Almost everyone has occasional trouble sleeping. Stress, anxiety, something we ate, jet lag or any number of other things might keep us tossing and turning restlessly once in a while. But for 60 million Americans, sleepless nights are a regular occurrence, as are the daytime sleepiness, irritability, impaired job performance, accidents and health risks that follow. In a survey conducted by the Centers for Disease Control and Prevention, 35% of adults reported getting less than 7 hours of sleep in a typical 24-hour period, 38% reported unintentionally falling asleep during the day at least once in the previous month, and almost 5% reported nodding off or falling asleep while driving at least once in the preceding month. “Insomnia affects both mental and physical well-being,” says psychologist Dr. Larisa Wainer of Morris Psychological Group. “Sleep is as important to our health as good nutrition and regular exercise. Not getting enough sleep is detrimental to daytime functioning – to our mood, energy, concentration and reaction time.”
What is insomnia?
Insomnia is the most common sleep disorder. It is characterized by difficulty falling asleep, frequent waking and difficulty getting back to sleep, waking too early, or not feeling rested on waking. Insomnia may be short-term (acute) – lasting from one night to several weeks – or it may be long-term (chronic). It is generally considered chronic if symptoms occur for three nights a week for a period of three months or longer. Insomnia is more common in women, possibly because of hormonal fluctuations, and in people over sixty, when changes in health, medications and activity levels play a role.
Insomnia may be associated with a wide range of underlying medical and psychological conditions, including anxiety and depression. Anxiety about being unable to fall sleep often makes it more difficult to fall asleep. Some medications also interfere with sleep, including antidepressants, heart and blood pressure medications, allergy medications and over-the-counter medications that contain stimulants. “When insomnia isn’t caused by medication or an underlying health condition, we encourage people to seek help for a chronic problem before it takes a serious toll on their health and daily functioning,” says Dr. Wainer. “Prescription sleeping pills can be helpful for a short period but generally aren’t advisable for the long term. A better approach is treatment that provides a long-term solution by changing the behaviors that make insomnia worse and instilling new behaviors that enable restful sleep.”
Do’s and don’ts of healthy sleep habits: Lifestyle changes and adjustments to bedtime routines can make a big difference for insomnia sufferers.
• Come up with and stick to a sleep schedule. Go to bed and wake up at around the same time each day, ideally including weekends.
• Establish a bedtime routine, allowing at least 30 minutes to wind down before going to bed. Do something relaxing, like reading or listening to quiet music.
• Keep your room cool, dark and quiet. Adjust the thermostat and bedding appropriately, use black out curtains, and block out distracting noise with a fan or a white noise machine.
• Exercise regularly (though not right before bedtime).
• Spend at least 30 minutes in natural sunlight within the first two hours of waking when possible. When this is not possible, try to at least spend 30 minutes per day in strong artificial light.
• If you struggle to fall asleep because you find yourself thinking and worrying, take a few minutes to jot down the items that are on your mind. Then shift your attention to relaxing your body and mind so that you can get the rest that you need to tackle your to-do/worry list when you wake up!
• Caffeine (coffee, tea, chocolate, certain sodas), nicotine and alcohol interfere with sleep. Reduce consumption of these substances, especially in the latter part of the day.
• Do not eat a heavy meal or drink a lot of liquid close to bedtime. If you do need a light snack, foods such as milk, peanut butter, bananas, and cheese contain chemicals that facilitate sleepiness.
• Remaining in bed when struggling to fall asleep for a prolonged period of time can worsen your sleep problems. If you are having trouble falling asleep for a period of 20 minutes or more, get up, do something relaxing, and only return to bed when you are tired enough to try falling asleep again.
• Try to avoid naps. If you do nap, the shorter, the better. Keep the length to 10 or 20 minutes when possible, staying under 30 minutes at most. Do not nap in the latter part of the day – you don’t want to interfere with bedtime!
• Watching the alarm clock contributes to sleep anxiety, which actually wakes you up! Avoid checking the clock.
• Try to minimize use of a computer, tablet or smart phone right before going to bed. The light from the screen wakes the brain, which then makes it hard to fall asleep. Dimming the brightness to a minimum and avoiding the blue light color hue is helpful.
Cognitive behavioral therapy has proven effective in reducing insomnia. It is a short-term therapeutic approach that focuses on changing the thoughts and beliefs that drive behavior. With cognitive behavioral therapy the therapist and patient work together to identify and then reduce or control the negative thoughts and anxieties that inhibit sleep.
Relaxation techniques such as breathing exercises, meditation and guided imagery have a calming effect that is conducive to falling sleep. Progressive muscle relaxation, a technique of systematically tensing and releasing different muscles, is also an effective route to relaxation.
“It’s normal to have occasional trouble sleeping,” Dr. Wainer concludes. “But it isn’t normal to regularly struggle to get to sleep or stay asleep. And it isn’t normal to wake up feeling exhausted or for lack of sleep to affect daytime functioning. Fortunately, you don’t have to live with insomnia. Addressing any underlying cause and improving sleep habits can restore a restful night’s sleep for most people.”