Strategies for Insomnia

By Mark A O'Rourke, MD

At the Center for Integrative Oncology and Survivorship (CIOS), we have found that the keys to reducing stress and taking charge of one’s health are 1) regular exercise 2) a healthy diet, and 3) good sleeping habits. All three are necessary. This article will address sleep disturbance, also called insomnia, and how to cope with it.
Sleep disturbance is more than just a lack of sleep. It also includes poor sleep efficiency, a prolonged time to fall asleep, low quality of sleep, and waking up in the middle of the night unable to return to sleep. Research has shown that sleep deprivation is tied to overall health including fatigue, distress, decision-making, missed time at work and disability rates. A recent article in the New England Journal of Medicine reported that persistent insomnia can increase the risk of major depression (Insomnia Disorder by John W. Winkelmann, M.D., PhD. New England Journal of Medicine 2015; 373:1437-44). There have also been associations reported between insomnia and increased risk of heart attacks, heart disease, elevated blood pressure, diabetes, and even early death, in people who sleep less than six hours per night. These issues are challenging and cannot just be remedied by taking a pill. In this article, we will discuss strategies for insomnia apart from sleeping pills.
Consultation with a medical provider can be useful in making sure that there is not a health problem that needs to be corrected to help with issues of insomnia. Health issues that can cause insomnia include sleep apnea, obesity, restless leg syndrome, hormone balance issues with aging, specifically decreasing estrogen and progesterone levels in women and decreasing testosterone levels in men. Other causes for lack of sleep can simply be a busy lifestyle and not taking the time to sleep.
There are multiple ways to approach this problem of insomnia. Taking sleep medication is not usually recommended as the first approach to improve sleep and quality of sleep. There are other approaches that can be taken and tried first, saving medication for later down the road and for occasional use. Let us start with a concept called sleep hygiene.
Sleep hygiene may be overlooked or under-appreciated but it is critically important. Sleep hygiene simply refers to reducing activities or behaviors that can interfere with sleep, such as exercising too close to bedtime, drinking caffeine in the evening, or using cell phones or other devices that can increase arousal of your mind. Activities that you can implement to improve sleep are decreasing napping during the day, keeping the bedroom dark, removing the bedroom clock from sight, and making sure that you get enough exercise but not too close to bedtime. In addition, keeping a regular sleep schedule if possible is helpful. This means making sure that you go to bed at the same time each night, awaken at the same time in the morning, and keep this schedule throughout the week and weekends.
There are some good, new models of therapy that can help with insomnia. They are discussed below and are frequently recommended at the Center for Integrative Oncology and Survivorship.
Cognitive Behavior Therapy (CBT) can be implemented in two to four consultation visits or telephone consultations with the physician, nurse, social worker or therapist, along with digital and printed materials to help reinforce the education. CBT ends up being more effective than just writing a prescription for a sleeping pill because the clinician has to also consider the psychological and behavioral factors and then foster self-management skills so the underlying issues are also part of the treatment plan. CBT is available through many healthcare providers and at CIOS.
Mindfulness Based Stress Reduction (MBSR) is a program where clients are guided through a mindful exercise to stay in the present moment, which decreases their overall response to a stressful situation. MBSR is especially helpful for those with distressing situations impacting sleep like divorce, loss or illness.
Mindful breathing education to enhance sleep is a simple set of exercises that are easy to learn. They are helpful for all ages. Please refer to our prior blog “Mindful Breathing to Sleep.”
Yoga is another avenue to explore for insomnia. There are a variety of classes that need to be explored to find the right class for each person. Most exercise facilities have yoga classes and often you are able to try a class for free or at a reduced price. Yoga classes labeled “restorative” or “therapeutic” may be less physically demanding with the goal of stress reduction and improving the mind-body connection.
Insomnia affects everything in one’s life and needs to be addressed. The take-home message, however, needs to change from “just prescribe a sleeping pill” to “let’s look at the choices because a pill shouldn’t be you’re only consistent option.” Learning and implementing some of the above activities can be helpful.

http://www.ghs.org/healthcenter/strategies-for-insomnia/