Those words are part of the Jewish prayer that i say at bedtime. After the events of recent weeks, and especially after the storming of our Capitol by armed thugs spurred on by our own President, many of us needed an army of angels to help us sleep.
Even before the years of the Trump Presidency, however, there was an epidemic of sleeplessness in our country, one that has been going on for years. Last week, for example, I saw a 17-year old girl I will call Gloria. (I am changing some specifics in the interest of patient confidentiality) I had seen Gloria for a knee injury, and I wanted to see that the injury had resolved. Gloria suffered from diabetes since childhood. She also had rather severe anxiety and depression, was on a variety of medications, and sees a therapist and psychiatrist.
But her major concern was that she could not sleep at night.
“I can’t turn off my mind” she said.
“I’ve just been put on a new sleep medicine,” she added, but it’s not working. She couldn’t remember the name of it. I looked at her med list. It was an A to Z of psychiatric meds.
It was not surprising to me that it wasn’t working. According to scientific studies , sleep medicines extend the duration of sleep by about seven minutes. That’s all!
And sleep medicines are a billion dollar industry. Despite the lack of evidence for their efficacy, most doctors are still addicted to the old fashioned habit of giving pills instead of teaching skills.
I asked what Gloria’s sleep schedule was. She typically stayed up way past midnight, then “tried” to go to sleep. When she unsuccessful, she stayed up most of the night. (“I’m a night owl, I guess” she said). Then she would fall asleep towards dawn, and sleep most of the day - missing school. Then about 8 hours after waking up, she would again “try” to fall asleep.
Add to this the fact that she was getting no fresh air nor exercise, and liked drinking caffeinated soda, no wonder she couldn’t sleep!
There were no loud noises nor tumult at home keeping her awake. She had her own room.
I found out that she talked about her worries with her therapist, but her therapist had not taught her any skills to help her sleep. It is unfortunate that too many therapists do not address sleep issues. One can not overcome ADD, anxiety, depression or any mental health issue without restorative sleep.
And therapist are the ones with who should be teaching kids and adults how best to sleep, because all the sleep experts say that behavioral therapies, specifically cognitive behavioral therapy and relaxation are the BEST remedies for insomnia.
In the remaining minutes of our visit, I discussed Gloria’s sleep habits. She had a very common problem: advanced circadian cycle. In other words, her biological clock was set so that she could not fall asleep until the wee hours. It was as if she was living in a time zone 5 hours earlier than ours —- in Hawaii or something. When I told her that she would be fine if she were living on a beach in Hawaii, she smiled —- the first I had seen on her face the entire visit.
I explained that she would have to adjust her sleep cycle by starting with a very late bedtime —- say 2am, but going to bed 5-10 minutes earlier every night, until she was falling asleep at 10:30 so she could get up for school.
Melatonin, taken at dinner time, could help her do that. That is the only medication or supplement I suggest. And melatonin is only good to help adjust the sleep cycle, not as a sleeping pill. The one exception is among young people on the autism spectrum; they may have a relative lack of this hormone in there pineal gland where melatonin is produced.
And I said that she would have to get up at the same time, every day. And she could take NO naps. If she wakened at night, she should not toss and turn, but get up and do something boring, like folding laundry or re-reading a book, for 15 minutes. (I plan to teach her a simple meditation technique to help her easily fall back to sleep - one I have taught successfully to many patients, and myself.)
And she should get out for walks, no matter the weather, every day.
Her bed should be used ONLY for sleep, not to eat, nor watch TV, or play video games.
She should keep a sleep diary to keep track of her progress.
An evening ritual, thinking of three things she is grateful for, or something new she learned, or reciting a simple prayer of thanks, is an excellent habit as well.
Finally, I said that she could begin to practice relaxation breathing techniques, or meditation, available on apps like Aura. I plan to see Gloria for a consult to teach her skills to help her fall asleep and stay asleep.
Or she could begin to practice yoga, also available online: I have previously discussed my experience with 30 Days of yoga with Adrienne. Yoga, practiced late in the day, is a great way of relaxing mind and body, and helping wind down.
Winding down: The entire process of getting ready for bed, whether you are 9 months old, 9 years or 90, should be a process of slowing down, of calming. It should be similar to a gentle pleasant ride down a hillside, with the destination being bedtime. Every step along the way - a shower, a cup of tea, brushing one’s teath should be seen as steps along the way. I floss, use a waterpik, and then brush. By the time I am on this third activity, I am half asleep already. My phone has gone to bed an hour earlier.
Only by altering our lifestyle, by being committed to learning skills instead of reaching for pills, can the epidemic of sleep deprivation, which affects millions of adults, from the President on down, and millions of kids, be successfully treated.