As a psychiatrist with an integrative focus, Ellen believes mental well-being is powerfully influenced by sleep, exercise, thought patterns, relationships, nutrition, spirituality and creative outlets. She incorporates a variety of modalities into her psychiatry practice, including acupuncture, yoga philosophy, breathing, and relaxation techniques in conjunction with conventional treatments such as cognitive-behavioral therapy, psychotherapy, and psycho-pharmacology. Ellen believes mental health is fundamental to primary care and treats a range of health issues, from panic disorders to bipolar illness and ADHD to fibromyalgia. After graduating from Yale University, Ellen earned her MD at Columbia University and stayed on to complete an internship at Columbia University Medical Center. She began her postgraduate training at Saint Vincent's Catholic Medical Center and completed her residency in psychiatry at Mount Sinai Hospital. She is a member of the American Psychiatric Association and the American Academy of Medical Acupuncture, and is a board-certified psychiatrist, licensed medical acupuncturist, and certified yoga instructor.
You toss and turn, trying to fall asleep, watching the minutes tick toward morning on your bedside clock. Does this scenario sound familiar? Do yourself a favor: Hide the clock. Constantly checking the time only increases your stress, making it harder to turn down the dial on your nervous system and fall asleep. “If you stare at the clock, it increases your stress and worry about not falling asleep,” says Meltzer.
Sedative-hypnotic medications (benzodiazepines and non-benzodiazepines) can cause severe allergic reaction, facial swelling, memory lapses, hallucinations, suicidal thoughts or actions, and complex sleep-related behaviors like sleep-walking, sleep-driving (driving while not fully awake, with no memory of the event) and sleep-eating (eating in the middle of the night with no recollection, often resulting in weight-gain). If you experience any unusual sleep-related behavior, consult your doctor immediately.
The following steps are organized to provide you guidance and support in your efforts to sleep better. It can be implemented over the course of a month, with different tasks assigned to each of the 30 days. Major changes are spaced out in the schedule to allow prior tasks the time needed to take effect. Most of the first week, for example, focuses on improving your sleep environment after the recommendation to fix your waking time is in place—but some of the groundwork laid through self-reflection this week will provide a foundation later on. Similarly, as is later recommended, creating a relaxing buffer zone and going to bed when you feel sleepy will take some effort, while simultaneously rearranging the use of substances may come easier.
When you first start, you’ll be desperate to just take in another breath, or you’ll want to speed up your counting, but if you stick to the numbers (or at least try to), and don’t take any breaks (in other words, consecutively repeat the 4-7-8 without resuming regular breathing), you can literally feel your heart rate slow down, your mind get quieter, and your whole body physically relax. It washes over you like a calming, relaxing drug. I can never remember getting past the first set of 4-7-8.

According to the National Center for Complementary and Integrative Health, research has shown that mindfulness-based stress reduction, and other relaxation techniques, such as music-assisted relaxation, can be beneficial. Cognitive behavioral therapy (or CBT) has also been shown to help — a study published in November 2017 in the journal Sleep that followed more than 500 women with insomnia found that CBT was significantly more effective than other treatments, including drugs or even yoga.
If your circadian rhythm is off, it negatively impacts your sleep quality. So having that consistent rhythm of going to bed and getting up at the same time will actually make your sleep more regenerative at night. Going for a walk outside and getting that sunlight in the morning is the best thing to do to wake up. Your circadian rhythm isn’t a fixed thing: It’s actually shiftable based on your environmental cues.

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.
Any general advice posted on our blog, website, or app is for informational purposes only and is not intended to replace or substitute for any medical or other advice. The One Medical Group entities and 1Life Healthcare, Inc. make no representations or warranties and expressly disclaim any and all liability concerning any treatment, action by, or effect on any person following the general information offered or provided within or through the blog, website, or app. If you have specific concerns or a situation arises in which you require medical advice, you should consult with an appropriately trained and qualified medical services provider.
Studies have shown that higher magnesium levels can help induce a deeper sleep, and as I noted, this is especially true when taken together with calcium for better absorption. Research from the Biochemistry and Neurophysiology Unit at the University of Geneva’s Department of Psychiatry indicate that higher levels of magnesium actually helped provide better, more consistent sleep since magnesium is a calming nutrient. In addition to the goat’s milk kefir, foods like spinach, pumpkin seeds and even dark chocolate can help since they’re loaded with magnesium. (5)
Clusters of sleep-promoting neurons in many parts of the brain become more active as we get ready for bed.  Nerve-signaling chemicals called neurotransmitters can “switch off” or dampen the activity of cells that signal arousal or relaxation.  GABA is associated with sleep, muscle relaxation, and sedation.  Norepinephrine and orexin (also called hypocretin) keep some parts of the brain active while we are awake.  Other neurotransmitters that shape sleep and wakefulness include acetylcholine, histamine, adrenaline, cortisol, and serotonin.
The latter portion of this plan is meant to tidy up some of the loose ends, including conditions that can undermine sleep. If the early changes haven't proven to be effective or relevant, it may be because other issues are at play. Ultimately, if your efforts aren't rewarded in the end, it may be useful to speak with a sleep doctor who can provide you the personal assistance you need to overcome any remaining problems. This advice is generally good for all, but carefully crafting it to attend to your individual needs may make it invaluable.
Chamomile tea. Simple, delicious, and effective. Chamomile tea has been used as a relaxation aid for centuries, but it’s more than just a folk remedy. One review found that the stuff acts as a mild sedative, helping to calm the nerves, reduce anxiety, and ease insomnia. And don’t be afraid to make a strong brew. Some experts recommend using two or three tea bags to get the full, sleep-promoting effect.
Sedative-hypnotic medications (benzodiazepines and non-benzodiazepines) can cause severe allergic reaction, facial swelling, memory lapses, hallucinations, suicidal thoughts or actions, and complex sleep-related behaviors like sleep-walking, sleep-driving (driving while not fully awake, with no memory of the event) and sleep-eating (eating in the middle of the night with no recollection, often resulting in weight-gain). If you experience any unusual sleep-related behavior, consult your doctor immediately.
A very common cause of difficulty sleeping relates to stress and the intrusion of stimulating substances and activities. You may have trouble falling asleep the night before a big test or presentation. In periods of emotional stress, such as after the death of a loved one, you may also have trouble sleeping. This is called acute insomnia. It usually passes when these stressors resolve. Similarly, stimulants such as caffeine and even nicotine can disrupt your sleep.
The amount of sleep that a healthy individual needs is largely determined by two factors: genetics and age. Genetics plays a role in both the amount of sleep a person needs, as well as his or her preference for waking up early (these are the so-called "larks," or morning-type individuals) or staying up late (these are the "owls," or evening-type people). Our internal biological clock, which regulates the cycling of many functions including the sleep/wake cycle, can vary slightly from individual to individual. Although our internal clock is set to approximately 24 hours, if your clock runs faster than 24 hours, you tend to be a "lark" and wake up early; if your clock runs more slowly, you tend to be an "owl" and go to bed later.
How melatonin helps sleep: Melatonin can shorten the time it takes to fall asleep and increase overall sleep amounts, according to research. It’s been shown to improve quality of sleep and reduce daytime sleepiness and fatigue. Studies also show melatonin may increase REM sleep. It’s during REM sleep that we consolidate and process memory, and prime the regions of the brain associated with learning.
Chamomile tea. Simple, delicious, and effective. Chamomile tea has been used as a relaxation aid for centuries, but it’s more than just a folk remedy. One review found that the stuff acts as a mild sedative, helping to calm the nerves, reduce anxiety, and ease insomnia. And don’t be afraid to make a strong brew. Some experts recommend using two or three tea bags to get the full, sleep-promoting effect.
When it comes to feeling tired of feeling so tired, I'm certainly not alone. Insomnia is incredibly common in the U.S., with 30 to 40 percent of American adults experiencing some symptoms of insomnia each year. [Etiology of adult insomnia]. Dollander M. L'Encephale, 2003, Mar.;28(6 Pt 1):0013-7006. So for anyone out there who has developed an expertise in fruitlessly counting sheep, we've rounded up a few strategies for finally catching those long-lost Z's when you can't sleep. And if you’re reading this at 3 a.m. because your mind won’t stop racing, don’t worry; we have tips for what you can do right now to improve the chances of getting (at least some) sleep.
Unless you’re in pain, your sleep aid doesn’t need to include painkillers. Products like Advil PM, which combine antihistamines with painkillers like ibuprofen or acetaminophen, have name recognition. But Dr. Gary Zammit, the executive director of the Sleep Disorders Institute, suggested following this rule when it comes to medications: Treat the problem that you have.
A study published in Complementary Therapies in Clinical Practice was conducted with cancer patients, a common group that has serious issues with sleeping well, to better understand whether aromatherapy using essential oils could help provide some much-needed healing shut-eye. Aromasticks were given to patients over a 13-week period. Of the participants, 94 percent reported using the aromasticks with 92 percent reporting that they would continue use. Bergamot oil and lavender oil, in addition to sandalwood, frankincense and mandarin, were combined to create the useful sleep-inducing blend. (7)
In other words, daylight helps your body’s natural clock—which is dictated by the 24-hour cycle of day and night—know when to feel awake and when to feel tired. When your hypothalamus—the gland responsible for regulating sleep and energy levels—senses a change in light, it tells your body to ramp up or ramp down its production of the sleep hormone melatonin. During the day, you feel energized and alert because you don’t produce much melatonin. At night, you produce more, so you feel sleepy.
Dr. Goldstein warned, however, that the sleep you get from an antihistamine isn’t going to be as restorative as unmedicated sleep. “It’s like alcohol,” she told us. “You’ll get sleep, but you’re not going to wake up with mounds of energy.” Dr. Zammit explains, “When you take a sedating antihistamine, REM sleep may be suppressed at the beginning of the night. But then it rebounds at the end of the night, and this can lead to vivid, intense, and sometimes disturbing dreams.”

Mindful breathing practices have been a part of yoga and Eastern wellness modalities for centuries but aren’t as popular in Western culture. The most well-known champion of the 4-7-8 breathing technique in the U.S., who is somewhat responsible for the prevalence that the technique does have amongst integrative medicine practitioners, yogis, and those in search of stress reduction and overall relaxation, is Harvard-educated Andrew Weil, MD.
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