No More Sleepless Nights

After dealing with chronic insomnia for nearly 6 years, I finally went to see a neurologist who specializes in sleep disorders who gave me the following instructions.  After following his plan religiously for a week, I was completely off ambien and sleeping WELL!  I'm happy to say that 3 months in to this routine, I am still sleeping.  So... I thought I would share those steps that worked for me with anyone who stumbles across this blog.  Sleep well...

Insomnia Patient instructions
Titrate off ambien 10mg (1/2 tab) for 2 weeks – then discontinue completely 
Read Peter Hauri's Book: No More Sleepless Nights 


SLEEP HYGIENE INSTRUCTIONS 
Recommended Bedtime 11:30pm 
Recommended Wake Time 6:30am 
Recommended Hot Shower Time 9:30pm 
After Shower: Keep room cool afterwards 
Wear Sunglasses till go to bed 
Scheduled worry (i.e. Keep a diary with the following:): (11pm) 
Write down all your concerns/stressors/anxieties After writing them down, write down several good things about yourself
Remove TV and any computers from bedroom 
Remove ALL clocks from your bedroom (if need alarm keep it underneath your bed) 
Wear earplugs each night If not sleeping: get out up of bed and read with as little as light as possible (don't work, watch TV, etc.). 
Go back to sleep when you can't remember the last line you read. 
Does not matter how long you've been reading: get up at 6:30 am and go to sleep at designated bedtime not earlier. 


Homeostatic Drive for Sleep 
• Avoid naps. If you need to nap keep it short: 10 to 15 minute nap only and not close to bedtime. 
• Restrict sleep period to the average number of hours you have actually slept per night in the preceding week. For example, if you feel that you are only sleeping 6 hours at night, make sure you are laying down in bed for just over 6 hours. 
Quality of sleep is important. Too much time in the bed can decrease quality on subsequent nights. 
• Get regular exercise each day, preferably 40 minutes each day of an activity that causes sweating. Stop all exercise after 6 pm. Circadian Factors 
• Keep a regular time out of bed 7 days a week. 
• Do not expose yourself to light if you have to get up at night and at least 1-2 hours before going to bed (i.e. no TV, computer). Wear orange-tinged sunglasses inhouse if necessary 
• Get at least one half hour of sunlight within 30 minutes of your out-of-bed time (do not wear sunglasses or hat at this time). 


Drug Effects 
• Avoid caffeine entirely for a four-week trial period. If you absolutely cannot go without caffeine: limit caffeine use to one to two cups no later than 10:00 AM. Arousal in Sleep Setting 
• Do not eat or drink heavily for three hours before bedtime. 
• If you have trouble with regurgitation, be especially careful to avoid heavy meals and spices in the evening. Do not retire too hungry or too full. Head of bed may need to be raised. 
• Keep your room dark, quiet, well ventilated, and at a comfortable temperature throughout the night. Earplugs and eyeshades are OK. White noise is also OK (Fan is great). 
• Use a bedtime ritual. Reading before lights-out may be helpful if it is not occupationally related. 
• List problems and one-sentence next steps for the following day. Set aside a worry time. Forgive yourself and others.
• Do not try too hard to sleep; instead, concentrate on the pleasant feeling of relaxation. 
• Avoid unfamiliar sleep environments. 
• Be sure mattress is not-too soft or too firm, pillow is right height and firmness. 
• Use bedroom only for sleep; do not work or do other activities that lead to arousal 
• If possible, make arrangements for care-giving activities at night (children, others, pets) to be assumed by someone else.