It's a nightmare!
Insomnia is defined as difficulty falling asleep, difficulty staying asleep, or unrestorative sleep. It is important to make a distinction between clinical insomnia and poor sleep habits.
Insomnia is a very common symptom for dysautonomia patients and also commonly occurs in 30% to 50% of the general population. With regard to dysautonomia patients there are physiological reasons for this symptom, and thus, it is often extremely hard to overcome and must be addressed firmly and taken seriously.
It is absolutely essential that you take a strict approach to improving your quality of sleep by practicing good sleep hygiene. Ultimately, insomnia is a symptom which the patient needs to take responsibility for overcoming. It will require great determination on your part. You will need to recognize that until your insomnia is under control, it is unlikely that your dysautonomia will improve.
It is not going to be easy to resolve this uncompromising symptom. It takes strict willpower, conviction, determination, routine, and inner-strength.
You will need to directly address any routines or behaviors that may complicate your insomnia and take steps to stop them.
Limit computer use
Turn off your computer at a set time each evening. Research has shown that a computer screen can alter the body's biological clock and suppress the natural production of melatonin that is critical to the normal sleep-wake cycle. Turn off your computer at a time which you, your parents, and your physician all agree upon. It won’t be easy! Stay firm in your conviction, and be uncompromising in your behavior and you will see results within an estimated 6-8 weeks. If the temptation is too great, it may even be necessary for you to turn over your laptop to your parents at a set time each night.
Turn off your cell phone
Yes, Virginia, there really is a Santa Claus and there is a life without your cell phone at your side too! Honestly, human beings can survive without sleeping with their cell phones on! There are these old time contraptions called Alarm Clocks that you can use to help you wake up at a set time. We recommend that the alarm clock that you place in your room have light control so as not to add additional light into your room at night. The great thing about alarm clocks is that they don't text you at 2 AM or call you once you have fallen asleep. They also don't tempt you to be up chatting all night. Get one and turn off your cell phone at a set time each night.
Turn off the lights
At a set time each night be sure to keep your family room dark (except for a a calming TV program or a good book and booklight). Doing this helps your body adapt to a natural sleep schedule (your body learns that when it is daylight you are waking up or awake and when it is dark you are getting ready to sleep or sleeping.
Consider relaxation therapy
This type of therapy aims to reduce stress and body tension. As a result, your mind is able to stop "racing," the muscles can relax, and restful sleep can occur. Multiple techniques and approaches exist, with a range of philosophies and styles of practice. Most techniques involve repetition (of a specific word, sound, prayer, phrase, body sensation or muscular activity) and encourage a passive attitude toward intruding thoughts. An Audio CD that we recommend is: Breathing: The Master Key to Self-Healing by Dr. Andrew Weil.
Some individuals suffering from insomnia spend way too much time in bed trying very hard to fall asleep. They may be helped by a sleep restriction program under the guidance of a sleep specialist. Sleep restriction is a behavioral treatment that works to improve your sleep efficiency by limiting the amount of time you allow yourself to sleep. The goal of such a program is to sleep continuously and to get out of bed at a strict desired wake time. This treatment involves, for example, going to bed later or getting up earlier and slowly increasing the amount of time in bed until you are able to sleep normally throughout the night (and at normal times).
The rules of sleep restriction therapy usually include:
- You only are allowed to stay in bed for the amount of time that you think you sleep each night, plus 15 minutes. For example, if you report sleeping only 5 hours during the night, you are only allowed to be in bed for 5 hours and 15 minutes. No sleeping all day!
- You absolutely must get up at the same time each day. No one is saying that you have to function and do Rocket Science - just drag yourself out of bed, take your morning medications, get a drink and snack and prop yourself up on the sofa or get in the recliner until you feel able to move around. Don't go back to sleep!
- You cannot nap during the day.
- When you are asleep for 85% of the time that you stay in bed, you can increase the amount of time in bed by going to bed 15 minutes earlier. (You still have to get up at the same time in the morning there is no exception to this rule).
- You repeat this until you are sleeping for 8 hours or the desired amount of time recommended by your doctor.
This procedure also takes 3 to 4 weeks to be effective. You may be very sleepy during the day while adjusting your sleep schedule.
Sleep reconditioning hints
- Use your bed only at bedtime when sleepy. Avoid other activities in your bed, such as using the computer, cell phone, reading or watching TV. Over time, your body will relate bed and bedtime with sleep.
- Go to bed at the same time each night and get up at the same time each morning. Until you can fall asleep at the same time each night, you must drag yourself out of bed at a set time each morning (and this will be very, very hard). Remember, until you get this resolved you don't have to function when you get up at a set time - you just have to get up and stay awake. Sleeping in only complicates insomnia so you must break that habit. Get into a sleep pattern and stick with it. Do not compromise it once you get onto a good schedule. If you break the pattern you will have to start all over again with the process.
- Do not take naps during the day.
- Avoid caffeine, nicotine, and alcohol (none of which you should be using with dysautonomia anyway).
- Keep your bedroom very dark, quiet, and cool (studies have shown that the best sleeping temperature is in the area of 61 to 66 degrees). If light is a problem, try a sleeping mask or black out curtains. Consider getting that old fashioned alarm clock that does not light up. If noise is a problem, try earplugs, a fan, or a "white noise" machine to cover up the sounds. Many patients have temperature regulation issues and run hot, and thus, they love having a cool fan on them at night. The soft noise of the fan can also be soothing and helpful.
- Cell phones emit the same blue light as computer screens, televisions, and some alarm clocks. Turn off your phone as it can be a source of both stimulation and temptation! Your calls and texts will be there for you in the morning, and the last thing you need to do is to feed off other people’s insomnia.
- Keep a cool head! According to research presented at the 2011 annual meeting of the Associated Profession Sleep Societies, cooling the brain can reduce the amount of time it takes people with insomnia to fall asleep and increase the length of time they stay asleep. Try placing a gel ice pack on your pillow or under your neck.
- Follow a nightly routine to help relax and wind down before going to bed. Turn off the TV at a set time and avoid stimulation. Make it a habit to do something relaxing but not overly stimulating before bedtime (work on a puzzle, read a magazine, brush your dog etc.). Then at a set time conduct your nightly hygiene routine. Remove your make up, brush your teeth, take a luke warm bath (avoid too hot of water as it dilates blood vessels and can make some patients more symptomatic). Over time this will train your body that this is what comes before sleep. A sleep routine is essential.
- If you can't fall asleep within 20 minutes or don't feel drowsy, go read a magazine or do something that is not too active or stimulating until you feel sleepier. Avoid stimulation, bright lights and computer screens during this time (don’t read a stimulating book that will tempt you to keep reading). Then try going back to bed.
Stop worrying about it
You can worry so much about your sleep that you develop a type of insomnia that is caused by the worry. Stick to the proven techniques and do your absolute best and allow the necessary time for the techniques to work (it won’t happen overnight).
Most importantly, be honest with your physician, parents and yourself about your habits, and address those that contribute to insomnia.
Feel free to call the DYNA office for support! (301-705-6995)
"The bed is a bundle of paradoxes: we go to it with reluctance, yet we quit it with regret; we make up our minds every night to leave it early, but we make up our bodies every morning to keep it late."
~Charles Caleb Colton