Insomnia

---

Insomnia

Toss and Turn No More

When everyone else in the house is asleep, do you find yourself taking a sheep census? Or watching I Love Lucy reruns? Or folding laundry to wear yourself out?

If you're like most people with insomnia, you'll do just about anything to get a few good Zzzs.

One-third of all adults can't sleep at one time or another. And as women get older, they're especially prone to insomnia. Once you turn 40, you are 40 percent more likely to experience some degree of insomnia, thanks to the midlife hormonal changes that precede menopause. During and after menopause, a common cause of insomnia is nights sweats, or hot flashes that occur during sleep. (For practical ways to manage night sweats, see page 292.)

CAN'T SLEEP? READ THIS

For most women occasional insomnia isn't much of a problem. But a wakeful night can leave you less than perky for the day at hand.

When To See A Doctor "If you've tried everything and still can't sleep, then it's time to see your doctor," says Rochelle Goldberg, M.D., assistant professor of medicine and neurology and cardiopulmonary director of the Sleep Disorders Center at the Medical College of Pennsylvania Hospital in Philadelphia. "She may refer you to a sleep disorders clinic for further evaluation."

Here's what women physicians advise for those who crave some shut-eye.

Turn the clock to the wall. "Staring at the clock makes you more tense about getting back to sleep," says Rochelle Goldberg, M.D., assistant professor of medicine and neurology and cardiopulmonary director of the Sleep Disorders Center at the Medical College of Pennsylvania Hospital in Philadelphia. "Instead of checking the time, concentrate on restful thoughts."

Dial into your comfort zone. "Make sure that your bedroom isn't too hot or cold," says Naomi Kramer, M.D., associate director of the Sleep Disorders Center at Rhode Island Hospital and assistant professor in pulmonary medicine at Brown University, both in Providence. Many people sleep best in a cool room, so turn down the thermostat when you turn out the lights.

Get out of bed. "If you haven't gone to sleep after 20 minutes, you could try to head for another room and do something dull," says Margaret L. Moline, Ph.D., director of the New York Hospital-Cornell Medical Center Sleep-Wake Disorders Center in White Plains, New York. If you distract your brain with something boring and stop fretting over your wakefulness, you'll nod off.

AND TOMORROW . . .

To prevent future episodes of sleeplessness, follow this advice.

Take a morning walk outside. "Light exposure during the day helps keep your body clock regulated," says Mary A. Carskadon, Ph.D., professor of psychiatry and human behavior at Brown University School of Medicine and head of the sleep research lab at E. P. Bradley Hospital, both in Providence, Rhode Island. "An early morning walk in the daylight upon rising will help promote sleep at night."

Set a daytime worry hour. "Set a concrete time for worrying during the day," says Dr. Goldberg. "Be very focused about it: List each worry in writing with a plan for handling each one. When a worry wakes you, tell yourself that you have it covered and go back to sleep."

Resist the urge to nap. Napping during the day after a sleepless night will only throw your body clock off balance, says Dr. Goldberg. "You want to consolidate your sleep and get enough of it," says Dr. Goldberg.

Set a bedtime. "Adults need a regular bedtime, just like children," says Dr. Carskadon. "We have body clocks that synchronize our systems. Establish a set sleep and wake time, then stick to it every day. That tells your clock to make you sleepy at night and wakeful in the morning."

Wind down before you get into bed. "Giving yourself about 45 minutes of 'quiet time' before you get into bed signals your body clock that the day is done and sleep time is imminent," says Dr. Goldberg. "Listen to soft music, write a letter, read something boring--but do nothing that jazzes you up (and nothing work-related)."

De-stress your bedroom. "You probably don't sleep in your office. Conversely, you shouldn't work in your bedroom," says Dr. Goldberg. "Your bedroom is for two things only: sleeping and sex. So remove your computer, your office reading pile, your fax machine and even your phone, if you can. And put your TV back in the living room where it belongs."

Lose the booze. "If you need a good night's sleep, don't have a nightcap," says Dr. Kramer. "Though you may feel relaxed at first, the alcohol will disrupt your sleep later. Avoid drinking anything alcoholic within two hours of bedtime." And of course, avoiding caffeine is smart, too.

Forget the smokes. "There's solid evidence that smoking disrupts sleep," says Dr. Carskadon. Nicotine is a stimulant. It raises blood pressure, gets your heart going faster and makes your brain more active.