Insomnia - Jill Kane, Psy.D.
Sarah said it best: “Insomnia sucks!” Jennifer mirrored this when she said, “I can’t sleep, I’m exhausted all the time and it’s ruining my marriage, my parenting, my mood – all are horrible and I can’t get anything done. Help!”
Sleep complaints are a huge issue in my practice. Sometimes the reasons are obvious and, thank goodness, temporary: as any mom can tell you, the pregnancy and post partum period are famous for sleep deprivation. The sleep disruption is due to hormone fluctuations and of course the needs of a newborn. Generally, time solves the issue – hormones settle down, the baby begins to sleep through the night, and the sleep problem resolves itself. Other times, and unfortunately, all to frequently, mom finds herself up in the middle of the night while everyone else in the house is sleeping soundly. As Sarah would say, “that sucks,” and she’s right.
Insomnia seems to affects nearly everybody at some point in their lifetime. Generally, insomnia is described as either trouble falling asleep (primary insomnia) or having trouble staying asleep (secondary insomnia). When insomnia (either kind) only occurs for a night or two, it’s no big deal; however, if it persists it can negatively affect nearly every aspect of day-to-day life. Insomnia has been linked to depression, anxiety, poor job performance, obesity, high blood pressure, and increased susceptibility to disease (especially later in life).
Reasons for insomnia vary. The most common are stress, depression, anxiety, poor sleep habits, sleep apnea (or other medical condition), snoring, medication, caffeine, alcohol (too much, not too little!), changes in the sleeping environment, eating too much late at night, and a learned behavior from many sleep-interrupted nights. Older adults have a higher incidence of insomnia than younger adults. One of the problems in diagnosing and treating insomnia is the circular problem that a lack of sleep has on mood and the impact mood has on lack of sleep. For example, is someone depressed and therefore not sleeping or is someone not sleeping and has therefore depressed? It’s a chicken-egg situation and it is often hard to tell which came first. By the time a person becomes so tired they cry for help, it probably doesn’t much matter anyway
Depending on the cause, there are a bunch of ways to solve your sleep problems ranging from easy behavior changes to more involved interventions like medication or a visit to the sleep research/diagnostic center. If you have a hunch that depression, anxiety, or a medical condition is the origin of your insomnia, please seek medical or psychological advice. Sometimes professional intervention is a fast and effective solution. If you think your insomnia is not fundamentally related to a medical or psychological problem, than there are a bunch of things to try before reaching for the sleep meds. Psychologists use the term “sleep hygiene” as the first line of defense against both kinds of insomnia. Here are some of the tools:
- ·Establish a bedtime routine and stick with it. Warm bath, brush teeth, get into bed, read, turn off light, & goodnight (This is obviously an issue with small children)
- ·Go to bed at the same time every night
- ·Wake up at the same time every morning (weekends included)
- ·Keep the room dark, comfortable and quiet
- ·If you are still awake after 30 minutes, get up. Don’t give yourself the chance to associate insomnia with your bed. Get some decaffinated herbal tea or read on the couch.
- ·Don’t watch TV before bed because it disrupts healthy sleep and may make it harder to fall deeply asleep.
- ·Relax – deep breaths, stretches, and light yoga can help you relax but no hard exercise after 8pm
- ·Cut down on caffeine to one cup a day (in the morning) or cut it out completely
- ·Do not use alcohol as a sleep aid (alcohol may help you fall asleep, but alcohol disrupts sleep patterns and you increase your chances of waking up in the middle of the night. Plus you won’t feel rested in the morning)
- ·Eat before 8pm – but not too much. Warm milk is a natural sleep aid, but other foods also promote good sleep including avocados, almonds, eggs, bananas, halibut, tuna, potato, and walnuts (Sorry, not chocolate!).
- ·If you wake in the middle of the night, soft music or an audio book can help you fall back asleep
If the above behavioral changes don’t help, it may be time to see your doctor. Medications like Ambien, Lunestra, and Trazadone (also an antidepressant) are often helpful in breaking the sleeplessness cycle. If depression or anxiety are possible causes, sometimes an antidepressant can work well as a sleep aid. A doctor can also advise you about various herbal remedies – but feel free to try a sleepy tea as part of a bedtime routine.
There is no set amount of hours that count as “enough sleep.” Some people need 8 hours, others may need 6 or 9. If you are extremely drowsy during the day and/or extremely grumpy, chances are you are not getting enough sleep. Your best bet is to find a bedtime routine and stick with it. Stay consistent, take deep breaths, turn the TV off, and hold off on emotional or stressful conversations. Save them for earlier in the day. So, although insomnia “sucks” and it is a very serious condition, there are some proactive and non-medical approaches to take.
Sweet Dreams.
