Insomnia
Insomnia
19 Steps to a Good Night's Sleep
It's been a long day that has left you dead tired, downright bushed. Yet it's happening again. You lie in bed, wide awake in the middle of the night. You hit the hay 3 hours ago, but try as you might, there's no way you can catch the dreamland express.
Your mind is racing a mile a minute, but the alarm clock next to the bed keeps ticking—ticking—ticking, and the minutes pass by like hours. You'd do anything for a good night's sleep—and so would millions of others.
Insomnia ranks right behind the common cold, stomach disorders, and headaches as a reason why people seek a doctor's help. In a Gallup poll of more than 1,000 adults, one-third of them complained that they woke up in the middle of the night and couldn't get back to sleep.
At one time, doctors might have automatically prescribed a pill or two to ease you into the arms of Morpheus, but that isn't always the case today. Researchers and doctors are learning more about sleep each year, and that has broadened their knowledge of how to deal with its related problems.
Indeed, there are quite a few commonsense approaches you can use to try to correct the problem yourself. It may take just one therapy; it may take a combination. In any case, the key to success is discipline. As Michael Stevenson, Ph.D., psychologist and clinical director of the North Valley Sleep Disorders Center in Mission Hills, California, says, "Sleep is a natural physiological phenomenon, but it's also a learned behavior."
MEDICAL ALERT
Some Insomniacs Need Help Serious sleeping troubles sometimes can result in what experts call chronic insomnia, which could have profound underpinnings, such as psychiatric disturbance, breathing problems, or unexplained leg movements during the middle of the night. Experts agree that if you can't easily fall asleep or stay asleep throughout the night for a month or so at a time, it may be time to consult an expert. According to the American Sleep Disorders Association, you should first explain your problems to your personal physician. If your doctor can't offer any advice, have him or her recommend a sleep-disorders specialist. |
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Set a rigid sleep schedule seven days a week. "Sleep is an unavoidable interval in the 24-hour day," says Merrill M. Mitler, Ph.D., director of research for the Division of Chest, Critical Care and Sleep Medicine at the Scripps Clinic and Research Foundation in La Jolla, California. "We insist on people trying to be as regular with their habits as possible."
The key is to get enough sleep so you can make it through your day without drowsiness. To help achieve that goal, try to get to bed at the same time each night so you can set your system's circadian rhythm, the so-called body clock that regulates most internal functions. Just as important is arising at the same time each morning.
Set a sleeping time of, say, 1:00 to 6:00 a.m. If you're sleeping soundly through that 5-hour period, add 15 minutes each week until you get aroused in the middle of the night. Work on getting through that arousal before adding another 15 minutes. You'll know when you reach the point where you've had enough sleep—you'll wake up refreshed, energetic, and ready to take on the day.
If you wake up during the night and can't get back to sleep in 15 minutes, don't fight it, says Dr. Mitler. Stay in bed and listen to the radio until you're drowsy again.
Again, be sure to wake up at the appointed hour in the morning; don't sleep in trying to pick up on "lost" sleep. That goes for the weekends as well. Don't sleep late on Saturday and Sunday mornings. If you do, you may have trouble falling asleep Sunday night, which can leave you feeling washed out on Monday morning.
Don't waste your time in bed. As you grow older, your body needs less sleep. Most newborn babies sleep up to 18 hours a day. By the time they're 10 years old, that usually drops to 9 or 10 hours.
Experts agree that there is no "normal" amount of sleep for an adult. The average is from 7 to 8 hours, but some people operate well on as few as 5 hours, others need up to 10 hours. The key is to become what experts call an efficient sleeper.
Go to bed only when you're sleepy, advises Edward Stepanski, Ph.D., director of the Insomnia Clinic at the Henry Ford Hospital's Sleep Disorders and Research Center in Detroit, Michigan. If you can't fall asleep in 15 minutes or so, get up and do something pleasantly monotonous. Read a magazine article, not a book that may engross you. Knit, watch television, or balance the checkbook. Don't play computer games that can excite you or perform goal-oriented tasks such as the laundry or housework.
When you feel drowsy, go back to bed. If you can't fall asleep, repeat the procedure until you can. But remember: Always wake up at the same time in the morning.
Set aside some "quiet time" before bed. "Some people are so busy that when they lie down to go to sleep, it's the first time all day that they've had the chance to think about what happened that day," says psychiatrist David Neubauer, M.D., of the Johns Hopkins University Sleep Disorders Center at the Francis Scott Key Medical Center in Baltimore, Maryland.
An hour or two before going to bed, sit down for at least 10 minutes or so. Reflect on the day's activities and try to put them into some perspective. Review your stresses and strains, as well as your problems. Try to work out solutions. Plan tomorrow's activities.
This exercise will help clear your mind of the annoyances and problems that might keep you awake once you pull up the covers. With all that out of the way, you'll be able to program your mind with pleasant thoughts and images as you try to drift off to sleep. If, for some reason, cold reality begins to seep into your conscience, shut it out by saying, "Oh, I've already dealt with that and I know what I'm going to do about it."
Don't turn your bed into an office or a den. "If you want to go to bed, you should be prepared to sleep," says Magdi Soliman, Ph.D., a professor of neuropharmacology at Florida A&M University College of Pharmacy. "If there's something else to do, you won't be able to concentrate on sleep."
Don't watch TV, talk on the phone, argue with your spouse, read, eat, or perform mundane tasks in bed. Use your bedroom only for sleep and sex.
The Alternate Route
Light Up Your Life Researchers at the National Institute of Mental Health (NIMH) are using bright lights in the morning to help chronically poor sleepers set their circadian rhythms, or "body clocks," on a more regular pattern. According to Jean R. Joseph-Vanderpool, M.D., a psychiatrist in the NIMH's clinical psychobiology branch, many people suffer from what he calls delayed sleep phase syndrome. In plainer terms, they just can't get started in the morning. That's why when they get up, say around 8:00 a.m., they're being placed in front of high-intensity, full-spectrum fluorescent lights for 2 hours —strong light that resembles what someone would encounter on a summer morning in Washington, D.C. Those lights, in turn, tell the body that it's morning and that it's time to get moving. Then, in the evening, they wear dark glasses so that the body knows it's time to begin to wind down. So far, Dr. Joseph-Vanderpool has gotten good results from his patients, who report more alertness in the morning and better sleep at night after several weeks of the therapy. At home, he says the same effect can be accomplished by walking around the neighborhood, sitting in the sun, or doing some yardwork as soon as you arise. During the winter, it might be worth consulting your doctor about the best type of artificial light to use. |
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Avoid stimulants after twilight. Coffee, colas, and even chocolate contain caffeine, the powerful stimulant that can keep you up, so try not to consume them past 4:00 p.m., says Dr. Mitler. Don't smoke either; nicotine is a stimulant, too.
Say no to the nightcap. Avoid alcohol at dinner and throughout the rest of the evening, suggests Dr. Stevenson. And don't fix a so-called nightcap to relax you before bed. Alcohol does depress the central nervous system, but it also will disrupt your sleep. In a few hours, usually during the middle of the night, its effects will wear off, your body will slide into withdrawal, and you'll wake up.
Question your medication. Certain medications, such as asthma sprays can disrupt sleep. If you take prescription medication routinely, ask your doctor about the side effects. If he suspects the drug could be interfering with your sleep, he may be able to substitute another medication or adjust the time of day you take it.
Examine your work schedule. Research has shown that people who work on "swing" shifts—irregular schedules that frequently alternate from day to night—have problems sleeping, says Mortimer Mamelak, M.D., director of the sleep laboratory at Sunnybrook Hospital, University of Toronto Clinic. The stress of an up-and-down schedule may create jet lag-like tiredness all the time, and sleep mechanisms can break down altogether. The solution: Try to get a steady shift, even if it's at night.
Eat a light snack before bedtime. Bread and fruit will do nicely an hour or two before you hit the hay, says Sonia Ancoli-Israel, Ph.D., a psychologist and associate adjunct professor of psychiatry at the University of California, San Diego, School of Medicine. So will a glass of warm milk. Avoid sugary snacks that can excite your system or heavy meals that can stress your body.
A caution: If you're older, don't drink a lot of fluids before bed; you might wake up later in the night when bathroom duty calls.
Create a comfortable sleep setting. "Insomnia can often be caused by stress," says Dr. Stevenson. "You get into bed and you're nervous and anxious and the nervous system is aroused and that impairs your ability to sleep. Soon, the bedroom becomes associated with sleeplessness, and that triggers a phobic response."
You can help change that by making the bedroom as comfortable a setting as possible. Redecorate with your favorite colors. Soundproof the room and hang dark curtains to keep out the light.
Buy a comfortable bed. It doesn't matter whether it's a coiled-spring mattress, a waterbed, a vibrating bed, or a mat on the floor. If it feels good, use it. Wear loose-fitting sleeping clothes. Make sure the bedroom's temperature is just right—not too hot, not too cold. Be sure there's no clock within view that can distract you throughout the night.
Turn off your mind. Keep yourself from rehashing a stressful day of worries by focusing your thoughts on something peaceful and nonthreatening, says Dr. Stevenson. Play some soft, soothing music as you drift off, or some environmental noise, such as the sound of a waterfall, waves crashing on a beach, or the sound of rain in a jungle. The only rule: Be sure that it's not intrusive and distracting.
Use mechanical aids. Earplugs can help block out unwanted noise, especially if you live on a busy street or near an airport, says Dr. Ancoli-Israel. Eyeshades will screen out unwanted light. An electric blanket can help warm you, especially if you're a person who always seems to be on the brink of a chill.
Learn and practice relaxation techniques. The harder you try to sleep, the greater the chances are that you'll end up gnashing your teeth all night rather than stacking some zs. That's why it is important to relax once you're in bed.
"The one problem with insomnia is that people often concentrate too much on their sleep, and they press too hard," Dr. Stevenson says. "The key to successfully falling asleep is to reduce your focus and avoid working yourself into a frenzy."
Biofeedback exercises, deep breathing, muscle stretches, or yoga may help. Special audiotapes can teach you how to progressively relax your muscles.
It may not come easy at first, but as Dr. Neubauer says, "It's like dieting; you must work on it all the time. It will take time to get results, but if you stick with it, it will pay off."
Here are two techniques doctors have found particularly successful.
- Slow down your breathing and imagine the air moving slowly in and out of your body while you breathe from your diaphragm. Practice this during the day so it's easy to do before you go to bed.
- Program yourself to turn off unpleasant thoughts as they creep into your mind. To do that, think about enjoyable experiences that you've had. Reminisce about good times, fantasize, or play some mental games. Try counting sheep or counting backward from 1,000 by 7s.
Take a hike. Get some exercise late in the afternoon or early in the evening, suggest Dr. Neubauer and Dr. Soliman. It shouldn't be too strenuous—a walk around the block will do just fine. Not only will it fatigue your muscles, but it will raise your body temperature. When that begins to fall, it may help induce sleepiness. Exercise also may help trigger the deep, nourishing sleep that the body craves the most for replenishment.
Try sex before bedtime. For many, it's a pleasurable and mentally and physically relaxing way to let loose before settling down to sleep. Indeed some researchers have found that hormonal mechanisms triggered during sexual activity help enhance sleep.
But again, it depends on the person, according to James K. Walsh, Ph.D., a clinical polysomnographer who runs the Sleep Disorders Center at Deaconess Hospital in St. Louis, Missouri.
"If sex causes anxiety and creates problems, it's not such a good idea," he says. "But if you find it enjoyable, it can do a lot for you."
Take a warm bath. One theory held by sleep experts has it that normal body temperatures play off the body's circadian rhythm. Those temperatures are low during sleep and at their highest point during the day.
Along those lines, it's thought that the body begins to get drowsy as its temperature drops. Therefore, a warm bath taken about 4 or 5 hours before bedtime will raise that temperature. Then, as it begins to fall, you'll feel more tired, which will make it easier to fall asleep.
PANEL OF ADVISERS
Sonia Ancoli-Israel, Ph.D., is a psychologist and an associate adjunct professor in the Department of Psychiatry at the University of California, San Diego, School of Medicine.
Jean R. Joseph-Vanderpool, M.D., is a psychiatrist in the clinical psychobiology branch at the National Institute of Mental Health in Bethesda, Maryland.
Mortimer Mamelak, M.D., is director of the sleep laboratory at the Sunnybrook Hospital, University of Toronto Clinic. He is also the author of the booklet Insomnia.
Merrill M. Mitler, Ph.D., is the director of research for the Division of Chest, Critical Care and Sleep Medicine at the Scripps Clinic and Research Foundation in La Jolla, California. He is also clinical professor of psychiatry at the University of California, San Diego.
David Neubauer, M.D., is a general psychiatrist in the Johns Hopkins University Department of Psychiatry in Baltimore, Maryland. He's also associated with the Johns Hopkins University Sleep Disorders Center at the Francis Scott Key Medical Center in Baltimore.
Magdi Soliman, Ph.D., is a professor of neuropharmacology at Florida A&M University College of Pharmacy in Tallahassee, Florida.
Edward Stepanski, Ph.D., is the director of the Insomnia Clinic at Henry Ford Hospital's Sleep Disorders and Research Center in Detroit, Michigan.
Michael Stevenson, Ph.D., is a psychologist and clinical director of the North Valley Sleep Disorders Center in Mission Hills, California.
James K. Walsh, Ph.D., is a clinical polysomnographer accredited by the American Sleep Disorders Association. He is also director of the Sleep Disorders Center at Deaconess Hospital in St. Louis, Missouri.
