If you’ve got your ceiling memorized from lying awake staring at it night after night, if you’ve got a spare tire you just can’t get rid of, you wake up and can’t get back to sleep, you wake up already exhausted, or if you need a nap by noon (or coffee, or chocolate, or…) then this article is for you!

The Importance of Sleep

Most of us need seven to eight hours of sleep each night for optimal daytime functioning, but at least 50 percent of Americans struggle with sleep problems- and these problems tend to get worse as we get older.

As a physician, I am no stranger to sleep problems. Medical residency was a life filled with chronic caffeine stimulation, an endless to-do list, long hours in front of a computer screen, stress and late work hours with little (or no) sleep. During those years, even when I had time to sleep, I couldn’t. I felt miserable and was all too familiar with the effects of poor sleep on my performance, memory and mood-which was really scary as I was handling life-and-death matters at work. After medical training ended, it took me a few months of concerted effort to regain normal sleep…but I was able to, and here are tips you can us to get your sleep back on track, too.

When Your Sleep is Miserable, So is Everything Else…

Poor quality sleep is no joke. Not only is the nighttime miserable, daytime can be, too. When we’re tired we’re more irritable, depressed, our hormones are a wreck, we can’t lose weight, we can’t concentrate, our digestion is a mess, we get more zits, we get sick more often, make mistakes at our jobs…. We even get into more accidents. Seriously. And who hasn’t bitched (ok, tellin’ it like it is, here!) at someone they love or a co-worker out of sheer fatigue? (When I was in medical residency? Ooh…guilty as charged!).

Oh right, and then there’s the old DOUBLE WHAMMY: Laying there awake (yup, memorizing the ceiling), worrying about how lack of sleep is going to wreck your day tomorrow – and BAM – that makes it even harder to fall asleep!

As if all of this wasn’t bad enough, the really bad news is that poor sleep increases your risk of diabetes, high blood pressure, and heart attack! In fact, if you’re having trouble shedding pounds, fixing your sleep may be all you need to do!

But there’s good news! (Would I ever just bum you out? Of course not!!!)

I can tell you from 30 years of clinical experience – there are solutions!

Prioritize Your Relationship With Sleep

To win back your sleep, you have to invite it back into your bed! Woo sleep like s/he’s the love of your life and you’ve been on a break-up! I’m serious, ladies. Dote on your sleep habits every day. And not just at bedtime.

Good sleep is a lifestyle habit. You have to make it a priority, not just at bedtime, but in the hours before bed. It may take a month or so before you see consistent results if your sleep problem is pretty bad, but it will be well worth it: Better sleep makes us happier, healthier and more relaxed in every way. And the evidence is really there that when you are happier and more relaxed, you are better for everyone and at everything you do. The following seven steps, practiced daily, will eventually help you sleep like a dream.

Regular outdoor exercise can help improve our ability to fall asleep.

The following 7 steps, practiced daily, will, over time, help you to sleep like a dream. In fact, one patient, who had not slept in years, just recently told me she is once again “sleepin’ like a baby” – and her whole life has been transformed as a result! It may take a few months for your body to adjust, so hang in there and keep at it! With persistence and loving attention, you and sleep can get back into a great relationship.

7 Steps to Great Zzz’s

1. Turn Your Lights Down Low

While some lucky girls can fall asleep with a jackhammer going outside their bedroom window (actually, it’s mostly the men that can do this, eh?), the rest of us need a somewhat quieter ambiance. Unfortunately, if you have sleep problems, you may have begun to equate your bedroom with a place of misery rather than rest.

Here’s how to create a sleep-promoting environment.

  • Make your bedroom your sanctuary – your place of peace and respite.
  • Use your bed for sleep (and sex) only.
  • Keep your bedroom temperature comfortable or even slightly on the cooler side.
  • Make your bedroom an electronics-free zone: no TV, computers, or other electronics in there – ever. (Small apartment? Get a room divider to separate your sleep and desk area.)
  • Reduce ambient noise and light; a flax eye pillow or an eye mask and earplugs can work wonders!
  • Paint and decorate your bedroom in restful colors (apparently purple and grey are very bad choices, blue is the best, and neutrals and yellows pretty good).
  • Make sure you have a comfortable mattress, pillows, and bedding.

If you’re having trouble falling asleep, don’t lay in bed tossing and turning. That will only make you hate your bedroom! Get up and read something relaxing on your sofa until you’re ready to try sleep again.

2. Get A Head Start

Good sleep starts long before you hit the pillow. In fact, your daytime and evening habits can have a major impact on your ability to get to sleep at night. Start planning for a good night’s sleep hours before bed by:

  • Avoiding caffeinated beverages after lunch (if you’re super sensitive, this includes green tea – and chocolate, too)
  • Avoiding alcohol, especially near bedtime
  • Avoiding smoking or other nicotine intake, especially during the evening
  • Avoiding daytime naps
  • Exercising regularly for at least 20 minutes daily, but preferably more than four hours prior to bedtime
  • Eating no later than three hours before bed and avoid foods that cause acid reflux (heartburn) if you suffer from it

And don’t go to bed until you are sleepy.

3. Power Down

Many of us live “tired and wired” – we’re dragging all day and then can’t sleep at night. Being “plugged in” to computers, email, and Iphones all day and evening exposes us to electromagnetic waves that potentially interfere with sleep, and also keeps us plugged into our endless “to-do’s” that prevent us from ever turning it all off and getting rest.

This same tired and wired phenomenon puts stress on our adrenal glands, the hormones that pump out stress hormones, leading to some of the medical problems associated with insomnia.

If you are going to improve your sleep, this means powering down for a designated couple of stress-free hours before bed. Relaxation skills practiced once you get into bed can increase your chances of getting to sleep – and having it be restful. Audio materials to support meditation and guided visualization are available for free on the Internet and on downloadable IPhone apps (listening to these is the one exception to the ‘no electronics in the bedroom’ rule).

Additionally, there are a number of yoga sequences that can help you unwind your body and your mind prior to bed. YogaGlo, a fantastic website with a wealth of recorded yoga classes with well-known teachers, offers a selection of yoga classes to help you relax. Do a class an hour before bed, then take an aromatherapy bath to help you decompress before you sleep.

4. Gotta’ Have Rhythm

Human beings evolved with natural day and night cycles – also called circadian rhythms. These rhythms control the hormones, for example, melatonin, which influence our sleep-wake cycles. Getting up at the same time each morning, followed by physical activity with exposure to outdoor light (e.g., a walk outside) or even just sitting next to a window with the shades and curtains open, may be beneficial, even on a cloudy day. If you have severe insomnia, using a light box for 30-40 minutes upon waking each morning might help. A completely dark environment is recommended at night for sleep. Benefits usually take 2-3 weeks to become apparent and the practice may need to be maintained indefinitely.

5.  Do Your Worrying BEFORE Bed

I have my patients start a pro-sleep journal –  any blank notebook will do. One hour before bed they write out all of their worries and concerns, including their to-do list for the next day. Doing this allows you go to sleep with a clearer head. Oh, and did I say vent in there, too? Never go to sleep angry. Even if you do sleep you’ll have rough dreams. After you’ve done your writing, read something inspirational for a few minutes. I highly recommend Tara Bennet Goleman’s Mind Whispering as a start. My patients tell me this whole practice works wonders. [Just don’t do it in your bedroom!]

6. Soak It Up

A hot aromatherapy bath before bed can relax your mind and your muscles. Add 1 cup of Epsom salts and 5-7 drops of pure lavender essential oil to your tub of hot water. SOAK away your day’s troubles. Lavender promotes relaxation and sleep. This can be done nightly just prior to going to bed and is safe for pregnant and nursing mothers, too.

7. Herbs and Supplements

sleep herbs

Herbs are my first go-to medicines. Botanical – or herbal – medicines are gentle, non-addictive alternatives to sleep medications. I use them, along with several nutritional supplements to help my patients sleep and they LOVE the results! You can combine any  (or all) of these safely and the herbal extracts can be put right into your chamomile tea!

As a rule I recommend not combining herbs and medications without the supervision of a physician skilled in the use of botanicals.

Lavela (lavender oil)

Fast becoming my favorite product for sleep and anxiety, Lavela is a proprietary lavender oil product so look for this brand. (I have no conflict of interest). It’s super easy to take – one pill about an hour before bedtime. It’s also helpful if you suffer with anxiety that keeps you awake, performance anxiety, or test anxiety. I’ve even had several patients come off of long-term benzodiazepines (you have to work with your doctor to taper off of these medications!).

Chamomile

Peter Rabbit’s mama knew just what to give Peter to help him sleep! Chamomile tea can be sipped throughout the evening in the hours before sleep – up to 2 cups of a strong brewed tea (use 2 teabags per cup or 2 TBS of loose herb) and steep for 10 minutes with a lid on the cup. Just remember to pee before bed or you’ll be waking up from a sound sleep! Alternatively, you can use the tincture, 40 drops 1 hour and again 30 minutes prior to sleep.

Passionflower

This herb has been used traditionally to promote sleep, and some evidence shows that it can actually improve sleep quality – thus it can help you stay asleep and feel more rested when you wake. It is also useful in the treatment of anxiety disorders. A typical dose is 40-60 drops of the tincture (or 320 mg in a capsule) up to 3 times daily. It can be taken an hour before sleep and again right before sleep at this dose. Limited data suggests safety in pregnancy but I would avoid it during the first trimester and not use for extended periods of time during pregnancy.

California poppy

California poppy is widely used by herbalists for its sedative effects. It is quite strong and should not be taken during the day or before driving. It is also a gentle analgesic and muscle relaxant. A typical dose is 20-30 drops before bed.

Hops

With a long traditional history as a sleep herb, this mildly estrogenic herb is a common beer ingredient and is wonderful for promoting deep sleep. I recommend the tincture (alcohol extract) to be taken in doses of 30 drops, 1 hour and again 30 minutes before going to sleep. It’s too strong for daytime use, should not be combined with alcohol, and should not be used if you suffer from moderate to severe depression or have a history of estrogen receptor positive breast cancer.

Ashwagandha

An herb with roots in Ayurvedic medicine, this herb is specific for the “tired and wired,” and as such not only helps sleep in the short run, but helps relieve “adrenal fatigue” and burnout when taken for at least 3-6 months or longer. It improves cognitive function, immunity, and stress resilience as well. The dose is 1 to 6 grams daily of the whole herb in capsule or tea form. The tea is prepared by boiling ashwagandha roots in water for 15 minutes and then cooling, or adding 1 tsp. of the powder to hot water or warm whole milk and steeping for 10 minutes before drinking. The usual dose is 3 cups daily. Tincture dose is 40-60 drops 3 times daily. There is no known safety data in pregnancy; I recommend it as safe during breastfeeding.

Melatonin

While not effective for everyone, individuals with sleep latency syndrome and those with melatonin deficiency may get moderate improvement from taking 1-3 mg in the hour before bed. Menopausal hot flashers may also get some relief and sleep from this remedy. This dose is considered safe for a duration of up to several months at a time. Not recommended during pregnancy.

5-HTP

5-Hydroxytryptophan (5-HTP), a product of the amino acid tryptophan, is converted into serotonin in the brain. Serotonin helps to initiate calm and sleep and reduces nighttime awakenings. A typical dose is 100-300 mg three times daily. Not recommended during pregnancy.

Calcium and Magnesium

A combination calcium (800 mg) and magnesium supplement (400 mg), or magnesium alone if you are avoiding calcium supplementation due to cardiac disease, can promote relaxation and sleep. They can also help if restless leg syndrome or muscle cramps interfere with your sleep, and can be helpful during pregnancy.

Relaxing Sleep Tonic by Herb Pharm, and Sleep and Relax Tea by Gaia Herbs are two reliable over-the-counter products you can find in most stores. Muscle Cramp/Tension formula by Pure Encapsulations is another excellent formula that combines the recommended herbs along with calcium and magnesium. 

When to See Your Doctor

If sleep troubles persist after 3 months of trying these tips, or if you have other medical symptoms, please talk with your primary physician who can evaluate you for sleep disorders, sleep apnea, and medical problems that can interfere with sleep, for example, depression and fibromyalgia. There are a number of medications that can be used to treat insomnia, however, many are addictive or have significant side effects, and so trying a natural approach first, if there are no associated medical problems, is a healthy choice. Sleep apnea must be treated with appropriate medical care in addition to the options above.

Sleep well,

AJR-Sig

 

60 Comments

  1. Aviva, thanks for this great list. I’m curious about why you don’t recommend Valerian as a sleep-inducing herb; I find it helpful. Also, what is your view on the recent discussions about lavender being estrogenic?

    My thanks for your wonderful blogs!

    • Hi Chara
      Some folks do really well with valerian; about 15% or more actually get stimulated by it – so it can be great but it’s not as reliable in my clinical experience as some others. Also trying to not overwhelm folks with too much info in one article so kept it to a limited number of herbs. But yeah, valerian is a terrific sleep herb for many folks. Best Aviva

    • I would love to hear your thoughts on the recent trend in herbalism to call lavender (and tea tree) estrogenic herbs. In my house they’re especially commonly used in their essential-oil forms.

      • hi erin
        all essential oils have some potential for interacting with estrogen receptors. that’s just a simple fact.
        however, the concerns over this being “clinically significant” or potentially harmful arose from a new england journal of medicine article on 3 adolescent boys who developed breast enlargement allegedly from external use of lavender oil containing body products. i co-authored a rebuttal to that article, which nejm published — refuting the quality of the reports and showing that the enlarged breasts in the boys could have simply been normal for their age (this does normally happen to tween and teen boys) or their weight — overweight boys also produce more estrogen (–> “man-boobs”). I am cautious with the use of internal essential oils, but i do not set limits on their topical use because of the estrogen concerns. That said, I don’t recommend slathering them on or taking a full bath in them every day. 🙂 Hope this helps!

    • As a clinical herbalist myself, Valerian has poor results in both research and in my practice.
      To be fair, it is calming to many, but for people with any kind of “heat” symptoms or who run warm they usually get stimulated by it (that 15% that Dr. Romm is speaking of), and I’ve seen weird reactions in people with thyroid disorders. I would only use Valerian for sleep in people without these indications, and never on its own (would combine with hops or passionflower in general).

      Best use I’ve seen for Valerian are people with IBS or people who get GI problems when they are stressed or anxious.

      • Hi Zachary,

        This is Megan from Dr. Aviva’s team. You bring up a great point and this is where it is really important to tune into the body and listen and to help our clients and patients understand how to do so. Thanks for sharing!

        Megan- Dr. Aviva Romm Nutritionist

  2. Would any of the herbs and supplements be more appropriate for children? My 10 year old, who is on medication for ADHD, has a terrible time falling asleep, even if he takes his medication early in the morning. He says his mind races.

    • Hi Ami,
      Many supplements are appropriate for kiddos. More care has to be taken when a child is also on medication. Working with a local integrative doc or licensed naturopath can be helpful. Also, check out my old book ADHD Alternatives, written with my husband who is a former high school principal. It has a whole section on herbs. Warmly. Aviva

  3. I have a tea made from equal parts of lime flowers and passiflora and find this helps me sleep well. California poppy helps on those evenings following or prior to a stressful day. Interestingly the doctors tablets never helped, I seem to be immune to the effects of them.

  4. I find that if I stay active (workout 4-6 times a week) that I sleep so much better. Also feeding yourself the right foods (clean and whole foods) during the day will nourish your body and not leave you feeling too hungry or yucky come bedtime.

  5. When you say NO electronics does that mean fans as well? We are in So. Cal and the ONLY way to keep the room cool is with fans or an air conditioner. If you mean those too, how can we go about cooling the room down with out those?

    • No- fans are cool (ha ha) – I mean the kind with electromagnetic radiation and blue lights (I phones, computers, etc).

  6. I love all of these suggestions and tips. I painted my room pale blue and it did wonders when I was really suffering from insomnia. These days, as a tired breastfeeding mama, “Legs Up The Wall” pose before bed for 20 minutes really does the trick, as well as letting myself get sleepy when putting my 4 year old to bed and going to bed right after, rather that waking myself back up to pick up the house, or check my email.

  7. Many people use their cellphone as their alarm clock these days. Make sure to put it in airplane mode when you have to this, do so it will not keep searching for a signal. Those EMFs on the nightstand. by your head…seems like a really bad idea. As a midwife for many years, I have noticed the increase in anxiety disorders in women and wondered if it could be exacerbated by exposure to all the electronics in our lives. “Amping us up” so to speak

  8. I find it is most helpful to sleep when I remove all devices (phones, ipad etc) from my bedroom and just “unplug” mentally and physically. I tell myself ” it is time to sleep” When my mind tries to keep active despite tired eyes, I drink some of my awesome sleepy time tea that has been steeped overnight, and this helps calm everything. Sleep then surely follows a cup of this liquid sedative. :~)

  9. Does anyone have any experience switching from synthetic/polyester type bedding to wool? I am thinking of investing in a toxin/chemical free wool mattress pad, comforter, and pillows along with organic cotton sheets…. they claim to help regulate body temperature during the night (which is something both my husband and I struggle with sometimes, we have already addressed consistency, winding down, exercise, and eating… which has all helped immensely)… but this stuff is expensive! And I don’t know anyone who has made the switch… is it worth it??

    • Little late reply but yes, definitely worth it. Wool is the best when choosing a duvet. Wear only natural material pj’s as well such as cotton, silk etc. Pure linen for bedding is also exceptional. Definitely no synthetics for sleeping, they do not allow your body to breathe like natural materials do,.

  10. Hi,
    Thank you for your wonderful blogs.

    I find that in relation to sleep Ayurveda brings a lot to the table. Since 6 pm to 10 pm tends to be more kaphic in nature and 11 pm to 2 am more pitta, I recommend to my clients that the try to be in bed (after a good sleep routine: warm bath, warm tea, calming bedroom, no electronic devices 1 hour before bed etc.) by 11 pm. If they stay up past then, they enter the more fire-y time of the night and can end up staying up a lot later, but “burn themselves” out. I also point out that it gives their immune system less time to repair (by sleeping during the “pitta” time). In addition, I always recommend some simple restorative yoga, such as legs up the wall or some simple pranayama, such as the 3-part breath to calm the body.
    Also, I disagree about the 20 minute nap. If I am particularly worn, I can not put myself to sleep. I probably only take a nap, once every other month, but when I do, it is restorative to my central nervous system.
    Be Well…

  11. Love this! Im super careful about sleep quality as a tired mama. I’ve forwarded this to my hubby as a support to my claims to “no computers in bed-drink your chamomile-go to bed before 11″… Thanks for all your wonderful tips and help thru your blog!

  12. I’m wondering about these tinctures, where you recommend a certain number of drops. How do you take these drops? Put them into a beverage, or just into a cup or onto a spoon?

    • In 1/4 cup of warm water for an individual dose.
      Or my personal fave to make sure I follow thru with my own recommendations — 🙂 –I put my daily (or half daily) dose into my full life factory water bottle and sip throughout the day.

  13. Hi Aviva,
    How do you feel about L-tryptophan? I am struggling immensely with insomnia – can’t fall asleep and more importantly, can’t stay asleep.. I am now doing Holy Basil tea, magnesium and ashwaganda in the eve.. I also have a Best Rest Pure Encapsulation supplement that I sometimes take and are now trying the tryptophan but see everyone recommends the 5-htp first.
    Would love your input on why and what you think..
    Thank you,
    Kim

  14. So what happens when the issue isn’t falling asleep, but staying asleep? I fall asleep just fine most of the time but often wake spontaneously during the night and have trouble going back to sleep. I’ve tried magnesium, time-release melatonin, and 5-htp with no real improvement.

  15. The suggestions are wonderful – only they don’t seem to address another underlying sleep problem: I can fall asleep immediately upon hitting the pillow. The problem is within 3-5 hours I wake up like I’ve been asleep for eight hours – only to find it’s the middle of the night (usually between 2 and 4 am). This has been going on for over 5 years. Each time I visit a doctor the standard prescription of sleeping pills or benzodiazepines seem to be their drugs of choice. I have asked about hormone imbalance, (had blood testing) and done the bioidentical hormone replacement. Most recently after going well over 6 months with little to no sleep I revisited the doctor only to have Ambien prescribed. It is the time-released pill and it doesn’t work either. Do you have any suggestions where I might turn to begin searching for the ROOT of the problem. I had an addiction to prescription pain-killers years ago and am wondering if this might have caused neurotransmitter issues – but unsure even where to begin looking. Thank you for any thoughts, or assistance you may provide me. All the best to you.

  16. I’m severely sleep deprived, but it is mostly due to many years of babies and toddlers who don’t sleep. Any recommendations for getting little ones to sleep so mama can be well rested? I’ve tried everything from cry it out, to co sleeping and everything in between. My 18 mos old will happily go to slope in his crib without crying, but wakes an hour or two later and frequently thereafter. You would think by child number five I would have it figured out, but I’m starting to think it is just genetic. By age 2 1/2 they all sleep really hard and long at night, but by then I’m usually nearly due with another baby.

  17. Thank you for the wonderful blog! What do you know about turmeric as a sleep aid (on of many of its other actions)? A friend from India grew up with the tradition of drinking a turmeric tea before bed.

    • hi robin!
      i don’t know about it as a direct sleep aid, but there’s some nice data on it for depression and the theory is that it’s calming down “brain-flammation.” of course, there’s the gut -brain connection, too, and it has wonderful gut anti-inflammatory action, so putting that all together i’d say, at least theoretically, makes sense that it might help…. and no harm, for sure! ~aviva

  18. Dear Aviva,
    I liked this article. I will forward it to the young and busy ladies in my family.
    It is not easy to go to sleep early. After everyone went to bed, the house is quiet, I really enjoy the late hours for reading, learning, writing…Even if I sleep less (and wake up tired), I still can’t give up the magic of my night time…However…it is worth keep trying…
    Thank You ,
    Frederica

  19. I am a midwife and take 10-11, 24 hour call shifts a month, sometime 3 day stretches on the weekends. I get called in maybe 50-60% of the time and resist always sleeping at the hospital when I am on call ( I miss my own bed and my husband) although I know it makes sense so I don’t have to wake up and drive 12 mile in the middle of the night. sometimes my best sleep is 1 hr stretches over the night. Do you have suggestions for such such a life as mine so I do not feel groggy when I awake but can fall asleep quick to catch cat naps easily????? I know it may not be possible. You can bet I include lots of swimming and yoga in my off time, lots of time outside and I enjoy healthy food with lots of fruit and veggies and proteins…..

    • Hi Judith,

      This is Megan from Dr. Aviva’s team. Dr. Romm likes both Herb Pharm and Gaia Herbs Tincture. I hope this helps!

      Megan- Dr. Aviva Romm Nutritionist

  20. I generally only sleep 4 to 5 hours at night, waking up to go to the bathroom and then not being able to go back to sleep. I’ve wondered if my problem has to do with menopause and depleted hormones. I won’t take hormone replacement but wonder if there is a more natural way.

    • absolutely can be. lemon balm, hops, and valerian all have great effectiveness for menopausal sleep problems. avoid hops with a history of estrogen + cancers. hope this helps!

  21. I was talking to someone about taking Lavella. She mentioned since I was already complaining of very heavy periods that could make my bleeding worse. Is that true?

    • Not likely. While all essential oils have some very mild estrogenic properties, this is a VERY low dose. Keep in mind, green leafy veggies and legumes also have those same properties!

  22. This is perfect timing as I am searching for ways to help my 7 yr old fall asleep at night. You mention melatonin… What are your thought on safety for kids? I read some controversial articles stating is is a hormone and long term effects on children is unknown. Thanks for your tips!

    • The medical literature suggests a high degree of safety, and in fact, its best use might be for kids with ADHD where it has been shown to be very effective.

  23. In your new book, you list “I wake at 3 to 4 o’clock in the morning” on a questionnaire or exhaustion. What does that indicate to you? Possible low blood sugar?

  24. Hi Aviva,
    I wake every morning between 3-4 am with adrenaline rush.. my cortisol is low in morning, and from what I have read is that it is low at night causing the adrenaline rush to happen due to the low cortisol.. I have been taking licorice at dinner time to try and help boost my cortisol so I can get a good nights sleep. With having adrenal fatigue the #1 thing they say is that sleep heals the body but it is sooo frustrating when I cant get the sleep my body needs to heal 🙁 What are your thoughts on this?
    Thank you

  25. I’m working on mindfulness but have developed fear when going to sleep, it’s become an association. I don’t have time to meditate like I should be doing because i have an 18 month old and a 3 year old and I work part time! The adaptogens and lavendar pill are amazing and have helped me really get through this time in my life. Would you say getting to my root cause of sleep issues has to do with the stress in my life? If so, how should I deal with it or remedy it without needing to depend on adaptogens? Like i said, I don’t have enough time for meditation and i know that would be the best!
    Thanks for all that you do!

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