The sort of things that we can do to tackle sleep disturbance require a regular on-going commitment to make a difference. It can be worth it though. I take the view that any kind of medication can add an extra load to our struggling immune system. It might be needed in the short term to counter balance a more damaging load, but the more we can find a natural balance the better chance our immune system has of fighting this disease. Discipline with sleep hygiene is an investment in your health:
• Make sure your bedroom is cool, quiet, dark and your bed is comfortable.
• The number one principle when dealing with sleep disturbance is routine. Aim to go to bed and get up at the same time every day whether or not you have slept well. Most important is the time you get up. If you’re really not sleepy when you would normally go to bed it’s not worth the inevitable tossing and turning, but get up at the same time the next day regardless.
• An optimal sleep pattern aligned with natures rhythms would be from around 10pm until 6am. However we are all different, so if this seems unworkable to you at least try to go to bed before 11pm and to get up before 8am. If your sleep pattern is very different from this, introduce change gradually by getting up 15 minutes earlier than usual every 4 or 5 days.
• Exercise a little every day. A short walk in natural daylight first thing in the morning will also help regulate your sleep/wake pattern.
• Have a regular bedtime routine. Give your body cues that it’s time to wind down and sleep by following the same order of going to bed activities. E.g. checking back door is locked, switching off kitchen lights, switching off living room lights, checking front door is locked, brushing your teeth, gentle reading for 10 minutes, lights out etc.
• Try to avoid sleeping in the daytime, however:
Ø If your symptoms are moderate to severe or you are still in a very acute stage, it might be beneficial to have a maximum two hour daytime sleep at the same time every day. However if you don’t drop off to sleep during your allotted time don’t continue to try afterwards.
Ø If you are a mild to moderate sufferer and not in an acute stage of infection, but are really exhausted take a cat nap. When you feel that you are about to fall asleep, set your alarm for no more than 40 minutes later. I usually find 20 minutes is enough, all you really need to do is reach the stage where you drop off and let everything go! Although you will not be doing this every day try to make sure that when you do it follows a regular timetable. Don’t take a nap in the evening.
Ø After your nap (or attempted nap) do some gentle stretching to tell your body its awake time again. It’s likely you will feel groggy and this stretching will help you face the world again. If you can do it outside in natural light, all the better!
• If you feel the need to sleep more often in the day try some relaxation or meditation instead. However set an alarm for the length of time you’d like to do it for, just in case you drop off.
• If you’ve had a particularly bad night’s sleep make sure you have a restful day but try to avoid the temptation to have a longer daytime nap than recommended above.
• If you are not already avoiding all stimulants make sure you do so after 5pm, e.g. Don’t drink coffee, hot chocolate or Coca-Cola etc. in the evening. Chocolate also contains caffeine, so try to avoid this in the evening too or at least have a cut off time of a couple of hours before you plan to go to sleep.
• Make sure you eat your evening meal early enough to give it time to be fully digested, e.g. 2 to 3 hours before you plan to sleep.
• Try to avoid lively music, stimulating reading (stressful thrillers etc.) or lively TV in the evenings or at least for an hour or two before you go to bed.
• If you’re struggling to get to sleep try not to worry about it. Just accept that at this moment you are struggling to sleep, try to trust that by following all these steps you will eventually find a regular sleep pattern, it doesn’t matter if it doesn’t seem to be working right now. You will cope with being tired tomorrow and you’ll relish your sleepiness tomorrow evening at bed time. Let things be as they are. Don’t struggle against what is. If your mind is invaded with thoughts try to take the observers viewpoint. Stand back and watch your thought, try not to get involved in it or in judging yourself for having it, just acknowledge it, accept it, and let it go. Imagine being in a wonderfully relaxing place: sleeping in a swaying hammock on the beach beneath the stars. A gentle breeze rustling the leaves of the palm trees, the lapping of the waves on the shore matching your slow and rhythmical breathing. The gentle scent of salt water in the air, the soothing aroma of jasmine etc. You could also try counting backwards from 1000, or trying to keep your eyes open in the dark.
• If you can’t get to sleep because of persistent worrying keep a pen and pad by the side of your bed to write down your worries. Once written, you could even put them in a box for safe keeping. But make sure that the next day you spend some time to tackling these worries. Make an action plan so that at night you can tell yourself it’s all in hand.
• If you find yourself wide awake in bed for more that about half an hour, get up, make yourself a hot soothing (caffeine free) drink. Sit quietly in a darkish room and wait for a sense of tiredness to beckon you back to bed. Maybe take this opportunity to meditate or do a relaxation exercise.
• If you are sleeping but it’s just not restful, regular meditation, relaxation and/or yoga in the day time could help your body find deeper sleep at night.
All of this can help but may not be enough on its own. If sleep disturbance is a persistent symptom please consult your doctor. Remember, one of the predictors of a poor prognosis for this illness is not tackling sleep disturbance.
Next week I’ll talk about the things we can take, or at least the ones that I’ve tried.