Insomnia
Insomnia may cause as much frustration as exhaustion. What is the best way to sleep better? Sleeping pills are a nonstarter. People prescribed fewer than 18 pills a year of hypnotics, the class of sleeping pills including Ambien, appear to have triple the hazard of dying prematurely, and nonpharmacological methods have been found to work as well or even better than the drugs.
The recommended first-line treatment for insomnia is cognitive behavioral therapy, combining conditioning techniques to reassociate the bed with sleep and education surrounding optimal sleep hygiene.
Four Rules of Sleep Conditioning
- Go to bed only when you’re sleepy.
- Only use the bed for sleep (and sex). No reading, eating, or screen time.
- If you can’t fall asleep within fifteen to twenty minutes or so, get up, leave the bedroom, and don’t go back until you’re sleepy again. Repeat as necessary.
- Get up at the same time every morning no matter how little sleep you have had.
Four Rules of Sleep Hygiene
- Exercise regularly.
- Avoid caffeine, nicotine, and alcohol before bedtime.
- Make the bedroom dark, cool, comfortable, and quiet.
- Establish a relaxing bedtime routine.
The best time to exercise to improve sleep appears to be four to eight hours before bedtime, and it seems to be a myth that exercising right before bed is somehow disruptive.
The majority of research does not show that daytime naps interfere with nighttime sleep, though hefty caffeine doses up to six hours before bedtime can, as may late-afternoon alcohol consumption. Nicotine in any form may also have negative sleep effects—though active nicotine withdrawal may as well.
Nocturnal noise can adversely impact sleep even if you aren’t consciously aware of it. Earplugs and sound masking, such as with a white noise machine, have been shown to help, as have relaxation techniques, such as massage, mindfulness meditation, and soothing music, as well as taking a hot bath or shower.
Food-wise, low fiber intake and high intakes of saturated fat and sugar are associated with lighter, less restorative sleep, while meat intake is associated with napping, suggested to be a proxy for sleepiness, which may help explain why insomnia is a reported side effect of ketogenic diets.
For substantiation of any statements of fact from the peer-reviewed medical literature, please see the associated videos below.
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