Up to 30% of the general population suffers from problems with sleep, also called insomnia. There are different types of insomnia. Some people have problems falling asleep; others fall asleep without a problem but have problems staying asleep. Still, others wake up very early and don’t get enough rest for the night.
What is good sleep? This might be a funny question. Sleep is sleep! But the truth is that “good” sleep varies from person to person. Some people only need five hours of sleep, whereas others need a good ten hours a night. Also, sleep needs and types of sleep problems change over time – in the same person. But in general, sleep is good enough when you feel rested the next day.
What causes insomnia? Insomnia has many causes, including medical problems (see below for a list), medication side effects (activating medications), stimulants (cocaine, ecstasy, amphetamines), alcohol (alcohol helps initiate asleep but causes awakening a few hours later), drug withdrawal (benzodiazepines, alcohol), and nighttime discomfort (hot room or uncomfortable bed). Psychological reasons for insomnia include nightmares associated with post-traumatic stress disorder, sleep problems from depression or mania, and worrying too much because of anxiety problems or stress. Sometimes a person might have primary insomnia, or insomnia for no clear reason.
What are the symptoms and consequences of insomnia? The occasional restless night is usually benign. Everyone has sleeplessness from time to time. When insomnia lasts days to weeks, it’s considered acute insomnia. On the other hand, chronic insomnia lasts more than a month. Apart from problems sleeping, symptoms of both acute and chronic insomnia include sleepiness during the day, general tiredness or fatigue, irritability, and problems with concentration. The daytime drowsiness can be very troubling. Insomniacs are more at risk of falling asleep at work or when driving.
How can I get good sleep without sleeping medication? Getting enough sleep usually involves what we call sleep hygiene. It includes:
- Sleep schedule. Try to go to bed and get up at the same time every day. Make it a habit and often your body will catch on.
- Calming activities. Learn calming activities to help you fall asleep: muscle relaxation exercises, meditating, breathing slowly, and imagery.
- Tossing and turning. If you’ve been “tossing and turning” for more than thirty minutes, get out of bed and do something else, something soothing. Take a warm bath. Drink a warm glass of milk. Listen to calming music. Don’t exercise, watch an action movie, or do something that will wake you up further.
- Heavy meal. Don’t eat a big dinner right before bedtime. A full, digesting stomach can keep you awake.
- Stimulants. No caffeine, smoking, or other stimulants six hours before bedtime.
- Alcohol. No alcohol six hours before bedtime either: alcohol might help you fall asleep but will wake you up a few hours later.
- Daytime naps. Don’t nap during the day. Napping often causes insomnia.
- Exercise. Get plenty of exercise, but never exercise right before bedtime.
- Environment. Keep your bed and bedroom comfortable and at the right temperature. Make sure the room is dark when you’re trying to sleep.
- Use of Bed. Use your bed for sex and sleep only. Don’t associate your bedroom with awake activities like watching TV, playing video games, or getting work done.
- Worries. If you find yourself stressed out over worries when you climb into bed, consider writing out a to-do list before climbing under the covers. Write the list, take a deep breath, and promise yourself you’ll pick it up in the morning. Don’t take your woes to bed with you at night.
- No stress. Sometimes people can’t sleep because they worry about not sleeping. Remember that occasional insomnia is normal. If you find you fret excessively about restless nights, consider seeing a therapist; cognitive behavioral therapy can work wonders for insomnia.
What if sleep hygiene doesn’t work? Talk to your doctor about medical problems that might be causing your sleeplessness. Problems might include:
- Sleep apnea
- Restless leg syndrome
- Periodic Limb Movement Disorder
- Undertreated pain
Once medical causes have been ruled out, consider medications that can help with insomnia. Your provider will tailor treatment to target your symptoms. This might include treating a different mental illness, like depression, mania, or post-traumatic stress disorder (PTSD). There is a medication that is helpful for nightmares in PTSD. If sleep is the primary problem, there are many sleepers on the market, ranging from sedating antidepressants and antihistamines to benzodiazepines, melatonin agents, and sedatives. Some sleep agents are safe for the long-run. Others, due to addiction potential, are meant to be used for a few weeks at a time, or on an as needed basis. Talk to your physician for more information.