Sleep is vitally important. Without sleep, we can go a little… strange. Sleep helps us consolidate our memories, create new solutions to problems, watch cheap films in the form of dreams, and promote healing of both our body and mind. While there are a few specific medical conditions that can interfere with sleep, and these need specific medical solutions, many people who struggle with a lack of sleep can try these methods to beating insomnia cheaply and easily first.

Insomnia is, medically speaking, is one or more of the following:

Problems getting to sleep
Staying asleep
Sleeping for long enough
Not feeling rested after you have slept

Preface

Sleep Hygiene

Sleep Hygiene is a common term that doctors and therapists use to refer to the routine activities that promote sleep. This is an ideal set of steps that work in with your circadian rhythm, biology and neurology, to create an expectation of sleep and stack the sleep odds in your favor.

Most Sleep Hygiene discussions assume that you are Neurotypical with an average biology. Here, we are going to go into far more detail and not make those assumptions.

In this article, we are going to look at how to wake up, how to get to sleep, how we manage overnight waking, and identifying the most common sleep interrupting habits.

It is important to recognise that regular Sleep Hygiene can help between 5 to 10 percent of people improve their sleep. To be frank, that isn’t a high percentage. This more complete guide will try to cover much of what the regular articles miss. Even so, even if this doesn’t specifically help you, you can at least cross all of these off your list of likely causes for your sleep troubles.

These strategies are the cheapest and easiest things to adjust, fixing the low hanging fruit. If these strategies fail, you may need to consider medication, sleep therapy and or medical investigations.

Understanding the Human Circadian Rhythm

All Earth biological creatures have an approximately 24 hour rhythm, based on the day/night cycle. This has led to most business relying on a 24 hour cycle to operate in. Stress and other factors can push your cycle out of alignment, which can disrupt sleep and rest resulting in fatigue. For example, we may stay awake longer for stress related reasons, resulting in not enough time to sleep before going to work or school the next day. This then creates extra stress to stay awake, leading to poor sleep and so on. The cycle is disrupted.

While we are asleep it is not efficient to have our digestive system ready to consume food – most of us don’t eat in our sleep. As such it will slow and even effectively shut down. Meals eaten late can cause problems with sleep. Also while we sleep, we dream for between 4 to 6 hours, some of which is REM (20 to 40 minutes of Rapid Eye Movement) sleep, most is not. During sleep, our brains are able to flush and refresh our neurons, helping to restore nutrients, build new neural pathways and prune old ones, flushing the toxins and waste products that we couldn’t properly do during the day. Our bodies do the most growing and healing while we sleep.

Around an hour before we normally wake up, our bodies start to increase in hormones and our digestive system starts up again.

To take advantage of this natural system in our bodies, we want to try to establish some useful routines. This sets up both our biological processes to expect what is coming, such as sleep time, and psychological patterns towards our goal, such as relaxing to go to sleep. We can similarly use routines to exercise, eat healthily and so on.

Avoid Shift Work

Understanding our Circadian Rhythm and how predictable routine helps our bodies and minds helps us to efficiently prepare for food, activities and sleep, leads us to understand that shift work leads to poorly predictability. The two worst kinds of shift work are Swing Shift and Night Shift, especially if you are struggling with sleep quality.

If you do shift work and are struggling to sleep, it is time to find another line of work.

Some people are naturally nocturnal, and if you are able to get enough sleep during the day, then that is fine. Do ensure that your Vitamin D and body Iron is high enough via your GP.

Light and Sleep Hormones

When our ancestors woke up, they would wake with the sun, or get up and go outside. The bright blue light of the morning sky triggers certain photoreceptors in our eyes, which trigger a biological reaction that decreases the amount of the hormone Melatonin in both our body and brain, which also signals to our body “this is morning”, acting as a reset to the time of our Circadian Rhythm.

At the other end of the day, the sun sets and things get dark. Low lighting on those same special photoreceptors in our eyes triggers the increase in production of Melatonin.

Melatonin is a hormone that we use as one of the many “wake/sleep” markers in our body. Melatonin is a member of the hormones that we also use as a neurotransmitter when it is present in the brain.

Our brain is constantly cycling through a list of basic checks to see if a task set needs to be triggered. Some examples are:

Do we need to go to the toilet?
Do we need to eat?
Are we safe?
Do we need to sleep?

There are many more in the list. Once the list is checked, our brain cycles around and starts the checks again. Any one of these that are “true enough” triggers some more actions, while any that are “false enough” are ignored until they become true.

When the “do we need to sleep” item occurs, our body checks a number of “sleep” and “danger” indicators. If the Melatonin Sleep Indicator level is high, we feel the need for sleep. If the Adrenaline Danger Indicator is high, then we ignore the Melatonin Sleep Indicator – staying alive is more important than falling asleep.

Adrenaline can override melatonin. This means that if you are prone to pre-sleep anxiety, negative thinking, sudden fits of creativity or a perceived pressure to get things done, this is going to wake you up even though you are exhausted and wanting to sleep. For a deeper understanding about this, read Beating Pre-Sleep Anxiety [LINK].

This can be due to boredom, adrenaline regulation problems, anxiety disorders and ADHD.
If you experience Pre-sleep Anxiety despite following this article is a prompt to get that addressed too. A common marker that this is a problem for you is that you use exhaustion, medication or drugs to go to sleep.

The Blue Light Myth

There is a strongly held idea that if morning blue light helps you wake up, then seeing blue light at night should logically interfere with you going to sleep.

While this is an interesting idea, it is not well backed up by science. While it is true that there are some studies that found that blue light from electronic screens did keep you awake, there are also studies that found that they don’t. Here is a meta-review [External LINK] that found that blocking the blue light from screens did not support the blue light hypothesis.

Two factors are far more important than the colour of the light – brightness and content.

Bright light of any colour signals the brain to decrease Melatonin, so turn the lights down. If you watch an exciting video, or read worrying social media content, or read intriguing mysteries, you will excite your system and resist the sleep signals. So switch your screen content to something more calming, but not boring.

Routine

Spoon Theory is the idea that all tasks cost something, and we simplify that inner cost as Spoons.

To remember to do a task costs some Spoons, to start a task costs some Spoons, and to do the task costs some Spoons. When we stack a few tasks together, we remove or significantly reduce the “remember” cost and the “start” cost. Often people who are living with a sleep deficit are short on Spoons and things always seem so darn hard. Low spoons, especially from a lack of sleep, increases the cost of every task, meaning that you run out of Spoons much earlier, even if you had a full allotment of Spoons at the beginning of the day.

The goal of understanding Spoon Theory is to build routines that connects several tasks together, decreasing the start up cost and ease completing tasks.

This also programs in an expectation of what is coming next, either sleep as the result of a sleep routine, or being awake for the getting up routine.

Don’t do shift work

If you are struggling with sleep, and you are a shift worker, then the best first move, if you can, is to stop doing shift work. While some people can do shift work and sleep fine, most people can’t. Long term studies have found that shift work is awful for most people’s health.

Beating Insomnia

Waking Up

Pick a time to wake up. Set your alarm for this time, multiple if you need. It is far more in your control to wake up than it is to go to sleep.

Sometimes people co-sleep and the other person doesn’t want the alarm set. This may mean that you will need to sleep in another room. This isn’t inconsiderate, this is considerate – they are considering your needs to get up, you are considering their needs to stay asleep.

Once the alarm goes off, sit up in bed. It is much harder to fall asleep again if you are sitting up in bed. If you are in a darkened room, turn the bedside light on and look at the brightest part you can that doesn’t hurt to signal “morning” to your brain. Have a bottle of water next to your bed and take a drink from it. If you have ADHD medication that you take in multiple doses, take one of them now.

Some people feel dizzy and or nauseous when they first wake up, especially if they haven’t practiced this and have had a very poor amount of sleep. Wait until that passes, then get out of bed.

Once you are up, go to a window and look out at the blue of the sky (not at the sun). If you can’t do that, or you have got up earlier than the sun, turn on a bright light and look at that for a bit. This is resetting the melatonin in your body and alerting your brain’s circadian rhythm that this is the start of the day. You only need a few minutes to do this. If you can, open curtains in the house to let light in or turn lights on in the house.

Go eat some breakfast. Ideally something with both some fast-acting sugars and something with carbohydrates. Fruit helps both energy and digestion but beware of fruits high in vitamin C if you take morning medication – many medicines are not absorbed well in the presence of Vitamin C. Check the instructions that come with your medication to confirm if this is relevant for you.

Now go and do something active, perhaps exercise, or going to work/ school, or start on a thinking /doing task.

Going to Sleep aka Sleep Hygiene

Pick a time to go to sleep. Most people need around 8 hours of sleep per night. As this is an average, this can be from 7 to 9 hours for the vast majority of people. There are a few notable exceptions to this: Short Sleepers and Long Sleepers.

Short Sleepers

Some people need 6 hours and 20 minutes for sleep. There are 2 genes that we have identified in humans that require this. More or less than the 6 20 is detrimental to these people. No real studies have shown people that can reliably be healthy with less than 6 hours and 20 minutes sleep, so if this is you, talk to your doctor about getting some sleep studies done, and get a referral to a sleep specialist therapist to try to help you navigate your situation. If it is pain that is causing you to sleep for less time, then talk to your doctor for a relevant referral about pain.

Long Sleepers

Some people need more than 9 hours of sleep. Generally, there is a co-occurring condition that a person has, such as a brain injury, chronic fatigue syndrome or some known sleep condition, that requires this. If you find that you need more than 9 hours of sleep and you don’t have a medical condition attached to that, you should go to your GP and ask for some investigations to find out why.

Step 1 – Taking control, Setting the wake-up time

The amount of sleep that you need is specific to you. You’ll know it is right because you will find that your day is optimal for you. When you find that more sleep doesn’t help, then that is too much sleep. When you find that less sleep makes you terrible, then that is too little sleep. On average, in this modern life, studies have found that most people are getting about 1 hour too little sleep. So the odds are high that what you think of as “enough sleep” is about 1 hour too little. Set your “sleep time” as your usual sleep plus 1 hour before the time you have set to wake up (see Waking Up above).

Let us be clear via an example. If my “wake up” time is 7 am, and I think the amount of sleep I should have is 7 hours, then I’m going to increase that 7 hours estimate to 8 hours based on the above statistic. That makes my “sleep time” number 8 hours prior to 7 am, which makes it 11 pm the night before. So 11 pm is my target to “be asleep”. For the first week, this won’t actually happen, but this is what we are working towards, and so the math is based on that target of 11 pm.

Sleep Routine

Your Sleep Routine will generally start 1 hour prior to your Sleep Time. In the above example for Sleep Time of 11 pm, we are going to start our Sleep Routine at 10 pm. This routine will help your body and brain be in a sleep receptive mode.

This starts by dimming the lights. Have a second light in your bathroom that you can use that is less bright that the default light you have, or use the flashlight app on your mobile phone. Most bathroom lights are very bright, so that you can see yourself well in mirrors, which will reset your increased Melatonin. Using a dimmer light when you brush your teeth and hair (if you have some) will trigger your body and brain towards sleep. Try not to brush vigorously. Some people find it beneficial to count their strokes, while some find it awful – pick what works best for you.

If you take medication to help sleep, take this at a time that it has strong impact around your chosen “Sleep Time”. For Melatonin Medication (fast acting), that is around 20-30 minutes before the Sleep Time. While “natural sleep” is the best sleep, medication assisted sleep is better than no sleep.

One of the last things to do before you go to sleep is to drink a 1 cup or 1/2 a cup of milk (either animal or plant based – soy is a better plant base if you aren’t allergic), then about 10 minutes later go to the toilet. The milk has soporific (sleepy) agents in it that help sleep and some of the other agents help brain chemistry while you are sleeping. Often people get thirsty in the night and this wakes them up, or they need to go to the toilet and this wakes them up. This step helps alleviate those odds, plus the various chemicals in milk help our brain and body.

Sensory Stimulation

Your Sensory Stimulation needs to be right. There are six common sensory stimulations that can affect sleep.

Light

Some people need the bedroom to be very dark. If that is the case, block light sources. Some people need a bit of light to sleep by, so tune the lights for this. Some people need enough light to see across the room clearly – try not to get too bright or this risks upsetting the melatonin production.

Some people find that flickering and blinking lights help, while others find this impossible.
I appreciate I have effectively said “all the options”, what I mostly am trying to say is that the light level is person specific and you need to figure out what is best for you – just don’t have bright light. Or put another way, none of these options is generically wrong if it works for you.

If you are cohabiting, you may be with someone who needs more light than yourself, or vice versa. Try a sleep mask to adjust your personal light level down, or sleep in another room for a while.

Sound

Much like light, people need various levels of sound to sleep.

This is going to vary from silence, various “white” / “brown” noise, music without words, to a podcast of people talking or the television on. Again, partners may have different needs.

If you have sound, try not to have the volume too high, or the content too interesting. But neither can it be boring – this is a distraction for a busy brain, so it needs to engage a bit, but not too much. If this seems like you, also consider ADHD [LINK].

Temperature

Most people sleep better a bit cooler than day temperatures. How much, though, depends on your body. Sleep studies have shown that most people who struggle with sleep are too warm, so the first step is dropping the temperature or layers a bit. Sleep studies have found that most people sleep poorly in summer as compared to winter, primarily due to the hot temperature at night.

If cooler doesn’t work, try raising the temperature a bit.

Some of us wake up hot, then find we get cold, so variable layers is very handy. A single layer is not adjustable.

This can make it tricky if you need a weighted blanket.

Pressure

Every blanket is a weighted blanket if you add enough cats, dogs or dragons.

Some people sleep better under a weighted blanket. This can often be simulated with multiple layers, but then runs the high risk of being too hot, and as we saw by the temperature section, most people sleep better when they are cooler. Weighted blankets can be purchased that are not filled so that your body temperature can escape and not cook you. Look around though, some are very expensive, and you can get cheaper weighted blankets for a reasonable price. If this seems like you, also consider Autism.

Texture

While some people don’t mind what they are sleeping on, for some the texture of the sheets and blankets is very important. Additionally, crud and other debris in the bed can be irritants that keep us awake. If you have pets that get on the bed or sleep with you, you may need to build into your sleep routine brushing the pets and cleaning out the debris from the bed first. This can be another indicator to consider Autism.

Air Flow

Some of us are sensitive to the amount of odour and carbon dioxide in the air that we are breathing. If we are locked into a small room overnight, we may wake up feeling claustrophobic or like we are suffocating, simply because we don’t have enough fresh air.
Many people benefit from leaving a door or window open (when safe, and climate appropriate), or having a flow of air over them. A small cheap to run electric fan can be enough. A fan can also provide helpful background white noise as well, acting as a two for one deal for those who also benefit from white noise.

Managing Unplanned Wake Ups

Some people have planned split sleep. This is not what we mean by an Unplanned Wake Up (UWU).

We humans have cycles within our sleep cycle. These cycles are between 20 to 60 minutes in length, depending on the person. We will cycle down into deeper sleep, then rise up to almost awake, sometimes rolling over, then back down to deeper sleep. We will cycle through this 8 to 20 times a night.

Sometimes we miss “almost wake up” and actually wake up. If our Brief Wake Up is rare, then we can generally ignore it. On the other hand, if our Brief Wake Up is frequent, we may have something to address.

Sometimes, though, when we wake up, we wake up all the way.

Consistent Split Sleep is Okay

Having a single block of uninterrupted sleep is a fairly modern western capitalistic idea. This is most common in colder climates and from countries strongly influenced by northern Europeans.

There are many cultures around the world who have a built-in siesta, a noon/afternoon nap, built into both social expectations and the economy. Cultural siestas are most common in countries that have hot middays.

While split sleep is more common in young children and elderly people of all cultures, it is not unique to them. Split sleep can be the above mentioned siesta nap in the day time, or it can be splitting night time up into three parts, where you sleep early in the night, wake up around midnight and potter around, and then resume your sleep towards morning.

If this is you, do not think that your sleep is broken. You may just have split sleep.

Brief Unplanned Wake Ups

Brief UWU comes in two major forms, the wake up, turn over and go back to sleep versus the Brief Out of Bed Excursions. Here we take a look at both of these, and the most common reasons why you may be briefly getting up.

Tossing and Turning

It is normal to rouse to almost consciousness or brief consciousness, roll over or move a limb or so, and then resettle back to sleep. We do this to shift blood flow to the part of our body that is under us, which prevents bed sores and blood pooling. Our nostril structure, specifically lamina propria, block and unblock alternating nostrils which prompt your body to roll over.

If this occurs only rarely in your sleep, then this likely is not a concern. It is normal for us to wake slightly and turn over, or reposition our limbs a few times in a night. Generally, you won’t wake up enough to store memories of the shifting position. To store memories often means that you needed to be awake enough to be conscious, and that conscious state needs to be stable for at least 1 minute for memories to be stored. Most repositioning doesn’t reach this level of consciousness, hence no real memory of it. There are a few factors that can mean that you wake a little more during these few Tossing and Turnings that aren’t terribly important if they are rare. Mostly, don’t worry about it.

If, on the other hand, you are Tossing and Turning regularly, for example more than ten times a night, this can be an indicator that the quality of your sleep is poor and that can be quite a significant issue. Having nasal congestion, a sinus infection or other breathing difficulty such as sleep apnea can cause you to sleep very lightly or wake up a great deal. This needs medical attention. Long term difficulties with breathing and sleep should be referred to your GP, while a temporary situation may, in some cases, be resolved by your pharmacist and a decongestant or antihistamine.

Some people are still all night, and so long as you don’t have any bed sores or discolouration, generally don’t worry about it.

Brief Out of Bed Excursions

A Fluid Break is primarily where you feel that you need to get up to go to the toilet, or get up and drink some water, or both. Sometimes it can be a for some other irritant based reason. Importantly, you felt the need to get out of bed, but were able to get back in and to sleep within minutes.

If your Fluid Break happens only infrequently, that is once or twice in a night, but generally not most nights; then this is not a big concern. It can be useful to recognise what may precede these rare nights, such as drinking more liquid at night, such as at a party, than usual; or perhaps you ate late night salty food and your body is trying to rebalance the fluid.

If you are feeling itchy, it may be the sheets, fabric detergent or some other new item or cleaning agent that is irritating you. It may be more of a sensory based thing, which we covered above. These can all be factored in and addressed if they are of semi-frequent concern.

If, on the other hand, you find that you get up most nights due to similar reasons, then we have a much stronger need to take a look at what is going on for you.

– Urination

For example, if you generally need to wake up and go to the toilet, then for a regular “go to sleep at 10 pm and get up at 6 am” sleep routine, you probably should stop drinking liquid around 6 pm and try to urinate before you get in to bed to sleep. If this kind intervention doesn’t address the toileting problem, then talk to your GP about bladder and fluid issues. This is even more important if you don’t drink more than around 1.5 Litres a day and find that you frequently need to urinate (more than 10 times in 24 hours).

– Thirst

A few reasons exist that can cause thirst.

Too warm
Mouth breathing rather than nose breathing
Medication side effect
Medical condition

Being too warm can often start as going to sleep you want extra layers due to either the comfort of weight, or initially feeling cold. As you find yourself becoming drowsy, take a few layers of cover off. Keep your movements slow so as not to trigger an adrenaline spike and wake yourself up. You may also benefit reviewing the Temperature and Fresh Air section under Sensory above. Some modern gadgets are also available to help, such as temperature regulated mattresses.

Breathing through your mouth can be caused by several reasons. Temporary reasons can include an infection that blocks your nose, seasonal allergies or alcohol. Decongestants and antihistamine medications can help the first two, the last really needs you to avoid sufficient alcohol that it affects your sleep. If you regularly drink more than 1 standard drink of alcohol, then you may have a substance use problem and that is discussed in a different section [Substance Use Condition LINK].

Continual feelings of thirst and mouth breathing can be caused by various medical conditions around obstructed breathing, such as Sleep Apnea. These need to be medically addressed, talk to your GP about what it could be. You may need your GP to refer you to a Sleep Clinic or Sleep Specialist.

Some medications cause Dry Mouth as a side effect. Have a bottle of water by your bed and use enough to wet your mouth and swallow (30 to 100 mL). This is more about wetting your mouth to trick your brain into thinking that you have drunk, rather than consuming much water which can lead to the need to go to the toilet.

There are a few medical conditions that may be at play if none of the above can explain why you frequently feel thirsty or have a dry mouth. Talk to your doctor about this.

– Snacking

Sometimes we wake up hungry and feel the need to go and eat something. Often this has more to do with Dopamine chasing foods (processed foods, fat, sugar, carbohydrates, salt and protein being the primary ingredients) or Adrenaline chasing (such as caffeine, theobromine [chocolate], nicotine). If you find that your reasoning is poor and your mood is compromised, go and take the ASRS Adult ADHD Self Report Scale test, even if you are medically obese or pre-diabetic.

If, on the other hand, you are diabetic, confirm that your blood sugar is out before you eat anything. If you are frequently waking up because your blood sugar is out, it is important to talk to your endocrinologist about this.

Mid-sleep Wide Awake

We briefly discussed the cycles of sleep within our sleep cycle, from awake to deep, then back up again. We are going to focus here on waking up too much. We want to try to get back to sleep within this cycle time length so that we can effectively resume our sleep.
There are generally three major causes for waking all the way and struggling to get back to sleep.

Pain

Pain is awful, do not recommend. Pain can be Temporary of Chronic.

Temporary Pain

If you are injured, take some pain relieving medication appropriate to your system and injury prior to going to sleep, and if enough time has passed upon the Mid-Sleep Wide Awake, take another dose. The odds are that you have reached the time where you need to re-apply your pain relief and this is a good time to take it. Follow the instructions given to you with your medication, or see your prescriber and ask about how to safely take pain medication during the night.

Most over the counter (non-prescribed) pain relief medications take around 30 minutes to achieve efficacy, so you’ll have a bit of time until the feeling of pain is relieved enough to sleep. While waiting for the pain to dissipate, do a distracting task, like playing a game or reading until you can go back to sleep. Mostly I’ll direct you to the section below “Getting Back to Sleep”. The exception to this is doing a Body Meditation [LINK].

Chronic Pain

In this section we are addressing where you will frequently wake up in pain, which often means you have a chronic pain condition. Ideally you will manage this via a Pain Management Plan which can include medication, movement methods (such as stretching, compression or rubbing), compression, temperature (around 15 degrees C if not painful) and Body Meditation [LINK].

Managing pain is very complicated and is beyond the scope of this article, but it is important to acknowledge that Chronic Pain often results in poor sleep.

Adrenaline aka Nightmares, Night Terrors, Sleep Paralysis and Panic

We can wake up with our heart beating, our breathing ragged and or feelings of doom, worry, or expectation. We may have had a nightmare, where you can remember some horror details of the dream, or experienced a night terror, where you are sure you were running or hiding, but can’t remember why. You may also not have any recall of a night mare or night terror, but you sure have woken up as if you had one.

We may experience sleep paralysis, where your brain hasn’t unlocked your voluntary muscles yet. This is often accompanied by a feeling of doom, or it can feel like something is sitting on your chest or belly. Don’t worry though, despite the feelings of doom. This only lasts for 1 minute of real time, although we can feel like it is lasting for hours. If you frequently struggle with this, put a digital clock in your room around where your eyes can most often see when you wake up, and you’ll notice that by the time the clock has changed twice, you can move again. Another thing you can do is count to 120, using every second heartbeat as your timer. This allows for your heartbeat to be very high from waking unexpectedly and still be approximately 2 minutes.

Sometimes our adrenaline fed wake up causes Restless Leg (or Limb) Syndrome. It can feel like someone is strumming with one of your muscles, where the muscle is getting tighter and tighter and we feel like we just have to move in order to relieve the anticipated or current pain. Once you have started to move the muscle, it oscillates back and forth and can be both uncomfortable and distracting. It is like a twitching muscle cranked up to 11.

If this is an infrequent occurrence for you, then get up out of bed and walk around the house for a bit (when you safely can). Go to the “Getting Back to Sleep” section and follow those steps. Keep in mind that the adrenaline has likely prompted your body to negate the Melatonin, so keep the light level low to prompt your body to make some more. You may need to do some mild stretches to help your muscles relax.

However, if this is a frequent occurrence, then we need to talk about how your body processes Dopaminergic Neurotransmitters.

About 50% of nightmares, night terrors, pre-sleep and wake up rumination/anxiety, and waking up with sleep paralysis is triggered by low levels of Noradrenaline, while around 10-20% are caused by excess levels of Noradrenaline. A simple way to predict which direction is likely is your relationship to caffeine (during the day time). If 40 to 90 mg of caffeine (tea, coffee, soft drink) is something that works well for you, bringing focus, calmed mood and feeling more capable, then you are more likely low in Noradrenaline. If you can’t stand caffeine because it makes you anxious, agitated or angry/aggressive, then you are likely high. This is a guideline only, not a medical test. Not all of these are due to Noradrenaline imbalance, but it is a great place to start.

Restless Leg Syndrome (RLS), other Limb Movement Disorders and waking up with significant brain fog is often due to low Dopamine. Dopamine is a natural hormone in the body and neurotransmitter in the brain which regulate limb movements. Antipsychotic medication blocks Dopamine and can cause movement problems as a side effect. RLS is strongly correlated with low iron reserves, generally measured by Ferritin levels in your blood pathology report. Generally you want your Ferritin to be higher than 50 if you experience RLS. RLS is strongly correlated with ADHD [External LINK].

Ongoing problems in this area should result in your GP referring you to a sleep specialist for management. If you have a history of ADHD, or family members diagnosed with ADHD, you should investigate this in parallel.

Feeling Rested

Sometimes we wake up and we just feel like we have had enough sleep. We don’t feel tired anymore and sleep is a stranger. If this is rare, don’t worry about it. Get up, watch an episode of television or read a chapter of your book and then go back to bed. Before you do go back to bed, try taking some pain relief with half a glass of milk (animal or plant).

If this is frequent for you, then there is likely something more going on. You may be a Split Sleeper, which we covered above. It may be natural for you to be awake for 1.5 to 4 hours in the night due to your unique biology, and if this is the case, adjust your first sleep to factor this mid-sleep awake time in.

You may have woken up because you have run out of Melatonin. This can be helped by taking a supplemental Melatonin pill, and if this helps you get back to sleep, then it is worth looking into what could be disrupting that. We cover this in more detail in Beating Pre-Sleep Anxiety [LINK].

Another common reason you may be done with sleep is that you have not had enough exercise throughout the day. Some people benefit most from morning exercise while others benefit most with afternoon exercise. Try doing some vigorous exercise for 30 minutes for a few days to see if this helps.

Getting Back to Sleep

Still Sleepy – Meditation

In this scenario, you still feel quite sleepy and relaxed. You also do not feel the need to get up and go to the toilet, change the temperature or get a drink.

If you are thirsty and have a bottle of water by your bedside, sit up slightly and take a mouthful of water. Gently swoosh it around your mouth so you can feel it wet your entire mouth. Swallow it down, resettle and try to relax.

Depending on what works best for you, do a meditation / mindfulness exercise. If you are not sure of what works bes for you, here are links to three kinds:

Body Meditation [LINK]
Self Guided Meditation [LINK]
Breathing Waterfall [LINK]

Wide Awake – Milk and Distraction

You have woken up and feel quite awake. Perhaps you need to go to the toilet, and if so, do so, but use your phone light so that things don’t get too bright.

We want to keep the lighting level low so that we promote Melatonin, therefore try to avoid turning on main lights. Instead use your phone light where you can, or dimmer lamps. Remember that bright light prompts your body to metabolise Melatonin and cease production of it, while dim lights prompt your body to produce Melatonin. This is doubly important if you woke up with Adrenaline (night terror, night mare, panic after sleep paralysis).

Go to the kitchen and pour yourself a small glass of milk (animal or plant based, ideally soy if plant; around 150 to 200 mL), and then try to go back to sleep. Milk includes water for thirst, a bit of sugars to boost blood sugar, and important proteins that help your body create neurotransmitters if you are missing those ingredients.

Use a meditation / mindfulness to help get you back in the mood. In the above “Still Sleepy” section are some links to some techniques.

If going back to sleep isn’t working, or you know that you are too awake to make that work, it is time to get back out of bed and become comfortable on the couch. Ideally you are going to spend around 20 to 50 minutes distracting yourself with reading or watching television. This distraction needs to be engaging enough that you won’t have cognitive space to ruminate, but not so engaging that you go into a rabbit hole of learning or get too excited and stay awake.

Ideally you will go back to bed to sleep. This promotes that being in bed is for sleep, while being on the couch is for awake, preparing to go to sleep – especially with low lit lighting. Some people find that the transition from couch to bed wakes them up too much and they are back to the beginning of this section. If you find that happens, then settle down on the couch and sleep there. Don’t allow perfection to become the enemy of good (Voltaire).

If you frequently find yourself sleeping on the couch instead of bed, then take another look at the sensory section above and see what is missing or needs to change. Sometimes the problem is who else is in your bed, and that requires a very different approach.

Prevention: Day activities that promote night sleep

Daily
• Exercise, AM for some is best, PM for some is best, not if CFS
• Diet, Food affects sleep, malnourishment really affects sleep
Caffeine and nicotine management, some need it to sleep, most don’t

Medication

Medication can affect sleep, either stimulating you to being awake, signalling to your brain that it is time to sleep, or directly sedating you.

To understand how these work, it is important to understand neurology and the role of brain chemistry. In short, some biochemicals promote an increase in the sympathetic (alertness) system; some neurotransmitters promote an increase in the parasympathetic (relaxing) system, some act as a marker to indicate that sleeping now is appropriate, some act to mask those indicators, and some override the system and force you to sleep.

Another important concept is that the sympathetic system and parasympathetic system are two distinct systems that influence each other. It is not a see-saw, where as your sympathetic system rises your parasympathetic system falls – you can have both rising trying to compete against each other, or both dropping. Many different brain systems have an influence on one or both of these systems.

Medications can have a direct primary action that either helps or hinders sleep for a period of time, and often these will be prescribed specifically because you have a sleep condition. These same medications can also be used for medical conditions that are not directly related to sleep; for example Diphenhydramine can be used as a sleep aid or as an antihistamine, or both.

Many medications can have a side effect that can affect sleep. If the side effect is mild to moderate, you will likely adjust to that nudge after a few days to weeks, so it is worth while continuing the medication to see if this settles, if you are gaining the positive primary affect the medication was prescribed for. If you don’t get past the mild to moderate effect on sleep by the end of 4 weeks, talk to your your health professional about how the medication is affecting you and whether you should or should not continue.

Sleep exists on a spectrum of best

Natural sleep is best, where managing your environment is enough to get good sleep
Sleep aids or alertness aids are helpful, if you are not managing with environmental changes
- Caffeine can help you feel rested and alert. You will receive a short amount of increased alertness (around 15 to 90 minutes), a moderate amount of reduced fatigue (around 4 hours) and a large time of sleep delay (around 8 hours). As not all bodies are equal, some people need some caffeine to sleep, and if this is your experience, you should check out our ADHD [LINK] playlist.
- Melatonin is a natural marker to help indicate to the brain that it should change states from awake to asleep. It does not well counteract Adrenaline, so if you have some anxiety issues, take a look at Beating Pre-Sleep Anxiety [LINK].
- Milk (animal or plant) helps promote sleep.
Sleep medication is better than not sleeping
- Sedatives come in 3 major classes: antipsychotics, benzodiazepines and opioids. In most cases these will override your system and force sleep.
- Stimulant medications will help you remain awake during the day time, but need to be stopped early enough in the day to help you get to sleep at night time.

Alcohol is almost never helpful. Some people will use alcohol at night to help them to sleep, and if this is you, take a look at Beating Pre-Sleep Anxiety and ADHD. You are using alcohol to block out a problem, and this problem needs to be properly addressed. Alcohol sleep may be better than no sleep, but it comes with costs that are often worse.

Exceptions to the Rules

Neurodivergence
• ADHD
• Autism
• Narcolepsy
• Sleep apnoea, mild may not benefit from a CPAP machine, chronic will but may do better with an operation if available
• Adrenaline dysregulation, often causing mood dysregulation and anxiety and or aggression
• Sleep clinics and studies, sometimes very useful, often miss important information, when you can actually sleep in the artificial situations

All of this is very generic advice for the most commonly occurring problems for most people, whether you are neurotypical, body typical, neurodivergent or body diverse – however humans are very varied and so this general, or sometimes quite specific, advice may not be the right advice for you.

If you find that your situation is more complex than what has been described here, or none of this is working for you, then you will likely need to see a specialist.

If you want specific advice tailored to your specific experience, brain and body, then make an appointment with us. Check out our Contact Page [LINK] for details how.

Nightmares are its own category

Nightmares, night terrors, pre-sleep anxiety, mid-sleep anxiety wake ups, restless leg syndrome and sleep paralysis have been covered over at Beating Pre-Sleep Anxiety [LINK].

Narcolepsy

Narcolepsy is a very different condition, where you can fall asleep randomly in situations where people normally do not fall asleep. While insomnia can be a contributing factor, and if so this article is likely to help some of those parts, it is generally a medical condition that is treated by day time stimulants and night time sleep enhancers (where daytime is defined as when you want to be awake). Coverying Narcolepsy is beyond the scope of this article.