Poor Sleep, Insomnia, and What to Do

Not being able to sleep is one of the most frustrating, problematic issues to have. I get it, I have been there.

The good news is, there are a few simple changes that may help improve your sleep drastically.

The first is to identify what is causing your sleep issues. Often, it falls under one of these FOUR CATEGORIES:

Your sleep environment, your sleep habits, your body, and your thoughts/emotions.

By optimizing these four factors, you will most likely find a more restful night sleep.


Your Sleep Environment

  • Make sure your bed and bedroom are quiet and comfortable:
    • Too Hot or Too Cold: Heat can make sleeping uncomfortable. I find for most of my patients, a cooler room along with enough blankets to stay warm always lead to optimal sleep. Try to keep your room about 65°F-67°F (~18.3°C), but experiment because it varies from person to person.
    • Consider noise: If noise bothers you, wear earplugs or get a “white noise” machine. Calming ambient music can also be great!
    • Light:
      • If you get city light through your window, consider getting a slumber mask.
      • Avoid overhead lights between 10 pm and 4 am. Use artificial light only as necessary to move safely around, but try to keep your room as dim as possible. Bright light impact your circadian rhythm, and therefore your sleep.  Candlelight and moonlight are fine.
      • Avoid blue light: try to AVOID cellphones or computer at least 2 hours before
    • Mattress:
      • Some people prefer firm mattress and others prefer soft. Know yourself and see what is best for you
      • For example, my aunt likes to sleep on a piece of plywood on top of her mattress. My sister likes to sleep with a soft mattress topper.
    • Avoid activity in the bedroom: Get the TV out of the room and any other “to do’s”.
    • Clear the clutter. Consider the Feng Shui of your bedroom.

Sleep Habits

Establishing a good sleep routine is important for optimal sleep. This starts even as you wake from you day!

  • Within 30-60 minutes of waking, get outside. Bright light during the day helps your body produce melatonin (sleep hormone) for nighttime.
    • The goal of this is to “wake up” your circadian clock. On beautiful bright days with minimal clouds (which fortunately is most days in California), step outside in the morning sun for about 10 minutes. On cloudy days, if time affords, you should aim for about 20 minutes. On overcast days, aim for 30 minutes.
    • If you wake up earlier than the sunrise or live in a place with minimal sunlight, you can consider artificial lights. When I was on my surgical rotation during medical school, I had one of these Wake-Up Sunlight Alarm Clocks.
    • Do not look directly at the sun or light when doing this practice. Just going outside an sitting down on the grass or a supported chair is enough as you sip your morning tea.
  • Sleep only when sleepy. This limits the time you are awake in bed.
    • Usually this is around 9-10PM for most people. If you push past this, you may find yourself up until past midnight.
    • If you do not sleep within 20 minutes, get out of bed. Try doing something boring like read a physics book or your insurance warranty plan.
  • Avoid TV/Computers: The light triggers your brain that it is morning time.
  • Avoid naps after 3PM and try to keep them for less than 30 minutes.
  • Get up and go to bed at the same time. Set an alarm clock for bedtime. Even on weekends! When your sleep cycle has a regular rhythm, you will feel better.
  • Sleep rituals and routines.
    • Have fun with this! It is important to give your body cues that it is time to go to sleep. Listen to relaxing music, use lavender oils, read something soothing for 15 minutes, have a cup of chamomile tea, do relaxation breathing exercises.
    • I like yoga nidra, sleep hypnosis, or sleep meditation prior to bedtime.
  • The bed is only for sleeping (or sex). Do not use your bed to watch TV, play on your phone, or do other tasks.

Your Body

  • Exercise during the day. Regular exercise helps improve sleep. However, try to keep it in the morning or early afternoon. Exercising late at night can impair sleep.
  • AVOID caffeine, nicotine, and alcohol (especially 6 hours before bedtime).
    • Caffeine and nicotine are stimulants that interfere with your ability to fall asleep. Coffee, tea, cola, cocoa, chocolate and some prescription and non-prescription drugs contain caffeine.
    • Tobacco products contain nicotine.
    • Alcohol may seem to help you sleep in the beginning as it slows brain activity, but you will end up having worse sleep.
  • Consider a light snack before bed. If your stomach is empty, that can interfere with sleep. However, if you eat a heavy meal before bedtime, that can interfere as well.
    • Dairy products, bananas, nuts, turkey contain tryptophan, which acts as a natural sleep inducer. Tryptophan is probably why a warm glass of milk is sometimes recommended.
  • Consider a hot bath 90 minutes before bedtime. A hot bath causes your body temperature to rise. After leaving it, your body cools down. This drop in body temperature induces sleepiness.
  • Avoid screens before bed. Using a tablet device for 2 hours before bed can completely stop your body secreting melatonin, a natural sleep aid.
  • Stop drinking liquids 2 hours before bedtime. Going to the bathroom in the middle of the night may interfere with your sleep.
  • Keep your feet warm and comfortable: some people like to soak their feet in warm water before bedtime, some rub oil or lotion on their feet, some like to wear socks.

Your Thoughts and Emotions

The most common reason I hear for sleep difficulties is “my mind is racing. I cannot turn it off.”

  • Relaxation Technique:
    • When you have overwhelming, thoughts, a good technique that I have found to help my patients is the RISE ABOVE technique. I think of these negative thoughts as these stress/rain clouds. If you are able to get your thoughts to rise above these clouds (and it IS possible), you can see the other side.

      1. Sit quietly in a comfortable position. Close your eyes.
      2. Take a deep BREATH IN through your nose for a count of 5. As you breathe in, allow yourself to observe any emotions that you may be feeling (pain, stress, anxiety, worry).
      3. Then HOLD your breath for a count of 5. Observe where in your body you are feeling these emotions.
      4. Then BREATHE OUT for a count of 5. As you do this, imagine you are purging all these negative feelings out, like a rainfall.
      5. When you finish this 5-5-5 breath cycle, imagine you are floating above these stress storm clouds. Continue for 10 to 20 minutes or until you drift off to sleep. Try to do this a few times a day.
  • Breath Counting:
  • Journal
    • Put a small notepad by your bedside with a pen/paper. Whenever a worrisome thought pops up, a to-do task, instead of dwelling on it, write it down.
  • Set-aside STRESS-OUT time: A lot of my patients get into bed, and that is when they start worrying. Instead of doing that, set aside 20 minutes during the day when you just give yourself time to STRESS OUT. When you go to bed and start worrying, remind yourself that you have time the next day when you can worry rather than at bedtime.