Insomnia – Tips on How to Overcome Sleep Problems

 

“People say, ‘I’m going to sleep now,’ as if it were nothing. But it’s really a bizarre activity. ‘For the next several hours, while the sun is gone, I’m going to become unconscious, temporarily losing command over everything I know and understand. When the sun returns, I will resume my life.’”– George Carlin

 

Insomnia 1

It’s true, isn’t it?  Sleep is really weird.  And mysterious.  And as David K. points out in the book Dreamland:Adventures in the Strange Science of Sleep ( Norton and Co., 2012),  we know very little about it.  Yet in this country, at least, many of us are terribly, horribly sleep deprived, either because we are so busy doing things other than sleep, or because we want desperately to sleep, but we can’t.

Among my friends and colleagues, I think there are as many, or more, of us who are insomniacs, or at least have significant issues with sleep, as there are those who take sleep for granted.   I have often counted myself among the insomniacs.  During parts of my life, I have had entire nights during which I was awake, occasionally making good use of that time, but usually spending it in misery, believing I was the only person in the world awake at 2:30 am, tossing and turning, exhausted, gritty eyed, and slightly delusional .  I would wind myself into a ball of worry about how I would function the next day, how bad I was going to feel by the next afternoon…of course keeping myself awake even longer.  If I did fall asleep, it would happen at about 4 AM, 2 hours before the alarm was set to go off, and it would be a heavy, dreamless sleep, from which I would have great difficulty surfacing at 6. Once I did, I’d leap up in a panic about the horrible day I was going to have and caffeinate heavily.  The truth is, I usually didn’t feel nearly as bad as I expected to, but that didn’t stop me from winding myself up the same way the next time I couldn’t sleep.

I thought internship and residency cured me forever from insomnia.  Being forced to stay awake for 36 or more hours at a stretch and to do shift work in the ER defitnitely put the issue of insomnia underground.  Need simply superceded my propensity to insomnia.

It was only after residency, when I was technically allowed to sleep again every night that it became clear that I still had a problem.  But I also found out at that point that I was hardly alone.  A close friend told me that I could call her at any time during a sleepless night, because all night every night was sleepless for her.  Another told me she slept only three hours each night.  Patients told me about difficulty falling asleep, difficulty staying asleep and early morning waking.  And I had a conversation with my father during which I found out that all the times he had gotten up instantly with one of us when we were sick as children was not, in fact, because the world revolved around us and he was just at our beck and call.  He was awake anyway.

Insomnia 2What kept me awake during my intermittent periods of insomnia?  When I was in school, it was worrying about tests and papers.  Later it was worries about other kinds of work.  When my children were infants I was vigilant, waiting to hear them needing me, and often after a feeding, I would have trouble going back to sleep.  Sometimes my husband’s snoring bothered me.  Sometimes I was cold, or I was too hot, or the room was too light, or I had an ache or a pain, or the house creaked.  Really, just about anything could wake me or keep me awake when I was in a bad sleep cycle.

Then inexplicable, I’d go through times when sleep was no problem at all.  Over the years, the bad sleep times became less frequent, as I learned more tricks and techniques to manage insomnia.  Now I rarely have problems with insomnia.  So I thought I’d share some of my tips.  Some of them are the same ones all the sleep experts tout.  Some are common sense, and a few are a little more idiosyncratic:

  • Take good general care of yourself.  Eating properly and exercising regularly really do matter.  Avoiding caffeine after 12 noon and minimizing alcohol and other recreational substances matters too.  Alcohol really disrupts sleep cycles.  If you smoke, nicotine is a stimulant- so sleep is one more reason to get rid of the worst health threat in your life.
  • Try to keep a regular schedule.  Don’t eat a meal within 2 hours of bedtime.  However a snack containing carbohydrate and milk may help promote sleep- think a small amount of cereal with milk.  Allow for 8 hours of sleep if possible.
  • Get your exercise in but not within 3-4 hours of bedtime or you may still be revved up.
  • Check out your sleep environment.  A good sleep environment is cool, quiet and dark.  Can you improve yours?  Do you need a new mattress? Have you turned your mattress in the last few months?  Do you need a white noise machine to neutralize noise from the upstairs apartment?  Do you have really dry heat?  If so, think about a humidifier or a bowl of water on the radiator.  If your partner’s snoring keeps you awake, earplugs really can help.  I discovered soft silicone earplugs that actually seal out snoring- it’s amazing!
  • As much as you may not want to, you have to give up screen time before bed.  If   David  Randall is right, all of us have been ruined for good sleep by artificial light.  Computer screens, particularly with super-stimulating activities like video games, social media and web-surfing winds our brains way up when they should be winding down.  Same goes for doing any kind of work right before bed, or tasks like paying bills.  And then there’s the TV.  Many of us watch TV right before bed.  But think about what’s on- police dramas, shows about grisly serial killings, the new (which isn’t much different from the other two)- maybe TV isn’t such a good idea before bed!  Even the way we read books now- on Kindles and IPads – puts us smack in front of artificial light.  There’s no proof, but maybe the old-fashioned way of reading books is less CNS stimulating.
  • If you are a worrier or you take your to-do list to bed with you, try one of these little behavioral therapy maneuvers:  for over-zealous to-do listers- keep a pad and paper next to the bed to add any suddenly-remembered items without even turning on the light.  For worriers, pick  a ‘worry spot’ and go there for 10 minutes at least one hour before you plan to go to bed.  Sit and intensely focus on your worries for that period of time.  Then tell yourself that you are done with it for the night.
  • If you have aches and pains that keep you up, consider if they require medical attention.  If not, would ice, or heat, or a Tylenol help?
  • If none of this helps, you probably should see your doctor.  Not necessarily for sleeping pills, though.  Remember that sleeping pills do not produce the same quality of sleep as the naturally induced thing, and that there is a risk of side effects, including dependence.  Your doctor should evaluate you for medical conditions that may lead to or contribute to insomnia, including depression, anxiety, sleep apnea and other sleep disorders, esophageal reflux, and hormonal problems.  Treating medical issues may resolve insomnia.  If not, appropriate use of medications or supplements like melatonin may be recommended.
  • If you are up in the middle of the night, do not stay in your bed tossing and turning. Get up for a while and go somewhere else so you don’t begin to associate your bed with discomfort and insomnia.  Sometimes I just go to a different bed in the house, and for some reason that works.  Try reading a book or another quiet activity for a while.  Maybe pick up a copy of Dreamland, and read about some of the really bizarre sleep problems some people have.  I guarantee it will make you feel better about your insomnia.
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RosalindKaplanMD
Rosalind Kaplan, M.D. is a general internist specializing in women’s health issues and medical management of eating disorders. She graduated from the University of Pennsylvania School of Medicine and did her residency at Temple University Hospital in Philadelphia. She is currently an Associate Professor of Clinical Medicine at Temple University School of Medicine and the Director of Temple Health Women’s Care, a multidisciplinary practice for women.