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The following free report is approximately 20 printed pages long. You may print it out if you like and remember to return to http://www.stresscure.com often, as we add more materials to help you cope with stress. Copyright © 1994-2007, M.C. Orman, MD, FLP. All Rights Reserved.
According to a recent Gallup Poll, one of every three Americans suffers from occasional or frequent insomnia. Common sleep complaints include:
Similar studies show that 20-30% of people in other countries also suffer from sleep-related problems.
69% of Americans with sleep disorders never mention the problem to their physicians. 26% mention it, in passing, while visiting their doctor for another problem. Only 5% directly seek help for their sleeping problem.
Four of ten insomniacs medicate themselves to get to sleep. The most common substances used are alcohol, non-prescription sleep aids, and aspirin.
The consequences of insomnia range from mild daytime drowsiness to serious injuries and even death. Accidents can occur due to falling asleep or loss of concentration, mainly while operating an automobile or other dangerous machinery.
Many insomniacs report loss of ability to enjoy family and social relationships. Some avoid social contact for fear of falling asleep while visiting friends.
Far from being a benign, harmless condition, insomnia causes thousands of deaths every year. Its total cost, in terms of illness, injuries, and decreased quality of life is staggering.
Insomnia is insufficient, disturbed, non-restorative sleep. This means not getting enough sleep to meet the needs of your body or to allow you to feel refreshed and energetic upon awakening and throughout the day.
There are three basic types of insomnia:
It is normal to wake up several times each night. Although most people don't recall these brief awakening episodes, insomniacs typically have trouble either getting to sleep in the first place or falling back to sleep once they have awakened.
The term insomnia should not be applied to "short sleepers," "poor sleepers," or "light sleepers" in the general population.
Some people need only 3-5 hours of sleep each night to feel refreshed and energetic. These "short sleepers" do not have insomnia.
Some people never sleep well, day or night, and they've been that way most of their lives. Often, family members will have similar sleeping patterns. These "poor sleepers" may have become insomniacs early in life, but they rarely respond to usual insomnia treatments.
"Light sleepers" are people who awaken easily to trivial environmental stimuli such as noise, light, or wind. In the absence of these stimuli, they have no problem sleeping and therefore do not have true insomnia.
NOTE: Some people think they sleep "poorly" when in fact they sleep quite well. When their brain activity is monitored during sleep, it is often found to be completely normal despite their belief to the contrary.
Insomnia also does not apply to problems that primarily result in excessive daytime drowsiness, such as "sleep apnea" and "narcolepsy." These disorders usually have biologic causes, and while disordered nighttime sleep patterns are sometimes involved, true insomnia is an infrequent complaint.
Significant insomnia can occur at any time. It is much more common, however, with increasing age. As people get older, they have difficulty sleeping for several reasons, which will be discussed later in this report.
Most people with insomnia have it on an occasional or intermittent basis. About 9% of the general population, however, has chronic, prolonged insomnia. Thus, at any point in time, more than 20 million Americans suffer from severe, debilitating insomnia lasting from several months to many years.
While occasional periods of poor sleep occur for just about everyone, chronic or recurrent insomnia can usually be traced to specific causes:
1. Biological Clock Alterations
All human beings (any many animals) have biological "clocks" deep within their brains.
These "clocks" control regular fluctuations in body functions, such as hormone secretions, temperature regulation, and sleep-wake cycles. The clock controlling sleep-wake periods typically cycles every 25 hours (interestingly not synchronized with our 24-hour day). In some people, however, this "normal" cycle can become abnormally shortened or prolonged.
2. Medication Side-Effects
Prescription and OTC (over-the-counter) medications can interfere with sleep. These include decongestants, sinus remedies, diet pills, some asthma medications, and many others.
Fluid pills can cause people to wake up at night to urinate. And sleeping pills can disturb or block the normal pattern of sleep activity in the brain, thereby worsening the very problem they are designed to alleviate.
NOTE: alcohol, nicotine (smoking), caffeine, and cocaine also disturb sleep patterns in the brain. These commonly ingested substances often interfere with sleep.
3. Withdrawal Of Medications
Abruptly discontinuing certain medications, after weeks or months of use, can cause insomnia. For example, people who have been on tranquilizers or pain pills for many months can suffer from disordered sleep when they suddenly stop these medications. The withdrawal of sleeping pills causes a well-known condition called "rebound insomnia" which can last from days to weeks. And people addicted to alcohol, cigarettes, coffee, tea, or other sources of caffeine often find it difficult to sleep during acute withdrawal of these substances.
4. Medical Or Psychological Problems'
Virtually any medical or psychological problem can interfere with sleep. Painful conditions such as arthritis, gout, and acute muscle injuries are common offenders. So are illnesses that cause itching, urination, or shortness of breath at night.
Anxiety, worry, depression, and stressful life events are also extremely common causes of insomnia. In addition, medicines used to treat these conditions can also have side-effects that prevent normal sleep.
5. Psychological Responses To The Failure To Sleep
Another common cause of insomnia is the way people respond to their inability to sleep. After not sleeping well for several days, many people become worried, frustrated, or depressed. This causes them to place added psychological pressure on themselves to sleep. This leads to increased anxiety at bedtime, which further interferes with sleep. In no time at all, a vicious cycle of "failure--worry-- more failure--more worry" develops. Once established, this failure pattern becomes self-perpetuating. It can be reversed, however, by following some of the guidelines discussed in this report.
6. Bad Sleep Habits
In addition to increased psychological pressure, many people fall prey to other bad habits in their efforts to restore normal sleep. These bad habits include:
7. Negative Associations
In addition to increased psychological pressure and bad sleeping habits, many people form negative "associations" with their bedrooms, lying in bed, lying in darkness, or other factors related to sleep. They literally learn to fear the act of sleeping. They become negatively conditioned about success in this area, and everything associated with sleep triggers unconscious expectations of failure, disappointment, shame, and humiliation.
If you are one of the millions of people with chronic or recurrent insomnia, this report can help. In addition to providing you with a comprehensive, up-to-date summary of basic facts about insomnia, this report will show you how to cure many of your sleep-related problems. After reading this report, you will understand why:
In addition, this report will also cover:
Whatever your problem might be, most people can learn to cure or reduce their insomnia by following the strategies discussed in this report. By increasing your knowledge of the causes of insomnia, and by learning the techniques most experts find successful, you can avoid the mistakes most people make and greatly improve your chances for success.
So far in this report, you've learned what insomnia is and what it is not, that it's prevalent in this country and around the world, that it has numerous possible causes, that left untreated it can have serious consequences, and that most of the time it can be successfully cured.
Now lets consider some additional background information, before going on to directly tackle your sleep-related problems.
This varies from individual to individual. The amount of sleep that's right for you is that amount which enables you to feel wide-awake, alert, and energetic throughout the day. For most adults, this ranges between 7-9 hours, although some can feel awake and energetic on as little as 4-5 hours of sleep per night.
Researchers have discovered that normal, restful sleep in human beings consists of four patterns of brain activity called stages. Stages 1 and 2 are considered to be "light" stages of sleep, and they typically predominate in the early part of the cycle. Stages 3 and 4 are deeper, more restful periods, and they tend to dominate in the latter half of sleep.
All four stages come and go many times during the night. Transient awakenings usually occurs during stage 1 sleep. Most dreaming occurs during stage 4, which is also known as REM (rapid eye movement) sleep.
If the normal pattern of alternating stages is disturbed, sleep may not be fully restorative. Thus, it not only matters how many hours of sleep you get , but the quality of those hours and the sequence of sleep stages in your brain also play a role as well.
When our bodies are deprived of sleep at night, we generally feel tired the next day. If sleep deprivation continues, our bodies try to make up for the deficit by causing us to sleep longer at night.
There is a well-known increase in sleep problems with age. As we get older, the frequency of nocturnal awakenings increases (remember, most people don't recall these brief awakenings). Changes in brain activity during sleep also occur . Stage 3 deep sleep progressively declines with age, while stage 4 (REM) sleep is relatively unaffected.
Another reason why sleep problems increase with age is that our biological clocks tend to change over time. These specialized brain cells located in the suprachiasmatic nucleus of the hypothalamus (a small region near the pituitary gland of the brain) control daily variations in our sleep-wake cycles.
As we previously discussed, the biological clock for most human beings cycles slightly longer than 24 hours. This is why it is easier for most people to go to bed late (since the body's sleep time is normally slightly delayed), than it is to wake up early. This also explains the problem of "jet lag," since our body's biologic rhythms become further out of synch with the social clock of the traveler's destination.
NOTE: Our biologic clocks also depend upon a certain amount of daylight exposure to maintain their regulating function. This is a problem for people living above the Arctic circle, where insomnia during the dark periods of winter develops in 20-35% of the population.
As we get older, our biologic clocks gradually change. Typically, their cycle length shortens, often falling below 24 hours. This means we tend to fall asleep earlier and wake up earlier as we age. This, in turn, may lead to increased sleepiness during the day, and more daytime naps may be required.
NOTE: Similar, but opposite, biologic clock alterations often happen in young people around the age of adolescence. Their biologic clocks tend to lengthen beyond 25 hours, causing them to not get tired until very late at night (or early A.M.) and have trouble waking up at "normal" hours in the morning.
Thus, the changes that occur in sleep patterns with age make us more susceptible to sleep deprivation and insomnia. There is no truth to the myth that older people sleep less during the night because they "need less sleep." They sleep less because their ability to sleep has been biologically impaired, due to changes in brain functions that are beyond their direct control.
The first step to approaching any sleep-related problem is to ask yourself the following questions:
The best way to deal with one or two bad nights of sleep is to go to bed early the very next evening. Never make excuses for why you need to stay up late more than one or two nights in a row. Manage your schedule so you get your work done during the day, and don't treat your body like you can deprive it of sleep whenever you want.
Going to bed early is better for your body than taking a daytime nap. Napping during the day can make you less tired--and less able to sleep--at night. This can further interfere with resuming your normal sleep-wake cycle.
Also, don't use caffeine to keep you alert during the day or alcohol to help you get to sleep at night. Both of these substances alter the normal sleep cycles in your brain and can lead to further insomnia, which could become chronic.
It's O.K. to use prescription or OTC sleep aids to help you catch up on your sleep, as long as you use them for just one or two nights. Longer use of these substances can eventually alter the normal sleep patterns in your brain.
Also, if you need to go to sleep early, make sure your family is aware of this, so you can enlist their support in keeping your environment peaceful and quiet.
Longer periods of insomnia, lasting 1-3 weeks, are often precipitated by stressful life events. Repeated loss of sleep leads to poor daytime function, increased irritability, and further decreases in one's ability to cope with stress. This, in turn, leads to more worry, anger, and frustration, which additionally compromises sleep.
If you notice you are suddenly not sleeping well for several days in a row, look for recent stressful events or conflicts in your life. When you identify them, try to resolve them quickly. Don't ignore them, put off dealing with them, or simply "hope" they will go away. Address them vigorously and successfully and your insomnia will usually resolve.
Your major goal should always be to restore your previous sleep pattern just as quickly as you can. The longer insomnia lasts, the more bad habits and negative associations tend to form.
Even if you have to use a short course of sleeping pills to help you sleep, this if often preferable to allowing your body to be deprived of rest for weeks at a time. Consult with your physician before starting such a course of treatment, and make sure that you limit yourself to no more than one or two weeks of use. Again, the goal is to restore your normal sleep pattern as quickly as possible, and once this is done, your need for continued medication will generally disappear.
NOTE: If you do use sleeping pills for more than 7 days in a row, don't stop them all at once. Gradually decrease the dose or frequency of use, and if you have any questions about how to do this, consult with your physician.
In general, swift, aggressive, intervention can cure most types of sleeping problems than go on for several days. This can prevent long-term problems, including bad sleep habits and other negative associations, from becoming established.
Don't wait 2-3 weeks before deciding to intervene. If you haven't slept well for 3 days in a row, call your doctor and follow his or her advice. Also, be sure to use some of the other coping strategies discussed in the next section of this report.
The best way to deal with chronic insomnia is to prevent it from becoming established in the first place. If you already have a problem that's lasted more than a month, here are some proven strategies most experts recommend:
A. Try To Figure Out The Cause
Remember, insomnia is a symptom which usually has a cause. Often there are multiple causes, and the ones that initiated the problem may no longer be the ones that are keeping it from resolving. When you are trying to figure out the causes of your insomnia, consider the following categories:
1. Medical Illness
Especially conditions that result in pain, shortness of breath, cough, urination, nausea, diarrhea, or other bothersome symptoms at night:
The Restless Leg Syndrome consists of abnormal sensations in both legs upon lying down. These sensations are usually described as "ants or insects crawling on my legs" and they are often relieved (temporarily) by moving the legs. The syndrome is also usually accompanied by periodic movements of both legs during sleep. Restless leg syndrome is a treatable problem (consult your doctor). It sometimes is associated with diabetes, kidney disease, or circulatory problems, but in the majority of cases no specific cause can be found.
2. Psychiatric Illness
Any psychiatric or psychological illness can interfere with sleep. Conditions associated with increased anxiety or worry often keep people from falling asleep, whereas depressive illnesses often result in early morning awakening or trouble remaining asleep.
In addition, many prescription medications for treating psychiatric illness can also compromise sleep. Certain antidepressants, such as Prozac, Zoloft, and Paxil, can have stimulating effects. Minor tranquilizers, called "benzodiazepines," may at first help anxious people sleep, but with prolonged usage they can disturb normal sleep activity in the brain. The same is true for caffeine, nicotine, and alcohol use, which frequently increase during times of psychological stress.
Also, negative associations and other bad sleep habits that become established during periods of psychological distress can remain as lingering problems after the underlying psychological crisis has resolved. For example, poor habits such as trying too hard to get back to sleep or spending too much time lying awake in bed can become established during a period of depression and remain as causes of persistent insomnia once the depression has successfully been treated (or cleared on its own).
3. Medications
Prescription and OTC medicines used to treat medical or psychiatric problems can also contribute to insomnia. If you are having trouble sleeping, look very carefully at any medicines you may have been taking recently or just prior to the onset of your problem:
Caffeine is often used by people to maintain wakefulness throughout the day. Excessive use of caffeine on a daily basis, however, can lead to withdrawal symptoms including headache and sleeplessness at night. If caffeine is ingested too close it bedtime, its stimulating properties can also interfere with sleep. And caffeine is known to cause an increase in palpitations, stomach problems, diarrhea, and Restless Leg Syndrome in certain individuals.
Alcohol is commonly used by people to help them get to sleep. While this may appear to be a good thing to do, it eventually leads to further trouble. In addition to causing a dependency state, alcohol also disrupts the normal pattern of brain activity during sleep. While its sedative and calming effects help people get to sleep at first, it tends to produce increased nighttime awakenings and reduces the amount of Stage 3 brain activity, which is needed for proper rest.
In addition to looking at any medications or insomnia-producing substances you may be currently using, also consider any medicines you may have recently stopped! Sometimes disturbed sleep begins shortly after stopping a medication you've been taking for quite some time. For example, people who suddenly quit smoking often find that their sleep is disturbed. Withdrawing from alcohol, sleeping pills, or psychiatric medications can also produce temporary insomnia. Sometimes a more gradual tapering down of these agents will prevent this type of insomnia from occurring, so it is best to consult with your physician if you think this factor might be involved.
4. Negative Conditioning And Negative Associations
Conditioned thoughts, feelings, and behavioral responses that become associated with sleep or one's sleeping environment are common "secondary" causes of insomnia. After prolonged, unsuccessful efforts to sleep, one's bed, bedroom, turning out the lights, lying down, etc., can all become associated with failure, pain, and disappointment. As a result of these learned (but mostly unconscious) associations, increased physical and psychological arousal often occurs at bedtime. This, in turn, makes it more difficult to relax.
In addition, insomnia-maintaining behaviors, such as staying in bed too long when you can't sleep, can also aggravate the problem. So can performance anxiety, where the more your try to make yourself fall asleep, or the more you worry about achieving your goal, the less you are able to relax.
These "secondary" causes of insomnia are very important to recognize. One good clue is that you sleep very well in places or at times that you don't normally associate with sleep. For example, you may sleep well on vacation or at a friend's home. You may have no trouble taking unplanned naps at home, while trying to sleep at "bedtime" is often unsuccessful.
5. Bad Sleep Habits
Some conditioned responses lead to bad sleep habits. These include:
These behaviors commonly contribute to long-term insomnia. It 's very important to recognize these causes, since in most instances they can be reduced or eliminated.
6. Recent Stressful Events
Another common cause of insomnia, particularly the short-term variety, is the occurrence of stressful events or crises in a person's life. These can include such events as:
In general, the successful resolution of these problems usually leads to restoration of normal sleep. However, if negative associations and bad sleep habits become established during periods of stress-induced insomnia, these "secondary" causes can keep one sleeping poorly.
7. Shift Work
Shift work is a common cause of sleep deprivation for millions of Americans. Working the night shift on a regular basis or working different shifts on a rotating schedule produce challenges and obstacles to maintaining a normal, healthy sleep-wake pattern. This can be especially troublesome for older individuals, since the ability to tolerate shift work (from a sleep perspective) declines significantly with age.
NOTE: Tips for dealing with these and other causes, once you've identified them, will be discussed below.
B. Make Your Sleep Environment Safe, Quiet, and Comfortable
One thing you should always do if you are having trouble sleeping is to make sure that your sleep environment is safe, quiet, comfortable, and otherwise conducive to your personal needs for peace and relaxation.
1. Noise
If bothersome noises keep you awake, see what you can do to eliminate or modify their source.
If your children are the problem, get them to modify their behavior. If neighbors are the problem, see what you can do to enlist their cooperation and support. If the telephone rings late at night, try to muffle the sound, turn off the ringer, or instruct friends and relatives not to call after certain hours.
If minor noises tend to bother you, consider using a constant background noise to help you get to sleep. Some people find that an air conditioner, fan, vaporizer, dehumidifyer, or other mechanical device helps to block out other distracting influences, such as noisy neighbors. Commercial devices designed to produce soothing "white noise" are also available. If these don't help, consider trying ear plugs (excellent for dealing with snoring bed partners). If all else fails, soundproofing your bedroom may be in order.
NOTE: some people need absolute quiet to get to sleep; others sleep better with mild background noise in their environment, such as T.V., radio, etc.
2. Darkness
If you are required to sleep during the day, too much light in your sleeping environment can be a problem. If this is true for you, consider buying thicker curtains, installing window blinds, or wearing a blindfold.
3. Clocks
If you are having trouble sleeping, it is best not to focus your attention on the time. This is one of the bad sleeping habits that can become a "secondary" cause of insomnia. Looking at a clock every 5-10 minutes while you are lying in bed or glancing at the clock to see what time it is each time you awaken during the night are unnecessary behaviors that should be avoided. To help you do this, consider making the following changes in your sleeping environment:
4. Temperature
Make sure the temperature in your bedroom is conducive to your needs. If not, consider installing an auxiliary heater, ceiling fan, airconditioner, fan, electric blanket, etc. If your temperature requirements differ from those of your sleeping partner, consider negotiating to arrive at a mutually satisfying arrangement.
5. General Comfort
Is your mattress comfortable? Is your pillow too soft or too hard? Would you sleep better in separate beds placed side-by-side? Would you sleep better in a queen-size or king-size bed? These and other questions of comfort should always be addressed.
C. Reverse Negative Conditioning
To reverse the insomnia-producing effects of negative conditioning and poor sleep habits, consider trying one or more of the following behavior change strategies:
NOTE: These are often the most helpful and powerful strategies for coping with insomnia. They often require substantial patience and commitment, however, since most established habits are difficult--but not impossible--to overcome.
1. Create Positive Pre-Sleep Rituals
Try reading, taking a warm bath, listening to soft music, or anything else that relaxes and pleases you on a regular basis before going to bed. Avoid any activities that might be arousing, stimulating, or worry-producing, unless they help you relax and get to sleep (e.g. sex).
2. Go To Bed Only When Sleepy
Don't use your bed for any other purposes other than sleep (and sex). Do not use your bed to work, to read, to watch television, or for any other purpose. Do these things in another room, at your desk, in a chair, on the floor, etc. When you finally feel sleepy, stop these activities and get into bed. (This strategy "positively" associates your bed with feeling sleepy.)
3. Avoid Trying To Sleep
By now, you should understand that the more you try to will yourself to sleep, the worse your problem will become. Remember, sleep is not a "task" to be performed. It requires a relaxed, calm, peaceful state which usually means you are not willfully trying to do anything!
If you tend to think at bedtime, don't let yourself think about work, problems, goals, projects, or other important considerations. Save these for the daytime hours, when you are more alert and can possibly do something about them.
Try to think about stupid, inconsequential, boring things instead.
NOTE: It is much, much easier to change the focus of your thinking than to keep yourself from thinking at all. Think about this for a minute. Now think about chickens. Now think about a quiet lake with a row boat floating peacefully on the surface. See, that wasn't hard, was it?
4. Establish A Regular Wake Up Time (Regardless Of How Much Sleep You Get)
One of the best ways to break an insomnia problem is to establish a consistent wake up time and force yourself to stick to it seven days a week. For instance, set your alarm for 8 A.M. every day, and force yourself to get out of bed and get moving no matter how you feel at that time. Don't allow yourself to sleep later on weekends or on days when you don't have any responsibilities in the morning.
By establishing a consistent wake up time, you encourage your body and brain to adopt a consistent sleep-wake cycle. After a while, this conditioned sleep-wake pattern will take over naturally on its own.
NOTE: When you first try to institute this and other strategies in this section, you may sleep worse at first. If you stick with the basic strategy, however, it will usually work out in the long run. For example, if you try to set a new wake up time but find you are waking up too early, go to bed later each night and you will soon find that the problem is corrected.
5. Set Aside Time To Worry (30 minutes) Before Going To Bed
While this may sound silly, it actually works for many people! If you tend to worry excessively whenever you try to sleep, set aside a period of time (no more than 30 minutes) to get all your worrying and thinking done before bedtime. Make a list of all your immediate problem and concerns. Write down one or two actions you could take tomorrow or in the near future to help resolve them. Then go to sleep knowing that you've given serious thought to each of these problems.
If you are lying in bed and begin to think of a new problem or difficulty that you forgot to consider, get out of bed, write it down, think about it for a minute, then get back into bed and forget about it. By all means, don't allow yourself to lie in bed thinking about it. If you do continue to think about it, force yourself to get out of bed until you are finished doing so.
Some people also find that keeping a small pad and pencil by their bedside is also helpful. If they awaken during the night with a critical new thought or idea, they can quickly jot it down, thereby avoiding any worry or anxiety that they will forget it come morning.
The bottom line is to condition yourself positively to associate your bed and bedtime with not-worrying rather than worrying. You may have to be somewhat creative to make this sort of change, but the results are very gratifying.
6. Limit Time Awake In Bed
Another very important strategy is to limit the time you spend awake in bed, particularly if you are unsuccessful at either getting to sleep or staying asleep.
If you are unable to fall asleep, don't stay in your bed for more than 10-15 minutes. Get up, get out of bed, and do something productive or enjoyable (but not stressful or overly stimulating, such as working on your taxes, paying bills, etc.). Read, watch television, go to another room, and when you eventually feel drowsy, get back in bed and allow yourself to peacefully go to sleep. If 10-15 minutes go by again and you are still awake, get out of bed and repeat the strategy again.
If you religiously stick to this strategy, you will eventually sleep better in the long run. This is because you will be avoiding the "failure-- worry--more failure-- more worry" cycle that leads to negative conditioning and negative sleep associations. Even though you may lose more sleep at first and have a slight increase in daytime drowsiness (which you should expect and take precautions not to engage in dangerous activities), your sleep should eventually improve.
NOTE: It may take as long as 2-3 weeks before this strategy begins to pay dividends.
7. Try Sleeping In Different Locations
Another useful strategy is to change your sleep environment. Since your main environment (usually your bedroom) can become negatively associated with sleep, you may find that you sleep much better in non-familiar surroundings.
Try sleeping in a guest room, on a couch in your living room, on the kitchen floor, a motel, etc. This may sound strange, but it works for many people! If you find that this helps, it should a clue that negative conditioning and negative associations are probably playing a role in your insomnia. Once you know this, you can apply some of the other strategies discussed in this section to reverse these negative patterns of thinking and behaving.
D. Avoid Alcohol, Caffeine, Nicotine (Especially Late In The Day)
If you are having trouble sleeping, it is best to avoid alcohol, caffeine, and nicotine altogether. For example, the caffeine you ingest from one or two cups of coffee or tea can effect your brain for 12-24 hours! Similar effects can be produced by colas, chocolate, diet pills, and other caffeine-containing substances. If you can't stay away from these completely, try not to use them after lunch.
While alcohol may relax you and help you get to sleep, it can disturb nighttime sleep activity in your brain. This can cause you to wake up more frequently during the night and fail to obtain the deep sleep that is needed to refresh you.
Smoking and other sources of nicotine (such as nicotine gum or patches) can also interfere with sleep. Nicotine is a powerful brain stimulant. When heavy smokers quit the habit, their sleep often improves in the long run.
Be careful not to abruptly withdraw any of these agents, especially if you have used them daily for months or years. Acute withdrawal reactions, and the arousal state that accompanies them, can often interfere with sleep and make your insomnia worse. For best results, consult your physician about how to gradually taper down and eventually discontinue these substances.
NOTE: chronic alcoholics may have disordered sleep patterns for months or even years after cessation of drinking.
E. Don't Nap During The Day
While napping during the day might seem tempting--and even helpful--it can also work against you. Sleeping during the day makes it harder for you to get to sleep at night. This keeps you from establishing and maintaining a regular sleep-wake cycle, which is one of your best defenses against insomnia. The failure to sleep well at night also makes you prone to develop other bad sleeping habits and negative sleep associations.
Frequent daytime napping can even reset your biological clock, thereby making it even more difficult to regain normal sleep-wake timing. For these and other reasons, it is usually better to deprive yourself of napping during the day so that you will feel more tired and sleepy at night.
NOTE: Some people, like the elderly, paradoxically find that napping during the day helps them sleep better at night. If this is true for you, it's fine to continue this pattern. Also, an occasional nap during the day may be fine for many individuals, just as long as it doesn't prevent the return to one's normal sleep-wake cycle.
F. Exercise
Regular exercise can also improve your sleep. The amount and timing of exercise are both important for achieving this goal.
In general, research has shown that the best time to exercise (for the purpose of improving sleep) is six hours prior to bedtime. Thus, for most people on a normal schedule, exercising late in the afternoon or early in the evening is best.
If you exercise early in the morning or too close to bedtime, this benefit may be lost. Exercise improves sleep by producing changes in chemical reactions throughout the body and the brain. Its effects may also be mediated by body temperature increases which occur with exercise. If you exercise too early in the day, these changes might wear off by bedtime. On the other hand, if you exercise too close to bedtime, these very same changes will be at their peak, and the resulting stimulation and body arousal may actually keep you awake!
For best results, it is good to exercise moderately for at least 20 minutes at a time, 5-6 days a week. The intensity and duration of exercise are not nearly as important as the long-term regularity of 20 minutes, 5-6 days a week, week after week, month after month, year after year.
If you are unable to exercise or are restricted from doing so for any reason, try taking a hot bath or hot tub about 2 hours (not six) prior to bedtime. The resultant increase in body temperature may give you some of the same sleep benefits that others obtain from exercise.
NOTE: Before you begin a new exercise program, see your physician for an examination. Also, if you experience any chest pains, shortness of breath, or other physical symptoms during exercise, consult your physician immediately.
G. Bedtime Snack?
Some people find that a bedtime snack helps them sleep. Others find that eating or drinking too close to bedtime keeps them awake. Since both hunger and eating too much can interfere with sleep, you will have to experiment to see what works for you. (Remember, eating close to bedtime can cause you to gain weight!)
Which types of foods are most helpful? Research dating back to 1937 shows that warm milk, with or without cookies or other food, is beneficial (although high in calories and cholesterol). Warm milk may be better than cold because of the body temperature effect noted above.
Turkey, which is high in trypophan--an amino acid converted by the body to serotonin, a brain chemical believed to aid sleep--is also thought to be helpful. Commercial tryptophan products should be avoided, however, since a recent outbreak of health-related side effects and manufacturing impurities has been reported.
It is also best to avoid excessive liquids within 1-2 hours of sleeping. This is especially true if you have bladder problems, prostate problems, or other urinary tract conditions.
H. OTC Sleeping Pills?
Over-the-counter sleeping aids generally contain antihistamines, which are known to induce a mild state of drowsiness. These agents are sometimes helpful for mild forms of insomnia. Care should be exercised in their use, however, since antihistamines can aggravate prostate problems and glaucoma.
I. Shift Work
If you do shift work, you must pay more attention to your sleep routine than other people. Especially important is the need to protect your sleep environment and designated sleep time. Since most other people will be up and around during the time you need to sleep, you must keep them from interrupting you.
Napping may be useful to catch up on lost sleep, but it is best to establish a daily sleep routine and do what is necessary to maintain it religiously.
You should also avoid using caffeine or other "stimulants" while on night duty, since these can interfere with your sleep the next day. Occasional use of sleeping pills might be needed, but you should avoid becoming dependent on frequent or daily use of these agents.
J. Learn To Deal With Stress
One of the best things you can do to prevent or eliminate insomnia is to learn how to deal with stress more effectively. Most people experience periods of anxiety, tension, worry, or irritability from time to time. These negative emotions can build up during the day and affect your ability to rest at night. In addition, unresolved conflicts and unexpressed emotions, which many people try to suppress or ignore, can come out at night in the form of troublesome dreams or the inability to relax when going to sleep.
Medications such as tranquilizers, anti-anxiety agents, and antidepressants, which many people use when under stress, can also disturb sleep. So can the increased use of cigarettes, caffeine, and alcohol which often accompany periods of emotional and psychological upheaval.
One way to mitigate stress is to use relaxation techniques. These include meditation, biofeedback, yoga, self-hypnosis, and other relaxation skills that can be used during the day or at bedtime. These techniques don't work for everyone, but you might want to give them a try. It's best to practice with any of these techniques during daytime hours for several weeks before trying to use them at night. This will help you avoid premature failures or the disappointment that follows from excessively optimistic expectations.
Many people discover, however, that the best way to deal with stress is not by learning how to manage its symptoms, but to learn how to identify and deal with its underlying causes. Most stress management techniques, such as exercise, dietary changes, and relaxation procedures, are symptom-oriented approaches. If you're worried about finances, or if you're having relationship conflicts both at home and at work, these coping strategies will usually be insufficient.
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K. When To Seek Medical Advice?
If you are having chronic or recurring sleep problems that don't clear up with the measures discussed above, you should consult your physician. Also, if you are feeling severely anxious or depressed, or if your sleep is being disturbed by pain or other physical symptoms, you should definitely notify your physician. You might need to be tested for a thyroid disorder, diabetes, or other medical problem. You might also need advice about pain medication, sleeping pills, antidepressants, muscle relaxants, or other prescription remedies.
Quinine, for example, is often helpful for relieving painful muscle cramps at night. Arthritis pains can be controlled or relieved by various anti-inflammatory substances. And if you have Restless Leg Syndrome, your doctor might choose to prescribe Klonopin (clonazepan), Sinemet (L-dopa), or other agents that frequently help this disorder.
Also, if you are thinking about using prescription sleeping pills, you should discuss this decision with your doctor. All major sleeping pills interfere with normal brain wave patterns during sleep. All can affect daytime functions, including memory, concentration, and rapid response times. In addition, the abrupt withdrawal of sleeping medication after prolonged--or several days of--use can lead to "rebound" insomnia.
While short-term use of sleeping medication is appropriate in certain instances, long-term use is rarely the answer. Most long-term insomnia can be corrected or controlled with behavioral, psychological, and other non- pharmacologic interventions.
Sleeping pills should definitely be avoided if you are pregnant, possibly pregnant, or are considering getting pregnant. They should also be avoided if you are elderly, if you work in a dangerous occupation, if you tend to drink alcohol, if you are taking other prescription medications, if you have severe kidney or liver disease, if you have any suicidal thoughts or tendencies, or if your bed partner complains that you snore excessively (this may be a sign of sleep apnea which can worsen with certain sleeping pills).
You should always use the lowest dose of medication that helps you to sleep, and discontinue usage as quickly as possible. Infrequent usage may sometimes be justified, but long-term administration should generally be avoided. (Never abruptly stop any sleeping medication you've been taking for some time without first consulting with your physician. In addition to rebound sleeplessness, you might also experience seizures, confusion, agitation, and possibly even death!)
NOTE: Some people with severe, persistent insomnia may need long-term treatment with sedative/hypnotic drugs. Since most of these drugs disrupt normal sleep activity in the brain, however, they should not be viewed as a good long-term solution.
L. Referral To A Sleep Center?
In most cases, referral to a sleep center is not necessary. It is most useful for people suffering from narcolepsy or a condition known as obstructive sleep apnea. Both of these disorders generally present with profound, uncontrollable daytime drowsiness, without obvious sleep disturbances.
While people suffering from the Restless Leg Syndrome are sometimes referred to sleep centers for testing, it is usually not necessary to do so. The diagnosis can usually be established from the typical history of abnormal sensations in the legs, and a trial of medical therapy can be initiated on this basis alone.
M. Sleep Logs And Diaries
Sometimes, keeping track of sleep patterns and habits can be very helpful. A sleep log or diary can be kept at your bedside and information can be recorded each night and the following morning. Notations can be made about the time one gets into bed, time of awakening, number of hours slept, number of wake up periods remembered, coffee consumption, cigarette usage, etc.
After several days to weeks of using a sleep log or diary, certain patterns or relationships may come to light. For example, if you notice you sleep worse on days when you drink more coffee, try cutting back on your use of caffeine and use your sleep log to track what effect this has. You can also use a sleep log to track any other pattern or intervention you choose to modify.
Sleep logs increase your awareness of habits, patterns, and other sleep- related behaviors. They can be used by you alone, or they may be prescribed and monitored in partnership with your physician.
While most people don't accurately remember how long it took to get to sleep or how many times they awoke during the night, their estimates correlate well enough to spot important trends and tendencies.
You can design you own log if you want, or make use of the sample one included with this report. For most logs to be helpful, you must use them consistently for at least 1-2 weeks.
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