Self-care has been a frequent theme in my recent sessions with clients as well as in my own life. Self-care is the topic I always begin with in therapy (and circle back to on a regular basis) because it is such an important foundation for improving mental health. When I attended a training Friday on Nutritional and Integrative Interventions for Mental Health Disorders with Dr. Anne Procyk, a naturopathic physician; I wasn’t surprised that the first topic of discussion was basic self-care. We began by discussing the basics of the physical basis of mental health: sleep, activity and food. These are the same areas I consider to be “macro” self-care practices. I know we can never get very far in therapy if these are not being addressed. I found her recommendations on sleep to be very useful with some new perspectives, so I’ll dedicate this post to sleep.
We know that lack of sleep and/or poor quality sleep can cause symptoms that may get diagnosed mental health issues such as depression, anxiety and ADHD. We also know that these mental health conditions can have symptoms of disrupted sleep (and sometimes medications prescribed can have side effects of sleep disruption). Even when not the cause of the problem, sleep inadequacy can exacerbate the problem causing a vicious cycle. It is very important to attempt to break this cycle to foster faster and more complete recovery.
Dr. Procyk shared that the main questions she asks in evaluating sleep in her patients are “do you wake up feeling refreshed?” and “do you have good energy throughout the day?”. If the answers are no, sleep needs to be addressed. Most people require 7-9 hours of quality sleep to feel refreshed and function well during their day. It is important to find your personal required number because even shorting yourself one hour can make a huge difference for some people. Be sure to factor in the time it takes for you to fall asleep, not just when you get into bed, when you are counting hours. Dr. Procyk discussed four areas that make up the foundation of refreshing sleep.
1.) Permission to sleep. We need to give ourselves permission to stop the activities of the day and set aside time for sleep. It simply has to be made a priority. Sleep is a basic human need and without it, things will become out of balance in many ways. Think of it as a self-compassion practice to give yourself permission to rest.
2.) “Story-time”: a bedtime relaxation routine. Our brains simply can’t go from being engaged to being asleep in two minutes… and many of us expect it to. For people who have trouble falling asleep, Dr. Plock asks her clients “what are you doing before you go to bed?”. She encourages people to think about how we might give a child a bath and read them a book to get them relaxed and ready for bed and to do something similar for yourself. This bedtime routine isn’t limited to something like a sleep meditation (although that can be very helpful for some), it can be anything that works for you- as long as you commit to doing it. She isn’t against screen time before bed if it is being used for something relaxing. She shared a story of a patient who found that cleaning the kitchen before bed was helpful. It helped her calm her mind and feel prepared for the next day and gave her brain a signal that it was ok to relax.
3.) Comfortable environment. We aren’t just talking about the mattress here. The first thing to address is, “do I feel safe?”. It is impossible for the brain to relax when we do not feel safe in an environment, which makes sense for survival. Check if there are ways to make the environment feel more safe and comfortable. Sometimes emotional residue from bad memories or traumatic experiences in that space can make a space feel unsafe and this needs to be addressed. Other things to check in with include light, noise, pets, family members, temperature etc. Make any adjustments needed to improve your comfort.
4.) Eliminate caffeine. This one can be difficult to accept for many of us but anyone having difficulty falling or staying asleep might benefit from eliminating caffeine, at least for a trial period. I’ve always gone with the assumption that caffeine wouldn’t have a big effect on sleep if it is consumed early in the day. Dr. Procyk explained that even one cup of coffee in the morning can have lasting effects on people who are sensitive to it. She discussed how even after the caffeine is metabolized it can continue to have secondary effects on our hormones for 2-3 days (which causes our circadian rhythm to get out of sync). It can also cause panic attacks and heart palpitations so anyone working on managing anxiety might benefit from eliminating caffeine as well. Since caffeine is a drug, if you consume it regularly and attempt to stop you should expect to experience withdrawal symptoms for 1-3 days. This might include feeling tired, lethargic, moody, unfocused and having a headache. These symptoms should improve on days 4-7.
Resetting the circadian rhythm can take some time but the above suggestions can help. The hormones of cortisol and melatonin work to keep us awake during the day and relax and sleep at night. Melatonin supplement is a popular over the counter sleep aide that can be used to help reset the circadian rhythm. Melatonin has better long-term safety studies than other over the counter sleep aides but Dr. Procyk still does not recommend using it long term. It can also be beneficial to make sure you are getting exposure to natural light during the day. If you work indoors, try to take breaks or eat meals outside.
Overall, finding what helps with refreshing sleep will be varied and unique to everyone and requires some experimentation. Keep in mind that the other physical basics of mental health such as activity and food will influence our sleep as well, so addressing all the areas at the same time will produce the best results. More information on activity and food coming soon!