From psychologytoday.com
By Kenneth Zweig MD
Insights into managing insomnia through simple changes
KEY POINTS
- Insomnia affects over 2/3 of American adults, often exacerbated by unhealthy lifestyle choices and stress.
- While commonly used, sleep medications have side effects and can disrupt natural sleep patterns.
- Adopting a consistent routine and creating a comfortable environment are essential steps to combat insomnia.
How often have you stared at the ceiling in the middle of the night, just hoping for sleep? You’ve tried counting sheep, warm milk, and a hot bath before bed, but nothing helps. We’ve all been there. Insomnia is a prevalent condition, and it’s getting worse. Over two-thirds of all American adults experience insomnia at least once per week. There are many reasons for this, but often we (unwittingly) do it to ourselves through bad habits.
Sleep is the most critical factor in good physical and mental health. We just can’t function well without it, so it should be a priority. However, in our fast-paced society, sleep doesn’t feel “productive” or “interesting,” so we tend to push it aside for other activities. Doing this interferes with our bodies' natural sleep cycles, making getting sleep more complicated once we finally try. In fact, in a cruel twist of nature, one of the most common causes of not being able to sleep is not having enough sleep.
So what can you do if you are awake at 2 am every night? First, let’s get the obvious out of the way. Many patients ask me for sleep medication, such as Ambien or Ativan. These medications can have a role in certain situations, but they are far from ideal treatment options. Most sleep aids, including over-the-counter medications, have multiple side effects, including morning grogginess, dependency, tolerance, respiratory depression, worsening mood and a possible association with dementia. Also, these medications interfere with your natural sleep cycles and suppress normal REM sleep. So, although you’re asleep when taking a sleep aid, you aren’t getting the restful, normal sleep you need.
The one exception is melatonin. It’s a mild sleep aid, but it can help with insomnia and increase REM sleep. You can start with 3 mg about 30 minutes before bedtime and increase the dose slowly until you get benefits or side effects. Be sure to get it from a U.S. manufacturer at a national chain store, such as CVS or GNC. These products are not regulated, so you can’t be sure what you’re getting if you’re not careful. I don’t recommend buying non-prescription medications online.
If you don’t like taking pills, there are many other actions you can take to help improve your sleep. A general rule of thumb is that the healthier you treat yourself, the better your sleep will be. Exercise and light meals help, while fatty foods, alcohol and excess caffeine worsen sleep.
Alcohol is a significant factor in insomnia – even one drink per night can negatively impact your sleep. Alcohol is short-acting, so it helps you fall asleep, but then it wears off around 2-4 am. If you have one drink per night and find yourself wide awake at 2 am, the first step is to stop your nightcap for 1-2 weeks to see if your sleep improves.
Here are some other steps you can try that have been shown to improve sleep:
- Keep your bedroom dark; try blackout shades or an eye mask.
- Be sure to have a comfortable, inviting bed and pillow.
- Do aerobic exercise daily, but not within 2-3 hours of bedtime.
- Try anaerobic exercises such as push-ups or sit-ups for 1-2 minutes before bed. This helps consume extra adrenaline that may be preventing sleep.
- Keep regular sleep and wake times, including on weekends.
- Limit alcohol; try weekends only.
- Avoid screens for at least 30 minutes before bed.
- Stop caffeine after 1-2 pm.
- Get sunlight during the day (i.e., go outside).
- Meditate before bed.
But what if you’ve tried all these and are still awake in the wee hours of the night? As I said before, one of the most common reasons for not sleeping is not sleeping. The more tired we are, the more anxious we are about sleep, and the more desperate we become to get some shut-eye.
At first, we may be anxious about work, which causes our insomnia. But after prolonged insomnia, we become anxious about sleep itself, and our bed becomes a place of anxiety rather than a place of comfort.
If this is the case, quit trying. Get up and leave the bedroom. Do something quiet and boring in another room, such as reading a fiction book or doing a crossword or Sudoku until you’re sleepy again. Don’t do anything with your phone or anything related to work or real life.
If it takes 1-2 hours to get sleepy, that’s ok; you probably won’t be able to sleep during that time anyway. You want to break the cycle of being in bed awake.
Are you experiencing insomnia yourself? Try one or two of the actions above to see if your sleep improves. Getting over your insomnia may take several nights of good sleep habits, so be patient. If you’ve tried everything and are still having difficulty sleeping, then it’s likely time to visit your doctor.
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