The Family Health Guide

Insomnia: Restoring restful sleep

What is insomnia?

Since there is no "normal" amount of sleep, a diagnosis of insomnia does not depend on the number of hours a person sleeps. Instead, it's defined as an inadequate quantity or quality of sleep that interferes with normal daytime functioning. For some people, insomnia means difficulty in falling asleep, for others it's difficulty in maintaining sleep, and for still others it's early awakening.

Everyone has a rough night or two, and about 30% of adults have occasional or short-term insomnia. Chronic insomnia, though, lasts for more than three weeks. About 10% of American adults experience chronic insomnia, and most need treatment to get relief. You can help your doctor evaluate your problem by keeping a sleep diary, which tracks such things as: number and time of caffeinated beverages during the day, naps during the day, your bedtime the previous night, and number of awakenings during the night.

What causes insomnia?

  • Psychological conditions, including depression, anxiety, stress, and over-stimulation or overload
  • Sleep disorders, including obstructive sleep apnea and restless legs syndrome
  • Medical illnesses, including gastroesophageal reflux, chronic obstructive lung disease and asthma, congestive heart failure, hot flashes, arthritis, and benign prostatic hyperplasia (BPH)
  • Neurological disorders, including Parkinson's disease, strokes, and dementia
  • Stimulants such as caffeine and nicotine
  • Medications, including decongestants, bronchodilators, certain antidepressants, steroids, beta blockers, and diuretics.

Sleep hygiene

Some simple tips can help you get a good night's sleep:

  • Stick to a regular bedtime and rising time.
  • Get lots of daylight, but avoid bright light before bedtime.
  • Use your bed only for sleeping or lovemaking, never for reading or watching TV. If you can't sleep after 15 to 20 minutes, get out of bed and go into another room. Read quietly with a dim light but don't watch TV, since the full-spectrum light emitted by the tube has an arousing effect. When you feel sleepy, get back into bed — but don't delay your scheduled awaking time to compensate for lost sleep.
  • Don't nap during the day unless it's absolutely necessary. Even then, restrict your nap to 15 to 20 minutes in the early afternoon.
  • Get plenty of exercise.
  • Wind down late in the day. Establish a regular bedtime and a relaxing bedtime routine.
  • Eat properly. Avoid caffeine, especially after mid-afternoon. Avoid alcohol after dinnertime; although many people think of it as a sedative, alcohol can actually impair the quality of sleep.
  • Be sure your bed is comfortable and your bedroom is dark and quiet. It should also be well ventilated and kept at a constant, comfortable temperature.
  • Try using a sleep mask, earplugs, or a white noise machine to compensate for problems in your sleeping environment.
  • Above all, don't worry about sleep. Watching the clock never helps. If problems or plans are worrying you, get out of bed and make a list, then return to bed and think of something relaxing and pleasant.

Treating insomnia: Behavioral therapy

If good sleep hygiene doesn't solve your sleeping problems, behavioral therapy may. Here is a quick list of some techniques:

Relaxation training. Learn deep breathing, progressive muscular relaxation, or meditation. Relaxing your mind at bedtime will help you drift off to sleep.

Stimulus control therapy. Go to bed only when you are sleepy. Don't read, watch TV, snack, or listen to music in bed. Get up at the same time every day, no matter how little you've slept. Avoid daytime napping.

Sleep restriction therapy. Reduce your time in bed to the estimated total time you actually sleep in an average night by going to bed later, but don't go below five hours. Make the change by getting into bed later, not getting up earlier. Get up at the same time every day. Maintain the same bedtime every night for a week, and then move it 15 minutes earlier every week until you get a satisfying, refreshing amount of sleep. Then maintain the same schedule every day.

Cognitive therapy. Learn to replace negative thoughts about sleep ("I'll never get to sleep tonight;" "I'll be a wreck tomorrow;" "I'll get sick unless I sleep eight hours a night") with positive thoughts ("If I relax peacefully in bed, my body will take care of itself").

Treating insomnia: Supplements

A number of dietary supplements are heavily promoted to improve sleep. None is subject to FDA standards for purity, safety, or effectiveness. The two most popular supplements are melatonin and valerian. Melatonin is a hormone produced by the brain's pineal gland; in low doses, it may have some benefit for temporary insomnia due to jet leg. Valerian is an herb; there is little evidence that it helps.

Treating insomnia: Medications

Sleeping pills are available over the counter or by prescription. Whether you're treating yourself or using a drug prescribed by your doctor, you should follow several basic guidelines:

  • Use medication only as a backup to behavioral changes.
  • Use the lowest dose that is effective.
  • Try to stop using medication after three to four weeks.
  • Discontinue medication gradually to avoid rebound insomnia.

March 2009 update

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