Sleep

It’s helpful to think of sleep difficulties as a 24-hour problem, not just a nighttime problem. What you do during the day can impact your sleep-wake cycle.

Our brains are hardwired to need sleep. This need is managed by our body clock and our sleep drive system. Our body clock, or circadian rhythm, controls when our body and brain are ready for sleep or wakefulness. This means that when you sleep (nighttime or daytime) matters.

Our sleep drive system balances our sleep and wakeful periods. Your sleep drive starts to build when you wake up. The more you do, the stronger it becomes. You may find it harder to fall asleep on a day you spent resting without enough activity to build your sleep drive.

1. Keep a consistent wake up time and bedtime. A consistent wake up time is most helpful for creating a healthy sleep pattern.
2. Gradually reduce naps if you are taking them.
3. Get regular physical activity. Gradually work towards 30 -60 minutes of aerobic exercise a day.
4. Get exposure to natural light during the day. This helps you maintain your circadian rhythm.
5. Avoid caffeine and sugar 4 - 6 hours before bed.
6. Eliminate alcohol, strenuous exercise or other stimulating activities for at least two hours before bed time.
7. Avoid heavy meals late in the evening.
   
8. Create a relaxing bed-time routine. Do things in a consistent order. Including a warm bath, light stretching, massage, or relaxation exercise may be helpful.

1. Keep your bedroom dark, cool, and comfortable at night.
2. Try to keep your bedroom quiet. Consider using neutral or natural sounds to help block out sounds that might wake you.
3. Use your bed for sleep and intimacy only! Remove yourself from the bedroom for other activities (using the internet, watching TV, reading, playing games, etc.). This will help your brain associate your bed with a place you sleep and not a place where you are alert and active.
4. Don’t watch the clock. Turn any digital clock face away from you.
5. Keep your bedroom clean and tidy.

Detailed list of Sleep Hygiene Strategies from the Ontario Neurotrauma Foundation available for review and printing here [pdf].

You may find it harder to fall asleep after a busy day. Remember, sleep difficulties are a 24-hour problem.

Give yourself at least an hour to wind down after being active during the day. Often called a “buffer zone”, this can make it easier to fall asleep once you go to bed. You may need a longer “buffer zone” after a busy day. Do an activity you find easy and enjoyable.

Consider what activities might work for you. Light reading? Listening to music? Gentle yoga or stretching?

Avoid activities that are very engaging or goal driven, such as projects, exciting movies, chores, or planning.

Limit the time you spend awake in bed. If you are spending long periods of time in bed not sleeping, this can create an association of your bed as a place that it is hard to fall asleep.

If you are lying in bed and it is obvious that you will be unable to fall asleep anytime soon, get out of bedroom and go to a different room (or different spot in the room if it is a one room space). Find a comfortable spot to engage in a quiet, “mindless” type of activity.

There is no “one size fits all” activity that will work for everyone. Consider activities that you find enjoyable and relaxing. Avoid bright lights and activities that make you feel more alert. Return to bed only once you feel sleepy.

If you are chronically sleep deprived, it can take time to gradually normalize your sleep cycle. If sleep is not improving after 4 weeks of using sleep hygiene strategies, talk to your family doctor. Your family doctor can assess for other medical conditions that can impact sleep, and recommend additional treatment. More information on addressing sleep can be found on a patient information sheet from the Ontario Neurotrauma Foundation (ONF) here [pdf].

If you have sleep difficulties at least three nights per week, for over three months, talk to your family doctor or a psychologist to see if you suffer from insomnia. The ONF recommends Cognitive Behavioural Therapy for insomnia (CBTi) as an evidence based treatment for insomnia following a concussion.

If you have been diagnosed with insomnia, ask your family doctor or psychologist if CBTi is right for you. If a healthcare provider with CBTi training is not available, your family doctor may be able to help you implement some components of the CBTi model. The following resources offer a self-help approach to CBTi:

Website:

Kelty's Key [webpage]

Books:

• Goodnight Mind by Colleen E. Carney & Rachel Manber
• The Insomnia Workbook: A Comprehensive Guide to Getting the Sleep you Need by Stephanie Silberman
• Sink Into Sleep: A Step by Step Workbook for Reversing Insomnia by Judith R. Davidson
• Quiet Your Mind and Get to Sleep: Solutions to Insomnia for Those with Depression, Anxiety or Chronic Pain by Colleen E. Carney & Rachel Manber