Getting a Good Night's Sleep

               I don’t think that there are many things more frustrating than lying in bed for hours, wishing I could go to sleep, or waking up in the middle of the night and not being able to return to sleep.  I know that when this happens, the next day never goes the way I had planned it to go, and the following night often is a replay of the night before.  My anxiety level increases as nights without sleep are followed by unproductive days, and the cycle keeps repeating itself.  So what to do to stop the problem in its tracks?  Getting a good night’s sleep is difficult for 30% of adults on an occasional basis, and 10% of adults report  insomnia severe enough to affect their functioning the next day.  There are different types of insomnia as well, all of which are different from sleep deprivation, which is confused with insomnia by sufferers.  (AASM, 2008). 

Sleep deprivation is defined as occurring when the sufferer does not have the opportunity to go to sleep.  Insomnia occurs when the person would be able to sleep were it not for the insomnia, but is unable to go to sleep or remain asleep once they go to bed.  Insomnia is considered Primary when the sleeplessness cannot be attributed to an existing medical, psychiatric, or environmental cause.  Secondary Insomnia occurs as a result of a medical disorder, a mental disorder, or other sleep disorders.  It may also arise after use, abuse, or exposure to certain substances, (AASM, 2008).

               Symptoms of insomnia may include one or more of the following symptoms:

·        Difficulty falling asleep even though you feel tired.

·        Waking frequently through the night.

·        Having difficulty returning to sleep once awake.

·        Feeling exhausted even though you slept.’

·        Needing to rely on sleeping medication or alcohol to go to sleep

·        Waking too early in the morning.

·        Daytime drowsiness, fatigue, or irritability.

·        Difficulty concentrating during the day, (Saisan, J., Smith, M., Robinson, L., & Segal, R., 2013).

There are also many potential causes for insomnia.  Sufferers routinely report the following stressors as relating to their insomnia:

·        Being under a lot of life stress

·        Being depressed or hopeless, or suffering from Bipolar Disorder or Post-Traumatic Stress Disorder

·        Being chronically anxious or worrying a lot.

·        A recent traumatic experience.

·        Being prescribed medications that affect sleep, such as anti-depressants, cold & flu medications containing alcohol, pain relievers containing caffeine, diuretics, corticosteroids, thyroid hormone, or high blood pressure medications.

·        Having health problems that interfere with sleep, such as asthma, allergies, Parkinson’s Disease, hyperthyroidism, acid reflux, kidney disease, cancer, chronic pain, or Sleeping Disorders such as sleep apnea, narcolepsy, or restless leg syndrome.

·        A sleep environment that is not quiet or comfortable

·        Not spending enough time in sunlight during the day

·        Not having a regular bedtime and time to get up each day, (Saisan, J., Smith, M., Robinson, L., & Segal, R., 2013). 

       Simple insomnia can be relieved by making changes in your schedule that will help prepare you to go to sleep.  Activities such as avoiding strenuous exercise or caffeine late in the day often help the person who is having brief insomnia symptoms.  However, if difficulty going or staying asleep continues for 10 days to 2 weeks or more, a visit with your doctor may be in order.

       When you see your doctor, she will ask you questions about your sleep habits and may do a short physical exam to discover any potential reasons for the sleeplessness.  You may be instructed to make some behavioral changes like having a regular bedtime and time to get up.  They also may prescribe medication for a short period of time to help you get your sleep back on schedule.  Medication is only the beginning, however.  Change in sleep habits and behaviors have proven over time to be more effective than sleep medications.

       There are six different types of medication often prescribed for short periods of time to help correct insomnia.  They are:

·        Prescription sleep medications, such as eszopiclone, (Lunesta), rameltron, (Rozarem), zaleplon, (Sonata), and zolpidem. (Ambien).  These may be helpful over a short period of time, but with longer use, they lose effectiveness unless the dose is increased.  Older people using these medications may have a higher risk of experiencing side effects which may include facial swelling and unusual behaviors like preparing food or driving whie asleep.  Other side effects also include excessive drowsiness, impaired thinking, night wandering, agitation, and balance problems, (Ancoli-Israel, 2009, in WebMD).

·        Benzodiazepines, such as diazepam (Valium), lorazepam, (Ativan), quazepam, (Doral), and alprazolam (Xanax), require a prescription.  These substances are also highly addictive, but they will help you fall asleep or stay asleep.  Because larger doses (and therefore, greater levels of addiction) are required over time, these medications are prescribed only for short periods and are not as popular as the non-benzodiazepine sleeping medications.

·        Over the Counter products containing antihistamines such as Benadryl are often prescribed because a side effect of the contained antihistamine is drowsiness.  These medications are fairly safe if the patient does not overdose and can be helpful to the person with simple insomnia.

·        Herbal Remedies such as Valerian or Melatonin are also sometimes recommended.  However, the efficacy of these remedies is not researched and they don’t always work for everyone.  Additionally, herbal remedies are not controlled by the Federal Drug Administration and product contents may vary with manufacturer.

·        Unapproved prescription drugs such as some anti-depressants like Trazadone (Deyserel), have proven helpful to some patients.  Other drug classifications that have proven helpful to some patients include anti-convulsants, antipsychotics, barbiturates, and nonhypnotic benzodiazepines.  Use of many of these drugs carry a significant risk, (WebMD, 2009; The American Academy of Sleep Medicine, 2008; Saisan, J., Smith, M., Robinson, L., & Segal, R., 2013). 

       Since medications have shown to be helpful only for a brief period, Insomnia sufferers are instructed to make changes in their lifestyles to help them sleep.  Your doctor may recommend meeting with a counselor who can help you learn mindfulness, relaxation, and meditation techniques that will help you prepare for sleep.  Additionally, practicing Yoga or Tai Chi may be helpful.  For people whose insomnia is persistent, Cognitive Behavioral Therapy techniques can help them learn to understand why specific habits and behaviors in their lives affect their ability to sleep.  Learning coping skills to deal with these habits and behaviors will be helpful in being able to sleep as well as have better functioning during waking hours.  Counselors may also provide behavior therapies including:

·        Education about good sleep habits to promote good sleep.

·        Cognitive Behavioral Therapy designed to replace worries about not sleeping with positive thoughts.  This can be done during individual sessions or in a group.

·        ‘Stimulus Control’: Limiting the time spent awake in bed, and associating the use of your bed only for sleep and sex.

·        Sleep Restriction decreases the amount of time you spend in bed, causing partial sleep deprivation, which makes the likelihood of sleep greater the next night.  Once sleep has improved, time in bed is gradually increased.

·        Light Therapy: Uses exposure to light to turn back an internal clock.  Patients who go to sleep too early and then wake too early use natural light or a light box to control their sleep patterns. (Mayo Clinic, 2010)

       A series of behaviors that are consistently practiced to become habits for helpful sleep have been identified as “Sleep Etiquette”.   These behaviors are listed below:

1.      Get regular exercise—stay active.  Get at lease 20-30 minutes of vigorous exercise each day at least six hours prior to bedtime.

2.      Avoid large meals and beverages before bedtime.

3.      Make sure your bedroom is quiet, dark, and cool.  Use of a “white sound” machine or earplugs can control sound, an open window will help keep the room cool, and blackout drapes may be helpful in keeping sleeping space dark.

4.      Stick to a regular sleep schedule.  Go to bed at the same time each night and arise at the same time every morning (including weekends and holidays).

5.      Get out of bed if you can’t sleep.  Change rooms after 20 minutes and read or do some other quiet activity until you feel sleepy.  Then return to bed.

6.      Avoid trying to sleep.  The more you try, the more stressed you become.  Move to another room and do a quiet activity until you feel sleepy.  Then return to bed.

7.      Use your bed and bedroom only for sleep and sex.

8.      Find ways to relax before going to bed.  Develop “Sleep Rituals” that help you prepare to sleep, such as taking a warm bath before bed, drinking Chamomile herbal tea before retiring while reading or listening to quiet music, do breathing exercises, or pray.

9.      Avoid taking naps.  If you must nap, limit it to 30 minutes before 3pm.

10.   Avoid stimulating activity and stressful situations before bedtime.  This includes vigorous exercise, big discussions or arguments, and TV, computer, or video games.

11.   Limit caffeine, alcohol, and nicotine.  Don’t use caffeine for 8 hours prior to bedtime, avoid alcohol and nicotine in the evening because both affect the quality of your sleep.

12.   Discuss medications you take with your doctor.  See if any of the meds you take before bed may be causing insomnia, and if they are, discuss dosing schedule changes with your physician.

13.   Don’t put up with pain when you are trying to sleep.  Make sure the pain reliever you take will control your pain while you sleep.

14.   Hide the clocks.  Being able to see how late it is can stop you from sleeping. (Saisan, J., Smith, M., Robinson, L., & Segal, R., 2013; Mayo Clinic Staff, 2013). 

       Consulting your doctor and practicing changing your habits around sleep can help you improve how rested you feel.  Working with a therapist can also be helpful.  Therapists at the Center for Personal and Relational Development can help provide the support you need as you change your lifestyle.  Give us a call and make an appointment to discuss how we can help.  You’ll be glad you did.

References

American Academy of Sleep Medicine, (2008),  Insomnia, retrieved online 7/27/2013 at www.aasmnet.org

Ancoli-Israel S. Sleep and its disorders in aging populations. Sleep Medicine. 2009;10:S7,

from Mayo Clinic Staff retrieved online 7/27/2013 at

http://www.mayoclinic.com/health/insomnia/DS00187/DSECTION=tests-and-diagnosis

Mayo Clinic Staff retrieved online 7/27/2013 at

http://www.mayoclinic.com/health/insomnia/DS00187/DSECTION=tests-and-Diagnosis.

Saisan, J., Smith, M., Robinson, L., & Segal, R., 2013; Mayo Clinic Staff, 2013.  Retrieved online 7/27/2013

              at http://www.helpguide.org/life/insomnia_treatment.htm#causes

WebMD, (2008) Insomnia—Treatment Overview, Retrieved online 7/27/2013 at

http://www.webmd.com/sleep-disorders/tc/insomnia-treatment-overview