that it makes them feel more awake. Exercise is particularly good if any of your difficulty falling asleep is due to worrying, as it can reduce anxiety.
- Go to bed at the same time each night and wake up at the same time each morning, to get your body back into a routine.
- Ensure that the sleep environment is right for you, before you get into bed (temperature of the room, lighting and sound levels, empty bladder, minimal disturbances eg from pets).
- Some people find soft ‘sleepy’ music helpful. If so, play the same music every night.
- Develop a regular evening routine, so that your mind and body wind down for sleep, to re-teach your body how and when to sleep. For example: dinner, book/music, bath/shower (relaxing), warm milk etc.
- Avoid TV last thing at night, as it can be stimulating, rather than relaxing.
- Once in bed, do a relaxation exercise. Work out which one or a combination is most effective for you, and get into a nightly routine.
- If you wake during the night: re-check your sleep environment factors, then redo the relaxation exercises.
- Keep a small pad of paper and a pen next to your bed: if you wake and start to worry, write it down and go back to sleep. Writing it down helps prevent you lying there fretting.
- No naps/sleeps in the daytime, including no sleep-ins.
- Be as disciplined with yourself as possible: it can take time for your sleep patterns to normalize, especially if they have been disturbed for some time.
- What about sleeping tablets: do they help? For some people, taking a low dose of a gentle sleeping tablet can be helpful in the short term, as long as the depression is also being treated, and as long as all these other strategies are being attended to.
All sleeping medications (prescribed, over the counter, herbal and alternative) can be habit forming, and some have the potential to be addictive. For this reason, it is generally best to use them for brief periods of time and under professional supervision.
So, if they are a part of a bigger sleep management plan, they can have a useful but limited role to play.
The approach described above is simple and easy, but it does work well to improve night-time sleep and daytime tiredness, especially when combined with optimal treatment for your depression. When people get depressed, such ‘self care’ strategies are easily overlooked or overwhelmed.
Good luck with returning to a restful night's sleep!