ONCE YOU AND your doctor have teamed up to figure out why you’re having insomnia, you can start taking steps to resolve the problem. For secondary insomnia—sleeplessness resulting from some other health issue, such as chronic pain, depression, or asthma, to name a few—you and your doctor can try to fix the sleep problem by focusing on the underlying condition. Sometimes a prescription drug being used to treat the underlying health issue is causing the insomnia, so finding a substitute medication may be the solution. It may even be possible to find an alternative that promotes sleep as a side effect, rather than impeding it. For primary insomnia—sleep problems not due to an underlying health issue—work with your doctor to find one or more of the following treatments and techniques that might work for you.
Cognitive Behavioral Therapy for Insomnia (CBT-I)
This type of therapy involves working with a professional to uncover unhealthy patterns of thought and behaviors that might be interfering with sleep. “It’s the cornerstone therapy of insomnia,” says Raj Dasgupta, MD, assistant professor of pulmonary, critical care, and sleep medicine at the University of Southern California in Los Angeles. “And it has a sustained effect.”
One aspect of CBT-I is offering constructive ways to deal with worry and other emotions, which often prevent people from dropping off to sleep. “We teach patients how to recognize when they’re ruminating— that is, brooding on negative thoughts and feelings,” says Robert S. Rosenberg, DO, medical director of the Sleep Disorders Center of Prescott Valley in Arizona. People might be instructed to try writing their worries down and then slipping the paper into a drawer, essentially storing them away.
Distraction is another key tool of CBT-I. For example, instead of staring at the ceiling when you wake up in the middle of the night, try counting backward from 300 by threes, suggests Michael Breus, PhD, author of Good Night: The Sleep Doctor’s 4-Week Program to Better Sleep and Better Health. It’s mathematically complicated enough to focus your attention, but so boring that you might just drift off before you reach zero. Other CBT-I techniques include establishing a regular morning rise time, going to bed only when sleepy, getting out of bed when you are unable to fall asleep, and avoiding napping during daylight hours. “These tactics help to build up a big sleep drive,” says Dr. Rosenberg. “They’re coping mechanisms that can last a lifetime.”
It may seem counterintuitive, but restricting sleep works for some people. The approach involves going to bed later rather than earlier, thereby compressing the time spent in bed—and helping to ensure that sleep is occurring the majority of time while in bed. Once you are asleep for at least 85 percent of the time, you can increase time in bed in 15-minute increments until daytime drowsiness disappears.
Many people try taking a supplement version of melatonin (a hormone that occurs naturally in the body) to help reset their internal clock. It may be most useful for people who cross time zones and for seniors who may have problems with sleep regulation, says Dr. Breus. Let your doctor know if you as is the case with any supplement, there is the possibility of undesirable drug interactions.
Calming the body and mind can make a big difference for many people struggling with sleeplessness. One popular approach is to do progressive muscle relaxation at bedtime or if you wake up during the night. First tense and then relax the body’s muscles sequentially, from the toes to the head.
Set the Stage
Sometimes it seems that the more you need a good night’s sleep the harder it is to get it. However, there are many things you can do to improve your chances of nodding off with ease—and staying there.
Become a creature of habit. Going to bed and getting up at roughly the same time each day may be the single best habit you can develop.
Exercise—but not too late in the day. Exercising for 20 to 30 minutes each day can help you sleep better at night, but doing so too close to bedtime (such as within four hours of going to bed) can interfere with sleep.
Stay cool. You’ll sleep better if you keep your bedroom a little on the cool side; body temperature gradually drops as you sleep. The National Sleep Foundation experts suggest a temp between 60°F and 67°F.
Be careful with naps. A short snooze during the day can be restorative, but napping can also bar you from a good night’s sleep. If you must nap, keep it to 20 to 30 minutes.
De-stress before bedtime. Simple stretches, easy yoga, or meditation can help you relax and clear your mind of worries before turning in.
Go to bed a bit hungry. A heavy meal right before bed won’t do you any favors with regard to shut-eye.
Cozy up. Make sure your bed and bedroom are comfortable an inviting. Consider replacing a mattress that’s more than nine or 10 years old.
Beware of caffeine. Stop drinking coffee after 1:00 p.m. The same common sense applies to tea, chocolate, and other foods that perk you up.
Use a night light. Turning on a bright light if you get up in the night could fool your body into thinking it’s time to wake up and start the day.
Sometimes, in addition to practicing good sleep hygiene, the most effective approach to insomnia is taking a prescription medication. Doctors used to rely primarily on a class of drugs called benzodiazepines, such as diazepam (Valium) and alprazolam (Xanax). But that has changed. These drugs depress the central nervous system and can be long-acting, causing drowsiness the next day. Newer alternatives appear to be safer and effective for longer-term use. They include agents that bind to specific receptors in the brain to induce sleep. Some examples of these drugs, which are called hypnotics, are zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon (Sonata). A medication called suvorexant (Belsomra) works by targeting receptors in the wake-promoting sections of the brain. “Where Ambien works by turning on the brain’s ‘sleep’ switch, Belsomra turns off the ‘wake’ switch. It’s a completely different mechanism,” says Dr. Breus. Another drug, called ramelteon (Rozerem), stimulates receptors for the hormone melatonin.
Over-the-counter medications are another option for sleep problems. However, they usually contain an antihistamine, which affects the central nervous system. Drawbacks include possible next-day drowsiness and loss of effectiveness over time.