What can you do if you can't sleep?
Tuesday, March 12, 2013 10:00 PM
This week I want to focus on some basic prevention and treatments for insomnia. If the cause is not readily identifiable, it is helpful to keep a sleep log for 2-4 weeks to share with your doctor. It should include sleep and wake times, naps, and actual time spent sleeping. You can download a blank sleep log at www.sleepny.com/sleepdiary.
A lack of good sleep hygiene is one of the most common things I usually identify when taking a sleep history or reviewing a sleep log. Sleep hygiene is defined as "daily activities and habits that are consistent with or promote the maintenance of good quality sleep and full daytime alertness."
When patients are asked what they do when they can't fall asleep in a few minutes, most people answer that they continue to lie in bed and watch the clock. A key concept to remember is that the bedroom should be reserved for sleep and sex. It should not be used for watching TV, surfing the Internet, doing work, exercising, etc. Your brain needs to be trained that when it's in that room, it's to be shutting off and resting.
If you find yourself in bed unable to sleep, you should get out of bed and go to another room. Engage in a low-energy activity such as reading or perhaps watching the latest round of infomercials. Do this until you become drowsy and then go back to bed. If you find you can't sleep after 15-20 minutes, get out of bed again and repeat the process. You may have to do this numerous times. However, don't be tempted to sleep in the following day - the total hours you spend in bed should remain about the same each day.
It's important to have a ritual before going to bed. This should include quiet "wind down" time for at least 30 minutes before retiring. Some say a warm bath or shower two hours before bedtime can be helpful. A light snack may also promote drowsiness.
It is very important to try and maintain a consistent bedtime. It appears that a consistent wake time is even more important. This is extremely difficult for folks that may work nights Monday through Friday who are then off on the weekends. They need to try and maintain the same schedule as closely as possible and get the same total number of hours of sleep that they get while working nights.
A tip for night workers is to put on dark wraparound sunglasses before leaving the workplace and wear them until you get in a dark room at home. This keeps the brain's daytime switch from being turned on and allows you to get to sleep more easily.
If you're still having trouble sleeping, it can be helpful to meet with a therapist to discuss relaxation therapy. Prayer and meditation are also commonly used to help the brain relax.
I touched on medications last week, but I want to briefly mention drugs that are commonly implicated in insomnia. Caffeine can stay in the system for up to eight hours so don't consume it within that time frame if you're having trouble sleeping. Cold medications containing pseudoephedrine (Sudafed®) keep the brain awake. Nicotine is also a stimulant so if you're a smoker, you should discuss quitting with your doctor. Alcohol is the last thing you want to consume if you're having trouble with insomnia.
There are some natural products, particularly melatonin, that can help some people. It's important to take it about two hours before bedtime. Prescription sleep medications should be the last resort for treating insomnia. These medications are all very addictive and may cause unwanted or dangerous side effects in some people, particularly the elderly.
An excellent resource for more information on insomnia can be found at http://tinyurl.com/27twsr3.
Dr. John Roberts is a family physician. He is also one of the owners of The Paper of Montgomery County. Send him your question today by e-mail at firstname.lastname@example.org.