SOLVING SLEEPLESS NIGHTS

WRITER: RICHARD BOSSHARDT, M.D.

Insomnia. The word conjures up vivid images in almost every adult. All of us have experienced sleepless nights for one reason or another. Tossing and turning in bed, trying to will a restful sleep that will not come. Staring at the ceiling as the minutes tick by at an excruciating pace, and knowing we will pay the price tomorrow.

WHAT IS INSOMNIA?

Insomnia is when one sleepless night follows another. Everyone has the occasional night of fitful wakefulness. In any given year, up to one third of adults experience a period of lack of restful sleep. Numbers are hard to come by because many episodes are never reported. To classify as true insomnia, one’s lack of restful sleep should last a week or more. Chronic insomnia is when poor quality sleep occurs at least three nights per week for a period of one month.

The impact of insomnia is huge and probably grossly underestimated because the underlying insomnia is not recognized or reported. An estimated 10,000 automobile accidents annually are due to the driver falling asleep at the wheel from fatigue. In addition, there are countless workplace accidents that can be blamed on excessive daytime sleepiness. We know that lack of sleep can impair critical thinking and motor skills. It would not be a stretch to imagine the impact on productivity nationwide to be in the hundreds of millions of dollars.

Causes Of Insomnia

Causes of insomnia are legion and include just about anything: anxiety, stress, poor bedtime habits, unsuitable sleeping environment, irregular work shifts, etc. Exercise is healthy but exercising too close to bedtime can negatively impact sleep. Eating, drinking alcohol, or consuming a caffeinated beverage too close to bedtime can adversely affect sleep. Just about any medical condition that results in discomfort of some sort can impact sleep. The list of medications whose side effects include disturbing sleep is longer than can be shown here.

Home Remedies

You can bet the more treatments there are for a medical condition, the less effective these treatments probably are. If there were one effective treatment, or even just a few, everyone would use them. Home remedies for insomnia range from the classic glass of warm milk before bedtime to taking a few teaspoons of apple cider vinegar. Some people swear by a warm bath. Others claim a handful of walnuts and a glass of tart cherry juice will do the trick. Reading a book, listening to relaxing music, drinking some wine, and the always popular having sex are promoted by some. All of these and many others can work for some of the people some of the time. If your problem is a relatively recent one, there is nothing to be lost by trying some home remedies to see if they work for you.

Medical Treatment

The first step is to see your primary doctor to learn if you have any medical conditions causing your insomnia. The list of possible conditions is also a long one. Check the medications you’re taking to see if they might be the cause. Once your doctor has ruled out obvious, correctable causes, the next step is to try to treat the insomnia itself. The main form of treatment today is called cognitive behavioral therapy, or CBT.

Cognitive Behavioral Therapy

The American Academy of Sleep Medicine recommends CBT as the most effective treatment for insomnia. Seventy-five percent of patients who follow its recommendations are successful in achieving restful sleep. CBT is made up of five parts.

PART 1- SLEEP HYGIENE

EDUCATION: Patients are taught how to make their bedroom a sanctuary for restful sleep. Measures include covering any lights in the room, setting a cool room temperature, and making sure you have a comfortable mattress and pillows. Quit smoking. Avoid consuming alcohol, drinking caffeinated beverages, or eating within two to three hours of bedtime. Don’t watch TV in bed.

PART 2- Learn to recognize and control negative thoughts and anxiety about sleep.

PART 3-RELAXATION

TECHNIQUES: These include meditation, learning how to progressively tense and relax your muscles, and visualization, a technique used by many athletes to mentally picture the outcome they are striving for.

PART 4- Learn to associate your bedroom with sleep, not lack of sleep. Use your bedroom for sleep and sex, not for eating, watching TV, or work. Go to bed only when you are sleepy. Try to go to bed and wake up at a consistent time. Do not stay in bed if you do not fall asleep within 20 to 30 minutes. Get up and go do something relaxing until you feel sleepy. Try to avoid sleeping during the day.

PART 5- SLEEP RESTRICTION:

This one may seem odd when the problem is already a lack of restful sleep. It is a fact that laying in bed for too long without sleeping can actually worsen insomnia. To do this, a baseline time in bed is set for the patient. The time in bed is increased when patients sleep for at least 85 percent of the time they are in bed. It is decreased if they sleep for less than 80 percent. These adjustments continue until the desired amount of restful sleep is achieved.

Drugs

A number of medications are available for insomnia, including sedatives, antihistamines, and antianxiety medications. All can work over the short term but they all become less effective over time and all may have undesirable side effects. Drugs can be used over the short time and to manage a crisis but they should always be supervised by a physician. When drugs are used, they are best used with CBT.

Resources

The following organizations can provide very helpful information on their websites:

• The Society of Behavioral Sleep Medicine (www.behavioral sleep.org)

• The National Sleep Foundation (https://sleepfoundation.org)

• The American Board of Sleep Medicine (www.absm.org)