How to Fall Asleep

March 17, 2016

There are several topics that seem to come up with patient after patient and I find myself making the same suggestions over and over again. One of these topics is sleep hygiene.

Simply stated, sleep hygiene is a way to describe your behaviors and habits related to sleep. There are several types of insomnia including delayed sleep onset, middle insomnia or frequent awakenings, and early morning awakenings. Though improving sleep hygiene can help with all three of these subtypes, change will be most dramatic with delayed onset or trouble falling asleep when you want to.

Sleep hygiene is all about rules, behavior change and “stimulus control.” Though I am rarely directive with my patients, when it comes to sleep hygiene I explain a set of rules they should follow if they want to be able to fall asleep quicker. Here they are:

  • Use your bed for sleep and sex only. Don’t read, do work , play on your phone or watch TV in bed. This is all about stimulus control: you want your body to react to the stimulus of being in bed by getting tired and falling asleep. If you like to read before bedtime, sit in a chair next to your bed or, even better, do so in another room.
  • Set rigid bedtimes and wake-times. Be reasonable and calculate out the number of hours of sleep you do best with. Note: more is not always better; most people tend to function best with approximately 7-8 hours of good quality sleep per night. Set these times and stick with them, even on weekends, at least in the beginning of your sleep hygiene training.
  • Set a rigid pre-bedtime routine. For example, before you fall asleep you probably want to wash your face and brush your teeth. Some people like to take out the next day’s outfit the night before. Make time to include saying your goodnights to your loved ones, engaging in prayer, doing your evening reading or whatever. After you’ve listed all your pre-bedtime activities, write them out in the order you want to do them each night, estimate the start time prior to when you want to fall asleep and then stick with this rigid schedule. Again, this is all about stimulus control.
  • This one is tough: If you’re not asleep within about 20 minutes or so, get out of bed and do something boring. Don’t read a good novel, watch an engaging movie or pay your bills. Instead do something mundane and boring like reading the user manual for your refrigerator. When you’re eyes get tired, get back in bed and start over. Once again, we’re focused on stimulus control: you are trying to get your body used to only sleeping (or having sex) when in bed.
  • If you have tons of thoughts that run through your head as you’re trying to get to sleep, have a notepad and pen (and maybe a small flashlight) next to your bed. Roll over, write down those important thoughts and then let them go; you no longer have to try to remember them because they’re written down.
  • Some people find that over-the-counter Melatonin is helpful if they take it about 30 minutes or so before bedtime. Unlike some other medications, Melatonin is not habit-forming.
  • Taking a very hot soaking bath immediately before getting into bed (i.e., the last pre-bedtime activity) can help “jumpstart” the process of falling asleep. The theory behind this is that a very hot bath will raise your core body temperature a bit. Then, when you get out of the bath and into bed, your core temperature will drop, and this is the jumpstart because when you fall asleep your core body temperature automatically drops a little.
  • No screens before bedtime. Recent research has demonstrated that the frequency of light emitted from televisions, laptops and handheld devices are neurologically stimulating and can make it much harder to relax and fall asleep.
  • Start exercising on a regular basis, but try to do so earlier in the day. Don’t do any strenuous activity within a couple hours of bedtime.
  • Eliminate caffeine from your diet. If you can’t do that, start to cut back by drinking half caffeinated and half decaffeinated drinks. No caffeine at all after lunch time.
  • Don’t have a big dinner and don’t snack after dinner. Eat your bigger meals earlier in the day.
  • Learn to do relaxation training. Now, the point of relaxation training is not generally to get you to sleep, but it surely doesn’t hurt. Most people find that progressive muscle relaxation and guided imagery are the best when they’re trying to fall asleep.
  • Instead of having the television or music on when you’re trying to get to sleep, turn off those stimulating sounds and muffle out distracting sounds with a white noise machine or a regular fan. The “wooshing” sound of the fan masks other sounds and is not stimulating like music or the news.
  • No naps. Though for some people naps can be quite rejuvenating, they alter your sleep-wake cycle and can delay sleep onset significantly. Cut naps out of your routine.
  • Remember that your sleeping difficulties didn’t just start over night; you’ve probably been dealing with them for quite some time. Even if you follow every tip on this list it’ll still probably take a little while before you’re able to get to sleep quickly. With consistent efforts however, you should be able to improve your sleep within a few weeks or sooner.
  • Speak with a psychologist, physician or other healthcare professional if you have questions or additional concerns.


Socializing may extend you life!

July 6, 2015

Some recent research (summarized nicely in the WSJ) has shown a nice correlation between socializing and life longevity (and quality).  It’s no surprise though, as we are social animals.  Surely some people are more extroverted than others and some people really need their alone time, but there are a handful of hypothesizes about why social contact with other people can extend a person’s life.  It may be as simple as having someone to call a doctor for you or as complex as physiological changes that occur when we interact with other people (e.g., increased oxytocin).

Regardless, it makes sense to make sure you  are connected with other people, interacting with them in a meaningful way and deriving pleasurable benefit from these interactions.  So throw a party, call up an old friend or grab lunch with a colleague.   It’s often difficult to start friendships.  Luckily we now have resources that make this much easier such as sites like  I frequently recommend that people – – particularly those who are more isolated, new to town or just shy – – browse to find like-minded people to socialize with.  It still requires effort and time, but it’s a nice, non-threatening way to reach out and connect with other people.

Need an antidepressant? Try exercise!

September 10, 2014

Research has shown that when depressed people exercise 3-5 times per week for 45-60 minutes per session and achieve a heart rate of 50-85% of their max heart rate, the exercise is as effective, if not more effective, than medication. The Atlantic published a nice summary of the research and relevant literature.

The Business Case for Sleep

January 23, 2013

The Wall Street Journal reported that researchers at Harvard Medical School have found that one-third of American workers are not getting enough sleep, and as a result, companies are losing billions of dollars. Companies such as Procter & Gamble and Goldman Sachs Group are investing in programs aimed at helping their employees improve their sleep.  A few months ago I posted a blog entry about how people are dangerously overusing caffeinated energy drinks to attempt to remedy their lethargy.

APA Promotes Psychotherapy

October 17, 2012

The American Psychological Association (APA) recently launched a new awareness initiative about the benefits of psychotherapy.  There are a couple cute videos (below) that mock the pharmaceutical commercials that we see too often.  Though I very much appreciate this approach, I do not fully agree with the claim that psychotherapy has no negative side effects.  I can’t think of anything we can ingest, be exposed to or do that doesn’t have some side effects; for example everything we do comes at the expense of something else that we otherwise could have done.  I speak often about “compromise formation” with my patients and consulting clients, and with this concept, I believe firmly that psychotherapy does have side effects, but that they are almost always “worth it” from a cost-benefit analysis perspective.

Enjoy the videos…


Physician Wellness

March 8, 2012

I just read an survey study about the health and well-being of medical residents that was done by a chief resident at a local Baltimore hospital.  The article describes the well-known difficulties that residents face such as sleep deprivation, social isolation, etc.  Then they looked at health-related behaviors including seeking medical or psychiatric care.  Not surprisingly, most medical residents reported not having a primary care physician, not calling out when they were sick and not seeking emotional support.  Perhaps even more disturbing than these results was the fact that many did not disclose information to their treatment providers (when they did seek treatment) or did not seek treatment because of fears of confidentiality breaches.  It’s a sad statement when doctors do not trust fellow doctors to keep private their personal information.

Stress in America

January 10, 2012

Tomorrow the American Psychological Association (APA) releases the results from their annual “Stress in America” study.  As part of the release of their findings, they will be holding a webcast tomorrow (Wed, 1/11/12 at 4:30pm EST) that is open to all.  You can register online.  For more information, go to APA’s Stress in America page.

Healthy Lifestyles

October 31, 2011

I have to admit that though I receive The American Psychologist (the main journal of the APA) monthly, I rarely get through more than one article per issue because the articles are so dense.  This month, there was a great article about Lifestyle and Mental Health.  What I loved about this article is that there was nothing all that radical in it; it simply listed dozens and dozens of published articles that support the association between improved mental and physical health with exercise, nutrition and diet, time in nature, relationships, recreation, relaxation and stress management, religious or spiritual involvement and service to others.

These “lifestyle” issues are all things that I have been talking about with my patients in therapy for years.  This article simply provides a wonderful review of the scientific literature that supports these lifestyle changes.  Take a moment and read through the article.  Hopefully it’ll inspire you to make a few lifestyle changes of your own.

Just do it

March 17, 2011

A new study was released (and summarized in the APA Monitor) about the use of placebo medications.  There have been many studies on the use of placebos, and they repeatedly demonstrate that when people are expecting a result to come from medication, it usually does… even when the “medication” is nothing more than a “sugar pill.”

What makes this study so interesting is that there was no deception.  The investigators gave subjects placebos and told the subjects they were placebos.  Remarkably, the research subjects still reported benefit from the sugar pills.  The authors hypothesize that this may be related to the benefit of the behavior of taking the placebo pill.  In other words, the act of going to the medicine cabinet twice per day, taking out a pill and pouring a glass of water and then swallowing the pill can bring you desired and anticipated, beneficial effects.

This is great news.  For years I have been encouraging my patients to improve their self-care.  This could come in the form of exercise, improved sleep hygiene, socializing, practicing relaxation training, taking needed breaks from work or school or just improving diet.  Surely each of these behaviors are likely to improve one’s well-being, but there is a secondary (or perhaps even a primary) effect of “just doing” the behavior that may be of great benefit too.  So the old Nike slogan, “Just do it” may be quite therapeutic: engaging in a behavior that you believe will help you may do so because it increases a sense of self-control and self-efficacy, it empowers you, and you just feel good about doing something to help yourself…. and all of these is on top of whatever benefits the actual exercise, diet or socializing brought you.

So, just do something good for yourself!

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