By Dr. Alex Dimitriu, March 12, 2019
Sleep isn’t optional. It is one of our most basic physiological needs, right up there with air, water, food, and shelter. It isn’t heroic to go without sleep and it isn’t true that many people need only four or five hours a night. Most of us need seven to nine hours. Critical functions needed to maintain life and health occur while we sleep and insufficient sleep doesn’t just cause daytime fatigue, irritability, and sleepiness but is associated with a broad range of health risks including heart disease, obesity, diabetes, and a weakened immune system. Sleep is a natural function and critical to our health yet millions of people struggle to get to sleep, stay asleep, and get sufficient restful, restorative sleep.
The cause of insomnia may be as simple as consuming too much caffeine or as complex as an underlying medical condition or a life overburdened with responsibilities. But overcoming insomnia is seldom simple. Many look for a quick fix with sleeping pills, making them one of the most commonly prescribed medications in the United States, but while sleeping pills may be effective for a little while, they do not offer a long-term solution. Troublesome side effects and a fast-developing dependency make sleeping pills effective only for occasional use. Fortunately, there are better and longer-lasting ways of improving sleep.
Improving Sleep Hygiene
Sleep hygiene encompasses lifestyle and bedtime habits that are conducive to restful sleep. Here are the basics of good sleep hygiene:
- Environment: Keep the bedroom cooler at night than during the day; nighttime temperature between 65 and 69 degrees is best for most people. Use room-darkening shades if morning light wakes you too early and try a fan or noise machine to mask distracting sounds. Consider changing your mattress and pillow if they’re more than 5-8 years old. Turn the bedside clock around so you can’t anxiously track the time. Use the bedroom only for sleeping and sex. Don’t work, eat, or watch television in bed. Keep your cell phone out of the bedroom!
- Bedtime routine: Establish a consistent schedule, going to bed and waking up at the same time every day, weekends included. Turn off your computer, tablet and smart phone at least an hour before going to bed; the light from the screen stimulates the brain and makes it hard to fall asleep. Relax and clear your mind before bedtime – read a book, listen to quiet music, take a warm bath. If you’re unable to fall asleep after 15-20 minutes, get out of bed and sit or lie down in another quiet place, returning to bed only when sleepy.
- Food and drink: Don’t eat a heavy meal or drink a lot of liquids close to bedtime. Reduce or eliminate stimulants such as caffeine and nicotine during the day and avoid alcohol in the evening. While it may help you fall asleep, alcohol disrupts sleep during the night.
- Daytime habits: Exercising every day will help you sleep at night but restrict vigorous exercise to the morning and afternoon; relaxing exercises like gentle yoga can be done before bedtime. Limit naps to 30 minutes and never after 3pm. In particular, don’t fall asleep in front of the TV in the evening. Exposure to sunlight or bright light during the day can help you sleep at night.
Cognitive Behavioral Therapy
If you have eliminated an underlying medical condition as the cause of your insomnia and diligently made changes to improve sleep hygiene but still struggle to consistently get restful sleep, working with a sleep therapist who specializes in cognitive behavioral therapy for insomnia (CBT-I) may be helpful. Cognitive behavioral therapy, a form of psychotherapy that aims to modify negative thoughts, emotions, and behaviors, has been proven effective in treating insomnia. The therapist helps you identify and change the harmful thoughts that are interfering with sleep and helps you retrain your brain, which has come to associate time in bed with wakefulness, to associate time in bed with sleep. The core technique of CBT-I is the counter-intuitive therapy of “sleep restriction,” which initially limits the time spent in bed to the time spent actually sleeping and then gradually increases the time in bed as you sleep more.
Cognitive behavioral therapy is the “gold standard” in treating insomnia, usually achieving results in four to eight sessions with the therapist. CBT and improvements in sleep hygiene offer more effective, safer, and longer lasting solutions for overcoming insomnia than medication.
Alex Dimitriu, MD, is double board-certified in psychiatry and sleep medicine and is the founder of the Menlo Park Psychiatry and Sleep Medicine Center in Menlo Park, CA. http://www.doctoralex.com