ambien

by

Sleep Hygiene – my version

1.  The bedroom is only for sleep and for sex.

  • If you aren’t having sex than all you get to do is sleep.  No food, no phone, no TV.  Only sleep.
  • The bedroom is a sanctuary for sleep. Your subconscious is way to powerful to toy with.  When you go to bed you want it to be telling you to sleep, not read that last chapter or check the latest on @Twitter.
  • This can be a change in family culture and affects everyone in the home.

2.  No naps longer than 20 minutes during the day time – Known as a “Power Nap.”

  • If you are tired and have the luxury of lying down, do it!  But set your alarm to wake you up in 20 minutes.  You can do this 20 times a day if you want to.  But no longer than 20 minutes.  Anything longer will break into your deeper stages of sleep and throw off your sleep cycle (also known as sleep architecture) at night.

3.  No caffeine second half of the day.

4.  Exercise but not before bed.

  • Exercise will help regulate your sleep cycle at night if you just give your sleep initiation some space.
  • Try to get forty to sixty minutes 5-7 days a week of aerobic exercise to get best results.
  • Look at exercise like a pill.  A prescription.  Something for your medical and emotional health (inspiring to me), not necessarily for your waistline (inspiration notoriously short-lived.)
  • Every day think, “I’m exercising so I feel good, so I sleep good, so I can do what I want in life” – what ever that may be for you.  Some people will say, “…so I’m not a crazy Mom!”

5.  Keep the lights dim before bed.

  • Light turns off melatonin release from the pineal gland in our brains.  Darkness releases it.  Having your face 6 inches from the computer screen or TV before you lay down doesn’t give your body much time to turn itself off.  Melatonin is a cornerstone in sleep architecture.
  • Some people who feel they must be on the computer or TV before bed have found that wearing sunglasses for at least the last 30 minutes helps.

6.  Go to bed and get out of bed at the same time every day.

7.  If you can’t fall asleep in 30 minutes, get out of bed and do something else until you feel sleepy.  Then go to bed and try again.

  • Refer back to #5 when choosing what and how to do your activities during that time.

8.  If you can’t fall asleep in 30 minutes, consider taking a sleep aid.

9.  Do not take any sleep aids over-the-counter except melatonin, valerian root, or chamomile.

  • All others including anything containing diphenhydramine, block your deep sleep. You may end up sleeping a longer amount of time, but you won’t be getting restorative sleep.  It is during the deep sleep that your body heals, replenishes it’s hormones and neurotransmitters, and consolidates memories.

10.  If you choose to take a prescription sleep aid, do not take benzodiazepines such as diazepam, temazepam, clonazepam, alprazolam, or lorazepam to name a few.  These also block deep sleep.

  • Sleep aids safe for deep sleep and sleep architecture, include atypical benzodiazepine receptor ligands – such as zolpidem (Ambien), eszopiclone (Lunesta), or zaleplon (Sonata).  The main differences between these are how long it takes for them to be metabolized/washed out of the body.  Some are quick and some last the full 8 hours.
  • Trazodone (Desyrel) is also safe for sleep structure and maintenance.
  • Sometimes people will find that combining something like zolpidem with trazodone is most effective for them rather than using only one agent.

11.  Do not use alcohol to sleep.  Alcohol is a depressant (will make you depressed) and also blocks deep sleep.

12.  Do not smoke before bed or if you awaken from sleep.  Nicotine is stimulating.

13.  Don’t sleep with your pets or children.  They are disruptive.

  • It’s not personal.  It’s sleep hygiene.

Self Care Tip #34 – Use these tips to decode how to sleep well.  Be a friend to yourself.

Questions:  Why do you skip the bits of sleep hygiene that you do?  What helps you in your tough work of being your own friend in regards to sleep?  Please tell us your story.  

Related Articles
by

Using The Force – I Am An Emotions Jedi Diagnosing In Those Who Function “Fine”

Jedi Master Qui-Gon Jinn (right) and Padawan O...

Image via Wikipedia

Self-Care Tip #200 – Use your emotions to sense the emotions around you or in your own self to detect depression.

Teracina came in initially for some sleeping pills.  She didn’t come to tell me about her personal life.  She just wanted the pills.  It’s understandable.  What a pain really to unveil on cue, like planned sex it was too impersonal to get personal.  She was in the category of people who weren’t pining for diagnosis, for a hearing ear or connection.  She wasn’t even actively thinking about those things.  Pushing them at her turned her stomach.  Foreign foods and smells to her, a girl who liked home.

Hearing what she is coming in for is the first part of anyone’s exam.

So what brought you in today?

What can I do by you?

What are your druthers?

In Teracina’s case, I got an answer of what she perceived she needed.  It’s my job to see if I can get more than that first answer, the patient’s chief complaint.  So we negotiated as we chatted.  Pills for history.  Only enough pills to get her in to her next appointment in a week when we can talk further.  She’ll come back ready to let me take a history or she won’t.

We talked a little more while I was writing out her secure-prescription for what she came in expecting to get, Zolpidem.  It turns out that her neighbor shared some with her a few weeks ago and it “worked.”

I was watching her too, while I wrote, while we talked.  She didn’t have much expression on her face and her voice lacked inflection.  She gave off this aura that the ground was about to open up and suck us both under.

This is a short-cut I learned early in my psychiatry residency training.  I also had extra credit because I was already hard-wired to listen to my internal emotional milieu.  I call myself the “Emotion’s Jedi.”  (Go ahead and laugh.  With these powers, I see right through you.)  When we are with someone and feel like the ground is going to open up and swallow us, we have a ladder-chute to diagnosis –> depression.

Depression is sneaky; an ebb out of our unsuspecting selves it takes bits of our personality away.  More often, many of us don’t know that we have been changed.  We are doing well enough at work, or school or the daily chores of a care-giver’s work-load.

I’m fine.  Nothing’s changed.

Colloquially we call this, “functional depression.”  Doing well on paper but inside fading, body changing, sleep changing, interest and motivation – changing.

No.  I never have thoughts of wanting to die.  I’m fine.

(Insert famous swooshing sound of my lightsaber.  You can add music too if you like.)

But who cares if Teracina doesn’t come back next week to see me?  I’m not fighting her.  No I’m not.  And that’s why I care.

None of us are fighting each other.  We are fighting these diseases, here to be tools to be used by each other and by ourselves for each others sake.  Flip it back again.  For our own sakes.  We fight that dark melancholy and are not worth much more than our posture if we don’t.

Question:  What has helped you to detect depression in those functioning around you?  Or yourself, when “everything was fine?”

Related Articles