Situational or episodic insomnia may not require treatment since episodes typically last only a few days or weeks at a time. For example, if insomnia is due to a temporary change in schedule, as with jet lag, the person's biological clock will often get back to normal on its own. However, for some people who experience daytime sleepiness and impaired performance as a result of episodic insomnia, the use of short-acting sleeping pills may improve sleep and next-day alertness. As with all drugs, there are potential side effects. The use of over-the-counter sleep medicines is not usually recommended for the treatment of insomnia.
Treatment for diagnosed chronic insomnia includes identifying and stopping (or reducing) behaviors that may worsen the condition, possibly using sleeping pills (although the long-term use of sleeping pills for chronic insomnia is controversial and should be a last resort), and trying behavioral techniques to improve sleep, such as relaxation therapy, sleep restriction therapy, and reconditioning.
There are specific and effective techniques that can reduce or eliminate anxiety and body tension. As a result, the person's mind is able to stop racing, the muscles can relax and restful sleep can occur. It usually takes practice to learn these techniques and to achieve effective relaxation.
Some people suffering from insomnia spend too much time in bed unsuccessfully trying to sleep. They may benefit from a sleep restriction program that at first allows only a few hours of sleep during the night and gradually increases the time until the person achieves a normal night's sleep.
Another treatment that may help some people with insomnia is to recondition them to associate the bed and bedtime with sleep. For most people, this means not using their beds for any activities other than sleep and sex. As part of the reconditioning process, the person is usually advised to go to bed only when sleepy. If unable to fall asleep, the person is told to get up, stay up until sleepy and then return to bed. Throughout this process, the person should avoid naps and wake up and go to bed at the same time each day. Eventually the person's body will be conditioned to associate the bed and bedtime with sleep.
Cognitive Behavioral Therapy
CBT for insomnia targets the thoughts and actions that can disrupt sleep. This therapy encourages good sleep habits and uses several methods to relieve sleep anxiety.
For example, relaxation training and biofeedback at bedtime are used to reduce anxiety. These strategies help you better control your breathing, heart rate, muscles, and mood.
CBT works on replacing sleep anxiety with more positive thinking that links being in bed with being asleep. This method also teaches you what to do if you're unable to fall asleep within a reasonable amount of time.
CBT may involve talking with a therapist one-on-one or in group sessions to help you consider your thoughts and feelings about sleep. This method may encourage you to describe thoughts racing through your mind in terms of how they look, feel, and sound. The goal is for your mind to settle down and stop racing.
CBT also focuses on limiting the time you spend in bed while awake. This method involves setting a sleep schedule. At first, you will limit your total time in bed to the typical short length of time you're usually asleep. This schedule may make you even more tired because some of the allotted time in bed will be taken up by problems falling asleep. However, the resulting tiredness is intended to help you get to sleep more quickly. Over time, the length of time spent in bed is increased until you get a full night of sleep.
For success with CBT, you may need to see a therapist who is skilled in this approach weekly over two to three months. CBT works as well as prescription medicine for many people who have chronic insomnia. It also may provide better long-term relief than medicine alone.
For people who have insomnia and major depressive disorder, CBT combined with antidepressant medication has shown promise in relieving both conditions.
Tips for a Good Night's Sleep:
Set a schedule
Go to bed at a set time each night and get up at the same time each morning. Disrupting this schedule may lead to insomnia. Sleeping in on weekends also makes it harder to wake up early on Monday morning because it resets your sleep cycle for a later awakening. If you can, avoid night shifts, alternating schedules, or other things that may disrupt your sleep schedule.
Try to exercise 20 to 30 minutes a day. Daily exercise often helps people sleep, although a workout soon before bedtime may interfere with sleep. For maximum benefit, try to get your exercise no later than five to six hours before going to bed. Sex can be a natural sleep inducer and helps some people.
Avoid caffeine, nicotine, and alcohol
Avoid caffeine for at least eight hours before bedtime. Sources of caffeine include coffee, chocolate, soft drinks, non-herbal teas, diet drugs and some pain relievers. Quit smoking: Smokers tend to sleep very lightly and often wake up in the early morning due to nicotine withdrawal. Avoid using alcohol in the evening. Alcohol robs people of deep sleep and REM sleep and keeps them in the lighter stages of sleep. Don't eat heavy meals before bedtime.
Relax before bed
A warm bath, reading or another relaxing routine can make it easier to fall asleep. You can train yourself to associate certain restful activities with sleep and make them part of your bedtime ritual.
Sleep until sunlight
If possible, wake up with the sun, or use very bright lights in the morning. Sunlight helps the body's internal biological clock reset itself each day. Sleep experts recommend exposure to an hour of morning sunlight for people having problems falling asleep.
Don't lie in bed awake
If you can't get to sleep, don't just lie in bed. Do something else, like reading, watching television, or listening to music until you feel tired. The anxiety of being unable to fall asleep can actually contribute to insomnia.
Control your bedroom environment
- Avoid bright lighting while winding down.
- Use comfortable bedding.
- Limit noises and possible distractions, such as a TV, computer, or a pet.
- Reserve the bed for sleep and sex.
- Make sure the temperature of your bedroom is cool and comfortable.
See a doctor if your sleeping problem continues
If you have trouble falling asleep night after night, or if you always feel tired the next day, then you may have a sleep disorder and should see a physician. Your primary care physician may be able to help you; if not, you can find a sleep specialist at a major hospital near you. Most sleep disorders can be treated effectively.
Sleep research is expanding and attracting more attention. Researchers now know that sleep is an active and dynamic state that greatly influences our waking hours, and they realize that we must understand sleep to fully understand the brain. Innovative techniques, such as brain imaging, can now help researchers understand how different brain regions function during sleep and how different activities and disorders affect sleep. Understanding the factors that affect sleep in health and disease also may lead to revolutionary new therapies for sleep disorders and to ways of overcoming jet lag and the problems associated with shift work. We can expect these and many other benefits from research will allow us to truly understand sleep's impact on our lives.
Almost everyone goes through bouts of sleeplessness from time to time. It happens to the average person about once a year. That's the cost of being human and having the capacity to worry about the future and chew over the past.
Chronic insomnia, however, is marked by difficulty falling asleep or staying asleep, or waking up too early. If it takes you thirty minutes or more to fall asleep, or you're awake for thirty minutes or more during the night at least three times a week–for a month or more–you're officially suffering from insomnia. Approximately 50 to 70 million Americans have a sleep or wakefulness disorder, according to the Centers for Disease Control and Prevention. Insomnia has major effects on mood as well as alertness. It is also a classic symptom of depression.
Short-acting sleeping pills may improve sleep and next-day alertness. But the best way to handle a bout of insomnia is to do nothing; the body's sleep mechanism tends to right itself, if given the chance. The most effective treatments for chronic insomnia are behavioral techniques that eliminate sleep anxiety and allow the body's own sleep cycle to kick in.