In 2012, having returned to work after my second maternity leave, my babies finally became good sleepers and I went the other way. Ironically, after years of four years of yearning for them to just let me sleep, they did, but I couldn’t.
It wasn’t for lack of trying. As a dietitian in cardiac rehab I knew well the health consequences of poor sleep. I’d dutifully go to bed at 10pm or so only to toss and turn until I got up for a snack or reading break and try again. Sometimes it worked, sometimes not. My google search history from that time is full of 2am “how to fall asleep” queries. Nothing seemed to help.
I’ve never been a stellar sleeper, but in my younger years I could just recover with some downtime or a sleep-in. The 20-something body can manage for a few days on insufficient sleep. My 41 year-old new mama self? Not so much.
I was cranky and tired and worried I’d make a tragic mistake driving or sabotage my long-term health. On my most exhausted days, in desperation, I’d take an over-the-counter medication with a drowsiness side effect, just to knock me out.
I had to do that more and more often until I got to a place where I couldn’t sleep without taking something. Not actual sleep medication, mind you, but products meant to do something else that made me feel sleepy as a side effect. It dragged on that way for almost a year.
Not a good plan. That’s why I’m not naming the products I used. They’re all legal and fine for their intended use, but for sleep? Do. Not. Advise. I finally reached out to my family doctor for some much overdue help.
Why I’m sharing this story
I’ve been wanting to share the story of how I overcame my sleep problem because so many of my clients over the years have had similar struggles. Disrupted sleep can contribute to overeating, weight gain, and a higher risk for cardiovascular disease, so people get sent my direction, sometimes when a sleep doctor would be more helpful.
Also, today is Bell Let’s Talk Day in Canada, a day where we open up about mental health concerns, and telecom giant Bell donates five cents to mental health initiatives for related online interactions, to the tune of just over $100 million over its history. Poor sleep can also affect mental health. One study showed people who reported a history of insomnia were four times as likely to develop major depression. Insomnia can worsen the symptoms of anxiety disorders or prevent recovery.
I should say that what worked for me may or may not work for you. I’m not a sleep doctor (obviously) and if you’re having trouble sleeping I strongly encourage you to see your family doctor for help. And if that doesn’t solve it, keep trying, as I had to.
The good news I want to share is that this problem is solvable, at least in terms of “progress, not perfection.” Also, you can use many of the same approaches that help with other health behaviour changes like cooking more or sitting less.
That said, how did I go from bleary-eyed to (relatively) well-rested?
First stop, family doctor
My (former) family doctor was sweet and fresh out of his residency. His response when I confessed to not being able to fall asleep without my trusty over-the-counter medications? “That’s not good. First of all, you’re probably still drowsy in the morning.” (True.) “Second, if you can’t fall asleep without it, something’s wrong with how you’re living.”
Phew. That was direct. Okay Doogie Houser, what do you suggest?
Meditation and sleep hygiene, he said.
I’d tried meditation at one of the (excellent) relaxation classes offered at our cardiac rehab program. It was lovely and calming but my attempts to use it to fall asleep hadn’t worked.
I knew about sleep hygiene too, and that wasn’t helping either. At the time I was teaching a cardiac rehab class about how to change health behaviours and it included a couple of slides on sleep hygiene. The class was developed by a local health psychology professor who patiently answered all of my (personally motivated) questions about the sleep content.
So given that I’d tried my doctor’s advice already and it hadn’t worked, I asked him for a referral to a sleep specialist.
He felt I should try again. In his defense, I think he wanted to save the sleep clinic referrals for suspected cases of sleep apnea and other medical sleep problems. He prescribed me a sleep medication I could take when desperate, but advised there would be no refills. He didn’t feel it was an appropriate long-term solution.
That prescription at least helped me sleep without the next-day drowsiness, and I continued trying to figure out the problem on my own. Getting a stretch of good sleep at least helped me gain patience and perspective, but still, every time I tried to sleep without medication I couldn’t.
Next stop, sleep doctor
I decided to see if I could refer myself to a sleep clinic. Fortuitously, a sleep doctor had given a talk at our clinic about the connection between sleep and cardiovascular disease. He was board certified in sleep medicine and taught at our local university med school and his clinic took self-referrals, so I did an end run around my family doctor.
It took about two months to get in, but it was worth waiting for. He took a thorough history, asked lots of questions, and came back with a declaration that stunned me: “You don’t have a sleep problem. You have a relaxing problem.”
Uh, okay? So what do we do with that?
His prescription: Relax for three hours before bedtime.
For a working mom with two and four-year olds at home, the idea of relaxing for three hours in the evening was inconceivable. When the kids went to bed around 8pm, I kicked into gear: Making lunches, tidying up, booking activities, answering emails… if you’ve been there, you know the drill. The dwindling period between their bedtime and mine was when I got everything done that needed to be done and I told him so.
And what on earth would I do for three hours?
“You’re proving my point, just by asking that,” he said. (He also went on to say that he didn’t remember his mother doing tasks like that in the evening, which didn’t help our rapport.)
“No really, what would I do? Meditate for three hours? Knit?” Honestly, I wasn’t sure what he had in mind.
“Anything relaxing,” he said. “Read a book. Watch TV. Meditate if you want. Talk to your husband. Would you like to have a relationship with your husband ten years from now?”
(Seriously. They need to work more on bedside manner in medical school.)
“Watch TV!?” I said, surprised. “I thought TV before bed interfered with sleep.”
“It’s better than what you’re doing now,” he said. “Just relax!”
Hmm… I’d have to figure that one out.
He also had a few other pearls of wisdom:
- I was trying for too much sleep. My keener attitude towards health was contributing to this problem. We figured out that I was getting around six or seven hours of sleep most nights, and the fact that I was reasonably functional meant that maybe I didn’t need eight. Conventional wisdom says we need eight hours, but his position was that sleep needs vary from seven to nine a night, and he suggested I start at the low end so that I’d be sleepy when I crawled into bed.
- He warned me that if I continued this not relaxing and not sleeping well, I’d have depression within five years. That got my attention.
He sent me off with a recommendation to follow the plan in this book, Say Goodnight to Insomnia*, which is a self-driven sleep cognitive behavioral therapy (CBT) program.
(His advice ultimately led me to overcome this problem but his bedside manner was a bit problematic, which is why I’m not naming him. If you’re comfortable with expertise over gentle delivery and want his name, just email me.)
Okay, let’s do this
I’d like to tell you that I took his sage advice and by the next week I was relaxing and sleeping like a champion. Not so. I was a living example of this joke about progress:
The book has a 6-week program that I went through faithfully. Two key lessons:
- It’s hard to sleep if you’re worried about falling asleep. No kidding. Anyone who’s experienced insomnia knows what I mean. You have to walk the fine line between realizing this is an important problem to address but not stressing about it in bed. The book teaches you to reframe your thinking from “OMG I need to fall asleep” to something like “I’ll just relax here and if I fall asleep, great, but if not, I’ll survive. I’ve done it before.”
- You have to be sleepy to fall asleep. That echoed what the sleep doctor said. They don’t let you get into bed until later in than you think is right, at least until you regain the confidence that you can fall asleep reliably.
I also referred myself to a therapist for help with the whole relaxing thing. Seriously. It might sound silly but it really helped. At our first meeting she asked me if I ever just took a book and went down to the river to read. Hahahaha are you kidding? We had our work cut out.
By the way, she was actually the third therapist I’d tried. I didn’t click with the first two.
Somewhere along the way, I switched from going to bed worried I wouldn’t be able to fall asleep to feeling confident in my ability to sleep. Both of those are basically self-fulfilling prophecies. I can’t say exactly when that mindset shifted, but it took a few years of trying and failing. I looked back at my annual goals and sleep is cited four years in a row as a top priority.
What repeatedly trying and failing taught me
Some things I just had to figure out the hard way:
- Upon (much) closer inspection, my sleep hygiene actually wasn’t perfect. The family doctor might have been right. First, I was taking my phone to bed. It seemed necessary because I used it to track baby’s sleep and as an alarm and to scroll through Facebook during midnight feeds. But it was keeping me awake. Parking the phone in the kitchen before bed was one of the most important things I did to solve my sleep problem.
- We invested in black-out blinds to make the bedroom really dark. I even covered up the clock radio with a hand towel. Light in the hallway? Off.
- And cool. The room has to be cool. We’d always lowered the house temperature to about 17C (63F) overnight, but we finally got central air conditioning to help in the summer, and a big driver was helping me sleep. (Happy mom, happy family.) We don’t set it that low on A/C, but it’s no longer 28C (82F) in our bedroom on hot days, which helps.
- I got serious about a sleep routine. Before, the routine was “finish the must-do-today tasks, brush teeth, wash face, collapse into bed”. The time varied based on the to-do list and how much energy I had to get off the couch. Taking my cue from the sleep doctor, I declared myself off duty at 9pm (8pm still felt too early) and planned a bit of relaxation: Connect with my husband, take a hot bath, read. When I say planned, I mean planned. I put it in my calendar as a recurring event and it’s still there!
- I banned myself from using the phone after 9pm. This has been a tough one, and I still slip sometimes, but plugging it in by 9pm and keeping it out of reach makes all the difference. Just checking one thing too often leads to an hour (or more) of scrolling.
- Meditation actually helped! Just not the way I was doing it. I was using guided meditation apps which required, you guessed it, my phone in the bed. Once I committed to meditating first thing in the morning, I got better at turning off my mind on command. (It takes practice!) Then I took that skill, not my phone, into bed. Instead of solving and planning and ruminating, I focused on breathing. Boom. Sleep.
- I figured out that I need to read something heavy right before bed. A page-turning thriller just doesn’t do it, at least not for me. I think I first realized this reading Catherine the Great, Portrait of a Woman. It’s an excellent read, but very, very detailed. And long. I kept nodding off, which meant sleep was a sure thing when I headed up to bed. Another excellent read/sleep aid is Matthew Walker’s Why We Sleep, another lengthy book with the added benefit of reminding you how critical sleep is. In between long and academic tomes, my other trusty sleep read is Macleans, but only the paper magazine, not digital.
- The circadian rhythm is powerful. This is also a lesson from Say Goodnight to Insomnia*. If you get up at the same time, go outside for a bit of natural light, and move your body, even for a few minutes, your body will figure out that it’s wakeup time. Go to bed at around the same time every day and your body will soon get into a reliable cycle.
If you want to double-check your sleep hygiene, this list is a good place to start. I haven’t mentioned everything here – just the ones that took me a while to figure out.
Also, one thing I learned from the health psychology professor: not everyone has to have perfect sleep hygiene, just those of us who struggle with sleep. So if your partner can drink coffee at 8pm and answer email until 11pm and then magically fall asleep, that doesn’t mean you can, if you’re a troubled sleeper.
Lessons for making any behaviour change
Whether it’s sleep, smoking cessation, or healthy eating, a few things I did can help you too.
- Bring in the experts. Neither of my two doctors were perfect, but they both gave me valuable clues, especially the specialist. Consultants like this can translate general guidelines into recommendations specific to you and your unique situation. (That’s what dietitians do too!) The therapist was good for reflecting back when unhelpful thoughts were getting in the way. Check with your doctor – there may be more resources included in your health plan than you realize.
- Try, try again. Lifelong habits can take months or years to change. Some things you think will help won’t. Some you’ll have to try again, perhaps taking a different approach. Sometimes you’ll mess up. We all do! Don’t give up. They’re all learning experiences, getting you closer to your goal, slowly but surely.
- Track habits you want to change. I use an app called “Way of Life,” which I wrote about a few years ago, but a notebook, calendar, or spreadsheet work just as well. The “no screen time after 9pm,” “in bed by 10:00” habits are in mine now, just as they were back when I wrote that post. You really have to keep working at this stuff.
- Stimulus control. Figure out what cues trigger the habits you want to change, and make sure they’re either out of sight or in place. For sleep, for me, that means the phone has to be out of reach. To hit the gym in the morning, I need those workout clothes laid out ready to go. For you it might be the TV remote or a bag of chips on the coffee table. Make it easy to follow through on your goal even when you’re tired and lacking willpower.
Again, this is just my story. There may be other roadblocks between you and good sleep or other health behaviours your working on. The point is that it may take a few years and numerous false starts to get there. You may never get to perfection, but progress is still worth fighting for.
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