Dr. L. Matthew Schwartz

by L. Matthew Schwartz, MD, FAAPM&R

Local doctor L. Matthew Schwartz tackles your reader questions about health every two weeks. Please feel free to ask him any question about physical medicine, pain and integrative holistic medicine or wellness. Send questions to askthedoc@chestnuthilllocal.com

Ty S. asks: Why can’t I sleep well?  I exercise regularly and take good care of myself, but I feel exhausted because I just can’t get the rest I need.  What should I do?

Ah, that rested and rejuvenated feeling!  We all seek it like it is the holy grail!  Elusive for many, a regular sleep pattern is of significant importance to a healthy lifestyle.

Not all sleeplessness is from poor sleep hygiene or simple anxiety.  It is wise to consider potential medical causes, and consult with your physician.  Pain, nighttime urination, abdominal upset, leg jerking, apnea (periods of breathlessness), medications (steroids, beta-blockers, calcium channel-blockers, bronchodilators, antidepressants, or mood suppressants) may be contributing to your sleep problem.

The following tactics are helpful:

  • Get to sleep before midnight – the sleep we get before midnight is the most rejuvenating phase of sleep – try to preserve the early temporal window
  • Get out of bed at the same time every day – preferably without an alarm – respecting your natural sleep cycle
  • Learn and perform daily mental and physical relaxation techniques
  • Perform daily aerobic exercises for at least 20 minutes
  • Make sleep and sex the only activities performed in bed. Men: consider bedtime sex; women: consider sex upon arising
  • Make your bedroom 72° and quiet
  • Unwind for one hour before bedtime
  • Have a carbohydrate snack before bedtime
  • Consider using pillows, wedges, foam, splints, a board under the mattress or a soft or hard mattress to improve comfort with sleeping postures and to decrease pressure on painful body regions
  • Raise the head of the bed instead of simply adding pillows under your head if you have sleep apnea

The following behaviors are to be minimized:

  • Napping to catch up on sleep
  • Using nicotine or caffeine (soda, coffee, tea, chocolate) after lunch – and especially avoid them altogether during sleep time. Try to limit these stimulants as much as possible
  • Skipping or over-eating at dinner, or drinking too much fluid after dinner
  • Engaging in mentally or physically stimulating activity for 2 hours before bedtime
  • Using alcohol as a sedative – it actually worsens sleep
  • Self-medicate for more than 2 weeks unless advised by your physician – expect a worsened sleep problem for a few weeks after stopping sleeping medication
  • Stay in bed awake for more than 15 minutes – you should worry, think, read, do paperwork, or use the phone, TV, computer/tablet, or music device outside the bedroom – try to do non-stimulating activity in a dimly lit room
  • Getting in bed unless you’re sleepy or sleeping on the couch
  • Increasing time in bed unless more than 90% of your time is spent asleep. Definitely decrease your time in bed if less than 80% of your time is spent asleep
  • Worrying about sleeplessness – it is not harmful. “Performance anxiety” about sleep is counterproductive.  Uncontrolled stress and “catastrophic thinking” may require psychological counseling

Have your physician consider prescribing: A sleep log; a sleep study (An excellent sleep center is located at Chestnut Hill Hospital); morning phototherapy; biofeedback (regain a sense of control over your body); relaxation techniques (focusing, capacity, and receptivity); and Autogenic Training.

If you know that you will have a sleepless night the night before a big day, make sure to get an excellent night’s sleep the night before that.  This way, even if you do not sleep well the night before your big day, you will be able to rally and maintaining your energy.  Plan on getting at least 7 hours and 20 minutes of sleep as an adult or at least 9-1/2 hours as a teenager per night.  Younger children need more sleep than that.  Getting less than 6 hours of sleep per night over an extended period will increase the risk of depression, anxiety, reduced vocational performance, and illness related to inflammation and lowered immune efficiency.

Being mindful about prioritizing sleep is of significant importance in optimizing wellness.  Opening your mind to these strategies will get you the shuteye you desire.

Dr. Schwartz practices physical, pain and integrative medicine in Wyndmoor. He is board certified in these specialty fields. He trained at Columbia University, the University of Pennsylvania, and Thomas Jefferson University. For more, see MyHealth360.org