SLEEP

By James Heaton

Sleep is a common problem for people who suffer from mental health issues, it isn’t isolated to just bipolar disorder.

Why do we have so many issues with sleep? So, we need to assume that the general consensus is that sleep should be done in the nighttime, from anywhere between the hours of 9pm to 9am. Some people go to bed earlier, some later. Some people have the need to wake up at very early hours between 5am and 7am. Some people prefer to sleep in later.

According to Sleepcycle.com, The Sleep Cycle app has more than three million active monthly users, and this report looked at three years’ worth of data, for a total of 148,116,221 nights of sleep.

Americans spend an average of 7 hours and 18 minutes in bed each night. They go to bed at 11:39 p.m., wake up at 7:09 a.m., spend 23.95 minutes snoring, have an average sleep quality of 74.2 percent, and rate their wake-up mood at 57 on a scale of 100.

As a population, Americans got six minutes more sleep in 2018 than they got in 2015 — 7 hours and 21 minutes, up from 7 hours and 15 minutes. Their average sleep quality has improved from 72.9 to 75.3 percent, but their wake-up mood remains unchanged at 57/100.

So, looking at this study we see the average American sleeps for a little over 7 hours.

Looking at mental health issues and sleep we see the effects of medication and how they contribute to sleep issues. The vast majority of people on medication for mental health issues also take medication for sleep issues.

Many psych meds can cause us to be drowsy during the day, and many patients feel the need to nap throughout the day, and this can interrupt our nighttime sleep cycle. So, what is the sleep cycle?

According to Hopkinsmedicine.org sleep is divided in cycles:

“Throughout your time asleep, your brain will cycle repeatedly through two different types of sleep: REM (rapid-eye movement) sleep and non-REM sleep.

The first part of the cycle is non-REM sleep, which is composed of four stages. The first stage comes between being awake and falling asleep. The second is light sleep, when heart rate and breathing regulate and body temperature drops. The third and fourth stages are deep sleep. Though REM sleep was previously believed to be the most important sleep phase for learning and memory, newer data suggests that non-REM sleep is more important for these tasks, as well as being the more restful and restorative phase of sleep.

As you cycle into REM sleep, the eyes move rapidly behind closed lids, and brain waves are similar to those during wakefulness. Breath rate increases and the body becomes temporarily paralyzed as we dream.

The cycle then repeats itself, but with each cycle you spend less time in the deeper stages three and four of sleep and more time in REM sleep. On a typical night, you’ll cycle through four or five times.”

You can read the entire article at https://www.hopkinsmedicine.org/health/wellness-and-prevention/the-science-of-sleep-understanding-what-happens-when-you-sleep

For people with sleep issues these cycles don’t always work this way. Many of us fight for hours to just fall asleep, only to experience part of the necessary cycles. This leads to exhaustion on the following day. And it’s a viscous cycle, from day to day. Sleep meds come in different categories, and they all work differently. Read more about sleep meds HERE. As a mental health patient, we have all dealt with sleep medications and most of us have been bounced around from one med to the next. Drugs like Ambien can cause alarming behavior while being used. We’ve all seen the news stories of celebrities making bad decisions while on Ambien, and if you’ve taken it you know that there is always a chance you might wake up and do things that you don’t remember the next day. I’ve also had difficulty with medications like Seroquel that have caused me to be violent if I am awoken from a deep sleep. My personal experiences have been that sleep meds are necessary for me, but I try to use as little as possible. The effects last to the next morning leaving me drowsy and unable to function properly until I have been awake at least two hours. And its even worse if I don’t get an adequate amount of time to sleep off the medication. We all react differently to these medications.

So, what are some of the things that can make sleep better for us?

There isn’t a perfect answer that works for everyone, and its best to focus on the things that actually work for you personally. Bizarre dreams and nightmares are often issues that people with mental health issues deal with, and sometimes medication can make it worse. If we prioritize our sleep and treat it with the importance it deserves then we can help avoid some of those issues. Providing a safe and comfortable location for our sleep can remedy many of the problems we have with sleep.

Sleep Environment

A healthy environment is essential for all of us. Creating the perfect room for sleep should be a primary focus if you have sleep issues. This isn’t always possible for every person. If you are fortunate enough to have a room designated for sleep, then customize it for yourself. Designate a room for the sole purpose of sleep, this can be a bedroom you share with your spouse or partner, or a room just for you. The important thing is making this room comfortable and a place where you enjoy being.

 The right temperature can help us fall asleep faster and sleep longer. We tend to sleep better in cooler temperatures. Fans are also a great way to keep us asleep, either for the noise or the cool air blowing on us that keeps us from getting too warm. A programmable thermostat that you can set to a lower temperature at night can benefit you as well. Ceiling fans are a low-cost option as well and having the air circulating in the room will help keep you cool throughout the night.

Adding essential oils to help with sleep is also a great addition to your sleep room. Lavender, Chamomile, and Valerian can all be useful. An infuser set up in your bedroom can provide the scent that works best for you. Infusers are found most everywhere home goods are sold. Some have lights that can provide a bit of mood lighting as well.

Using room darkening curtains is a great addition to your sleep environment. They are lined and keep most of the light out of your room. You can add tape or fabric to completely block out any light that leaks in. I bought mine at Walmart for under $30 and they keep my room very dark during the day and block out any light at night.

Personally, I have to sleep with a television on, and this is a very debatable conversation. Some people absolutely need the noise from a television and others find the existence of a television in a bedroom deplorable. If you need the noise to get you to sleep, then utilize the timer on your television to go off after an hour or so. But if it needs to be on all night for noise, then find what works best for you. Roku offers several sleep apps on their streaming devices that provide sleep channels for no additional cost. Some of the apps offer noise only and turn off the screen portion after a period of time.  Some apps like YouTube have longer videos for sleep but may interrupt them with commercials. Finding what works best for you takes a little time. Creating a music playlist can also be useful and you can make it last as long as you need. If you do like the television on while sleeping, try to pick shows with mostly dialogue and little to no environment noise, like explosions or gun fire. I prefer cartoons like The Simpsons or Futurama, and some people like crime documentaries. Whatever makes you comfortable.

Sleep mask and earplugs are useful for people who like absolute darkness and silence. There are many sleep mask choices and companies like Mantasleep offer 100% darkening mask that are padded for your eyes and very comfortable. There are hundreds of choices on Amazon, from silk mask to other fabrics. Its usually good to buy two mask and rotate them. Washing them weekly to avoid any germs or stains is a good practice.

Mood lighting is also a nice addition to your sleep room. There are many high quality led choices that can offer programmed lighting choices using your smart phone as a control. I personally like the Bluetooth controlled lights from Amazon (click for link), that are programmable and allow you to choose the colors and intensity.

The most important tool in my sleep room is my weighted blanket.  Weighted blankets range from 5lbs to 30lbs. There are many options available in local stores like Target and Walmart as well as on Amazon. The addition of my 15lb blanket was what I needed to not only provide security but also assist with my arthritic issues. I find that the 15lb option was the perfect weight for me, it isn’t too hot and its light enough to travel with. I’ve become so accustomed to it that I find it difficult to sleep without it. 15lbs is also usually a good weight for most washing machines, anything heavier would need to be taken to a dry cleaner or laundromat to prevent damage to your washing machine and dryer.

Now that we’ve created the perfect sleep environment lets look at how our day effects our nightly sleep.

The Daily Routine

I avoid naps during the day at all costs. Occasionally the fatigue from my bipolar disorder or my psoriatic arthritis hits me hard and I need a small afternoon nap. Thirty minutes should be your limit. Anything more and it can disturb your nighttime sleep. Try to avoid lengthy slumbers throughout the day. Depression can be crippling, and it may be difficult to pull yourself out of the bed and function throughout the day, but you will sleep better at night if you can remain active during the day.

An evening walk or some form of exercise can help promote nighttime fatigue and encourage a better sleep. If you are suffering from severe depression the last thing you want to hear is, Exercise! But getting some fresh air, a short walk

Avoid caffeine at least 6 hours before bedtime. Even small amounts can prevent sleep or disrupt your ability to fall asleep. For some of us caffeine is a necessary evil in our lives. Fatigue from mental or physical disorders requires consumption of caffeine to function throughout the day.

Eating a meal of complex carbohydrates can help with sleep. A turkey sandwich on whole wheat bread with a cup of caffeine-free chamomile tea or a banana with cottage cheese or yogurt can be a nice snack before bed. Avoid chocolates and other stimulants, as well as sugary foods.

All of these suggestions can help build a schedule, which is one of the best ways to promote a routine that can help with better sleep habits. Waking up at the same time daily and going to bed at the same time help your body to develop an established routine that is easier for your body to follow. Researchers at Boston University in Massachusetts have found that during sleep, the fluid present in the brain and spinal cord — called the cerebrospinal fluid — washes in and out, like waves, helping the brain get rid of accumulated metabolic “trash.” What this means is simply, sleep is essential not only for rest but for our bodies to reset and prepare for the following days activities.

One bad night’s sleep can affect the next days activities, and like a snowball effect it can ruin your entire week. This is why a routine is the best tool for dealing with all the issues of mental illness.

Two other things that can help with sleep are cannabis and sex. THC heavy strains of cannabis can help get you to sleep and keep you asleep. Edibles are usually more effective than smoking for sleep, as the THC gets into your system through your stomach and has a stronger effect. And sex before sleep releases essential chemicals in your brain like Oxytocin that can help you relax and sleep better. As these two choices are not for everyone, discretion is essential. Depending on your views about cannabis use and your views on sex (alone or with a partner) these two suggestions are simply that, suggestions.

So, establishing a routine, setting up a comfortable sleep environment and avoiding stimulants can assist with overall better sleep. Over the counter Melatonin is helpful for some people but avoid mixing medications without your doctors advise or counsel. If you have to be on sleep medication ask your doctor to start you off with a very low dosage and give yourself enough time for it to get in your system at night. Waiting too late to take a sleep medication and having to wake up early can be a recipe for disaster. I like to allow an extra hour for my sleep meds to take effect.

As with everything involved in living with mental health issues, sleep is something we have to work at. The more work you put into establishing an environment for sleep and creating a routine the better your chances of getting quality sleep. Mental health is about seeing an issue and coming up with a plan of treatment and putting in the work to better yourself and your life.

Creating boundaries is also essential when it comes to prioritizing your sleep patterns. Being selfish and knowing that you need a certain amount of sleep per night might mean saying no to people who want your time. Putting your health first instead of a late night with your friends can be a difficult choice but its always best to put your health first. Learning to say no to people who do not share your condition is difficult but also establishing boundaries that tells friends and family that you need to be in bed by a certain time in order to get an adequate night’s sleep is the best choice for your health.

Prioritizing your sleep regimen is part of self-care and being proactive with your mental health. Making good choices can benefit you in every aspect of your life.

Copyright 2021 James Heaton Life with Bipolar Disorder

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