By Jo M. Solet, MS EdM, PhD, OTR/L
April 6, 2013      

Adequate sleep duration is 7.5-9.5 hours for adults, 10-12 hours for children.

Consistency in schedule, both bedtime and wakeup, supports the natural cycle of circadian rhythms.

Light is alerting. Morning walks offer well-timed light exposure.

Pace and balance activities in order to maintain a consolidated night sleep period, rather than drifting in and out of sleep throughout the day and night.

Sleep diary or phone app can be used to track bedtimes, time in bed, waking after sleep onset. Plan for time to pay off Sleep Debts, including Social Jetlag, when activities leave you under-slept.

Wind down ritual is helpful before sleep: progressive muscle relaxation, breathing, music. A warm bath encourages sleep within 2 hrs and may moderate FM pain.

Exercise is immediately alerting and produces rise in body temperature. Temperature falls off after about 90 minutes. A cool shower hastens the drop. While night sleep is ordinarily enhanced by exercise during the day, this must be balanced against post-exertional malaise.

Appetite and satiation are altered by limited sleep. Deficient sleep is associated with weight gain and increased pain.

Limit bright screen exposure before sleep since blue light blocks melatonin; this includes back-lit e-readers.

Power naps may consolidate memory, improve alertness and empathy. Timing: 20-30 min or 1.5 hrs  (the latter is a full sleep cycle). Prophylactic nap: Late afternoon before night activity. Anticipate and manage sleep inertia: get slowly vertical and obtain bright light exposure.

Caffeine is best avoided after early afternoon. If used “pharmaceutically”— 20-30 minutes to take effect.

Alcohol is initially sedative, decreases sleep duration and efficiency, suppresses REM, and increases waking after sleep onset—especially in women. Next day alertness is reduced. Alcohol intolerance is very common in CFIDS/ME.

Benadryl inhibits slow-wave sleep and REM. It is sedative but not restorative. It has a long half-life, lasting sleep inertia, rapid tolerance and rebound insomnia.

Seek information about sleep effects of over-the-counter or prescription meds.

Self-awareness is needed to recognize signs of Excessive Sleepiness. Ask for help. Seek alternate transportation: DO NOT DRIVE.

 

Setting your sleep environment

Dark: 

• Light blocking shades
• Eye mask, may be designed to hold moisture
• Dim lighting for sleep prep, full darkness during sleep

Quiet: 

• Masking machine, fan or HEPA air cleaner
• Ear-plugs
• Limit-setting in household
• Advocacy with neighbors and community

Safe:

• Anticipate nocturia: To avoid falls clear cords and obstructions from paths leading to room exit & bathroom
• Have dim lighting available to enhance vision
• Watch out for pets!

Cool: 

• Cool room (e.g. 65 degrees) is conducive to sleep
• Select seasonally appropriate bedding and bedclothes

Humid:

• Humidifier may be used to modify dry air, especially in winter

Low Tech:

• No bed texting!
• Computer, smart-phones and TV out of bedroom

Thirst:

• Place non-breakable drinking water source and eye-drops on night table for easy access

Positioning:

• Be aware of possible light-headedness with quick rising
• Consider pillow wedge for head/shoulder elevation, especially related to gastric reflux               
• Pillows under knees may increase back/hip comfort

Partners /Family/Roommates:

• Negotiate sleep schedule differences to insure a quiet environment

Pets: 

• Arrange for pet night independence: bed, water bowl, night food
• Schedule frequent cleaning to eliminate fur and dander