Many experts recommend cognitive behavioral therapy for the treatment of insomnia. CBT corrects the thought patterns and behaviors that can cause or worsen insomnia, with help from a psychologist. But many of the strategies can be done on your own. Here’s how.
Keep a Sleep Log
For seven to 10 days, track the time you get into bed, the approximate time you doze off and the time you wake up. Gathering this information will help you determine how much sleep you need and the best time for you to actually fall asleep. While you may go to bed at 10 p.m., you may not fall asleep until 11 p.m., which suggests that your circadian clock sets a later bedtime than you do.
“Sometimes, our desire for sleep has nothing to do with our own underlying circadian clock,” says Helene Emsellem, MD, director of the Center for Sleep and Wake Disorders in Chevy Chase, Maryland, and author of Snooze or Lose. “Getting in tune with your circadian clock is the first step in understanding your insomnia.
Restrict Your Time In Bed
Once you’ve determined how much sleep you need, work backward to figure out your bedtime. For instance, if you need seven hours of sleep and get up at 7:30 a.m., you shouldn’t hit the hay until 12:30 a.m. When you’re able to fall asleep without long bouts of insomnia, you can go to bed a little earlier. But try to spend most of the time in bed actually sleeping. “Sleep restriction is based on the idea that time spent awake in bed is counterproductive,” says Nancy Foldvary, DO, director of the Sleep Disorders Center at the Cleveland Clinic and author of The Cleveland Clinic Guide to Sleep Disorders.
By limiting your time in bed, your brain learns to associate bed with sleep. The technique is also effective because it creates a mild form of sleep deprivation, especially in the beginning, says Donna Arand, PhD, clinical director of the Kettering Sleep Disorder Center, in Kettering, Ohio.
“The sleep deprivation makes it easier to fall asleep on subsequent nights and also begins to reduce awakenings during the night,” she says. “This forces the sleep time to be consolidated. The body and brain soon learn to reestablish the connection of being in bed with being asleep.”
Get Out of Bed
Lying in bed awake repeatedly teaches you to associate your bed with anxiety, which perpetuates insomnia. To break this association, get out of bed if you’ve been awake for 20 to 30 minutes. Do something monotonous like folding laundry or reading a book. “You want to take your mind off thoughts about not sleeping, but you don't want to do anything that will activate or arouse the body or brain,” Dr. Arand says.
Once you feel sleepy, go back to bed. If you’re awake 20 to 30 minutes later, get up again. Repeat the process until you fall asleep. “This technique works because of the conditioning effect,” Dr. Arand says. “It also reduces the stress and anxiety that occurs when people are lying awake in bed.”
Of course, if you’re getting out of bed every night to spend an hour folding laundry, you may need to reconsider pushing back your bedtime permanently, Dr. Emsellem says. “The idea of getting out of bed is to break the negative train of anxious thought,” she says.
Stay on Schedule
Come Friday night, it’s tempting to hit the hay late and sleep in the next morning. But if you have insomnia, don’t. Getting up and going to bed at the same time every day helps regulate sleep patterns. “If one allows him or herself to wake at different times — most people err by sleeping longer — it will be hard to fall asleep the next night, which creates an opportunity to develop negative thoughts and bad habits,” Dr. Foldvary says. “The cycle perpetuates itself.”
Skip the Siesta
It’s normal to feel tired in the afternoon — that’s when your body experiences the postprandial dip, when your circadian rhythm — the internal clock that dictates when you’re asleep and when you’re awake — naturally hits a slump. Healthy people without sleep problems can sometimes get away with a 30-minute nap — many cultures even build a nap into their routine. And in fact, according to a poll by the Pew Research Center, 34 percent of adults do in fact take a short snooze.
But if you have insomnia, it’s best to avoid napping. “Everyone has a certain number of hours that her body needs to sleep, and sleeping during the day moves some of the nighttime sleep to the day,” Arand says. “This will make it difficult to fall asleep and reduce the time you spend sleeping during the night.”
Exercise might be the farthest thing from your mind when you’re tired. But physical activity can do wonders for insomnia. Studies show that people who exercise spend more time in slow-wave sleep, the deepest stages of sleep.
Exercise works best when it’s done at least three hours before bed, says Lisa Shives, MD, medical director of the Northshore Sleep Medicine, in Evanston, Illinois. “We think that exercise helps by raising the core body temperature and then it’s the subsequent drop in body temperature that encourages drowsiness and sleep,” she says. Rigorous activity in the two to three hours before bed on the other hand, can make it hard to sleep since it elevates body temperature.
Clean Out the Medicine Cabinet
Certain drugs can cause sleeplessness, including antidepressants like fluoxetine (Prozac) and bupropion (Wellbutrin); beta-blockers for high blood pressure such as metoprolol (Lopressor); and bronchodilators such as albuterol (Proventil). If you suspect a drug may be involved in your insomnia, talk to your doctor. You may need a different medication or a change in dosage.
Consider Sleep Drugs
For some insomniacs, sleep medications become necessary. Most people these days are prescribed nonbenzodiazepine hypnotics such as zolpidem (Ambien), zaleplon (Sonata), eszopiclone (Lunesta) and ramelteon (Rozerem). Other sleep drugs approved to treat insomnia include benzodiazepines, such as triazolam (Halcion), lorazepam (Ativan) and flurazepam (Dalmane). Your doctor may also prescribe sedating antidepressants such as trazodone (Desyrel) and amitriptyline (Elavil). Some people also use over-the-counter sleep medications such as diphenhydramine (Benadryl) or supplements such as melatonin.
“If you’re being treated for insomnia, sleep medication might play a role until the methods of cognitive behavioral therapy kick in or stress abates,” says Thomas Morledge, MD, of the Center for Integrative Medicine at the Cleveland Clinic. “People who take sleep medications on a regular basis will be better off in the long run when they can eliminate the medications that they are depending on. These medications can interfere with the sleep cycles,” he says. These sleep drugs are not recommended for long term use for a variety of other reasons as well, including: the drugs may become less effective over time, have possible side effects and don’t treat the cause of insomnia. Some people may also become dependent on the medication.
Create the Right Ambience
For the best sleep, try setting the thermostat between 60 and 68 degrees Fahrenheit, considered the optimum for sleep. Studies have found that most insomniacs have higher-than-normal core body temperatures, which keeps you awake. Cooling the room will cool your body and help bring on sleep.
It’s also important to darken the room, with shades and curtains, to keep out light — or even to use an eye mask. Remove all light-emitting electronics, including TVs and computers. Darkness helps stimulate your body’s production of melatonin, a hormone that promotes sleepiness.
Have a Nightly Ritual
You might think you’re just watching a little TV and brushing your teeth, but your brain knows otherwise — these nightly habits signal that you’re preparing for bed. “The routine becomes an expectation, and your brain will anticipate sleep,” Dr. Emsellem says.
Ideally, your ritual should include relaxing activities like taking a warm shower, listening to soft music or reading a book. Whatever you do, try to do it in dim lighting. Practicing the same ritual every night will train your brain to wind down for sleep, Dr. Emsellem says.
– by Winnie Yu
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