How to Stop Taking Pills Without Relapsing into Insomnia

From todoalicante.es

By Doménico Chiappe, Madrid

Patients arrive medicated from primary care when the condition is chronic. Three specialists discuss how they help patients stop taking medication

More than six million people in Spain regularly consume hypnotic sedatives, such as sleeping pills or benzodiazepines. This is especially prevalent among women, increasingly younger, according to data from the Ministry of Health's Survey on Alcohol and Other Drugs. "We live in a country where more sleeping pills are consumed than anywhere else. The problem is that higher doses are needed over time due to tolerance, leading to abuse. In this case, the patient faces two issues: insomnia and abuse," says Carlos Egea, president of the Spanish Federation of Sleep Medicine Societies (Fesmes). "Each year, the proportion of people taking them increases," confirms Ainhoa Álvarez, president of the Spanish Sleep Society. "Most drugs used for insomnia, though not all, are benzodiazepines, which cause dependence and tolerance."

When they reach the specialist, patients with sleep problems are already medicated. "An insomnia patient sleeps poorly or little, struggles to fall asleep, or wakes up and cannot return to sleep, and then feels unwell during the day. A diagnosis must rule out other sleep disorders and confirm insomnia," Álvarez continues. "The issue is that by the time they reach the Sleep Unit, they have often already been through primary care and have been prescribed medication, which is the quickest way to sleep."

The use of these drugs begins before the age of 15 in Spain, with an average age of 46. The groups with the highest consumption have low educational levels and work in unskilled manual jobs, administrative roles, rural areas, social services, or are unemployed, according to the 'Conclusions of the Gender Working Group of the Spanish Council on Drug Addiction and Other Addictions'. "If after an evaluation we diagnose chronic insomnia, the first-line treatment is cognitive-behavioural therapy. If there is no response, it is combined with pharmacological treatment to address the underlying mechanisms and correct the disorder with medication," recommends Adolfo Alcoba, a member of the Sleep Alliance. "The question is what to do if there is already dependence and the patient has been taking medication for a long time and developed tolerance."

"There are two public health issues: general sleep problems and the high consumption of hypnotic sedatives."

The most common drugs for insomnia cause cognitive decline in the elderly, affect memory, create dependence, and require increasingly higher doses until they become ineffective, Alcoba states: "Here are two major public health issues. First, general sleep problems, affecting 40% of the population; and second, the high consumption of benzodiazepines and hypnotic sedatives. We need to reduce this percentage to a minimum. But if someone goes to their GP and says they can't sleep or wake up very tired, they are often given a pill by default. Can they stop taking it later?"

                                                                   A person sitting on their bed at night. (R. C.)

This week, the Sleep Alliance presented the 'Practical Guide to Cognitive Behavioural Therapy for Chronic Insomnia', on psychological intervention in these cases, as the first level of care and to help stop these drugs. This guide outlines several steps: the patient must learn what induces sleep and how to manage these factors, develop a "sleep hygiene routine", control alert stimuli, and apply various measures during insomnia, restrict time in bed, and feel the "pressure of sleep, because if a person doesn't go to sleep and watches TV or uses their phone, they won't sleep and become more alert," says Alcoba, co-author of the study.

"Thoughts about their insomnia problem, which can be intrusive, are changed."

"It has two parts. In the behavioural part, the patient is taught to adopt more suitable behaviours to overcome insomnia, as sometimes we make it worse. For example, staying in bed for too long, hoping to fall asleep. So, we work to change these patient behaviours. In the cognitive part, thoughts about their insomnia problem, which can be intrusive or myths about sleep, are changed," Álvarez explains about a treatment that "is often not offered in the National Health Service. Ideally, this therapy would be provided in primary care."

Years Go By

Something that is not a myth is that insomnia increases with age. "Yes, because we have more problems as we age. Mr. Prostate, Mrs. Hot Flushes, Mr. Pain. Older people have fragmented sleep and not the continuous sleep we all desire. It's more complicated," Egea states. "The age range for sleeping seven to nine hours starts at twenty and goes up to 65, pressured by our working lives. Then comes retirement, which allows more time for sleep, but there are also doctors, anxiety... Each stage has its general problems."

With age, night-time awakenings become more frequent and especially "longer," says Álvarez. "When you're young or a child, you wake up several times at night; it's normal to wake up three or four times. But we turn over, go back to sleep, and don't remember because it lasted thirty seconds or a minute. But when awakenings are longer, we are more aware and have less deep and shorter sleep. Sleep also changes with age. An elderly person may sleep less than two hours at night but take one or two naps, mid-morning and mid-afternoon."

One or Two Naps

Is it beneficial and advisable to take a nap? The experts' answer is 'yes'. "Napping is good, but always short. Less than 30 minutes," Álvarez maintains. "Our brain is programmed to nap, but if it's too long, it will take away from night-time sleep. We tell insomnia patients not to nap for more than 30 minutes, although it depends on each case. Some people work nights, sleep little, and then take a long nap. So, everyone has to adapt their lifestyle."

Egea agrees: "It's only good for about half an hour. The nap complements a little but doesn't replace night-time sleep. It doesn't take away from night-time sleep afterwards, but if you're an insomniac, we don't recommend it."

https://www.todoalicante.es/english/stop-taking-pills-without-20260430100423-nt.html

Want to Fall Asleep Faster? Try Gaslighting Your Brain

From oprahdaily.com

Psychologists explain why telling yourself to stay awake can have the opposite effect  

If you’ve ever lain in bed desperately willing yourself to sleep (me on most nights!), you’re familiar with a cruel irony: The harder you try to force sleep, the more awake you feel.

When you can’t drift off, panic sets in, and your insomnia feels like a high-stakes problem that needs solving ASAP. After all, sleep supports our metabolism, immunity, and mental well-being, while offering our bodies much-needed time to repair and reset. But the more you try to make it happen, the harder it is to achieve. That’s because sleep is a biological process that “collapses under pressure,” says Shelby Harris, PsyD, a clinical psychologist, sleep specialist, and the author of The Women’s Guide to Overcoming Insomnia.

Fortunately, there may be a simple solution to this type of sleeplessness. It’s called “paradoxical intention,” or pretending you want to stay awake—even when you definitely don’t.

We asked sleep experts about the surprising science behind paradoxical intention, and how you can try it at home.

                                                                                     Getty Images. Oprah Daily.

When Trying to Sleep Backfires

Under normal circumstances, your body builds sleep drive (your natural need for sleep) throughout the day simply by being awake and active, says Colleen Carney, PhD, a professor and director of the Sleep and Depression Laboratory at Toronto Metropolitan University. By the time you get into bed, you should have accumulated enough to drift off easily. But when you lie there willing yourself to conk out (because you’re worried about being well rested for tomorrow’s presentation, or you want to make up for a bad night earlier in the week), that mental effort creates arousal that overrides your sleep drive. Suddenly, you’re wide awake and exhausted.

Over time, this issue can create a cycle of sleeplessness. “The more you try to make sleep happen, the more anxious you get, and the harder it is to attain,” says Aric Prather, PhD, a sleep scientist at the University of California, San Francisco, and the author of The Sleep Prescription. And the more bad nights you have, the more stressed you get about sleeping, which only amplifies your issues.

Many people then try to double down on their sleep efforts: reaching for an eye mask, downloading a white noise app, or going to bed an hour earlier, says Carney. But each of those fixes reinforces the idea that there’s something wrong with you, which only worsens your stress about getting a good night’s rest. “Trying to sleep is like trying to fall in love—it’s not going to work,” she says. “Sleep has to unfold naturally.”

The Simple Magic of Paradoxical Intention

Essentially, paradoxical intention is treating your brain like a petulant child: Ask it to do something and it will do the opposite. In this case, instead of fixating on falling asleep, you lie quietly in bed with your eyes open and try to stay awake—without turning on lights, reaching for your phone, or otherwise engaging your brain. Shifting your mental effort away from sleep in this way can reduce arousal and allow your natural sleep drive to take over, says Carney.

“One of the fears in insomnia is that you’ll lie awake all night long, and paradoxical intention directly faces that fear,” adds Carney. When you’re actively trying to stay awake, you no longer brace for the thing you dread—insomnia—and this reduces the sense of threat around sleep. Threat averted, your brain can relax…and conk out.

This may sound like a TikTok hack, but paradoxical intention is a legitimate technique developed by renowned psychiatrist and neurologist Viktor Frankl to treat anxiety and phobias. It was later adapted for insomnia in the 1970s by psychologist L. Michael Ascher, says Carney, and there is some evidence to support its efficacy.

In professional settings, paradoxical intention isn’t widely used as a stand-alone treatment, Carney says. But it may be included as part of a more comprehensive cognitive-behavioural therapy for insomnia (CBT-I), a structured, evidence-based approach that addresses the thoughts and behaviours that interfere with sleep. “CBT-I is the treatment of choice for chronic insomnia,” Carney says.

Who Can Benefit from This Technique

Paradoxical intention tends to work best for people with sleep-onset insomnia (those who struggle to fall asleep at the start of the night) rather than people who wake in the middle of it, says Carney. It’s especially useful when anxiety about sleeping is part of the problem, adds Prather: not just difficulty sleeping, but stress and worry about that difficulty.

The technique may be less effective for other sleep struggles, says Prather. For example, if you fall into rumination—repetitive, intrusive thoughts that are hard to shut off—lying awake can sometimes give those thoughts more room to spiral. In those cases, strategies that gently redirect your attention, like listening to something calming or reading, may be more helpful. (We’ve got a whole list of ideas you can try.)

If you want to try paradoxical intention, remember that repetition matters. With practice, Carney says, you can potentially learn to trust your body to do what it already knows how to do. As Prather says, sleep is built into our biology—it doesn’t need your help. “If people can just get out of their own way, sleep will happen.”

https://www.oprahdaily.com/life/health/a71119068/paradoxical-intention-for-sleep/

Why Your Brain “Dreams” Even When You’re Awake

From neurosciencenews.com 

Summary: We usually think of wakefulness and sleep as two separate worlds, but new research proves the boundary is an illusion. Using an experimental setup inspired by Thomas Edison, researchers analysed 92 participants drifting into sleep and found that “dreaming” isn’t exclusive to the night.

By identifying four distinct mental states, including a “bizarre” dream state, the team discovered that these experiences occur across all levels of alertness. Whether you’re fully awake or in light sleep, your brain can flip into a “dream narrative” at any moment, suggesting that the content of our thoughts is independent of our state of vigilance.

Key Facts

• The Edison Technique: Following the legend of Thomas Edison, participants held a bottle that would drop as they drifted off, waking them at the precise threshold of sleep to report their immediate “hypnagogic” thoughts.
• The Four Mental States: An unbiased AI algorithm identified four distinct clusters of thought:
  • C1: Fleeting, isolated recollections.
  • C2: High connection to the external environment (street sounds, room temperature).
  • C3: The “Dream State”, bizarre, vivid, and spontaneous (e.g., “aliens” or “ants on crossword puzzles”).
  • C4: Goal-oriented, voluntary control (planning tomorrow’s schedule).
• The Major Finding: All four states, including the bizarre C3 dream state, occurred while participants were fully awake, in sleep onset, and in light sleep. You can “dream” while awake and “plan” while asleep.
• Neural Fingerprint of Bizarreness: The dream-like C3 state has a specific brain signature: reduced long-range connectivity between the frontal (reasoning) and occipital (visual) regions. This essentially allows the visual brain to “run wild” without the logical brain’s oversight.
• Paradoxical Insomnia: The study offers a breakthrough for insomnia patients who feel they “didn’t sleep a wink” despite clinical data saying they did. Their brains may simply be spending too much time in the “environment-connected” C2 state, making sleep feel like wakefulness.

By convention, wakefulness and sleep are regarded as physiologically distinct states. It is therefore tempting to assume that the images, sensations, and ideas that cross our minds while we are awake are fundamentally different in nature from those we experience while we sleep, and especially while we dream.

“Yet this is far from obvious. Being awake is not synonymous with being attentive, fully aware of one’s surroundings, or able to act and think rationally,” explains Delphine Oudiette, co-leader of the DreamTeam.

“We now know that there is a continuum between wakefulness and sleep, with intermediate states such as mind-wandering or mind-blanking, during which certain regions of the brain may be asleep. What remained to be determined was whether the content of our thoughts also varies independently of our state of vigilance.”

To answer this question, the researchers chose to study sleep onset, the transitional stage between wakefulness and sleep.

“Sleep onset allows us to capture, within a very short time span, fluctuations in our state of vigilance, from wakefulness to sleep, and to observe the mental experiences associated with them,” says Nicolas Decat, a PhD student at the Paris Brain Institute and first author of the study.

“As we drift toward sleep, sensations, visions, and snippets of speech unfold—what are commonly called hypnagogic experiences. Tracing the evolution from ordinary thought to dream-like narrative can help us understand how a dream emerges.”

Nap experts to the rescue

To explore the transition between wakefulness and sleep, the team conducted a study with 92 participants who were accustomed to napping and trained to report the content of their thoughts upon interruption.

The researchers used an experimental setup inspired by Thomas Edison. According to legend, the inventor had a habit of falling asleep in his armchair while holding a heavy object, the fall of which would wake him at the threshold of sleep; he would then make use of the whirlwind of creative ideas that flooded his mind during this critical moment.

After each interruption of their nap—either by dropping a bottle held in the hand or by an alarm—participants were asked to describe their mental experience of the previous ten seconds, then rate it on four dimensions: bizarreness, fluidity, spontaneity, and perceived level of wakefulness. In parallel, their brain activity was continuously recorded with an EEG cap.

The researchers then let the data speak for themselves, applying a clustering algorithm that imposed no preconceived categories.

“This data-driven approach was essential for us, because in research, there is no consensus on what hypnagogic experiences actually are. It was important not to bias this exploration with our own definitions or beliefs,” says Nicolas Decat.

A brain signature of dream-like states

The analysis revealed not the two mental states one might expect—dreaming and waking thought—but four. The first (C1) was characterized by fleeting recollections (“An image of my dad crossed my mind”); the second (C2), by a high level of connection to the surrounding environment (“I was listening to the street sounds”); the third (C3), by its bizarreness (“I saw images of small aliens”); and the last (C4), by a high level of voluntary control (“I was thinking about what I would do tomorrow”).

Each of these four mental states appeared across all three vigilance stages measured: wakefulness, sleep onset, and light sleep.

“This is the major finding of our study. The mental states traditionally associated with dreaming can arise just as well when we are asleep as when we are awake. In other words, the content of our thoughts does not follow the boundaries between waking and sleep!

“One of our participants, while awake, reported seeing ants crawling on her body against a backdrop of crossword puzzles. Conversely, another participant mentally went through his schedule for the next day while he was fully asleep,” adds the researcher.

The team then went further, searching for neurophysiological markers specific to each mental state. By analysing the complexity of the EEG signal, its spectral power, and the functional connectivity between brain regions, the researchers identified distinctive signatures.

They show that there is a specific brain signature for the “bizarre” C3 mental content—that is, the dream-like state. It is characterized by reduced long-range connectivity between the frontal and occipital regions of the brain.

“This signature may well be the correlate of what we feel in such a state: lucid reasoning is overtaken by a whirlwind of vivid sensations characteristic of dreams,” suggests Nicolas Decat.

Mental activity and introspection

If dreaming is not specific to sleep, why do we have the impression that extravagant mental content occurs only in the depths of the night, when we are oblivious to the world around us?

“This preconception probably stems from a memory bias. We mainly remember dreams that come with strong emotions or those to which we attach particular meaning. Yet it is just as common to dream that we are working!” notes Nicolas Decat.

“Conversely, some people report that fanciful daytime thoughts—elusive, like fragments of a dream—sometimes surface during their everyday activities. Because these thoughts are seen as incongruous, they may well be more frequent than we imagine, but we tend to dismiss them.”

Potential applications for sleep disorders

We are generally not very good at judging our own level of vigilance or describing the content of our thoughts. As a result, some people suffering from insomnia regularly complain of spending entire nights without sleeping, even though polysomnographic measurements taken in sleep clinics indicate otherwise.

This is what we call paradoxical insomnia: a mismatch between the patient’s experience and clinical observations based on conventional sleep-stage criteria.

“These criteria are probably inadequate. Our study proposes a new one—mental content— which may be better aligned with what these patients actually experience. Through this lens, some of them may spend an unusually long time in an alert state (C2), hyperconnected to the outside world, or, conversely, very little time in a dream-like state (C3), blurring the line between their waking and sleeping lives,” explains Delphine Oudiette.

“Beyond giving patients’ reports the weight they deserve, this approach paves the way to identifying objective markers of insomnia.”

Key Questions Answered:

Q: If I’m “dreaming” while awake, why don’t I notice it?

A: We often dismiss these flashes of “bizarre” thought as mind-wandering or simple distractions. Because they are fleeting and lack the heavy emotional weight of a 3:00 AM nightmare, we tend to filter them out of our memory.

Q: Can I use this “Edison method” to be more creative?

A: Yes. The transition state between wakefulness and sleep is a “creative sweet spot.” By catching yourself right as you drift off, you can access the C3 bizarre state where the brain makes unusual associations that your logical, waking brain would normally reject.

Q: Does this mean “daydreaming” is actually dreaming?

A: Scientifically, yes. This study suggests that the brain’s internal narrative doesn’t check your “vigilance status.” If the connectivity between your frontal and occipital lobes drops, you are technically in a dream state, regardless of whether your eyes are open or closed.

https://neurosciencenews.com/dream-continuum-wake-sleep-consciousness-30637/

This 'healthy' bedtime habit caused my insomnia — a doctor explains why and how to fix it

From tomsguide.com

By Lauren Jeffries

Plus, the '10-3-2-1-0' rule a board-certified sleep specialist recommends to stop middle-of-the-night wake-ups and help me sleep through again 

As someone who writes about sleep for a living, I thought I was doing everything right to sleep through the night: consistent sleep schedule, no caffeine after midday, and a calming night-time routine. So when I started waking up around 2 a.m. night after night, I was baffled.

Why was my sleep suddenly being sabotaged? After combing through my routine for the culprit, I realized that a supposedly 'healthy' bedtime habit could be the cause of my middle-of-the-night insomnia: my sleepy tea.

I reached out to sleep specialist Dr Shelby Harris to find out why, and to learn about the '10-3-2-1-0' rule she recommends for boosting your chances of sleeping through the night instead...

                                                                                          (Image credit: Getty Images)

Key take-aways: At a glance

• My bedtime habit: I was drinking sleepy tea every evening. It was causing me to wake up around 2 a.m. and even though I wasn't desperate to use the bathroom, once awake I couldn't go back to sleep until I did use it.
• The temperature trap: Drinking hot liquids too close to bed can raise your core temperature. This can keep you in a lighter state of sleep for longer, where you're more likely to wake up.
• Bladder irritants: Peppermint and some floral blends can irritate your bladder, making your 'urge to go' feel stronger.
• The 90-minute cut-off: If you can't sleep without a cup of bedtime tea, Dr Harris recommends finishing it around 60-90 minutes before sleep to reduce the chances of it waking you up in the night.
• Fluid-free ways to wind down: Try gentle stretching, reading or using a "wind-down audio program" instead of bedtime tea.
• The '10-3-2-1-0 rule': Dr Harris recommends no caffeine 10 hours before bed, no food or drink (only small sips) 3 hours before bed, no work two hours before bed, no screen time an hour before bed, and not pressing snooze on your alarm.

The 'healthy' bedtime habit that caused my insomnia

                                                                                                       (Image credit: Getty Images)

As part of my night-time routine, I’ve been enjoying a night-time tea with a blend of chamomile, lavender and valerian — ingredients known for their sleep-inducing qualities.

Practising the same activities in the evening can help the mind and body recognize that it’s bedtime and start winding down, so along with my evening bath, book and tidy, my cup of tea became a habit.

I found it was helping me sleep, but I reached out to Dr Harris to find out how effective a tea could be.

Herbal teas like chamomile may have mild calming effects for some, primarily by promoting relaxation rather than directly inducing sleep

Dr Shelby Harris

While the ritual of drinking something warm and caffeine-free can signal to the brain that it’s time to wind down, “it’s not inherently sleep-promoting on its own,” explains Dr Harris.

“The key is what’s in it and how your body responds to it. Herbal teas like chamomile, lemon balm, valerian root, and passionflower may have mild calming effects for some individuals, primarily by promoting relaxation rather than directly inducing sleep.”

So I think my tea habit was helping me fall asleep faster because of my calming evening routine, but why was it waking me up later that same night?

Why it was waking me up at 2am

Even though I wasn’t waking up desperate for the toilet, I always felt like I needed to use the bathroom to go back to sleep once I was awake.

“Even if a tea is caffeine-free, the fluid volume can be enough to disrupt sleep,” explains Dr Harris, adding that “this is one of the most common causes of waking up in the middle of the night.”

                                                                                                                   (Image credit: Getty Images)

“Some people are also more sensitive to bladder filling during lighter sleep stages, so even a relatively small amount of liquid before bed can disturb sleep,” adds the board-certified Sleep Specialist at BetterSleep, advising to drink tea around 60-90 minutes before bed to avoid the issue.

While Dr Harris recognizes the importance of a night-time routine, she recommends a non-fluid-based wind-down instead.

“This might include reading, gentle stretching, guided relaxation, or using a wind-down audio program,” she says.

The new '10-3-2-1-0 rule' I’m sticking to instead to sleep through the night

A sleep rule Dr Harris recommended is the 10-3-2-1-0 rule. This means:

No caffeine 10 hours before bed
No food or drink three hours before bed
No work two hours before bed
No screen time one hour before bed
And 0 times pressing the snooze button

“The 10-3-2-1-0 framework is a helpful educational tool because it simplifies healthy sleep habits,” says Dr Harris.

What’s important if you’re having constant sleep disturbances is discussing potential causes with your doctor

Since implementing this, my middle-of-the-night insomnia has stopped. I fall asleep fast and sleep through the night, without waking to use the bathroom.

It also stops me from scrolling on my phone at night, meaning keeping a regular sleep schedule (one of the most important steps for a regulated circadian rhythm) is easier.

However, despite the sleep expert saying it’s a good guide, “people should do what works best for them,” she advises. “Some people do fine with a light snack or a small amount of fluid before bed, while others are very sensitive and benefit from tighter restrictions.”

“What’s important if you’re having constant sleep disturbances is discussing potential causes with your doctor,” Dr Harris says.

https://www.tomsguide.com/wellness/sleep-problems/this-healthy-bedtime-habit-caused-my-insomnia-a-doctor-explains-why-and-how-to-fix-it