Part of the Army Medicine Performance Triad Series on Activity, Nutrition and Sleep (ANS)

Sleep is one of the three componentswhich make up the Performance Triad. Activity, Nutrition, and Sleep are three key areas that affect cognitive and physical performance in the Army. By improving Soldiers' knowledge, attitudes, and behaviors in these three areas, it is expected that performance and resilience will improve.

"Sleep is crucial for a balanced life. It can be impacted by poor diet, medical problems, negative emotions, troubled relationships, and other life stressors," said Dr. Laura Avila, Clinical Health Psychologist at SAMMC's Pulmonary Clinic. "It is important that we strive for a balanced sleep-wake cycle, aligned with our 24-hour circadian rhythm."

Insomnia is one of the most frequent problems I encounter among patients (and staff!). Whether it is the inability to fall asleep, stay asleep, or wake up ready to go, insomnia is very frustrating.

However, insomnia is also very treatable. Sleep is a very natural, automatic process. The brain left to itself, without any interference, would likely maintain a very balanced and protective sleep-wake cycle. The following tips have been found by sleep experts to be effective in managing insomnia:

Manage your dietary intake
Going to bed too hungry or too full can make it difficult to fall asleep. Also, certain foods and drinks prior to bedtime can interfere with sleep. Foods high in carbohydrates
and sugars cause the stomach to work overtime at night to digest. Spicy or greasy foods can cause stomach problems at night, while salty foods can create excessive thirst. Hunger, heartburn and thirst can cause you to wake up repeatedly during the night.

Manage your environment
Temperature, noise, smells, light, pets, children, digital clocks, uncomfortable pillows/sheets, noisy neighbors, or "snoring" partners all contribute to risk factors for insomnia. Evaluate your environment critically and make plans to change things within your control.

Manage your medical conditions
Remain an active partner with your healthcare provider to manage your medical problems or physical symptoms. Conditions such as fibromyalgia, obstructive sleep apnea, gastroesophogeal reflux disorder, and depression, if unmanaged, can negatively impact good, quality sleep.

Some medications, prescribed or over-the-counter, can inhibit sleep by acting as stimulants in the central nervous system. Other medications, such as diuretics, if taken at bedtime can cause increased awakenings during the night for obvious reasons. It is important to maintain an ongoing
dialogue with your healthcare provider to discuss any concerns you ay have related to your medications. It is not wise to stop a prescribed medication without the consent of your treating provider, as abruptly stopping a medication can actually worsen your sleep problems or
cause other health-related problems.

Manage your lifestyle choices
Regular and moderate physical activity during the day helps regulate your sleep-wake cycle by keeping hormones and neurotransmitters in balance. A balanced mind-body system is important to good sleep. Physical activity also promotes increased energy during the day, which increases the likelihood of sufficient sleepiness during the night. Nicotine and caffeine act as stimulants,
and also cause nighttime awakenings due to withdrawal effects. Alcohol has been found to negatively impact the quality of deep sleep.

Manage your stress and negative emotions
Stress and negative emotions increase the level of arousal in the central nervous system making it difficult for your brain to transition naturally into a sleep state. Cognitive activities such as planning, problemsolving, and stressful conversations should be completed during the day and not prior to bedtime.

Manage your thoughts related to sleep
Never "try" to fall asleep. The cognitive act of trying to sleep is mental work, and mental work increases arousal in the brain, which creates an environment that is not conducive to sleep. Replace your goal of trying to fall asleep with just relaxing (whether you fall asleep or not). Most people realize that once the pressure to fall asleep is gone, sleep problems improve. Relaxation, in and of itself, is very therapeutic to the mind and body. If you happen to fall asleep while relaxing, bonus!

"The ultimate goal is to allow sleep to occur naturally and effortlessly. Good quality sleep, regular physical activity, and a healthy diet are good investments in life, with returns seen in mood, health, and relationships," said Avila.

Ask your primary care manager about information or programs on insomnia and other sleep-related healthcare. Beneficiaries can call the Clinical Health Psychology service at 210-916-1063 to receive information on insomnia programs offered at BAMC.

To access Avila's article on National Sleep Awareness Week, visit Brooke Army Medical Center's Official Blog at: