“I got the best sleep of my life in med school,” said no one ever. Between the steady stream of caffeine and the chronic stress of looming deadlines it’s no wonder as to why most students have poor sleep hygiene practices. In fact, sleep deprivation is seemingly synonymous with being a student these days.

So if you struggle with sleep (and two sentences ago was the first time you read the words “sleep hygiene”), I encourage you to do some research on it. Many of the barriers that get in the way of adequate sleep can be counteracted using sleep hygiene practices. Implementing a few small changes can change the quality of your sleep and thus, the quality of your life.

If you’re like many of my students, whose sleep problems stem from anxiety and rumination keeping them up at night, then you may want to try one of the following tips:

1. The ICE Trick For Sleeping. (*Do not use if you have a heart condition; Skip to Skill 2*)

Can’t sleep? Put some ice on your face. Literally. It sounds counterintuitive, but this actually works.

The full skill consists of holding your breath and submerging your face repeatedly in a sink (or bucket) filled with ice and cold water (around 50 degrees temperature). The act of putting the body — in particular the face — in contact with cold water activates what is known as the “dive reflex.”

This reflex is the body’s way of activating the parasympathetic nervous system, which is basically the brakes to the central nervous system. Once activated, the PNS slows one’s heart rate, breathing and blood pressure which decreases one’s overall physiological arousal and consequently those racing thoughts as well. The ice trick is the short term antidote to the effects anxiety and chronic stress have on our bodies.

Don’t want to stick your face in a ice bath? You’re not alone. Here are some modifications to try instead:

• Own one of those bean or buckwheat bags you place in the microwave to put on a sore muscle or back ache? Keep one in the freezer instead. When needed, put one on your face to activate the same response.

• Using frozen peas (or anything frozen, really) is similarly effective. The key is to have the cold packs on your forehead, the skin directly underneath your eyes and the back of your neck, right under your hairline. A lot of times, two packs will be necessary.

• • Still sounds too intense? Another option is to simply hold frozen or very cold objects. I like to keep a couple of pieces of fruit, like an orange or lemon, in my freezer at all times. They’re typically easier to hold and stay cold longer due to their thickness.

2. Paced Breathing to Clear Out the Med School Racket

Another way to activate the PNS and slow your system down is through the practice of paced, or slowed, breathing. There’s a ton of research on how this works and why it’s effective. Long story short, when you breathe in, your heart rate increase, getting your body ready for action. When you exhale, your heart rate slows down, preparing for rest. (Go ahead, try it out!)

The most simplified exercise is to breathe while imagining that your breath is tracing the shape of a rectangle. Breathe in for the duration of the shorter vertical sides and breathe out for the longer length of the horizontal sides. Everyone has a different optimal or target heart rate, but a “ball park” target to shoot for is 6 breaths per minute or 10 seconds per breath. In a rectangle form this would be breathing in for four seconds and breathing out for six seconds.

• • Tried it and seems too long to exhale? Try this: Grab a straw and on your next exhale, blow the air out slowly through the straw. The straw acts a barrier for how much air you can expel at once. You can do this same technique even without a straw, simply purse your lips and imagine you have a straw there. Go ahead — give it a whirl!

• • MyCalmBeat, is a free app that allows you to set your breathing rate and has illustrations demonstrating when to inhale and exhale.

• • Advanced skill: Pair the ice trick together with paced breathing. Shoot for at least 5 minutes of breathing at a slower pace and then use the ice.

3. Get out of bed (and go worry)!

This may sound like another counterintuitive tip, but chances are, if you’re reading this, you haven’t just had one night of racing thoughts getting in the way of sleep; it’s more likely that this happens to you frequently, especially during times of high stress. This is important to note because the more nights you’ve laid in bed ruminating instead of sleeping, the more nights you have laid the foundation for your brain to associate your bed with anxiety. The longer you lay in bed awake and worrying, the worse things are going to get.

The good news is that you can reverse this! The work here becomes breaking the association that bed time = worry time. The antidote is to worry somewhere else: the couch, the floor, the kitchen table, standing up, at your desk… anywhere. Once you get to your designated worry space here’s what to do next:

• Set a timer for 5-10 minutes (max) and get ready, set, worry! That’s right: consciously choose to worry your innermost worries away. Walk into those catastrophes. How would you handle it if you showed up for your presentation and forgot your pants? Or, how would you cope with having a panic attack and not being able to finish? Write the worries and coping plans down, say them out loud, or turn them into a song! Whatever you want. And then, here’s the trick: When that timer goes off, that’s a wrap! Worry time is over.

The Sleep Hygiene Trifecta

The perfect combination of these skills would be to: complete worry time, then practice paced breathing paired with the ice skill. If and when worries come back, you can say to yourself, “Okay, I’ve dealt with these thoughts for tonight. I can come back to them tomorrow.” Then bring yourself back to focusing on your breath.

1. Worry
2. Imagine coping effectively with the catastrophes
3. Practice paced breathing (option to add ice skill)
4. When worries return (they will) remind yourself: I’ve already gone over this, it’s right over there on that note pad, and I will get back to it tomorrow. Not now, thank you very much!
5. Lie down. Return to your paced breathing.

resource: https://www.ncbi.nlm.nih.gov/pubmed/21166537

Meredith Meyer is an LMFT who has extensive training in DBT (dialectical behavior therapy) and CBT (cognitive behavioral therapy). She obtained her Masters in Marriage and Family Therapy from the University of San Diego, and her B.S. in Business Administration with a minor in Psychology from the University of San Francisco. www.meyermft.com