It's pretty normal to experience a restless night of sleep at least once in your life. The scenario could look like this: You're lying in bed wide awake, continuously looking at the clock, thinking about how tired you're going to be the next day, and stressing about when you'll ever fall asleep. For some people, this might happen for one night only, but other people may experience chronic or long-term insomnia.
According to the U.S. Department of Health & Human Services' Office on Women's Health, insomnia is a sleep disorder that is defined as, "an inability to go to sleep, waking up too early, or feeling unrested after sleep for at least three nights a week for at least three months."
Missing out on precious hours of sleep can really mess with your health and lifestyle. You could feel fatigued throughout the day, which can stop you from getting things done at work and in your personal life. When left untreated, it can also lead to or contribute to the development of other health problems, like depression, heart disease, and stroke.
"The definition of insomnia is difficulty initiating sleep, difficulty maintaining sleep, getting non-restorative sleep, and early morning awakenings with the caveat that you are getting adequate time to sleep," adds Rajkumar Dasgupta, MD, assistant professor of clinical medicine at USC's Keck School of Medicine and a spokesperson for the American Academy of Sleep Medicine. "And you have daytime problems—I can't mention that enough. Because quite commonly people always say, 'Hey, I'm getting six hours of sleep but I won three gold medals...' And I'm not worried about that person. What makes me motivated and aggressive about diagnosing and treating a night-time issue is how you're functioning during the day."
So how do people take control of their sleep quality and say goodbye to insomnia? We asked Dasgupta about some of the treatments he recommends to his patients. Just remember that if you do have insomnia, or think you do, you should check with a healthcare professional first before you try any of the below. Sleep problems are very individualized, so what works for someone might not work for you, and vice versa.
Dasgupta says one way to categorize your insomnia is by figuring out if it's acute or chronic. "Acute insomnia usually occurs by having a life-changing event, a marriage, a divorce, a heart attack—and we could refer to that as adjustment insomnia," he explains. "And everyone has it. In theory, at least once the acute stress relieves your insomnia goes away. But there are some people where they are predisposed to insomnia, and once they get a trigger it perpetuates. Based upon definitions, if you're having insomnia for greater than three months, multiple times a week, well then we could call it chronic insomnia."
He also says that there's sleep onset insomnia, which is difficulty falling sleep at the beginning of the night. And then there's sleep maintenance insomnia, which is the inability to stay asleep.
Knowing what type of insomnia you have will help your practitioner tailor a treatment plan for you.
Dasgupta says a lot of people assume that once you visit a sleep doctor, they're going to order a sleep study, but that's not the case for everyone. Your doctor will most likely want to learn more about your lifestyle and health history to understand why you are experiencing insomnia. "You don't need an in-lab or a home sleep study," he says. "The hardest part about diagnosing insomnia is you got to spend time with your patient. You've got to get a good sleep history. And really, [figure out] what medications are they on, what are other medical disorders do they have, what are other triggers. And is there a big psychiatric component?"
Depending on the case, Dasgupta might try cognitive behavioural therapy. According to the Mayo Clinic, it's often the first step for treatment, and is "a structured program that helps you identify and replace thoughts and behaviours that cause or worsen sleep problems with habits that promote sound sleep." This might involve teaching the patient relaxation techniques and imagery, which can take some time and practice.
After finding that cognitive behavioural therapy isn't working for the patient, Dasgupta says he might consider prescribing medications. The type of medication will depend on what types of insomnia the patient has.
Dasgupta says stimulus control and sleep restriction (which we'll get to below) are two classic behavioural therapies he employs. "Stimulus control means the bed is only meant for one thing," he explains. "It is for sleeping, and it means that if you go to bed and you can't sleep within 15 to 20 minutes, you need to leave the bed, do things that are non-stimulating in a kind of a dim light, and then only go back to bed when you're ready to sleep. Easier said than done."
Sleep restriction is what you might guess—a set bedtime and a set wake time. "This includes weekends, holidays, travel... so those are strict foundations of what we do and those can work for people with acute insomnia, and can work chronically," Dasgupta says.
You want to make sure you're eating well and exercising regularly. The Mayo Clinic recommends avoiding large meals and beverages before bed, and avoiding or limiting caffeine, alcohol, and nicotine, which can make it harder to sleep.
Dasgupta says, personally, he thinks meditation is amazing and worth a try because there are very little downsides to it. Studies have shown that meditation can help with sleep, along with anxiety and stress.
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