Insomnia, the most common of sleep disorders, is the inability to initiate or maintain sleep. If you have insomnia, you are probably very frustrated and sleep-deprived. The following information is presented in the hope that it may improve the quality of your sleep. Other disorders include obstructive sleep apnea, narcolepsy, or myoclonus. Sleep disorders should be managed by a qualified physician.
Changing Your Beliefs and Attitudes about Sleep
It is important to examine your beliefs and attitudes about sleep and insomnia. The way people think about a particular problem can either alleviate or aggravate that problem. For example, when you worry about how poorly you slept the night before, it is likely to make you more apprehensive about the upcoming night. Excessive concerns about the consequences of poor sleep can also feed into your problem, and an overly preoccupied mind or emotional upset are not very conducive to sleep.
To regain greater self-control over sleep, you must first set aside previously held beliefs and replace them with more adaptive ones. Self-imposed pressure to achieve certain sleep standards, excessive concerns about the consequences of poor sleep, and false assumptions about sleep all attribute to insomnia. Consider the following. . .
- Don't blame the loss of sleep on such things as "my sleep problem is entirely due to pain or to some biochemical imbalance" or "I'm just getting older and it's normal to have sleep problems."
Although age, pain or physical ailments may contribute to sleep difficulties, psychological factors can either make them better or worse. It is more important to adopt a more constructive attitude and assume some control over these factors.
- Don't blame insomnia for mood swings, lower energy, and poor daytime performance.
There are numerous factors, including natural fluctuation in energy levels as well as stress in other areas of your life, which may cause those problems. Be careful not to blame it all on sleeplessness.
- Don't worry about the daytime consequences of an occasional poor night's sleep.
This will only aggravate your problem. When you worry about those presumed consequences, it only makes you more anxious and decreases your tolerance for sleep loss. It also feeds into the vicious cycle of insomnia, emotional distress, and more disturbed sleep.
- Don't have unrealistic expectations such as "I must sleep eight hours every night" or "I must fall asleep in minutes."
Sleep requirements vary widely among individuals. Sleeping only a short time may not be abnormal. There is no "normal" for the amount of sleep a person needs. The average sleep duration for adults is seven to eight hours, but some people function well on as little as four to five hours of sleep. Sleep as much as you need to feel rested in the morning and remain alert during the day, but no more.
Do not put pressure on yourself to achieve a certain level of sleep; this will only increase your anxiety and perpetuate your insomnia. The speed with which one falls asleep also varies. Your spouse may go to sleep as soon as his/her head hits the pillow. Yet, it may take you 30 minutes to fall asleep; don't worry about it. It is better not to compare your sleep patterns with others.
- Don't panic after a sleepless night, it only makes matters worse.
Stay calm and accept the fact that you didn't sleep well. Sleep loss is more likely to be distressing if you perceive it as stressful rather than a challenge. There is no need to feel like you have to make up the sleep you have lost. One good night of sleep usually is enough to put you back in shape.
- After a sleepless night, try to minimize problem-solving tasks the following day.
After a sleepless night, some things may seem more complicated or more difficult to handle than they really are. Stay on cruise control that day, if you can, and avoid detailed tasks.
Changing Your Sleep Habits
The following are non-drug methods of dealing with insomnia. There are several steps you can take to beat insomnia. The ultimate goal is to regain control over your sleep by altering your attitudes about sleeplessness and by changing sleep habits known to contribute to insomnia.
- Allow yourself at least one hour before bedtime to unwind.
Use this time as a transitional period to engage in your pre-bedtime rituals such as reading, washing, or brushing your teeth. Do not rehash events of the day or plan tomorrow's schedule. No problem solving should be done as it will over stimulate you and interfere with falling asleep.
- Lie down intending to go to sleep only when drowsy.
There is no reason for going to bed if you are not sleepy. This gives you more time to worry about your inability to sleep and reinforces the negative association between your bedroom surroundings and wakefulness.
- If you can't sleep, get out of bed.
When you find yourself unable to sleep or return to sleep within a period of 10 - 15 minutes, get out of bed, go into another room, and engage in some quiet activity such as reading. Do not sleep on the couch. Return to bed only when sleepy again and repeat this step as often as necessary.
- Maintain a regular time of getting up.
Set your alarm clock and get out of bed at the same time every day. This should be done consistently regardless of the time you went to bed or the amount of sleep obtained on the previous night. This will help your body acquire a consistent sleep rhythm.
- Reserve your bed and bedroom for sleeping only.
Do not read, eat, watch TV, work, pay bills, or worry in your bed or bedroom either during the day or at night. Sex is the only exception to this rule. This will reinforce the bed/bedroom as a cue to sleep, not for non-sleep activities.
- Restrict the amount of time you spend in bed.
People with insomnia frequently spend excessive amounts of time in bed to make sure they achieve adequate sleep. Excessive amounts of time spent in bed tend to exacerbate rather than alleviate your sleep problem. As your sleep improves, you can gradually increase the amount of time in bed.
Daytime napping is best avoided entirely. If you must nap, limit it to no more than 1 hour per day and should be taken well before your regular bed time to minimize interfering with your sleep.
Sleep Hygiene Guidelines
Sleep is affected by a host of factors including diet, exercise, and substance use. Below are some guidelines on sleep hygiene which may help promote better sleep.
Caffeine disrupts sleep and should be avoided four to six hours before bedtime. Caffeine is a stimulant that produces fragmented and lighter sleep. Some people are more sensitive to caffeine than others, but, in general, it affects everyone, even in those who claim it has no impact on their sleep.
Caffeine taken prior to bed may delay sleep onset or disrupt sleep throughout the night. Caffeine is present in coffee, chocolate, several soft drinks and some over-the-counter medications.
Nicotine disturbs sleep and should be avoided, especially around bedtime. Nicotine is also a stimulant even though most smokers claim it helps them relax. Although it would be best to quit altogether, smoking should be reduced, especially before bed. It is also important to avoid smoking when waking up in the middle of the night; nighttime awakenings may become conditioned to nicotine withdrawal symptoms.
- Watch your food and eating patterns.
A light snack may promote sleep. Food intake can be sleep-inducing, but the timing and the amount of calories is important. Having a snack before bed seems to promote sleep. People tend to be sleepier after a snack high in carbohydrates. Foods high in L-tryptophan, such as milk, seem to promote sleep in some people. Avoid the following foods around bedtime: peanuts, beans, most raw fruits or vegetables, potatoes or corn chips. Avoid snacks in the middle of the night because nighttime awakenings may become conditioned to hunger, and avoid drinking excessive amounts of fluids.
Exercise elevates autonomic activity and may interfere with sleep onset. Regular exercise is excellent, but the impact of exercise on sleep depends on its timing. Regular exercise in the afternoon tends to deepen sleep. If you exercise after dinner, make it light.
Alcohol is the most likely substance to cause sleep disruption, so avoid alcohol four to six hours before bedtime. Although a "nightcap" may help tensed people relax and fall asleep, alcohol is a central nervous system depressant and produces lighter and more fragmented sleep.
- Beware of sleeping pills.
Sleeping pills are effective only temporarily. Research has shown that most sleeping aids wear off within two to four hours when taken nightly. Short-term use may be indicated in cases of acute and severe insomnia. However, long term use may produce some of the following side effects: nausea, headaches, dry mouth, reduced daytime alertness, and impaired performance. Some people feel as groggy in the morning, if they have taken sleeping pills, as if they have had no sleep.
Sleep induced by drugs is lighter and more fragmented. A tolerance level for some drugs may be achieved, thus requiring higher doses to be effective. This can be dangerous. Because all drugs are metabolized in the body at different rates, caution should be taken by the elderly, as their slower metabolism may cause the drug to linger longer than in younger people.
