Insommnia

WHEN TO SEE YOUR DOCTOR

* You've been having a problem falling asleep almost nightly for more than a few weeks.

* You dread going to bed because you're anxious over your ability to fall asleep.

* You're dead tired during the day and can't concentrate or function adequately.

* You're relying on alcohol or drugs to fall asleep.

What Your Symptom Is Telling You

Everyone suffers through an occasional sleepless night. Lying wide awake night after night is another matter. Insomnia is almost always a sign of another problem—either a medical condition or an emotional tumult.

Chronically painful conditions such as arthritis can keep the sandman from your door, as can something as fleeting as an itchy bout of poison ivy. A fight with your spouse can leave you punching the pillow all night, while trouble at work turns into tussling with the covers.

Also, a change in your regular routine can alter your natural biological rhythm enough to cause a problem. Going on dayturn from the night shift can get in the way of a good night's sleep, for example, as can jet lag following a coast-to-coast flight.

Insomnia often starts with a few wide-eyed nights caused by, say, an injury or a minor emotional disturbance, according to Edward Stepanski, Ph.D., a clinical psychologist and director of the insomnia clinic at the Sleep Disorders and Research Center at Henry Ford Hospital in Detroit. Those few sleepless nights create habits that can lead to a long-term problem—you take a nap during the day or a nip at night. You watch TV in bed or raid the fridge at 2:00 a.m. Before you know it, you're doing these things on a regular basis and you've developed what's known as behavioral insomnia.

"All of the things most people do to supposedly improve their sleep will actually worsen it," says Dr. Stepanski. "The original problem goes away, but the insomnia remains. They've developed terrible sleep habits that wouldn't allow anyone to sleep, plus now they're watching the clock and they're very fearful as bedtime approaches." By then, the natural rhythms of the chronic insomniac are so out of whack it's like they're doing the watusi while the band plays that old country waltz.

Symptom Relief

If you slept well before, you will sleep again, experts say. But don't expect miracles from a one-night experiment with good sleep habits. "Your sleep probably took a long time to get as bad as it is," Dr. Stepanski says. "It will gradually get better. It isn't going to happen instantly the very first night."

Can't sleep? Then don't go to bed. "If there's one recommendation I would make for insomnia, it's to delay bedtime by an hour, maybe two hours," Dr. Stepanski says. One of the worst practices people follow is to go to bed when they're not really tired. "They don't even feel sleepy, but they think it's time they should go to bed," he says. And few events can tighten the tension like lying in the dark, listening to the bathroom faucet drip and wondering why you can't sleep.

Once you snuggle under the covers, if you don't fall asleep within 20 minutes, get up, leave the bedroom and muddle through something mundane. "Don't sweat it. Go ahead and watch the late show and ride it out," Dr. Stepanski advises.

Practice good sleep habits. Sleep experts like to rattle off a list of what they call sleep hygiene tips: Don't use the bedroom for anything but sleep or sex; get up at the same time every morning regardless of when you retire; don't take naps; exercise in the late afternoon or early evening; don't go to bed hungry. Most people trying to banish insomnia go down the list, trying each item for a day or two, then discarding it and returning to the old habit.

"They end up concluding that none of these things works, but you really have to try them all simultaneously and give them a chance," Dr. Stepanski says. "Instant sleep won't come the very first night you skip an evening cup of coffee or go to bed at 1:00 a.m. rather than midnight."

Warm up with water. A hot bath, whirlpool or Jacuzzi before retiring can relax muscles and warm you up for a sound sleep, says Suzan Jaffe, Ph.D., clinical director of the Sleep Program at Hollywood Medical Center in Florida.

Relax to the max. Gentle, quiet talk or a muscle-kneading massage can soothe the tension beast that scares off the sandman. So can yoga or relaxation training.

See the light. Bright light therapy can help you reset your natural sleep rhythm, especially if jet lag or time-shifting at work has induced the insomnia, Dr. Stepanski says. Try taking a half-hour walk in the early-morning sun. "It sends a message to the body to activate for the day," he says, "and you'll be more prepared to sleep at night."

Don't raid the fridge; don't light a butt. If you wake up in the middle of the night, never smoke a cigarette or go to the kitchen for something to eat. "I can take the best sleepers in the world and wake them up five nights in a row for a sandwich or a cigarette," says Dr. Stepanski. "On the sixth night and thereafter, they'll wake up on their own. Both should be absolutely forbidden in between bedtime and waking time."

Drugs are tough pills to swallow. Sleep physicians are extremely reluctant to prescribe sedatives, Dr. Jaffe says, except in the event of an obvious trauma, such as the death of a spouse, and even then only for a very temporary period. Improper withdrawal from sleeping pills can cause the insomnia the prescription was designed to treat, she says.

What about the occasional use of over-the-counter sleeping pills? "Don't routinely take them," Dr. Jaffe advises. "We don't know the long-term effects of them. But they're absolutely not benign. They contain ingredients that can cause addiction."