Chapter 11: A Good Night’s Sleep: Nature’s Gentle Nurse

When I was growing up in Colorado, a local disc jockey dreamed up a PR stunt to see who could guess how long he could broadcast music without falling asleep. I must have been fascinated by his masochism, because it impressed me as one of the worst possible violations of the laws of nature. He lasted eight days.48

When Shakespeare wrote, “Gentle sleep is nature’s soft nurse,” he invoked the idea that there are few panaceas like a good rest, and restful sleep is the norm of all animals except humans. Even animals that are prey manage to sleep. It is amazing how humankind has manipulated something so natural into something so complicated. Chronic sleep disorders have their roots in poor lifetime sleep habits. The epidemic likely began with the invention of the electric light, which permits us to rearrange our circadian rhythms on a whim. Sleep problems happen to one half of us according to a National Sleep Foundation survey, with a quarter of Americans using sleeping pills at some time during a year. One of the worst forms, chronic sleep maintenance insomnia –  regularly spending long periods awake after initially falling asleep –  is the commonest and hardest to treat of sleep disorders, affecting 10-35% of the population in a given year.49 The situation is getting worse, probably fueled by late night talk shows, cable television, irregular and long work schedules and the Internet. Worse, Americans have simply never been taught how to sleep properly. One-third of us have no set sleep schedule, the toxic ingredient for chronic insomnia.

In a good proportion of people with insomnia, especially if it is of recent onset, an underlying cause can be found. Before undertaking this Vedic approach, you have to rule out a treatable cause for your wakefulness, including other diseases and medications. Consider nervous disorders like anxiety, depression, grief, stress, bipolar disorder and restless legs; GI problems like overeating, reflux or constipation; endocrine problems such as obesity, menopause and an overactive thyroid; frequent urination including the type caused by diuretics; chronic pain such as arthritis, headache and back pain; respiratory problems like sinusitis, allergies, asthma, and obstructive sleep apnea, which can make you wake up hundreds of times a night just when you enter deep sleep. The best test to determine the nature of your sleep disorder is an overnight sleep study. Consider any stimulating agents –  or their withdrawal –  including alcohol, decongestants, Ritalin, weight loss drugs, antidepressants and other “pep pills,” bronchodilators, steroids, thyroid replacement, recreational drugs and sleeping pills which in some people have a paradoxically stimulating effect, and the most common offender of all, caffeine. If you and your doctor fail to identify a treatable cause for your insomnia, the rest of this chapter is for you.

Detaching Your Senses from their Objects

Sleep that knits up the ravell’d sleave of care. The death of each day’s life, sore labour’s bath. William Shakespeare. Macbeth Act II, Scene III

The ancient Sanskrit medical textbooks of Ayurveda state “A man sleeps when, with an exhausted mind, his sensory faculties and organs of action detach from their objects.” This implies that as long as you are using the mind, sleep will not come. Sleep is healing, not only because it permits your body to physically rest, but also because it allows your mind to reorganize and digest your experiences and circumstances to better understand your situation and plan future action. Hence, the phrase, “I’ll sleep on that.”

The Vedic textbooks state further “Sleep brought on by the nature of the night itself is true sleep, called reparative sleep by the wise. Sleep caused by [dullness from foods, drink, medications and activities] is the root of misconduct and should be treated as a disease.” The texts state that sleep caused by imbalances such as heaviness in the body, disease and even fatigue is not true sleep. The ancient physicians understood that the circadian rhythms induced by cycles of light and dark are the synchronizers for our best sleep and that we do our most important sleeping when we are actually rested. Just as an athlete or musician will prefer to perform when well rested, our minds and bodies are best healed by sleep undertaken when we are not exhausted.

Unfortunately, we take the same goal-oriented approach to sleep that we use to attack other aspects of our competitive lives. You think, “I’ve got to get a good night’s sleep so I can do well in my meeting tomorrow.” When you find yourself lying awake thinking about the meeting, you get anxious, further preventing the senses from withdrawing from their objects. Even worse, you start to get angry at things that seem to be preventing you from falling asleep and more anxious because you haven’t fallen asleep yet. It becomes a vicious cycle. People with insomnia may have developed the bad habit of using their bed to watch television, read, or plan their schedule for the next day and lying in bed gradually becomes associated with wakefulness rather than sleep.

Cultivating a New Attitude toward Sleep

Sleep is not something we plan or desire to do. It is the by-product of creating specific circumstances and letting nature do the rest. A proper attitude is that we go to bed to rest and not to sleep. We just lie down innocently without any expectations and whatever our nervous system needs, that is what we will get. This attitude prevents us from being disappointed at how we slept and saves us from worrying.

In this context, Edinger and his group from Duke University found that people who were given cognitive behavioral therapy for treatment of sleep maintenance insomnia, the kind most common in middle-aged and older people,  were able to make long-lasting changes in their bedtime habits that translated into better sleep.50 Treatment group subjects were given a program to change the specific thoughts, behaviors and beliefs that stand between them and a good night’s rest. They were taught to (1) establish a standard wake-up time; (2) get out of bed during extended awakenings; (3) avoid sleep-incompatible behaviors in the bed/bedroom; and (4) eliminate daytime napping. This study essentially tested a critical part of the ancient Vedic approach to sleep disorders. The treatment group had a reduction of 54% in the time spent awake in the middle of the night, compared with groups getting progressive muscular relaxation or sham, placebo counseling. This is one of the most important studies to address sleep disorders because it showed that dramatic improvements in sleep could be achieved by tackling sleep habits themselves, unlike the superficial effect of sleeping pills, which are addicting and do not address the problems underlying your sleep disorder.

Stop Trying to Sleep

Most people can change several factors to improve the quality of their rest at night and to prevent age-related sleep disorders. First, change your attitude toward sleep. Stop using the word “sleep” and substitute the word “rest.” Announce to your spouse, “I’m going to rest now.” Take the attitude that you are simply going to put yourself in a comfortable, quiet, dark place for six to eight hours and let go. Whatever happens, fine. Take the outlook that you are just turning yourself over to God, and whatever She or He plans for you for that night is exactly what you need. Dreams, thoughts, and those moments of silence between waking, dreaming and sleeping are all as important as unconscious, dead-to-the-world sleep. Stop judging how good your “sleep” is tonight and how you “slept” the next morning. Adopt the attitude that as long as you passed your time lying down in a quiet, dark room with your eyes closed, that you are ready for your day. Asking certain yogis, “How did you sleep?” may actually be considered an insult, because sleep is considered a lower state of consciousness, barely worthy of human dignity; These yogis have cultured the ability to remain in a state of restful wakefulness even while their bodies “sleep.” Keep this in mind when you retire, telling yourself you don’t care about sleep, that you’ll be satisfied with whatever nature presents.

Do you have Rhythm?

The ideal time for rest according to just about every tradition of wisdom on the planet (except the modern western one) is from an hour or two after sunset to an hour or two before sunrise, say around 9-10pm to 4-6am. In these six to seven hours, more can be accomplished than from midnight to 9am., and endocrinologists studying the circadian hormonal fluctuations of cortisol and melatonin would agree. When the lights go out, melatonin goes up, cortisol goes down and you sleep. Four am is the onset of the brahmamuhurta, the period of the day when nature is beginning to stir, and the period most conducive to meditation. Take the attitude that you can get up anytime from 3:30am. onwards, but at least get up before the sun.

The long-term health consequences of chronic sleep deprivation include the predictable depression, anxiety, poor problem solving and risk of accidents as well as heart disease and premature death. It is obviously important to learn to sleep again if you have never been properly taught. But you needn’t lose sleep over a little missed sleep. Many people do fine on as little as four to five hours. Some men of great achievement (and admirable longevity) including George Bernard Shaw, Winston Churchill and Charles Darwin slept very little indeed. Thomas Edison, who lived to 84, was famous for staying up for days working in his lab, taking short naps on a cot. In case your mother never taught you, here is an elementary course on how to get your forty winks:

Establish a regular time to rise. Get up at the same time every day, whether or not you think you slept well. Studies have shown that almost everyone functions well the next day, even if they have the perception they have not slept a wink. Make your rising time early –  by at least six am. Then go to bed early enough to get the amount of “rest” you would like. If you want 8 hours, that means 10pm.

You do not need to abandon your old bedtime immediately. Many people with chronic sleep disorders end up retiring at 2am because they are afraid to go to bed and just lie there. They call themselves night owls and have learned that retiring early only creates anxiety and is counter-productive. They may stay up and wait until they know sleep is coming. But two hours later, at 4am, brahmamuhurta for the blue jays, their eyes pop open and they are wide awake, superficially refreshed after 2 hours of sleep. After lying awake for a couple more hours, they need to sleep in to 10am

If this describes you, start moving your arising and retiring time earlier by ten to fifteen minutes per day. In a couple of weeks, you will have painlessly reset your biological clock to a healthier pattern. After all, you are basically on jet lag, a disorder from which we can recover at the rate of about one hour per day. The issue is not just your inner clock, but also a lifetime of lousy habits, including most importantly the habit of staying up doing things and taking in information, usually of little consequence, in compensation for a day that was less than satisfying. You can think of it as sensory bulimia, ingesting perceptions of little nutritive value from a screen or magazine. Call it a day and go to bed with the intention of making tomorrow more fulfilling.

Arise at the same time, but avoid using alarm clocks. Keep your curtains wide open to let the morning sunshine turn off your melatonin. Find someone to rouse you gently, or just set a radio alarm softly to awaken you. After a few weeks, you will be waking up without assistance at your proper time. You can have coffee or tea for breakfast, but don’t take any more the rest of the day. Your late afternoon cup of joe is still in your brain when you want to be retiring that night. Avoid stimulants, including decongestants found in cold remedies, diet pills, Ritalin and alcohol.

If you spend 3 hours awake in the night, do not sleep in. Get up and get going. Above all, do not indulge in daytime sleep to make up for missed time. Stay up, but avoid using caffeine. The next night you will fall asleep more easily and awake less often. It may take some time to culture this habit, but persistence will pay off.

If you find yourself not sleeping for a while, don’t let yourself think, “How will I possibly manage during my important meeting tomorrow?” Instead, just remember, “I miss sleep regularly but I always manage to get through my day just fine.” This logic helps you avoid taking a rescue sleeping pill, a futile measure that has never been shown to have a significant benefit in the long-term management of insomnia. A study published in the fall of 2009 showed that changing poor attitudes regarding sleep, gave better sleep after six months than the same program combined with intermittent use of Ambien in the middle of the night if the subject felt her sleep was going poorly.51  Using sleeping pills, even now and then, appears to sabotage both your resolve and your circadian rhythms.

A Primer on Preparing for Bed

Besides regular lights out and wake up times, eating, exercising and meditation are the three most effective pacemakers. Follow structured routines to use these biological metronomes at the same time every day to entrain your circadian rhythms, as described in the preceding chapter.
• Get plenty of exercise during the day. After a good afternoon workout, you should be ready to collapse for the night by ten pm. Don’t exercise in the evening, though, as it may be stimulating.
• Use the evening hours for light, enjoyable activities with family and friends and not for exercise, work or TV. Laugh, sing, listen to or play soothing music. Avoid murder mysteries.
• Establish a bedtime routine: take a cup of hot milk (with a teaspoon of soaked poppy seeds), perhaps a hot bath or shower. Read a few verses of spiritual texts.
• Avoid sleeping pills, especially the benzodiazapene category that can quickly create dependence and tolerance.
•  Use natural fibers such as cotton for your bed linens and bedclothes.
• Create a quiet environment, or if that is not possible, use earplugs or white noise.
• Avoid associating the bedroom with anything but sleep, including TV, reading or working. The bedroom should be for sleep, sex and nothing else. If you have a TV in your bedroom, move it out. In fact, move out all but the essentials. Removing the physical clutter will keep your mind uncluttered when you spend time there.
• Massage the soles of your feet with warm ghee or oil (sesame or coconut). Perhaps the ancient physicians felt that metal is a good sponge for excess mental static; they recommend massaging the oiled soles with a brass or copper pot, or sponge them with a cool washcloth. • The best single herb for bedtime is gotukola (brahmi),52 either as a tea or as tablets. Avoid many commercial bedtime sleep-inducing teas because they often contain diuretic herbs including spearmint and chamomile. When you finally fall asleep, you may soon be up seeking relief.

What to do in the Wee Hours: Listen to your Body’s Song.

If you find yourself lying awake, avoid giving in to anxiety or anger, or succumbing to the worst mirage of lying awake: “This is boring.” Your nature, after all, is cosmic, and your physiology is a reflection of the nature of the Divine. Allow your mind to innocently experience a part of the divine by interfacing with your body. Practice the exercise of body awareness from Chapter Eight. Let the mind go where it will go. Sometimes the mind will be aware of your breathing, sometimes of your heart, your limbs or your digestion, etc. Enjoy the feeling of your body resting. If you find your mind wandering to anxiety-provoking thoughts, come back to the body.

Establish a yoga space separate from the bedroom for resting during the night when you find that the body is not in a mood to sleep. Adopt the attitude that time spent in this space is just as valuable as time spent in bed. This room should have a faint night-light, a comfortable chair for meditating and listening to music, perhaps a recliner that will allow you to change positions. It could also have a yoga mat where you can go through a set of slow, soothing (vs. invigorating) postures.

If you have been awake in the middle of the night for a prolonged period and feel restless, get up for a brief period. Avoid turning on the light, which stimulates arousal by blocking the sedative melatonin secretion from your pineal gland. Place a few night-lights so you can take a walk around the house. Go to your yoga space and meditate. Or just sit in the chair and go back to your routine of projecting the awareness in the body. You can do the same technique sitting up in bed, and when sleepiness seems to be coming, slide down in bed and continue.

So why did it take so long before another study, this one from Harvard, finally found that behavioral approaches to chronic insomnia –  basically a simplified form of this Vedic approach to good sleep –  was more likely to produce a more normal night’s repose than the prescription drug Ambien, the biggest selling sleeping?53 Sixty-three chronic insomniacs were divided randomly into four groups receiving either Ambien, five behavioral therapy sessions, both Ambien and therapy, or a placebo pill. For eight weeks, they recorded factors such as how long it took to fall asleep and how long they remained awake during the night. After eight weeks, the group getting therapy reduced their sleep onset from 67.9 to 34.1 minutes, while the Ambien subjects only went from 71.5 to 58.7 minutes. The therapy group was better at staying asleep than the group drugged on Ambien: 83.5% of their night in bed was sleeping vs. 67.2% with the hypnotic.

Your great, great grandmother who did not have electric lights and late night TV would call these recommendations common sense. Chronobiologists call them “good sleep hygiene.” If you take the time to have good hygiene by showering, brushing your teeth and wearing clean clothes, take the same care to turn your routine of resting over to nature. It’s your only ticket to get the rest you need without pills.

48 The world record is now eleven days.
49 American Journal of Epidemiology (1997; 146:105-114)
50 Edinger J et al. JAMA 2001; 285: 1856-1864
51 Morin CM et al. Behavioral and pharmacological therapies for late-life insomnia: a randomized controlled trial. JAMA. 2009; 301(19):2005-2015.
52 Infuse a heaping teaspoon in boiling water for five minutes, and drink it, including the dregs. Or take 1-2 grams of gotukola powder or tablets available at most pharmacies or health food stores. See a wider discussion of this herb, including its side-benefits, in Chapter 27.
53 Gregg Jacobs et al, Archives of Internal Medicine, September 27, 2004.