From the Canadian Addiction Medicine Bulletin
Volume 4 Number 2

Sleeping Problems - What to do?

Many patients complain and fear insomnia. In order to prevent relapse due to problems with insomnia the therapist must be prepared to provide alternatives for the patient. Here is a list of techniques I have obtained from various sleep institutes.

Suggest that the patient review this list at least a few times, then try one or two items that they have never tried before to help them sleep. Have the patient implement them as a daily routine to help them sleep! If they do not work after a few days, then have the patient pick one or two more items and repeat the process until they discover the items which help them the most.

Developing Better Sleep Patterns

  • Go to bed at the same time each day and get up at the same time each day
  • Do same bedtime sleep preparations each night.
  • Pursue relaxing activities prior to bedtime.
  • Be in bed before (not after) inner clock dictates. Inner clock i.e. tired at 10 pm but more awake at 11 pm, so in bed at 10 pm!
  • Avoid napping during the day because this could alter your inner clock.
  • If you must nap, limit number & length.
  • If you can't fall asleep, get up and do some relaxing activity until you feel sleepy.
  • Limit "catch up" sleeping sessions to an extra hour or two.
  • Avoid marathon sleeping sessions on weekends.

Food and Beverages

  • Do not go to bed too hungry or too full.
  • If hungry, at bedtime, try a light snack of fruit, crackers, but nothing spicy or large.
  • Use milk as a nightcap.
  • Avoid all caffeine beverages after lunch.

Environmental Considerations

  • Make sure bedroom is not too noisy, warm or well lit.
  • Set thermostat at 65-70 degree F range.
  • Use bed for sleep or sex but not for reading, TV, writing letters, intensive studying, paying bills or other stressful activities.
  • Make room quieter with carpeting, window shades, draperies, and/or a small fan (white noise device).
  • Keep your bedroom darkened with shades or blinds.
  • Check the condition of your mattress. Buy the BEST! Would you pay $1/day for 8hrs a day of pure comfort?
  • If your mate steals covers or snores, consider separate temporary sleeping arrangements until you re-establish a satisfactory sleeping pattern. If they snore then try using soft FOAM ear plugs because they are comforatable.
  • Wear loose-fitting nightclothes.

Exercise and Play

  • Exercise every day, but not vigorously after 6PM. Try walking, light jogging, swimming, biking.
  • Aerobics or any large muscle exercises are excellent to induce good sleep.
  • A workout 3-4/wk where you are sweating and breathing hard for 15-20 mins will really decrease tensions!
  • Get enough play in your day. Plan for Relaxing getaways with simple agendas without extensive touring!
  • Fresh air activities are most beneficial.

Relaxation Techniques

  • Use the half hour prior to bedtime as time for relaxing activities, such as reading or soothing music.
  • Take a good warm, not HOT, bath/shower prior to bed to help wash off your worries and reduce muscle tone.
  • When in bed, imagine yourself in a pleasant setting and think only about pleasant things or use progressive muscle relaxation techniques to reduce muscle tension prior to falling asleep.
  • Play a sleep induction tape or other relaxation tapes after you are in bed.

Thought Patterns

  • Allow time for "worry/planning" session each PM but late in the afternoon or early evening.
  • Write down your worries, what you plan to do about them tomorrow and reasons why it is not worth worrying about now.
  • When you turn off the light, relax and try to avoid worrisome thinking.
  • Do not allow yourself to overly dwell on work or other stresses! If you do then try THOUGHT blocking!
  • Thought Blocking - Focus intently, on one point with your eyes open and don't THINK. Try it for 5 minutes.
  • Avoid stimulating or distressing mental activities the last couple of hours prior to bedtime.
  • If unable to sleep in 20 minutes, get out of bed and read or otherwise divert yourself until urge to sleep returns i.e. TV.

Medications or Drugs

  • Beware of hidden caffeine in over the counter medications, eg. headache pills and foods, eg. chocolate!
  • Do not smoke or at least refrain in the evening hours because nicotine is a stimulant.
  • If you can't sleep, then give yourself permission to stay awake!

F. Evans, MD
Toronto, Ontario, Canada


Two other techniques that have been helpful for my patients are - journal writing, even in the middle of the night, to clarify feelings and thoughts that are racing around, and Transcendental Meditation, twice a day - Editor