Insomnia ("not sleeping") means difficulty in falling asleep, staying asleep, or sleeping deeply and restfully. There are two types of insomnia, primary (insomnias not ascribed to any external cause) and secondary (insomnias resulting from an illness or substance, or defined as sleep disorders).
It is advisable to determine what's causing your particular insomnia so you can select the most efficient way to address the problem. For example, if you cannot sleep because that's a side effect of medication prescribed for you, changing your sleeping behavior will not help you sleep properly. You'll need to discuss the choice of medication with your doctor.
Insomnia is very common today. According to the National Center on Sleep Disorders Research, about 30-40% of American adults report some kind of insomnia, and insomnias that cause diminished functioning affect 10% of that number. People who lead busy lives tend to treat sleep as an unwelcome interruption, but changing that behavior can often make a great difference in the quality and quantity of sleep.
Methods of Coping With Insomnia
Remove Its Environmental Cause
That sounds like a simple and effective method, but not all events that trigger insomnia can be avoided. A change in habit, including traveling, moving, or starting a new job, can all be happy choices for which you're willing to put up with temporary insomnia. Over-the-counter sleeping pills, taken for a week or two, can help you adjust to altered circumstances while not losing too much sleep.
There is a laundry list of substances that can promote insomnia, so check to see whether anything you're taking could be the culprit. To achieve the most restful sleep possible, you should avoid nicotine, caffeine, alcohol, decongestants, any appetite control medication, or stimulants like cocaine and amphetamines.
Other medications like heart and blood pressure drugs, diuretics, antidepressants, allergy medications, and corticosteroids can also make it difficult to sleep. If you must take any of the above over-the-counter, do so in moderation and try to avoid consumption during the evening hours. If medication is prescribed, ask your doctor whether any substitution is possible.
Treat the Underlying Condition Causing Insomnia
Any mental disruption like ongoing stress or anxiety, or mental disorders like depression, bipolar disorder, and schizophrenia, can prevent normal sleep. You should always seek the help of a therapist if you're experiencing both insomnia and trouble dealing with your moods, because the two problems are very often related. Frequently, resolving an emotional issue will also cure attendant insomnia.
Some medical conditions that cause pain, impaired breathing, or frequent urination cause patients to develop insomnia, and in these cases the best advice is to follow the advice of your physician, making sure he knows you're not sleeping properly.
The Cognitive Behavioral Approach
This common-sense method involves tailoring your thoughts and behaviors to give yourself the best possible chance of getting a good night's sleep. You will learn more about how sleep works and change your sleep habits to focus on easing into sleep at the end of each day. There are a number of ways to modify what you do to bring on sleep and how you think about the sleep process.
- Experts recommend sleep education, a short course of instruction about sleep cycles and how your own attitudes and actions change the way you sleep. That can be followed up with:
- Traditional cognitive behavior therapy directed specifically at sleep. You can learn to control negative thinking related to personal concerns, or even to sleep itself, that has been impairing your ability to sleep easily and well. You will not take your worries to bed with you, but dismiss them before you turn out the light.
- Relaxation therapy involves any form of relaxation exercises, including meditation, lowered lighting, and quiet music or white noise, used in preparation for falling sleep. Self-hypnosis and muscle relaxation techniques are also helpful.
- Practice good sleep hygiene. Do not coerce yourself to sleep and, conversely, do not oversleep. Keep a set schedule of sleeping and waking hours. Take 20 minutes (or more) of exercise every day, but do not exercise near your bedtime.
Shun the substances that can prevent you from sleeping. Eat lightly and sensibly: make sure you are neither hungry nor excessively full, and do not consume too much fluid. Keep your bedroom dark, quiet, and at the most comfortable temperature for you, considering your bedclothes and what you intend to wear.
Do not nap during the day. Do not remain in bed more than a half hour before falling asleep. If you find that happening, you should relocate to another dark and silent room, make yourself comfortable, and practice your relaxation exercises.
- Sleep restriction. The goal here is to avoid lying in bed awake, in order to associate that action entirely with sleeping. If you lie down only when sleepy and get out of bed the moment you awaken, that will help you sleep. Try to use your bed only for the purpose of sleeping, and keep regular hours for doing it.
- Passive wakefulness. When you lie down, surrender any worry about whether or not sleep will come, and make no effort to bring sleep on. That prevents any anxiety provoked by the fear of not sleeping from interfering with the natural onset of sleep.
- Fight stress with technology by using a biofeedback monitor to help you determine whether you're exhibiting physical stress responses. If you can identify times of higher muscle tension or heart rate, for example, you can apply your relaxation techniques on the spot to counteract the effects of stress.
- Study your own sleep by keeping a diary about your sleep preparation, habits, and experiences. Do this at the beginning of your campaign against insomnia, so you'll have the most information about when you go to bed, when you wake, how long it takes sleep to arrive, and preparing for bed. Once you've identified trouble spots, it will be easier to make specific corrections.
When you have consulted a doctor about your insomnia, tried the cognitive behavioral approach, and still have trouble sleeping, then you may wish to consider taking sleeping pills, also called hypnotics. The main function of hypnotics is to let you fall asleep, although some also work to keep you asleep for a while. They are considered the safest class of the drugs that can induce sleep.
Bear in mind that all drugs have side effects. With hypnotics, you may still feel groggy when you wake up. Your memory can be affected, and you may do things under the influence you would not otherwise do, and do not remember. Some hypnotics are addictive, causing some withdrawal symptoms when you try to stop taking them.
For all those reasons, it is advisable to exhaust your other options before taking medication for your insomnia. Hypnotics do not cure insomnia, but merely mask its effects. It is always preferable to follow a doctor's advice when taking any medicine.
Here is a brief review of some of the drugs that may help you fall asleep.
Available Over the Counter (OTC)
- Drugs advertised as sleep aids. Examples of this type of medication include Nytol, Sominex, Unisom and Sleep-Eze. If you intend to take a painkiller before bedtime, you may use a compound preparation like Tylenol PM, but in general it is not recommended if you do not need the painkiller.
Always follow the manufacturer's instructions in using any over-the-counter drug.
- Antihistamines that have sedative properties. Benadryl (active ingredient diphenhydramine) is a good choice.
- Melatonin. This hormone is present in the body in larger amounts during sleeping hours, it is involved in maintaining the body's circadian rhythm, and some people have reported success using low dosages of the OTC variety to treat insomnia.
- Valerian (Valeriana officinalis) has a slight sedative property and very few unpleasant side effects, and it is usually taken in capsules.
- Hops (Humulus lupulus) are frequently found stuffed into herbal sleep pillows, which are quite easy to make.
- Herbal teas (catnip, chamomile, passionflower) help some people relax before bedtime, although they don't have any effect on sleep.
- Kava is fairly effective, but can have a deleterious effect on the liver.
Prescription Sleep Medication
There is an ever-growing list of prescription drugs targeted at insomniacs, and here are some of the currently popular brand names: Lunesta, Ambien, Rozerem, Sonata, Restoril, Halcion, and Silenor. You must work with a doctor in order to use these, and follow his directions to the letter.