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When Sleep Won’t Come…Do You Need Help?

By Dr. Alex Dimitriu, July 11, 2019

We all have occasional trouble sleeping. Anxiety, jet lag, something we ate, or any number of other things can have us tossing and turning restlessly now and then. Most of the time, these episodes of sleeplessness are of brief duration and with resolution of the root cause we once again sleep for seven to nine hours a night. But for millions of Americans, a night of restorative sleep is elusive and with prolonged difficulty sleeping they suffer both immediate impairment to daytime functioning and long-term risks to health and cognitive function.

What can you do if you’re struggling night after night?  When should you seek help? Is it insomnia or a temporary predicament? Here are the five key considerations that can help you determine how to address the problem:

  • How often and for how long have you had trouble sleeping? Insomnia is characterized by a persistent combination of difficulty falling asleep, frequent waking and difficulty getting back to sleep, waking too early, and not feeling rested on waking. It is generally considered chronic if symptoms occur for three nights a week for a period of three months or longer.
  • How are you functioning during the day? Do you have enough energy to get through the day? Are you regularly falling asleep in meetings or classes? Can you concentrate effectively to learn and remember? Are you making errors of judgment? Are you drowsy when driving? Irritable with family or colleagues? Have you noticed diminished sex drive? These are all symptoms of insomnia.
  • How is your general health? Any number of underlying medical and psychological conditions can disrupt sleep. Conditions linked with insomnia include chronic pain, cancer, diabetes, heart disease, asthma, gastroesophageal reflux disease (GERD), overactive thyroid, and dementia-related illnesses. Mental health disorders such as anxiety and depression, including post-traumatic stress disorder, also interfere with sleep. Treating the underlying condition can often improve sleep.
  • What medications – prescription and over-the-counter – are you taking? Many prescription drugs interfere with sleep, including some that treat depression, anxiety, asthma, and high blood pressure. Many over-the-counter medications for pain, allergies, and colds contain caffeine and other stimulants that can disrupt sleep.
  • How are your sleep habits? Changes to bedtime routine and your sleep environment, as detailed below, can make a big difference in helping to overcome insomnia.

Considering these questions can help you decide how to proceed. If you suspect that an underlying medical condition or current medication might be a factor, see your primary care physician to explore your options. And make sure you’re practicing good “sleep hygiene”:

  • Environment: Lower the bedroom temperature at night. Consider room-darkening shades and a fan or noise machine. Change your mattress and pillow if they’re more than 5-8 years old. 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: Go to bed and wake 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. Relax before bedtime – read a book, listen to quiet music, take a warm bath. Relaxation techniques such as breathing exercises, meditation, and guided imagery have a calming effect that can help you fall asleep. If you don’t 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.
  • Daytime habits: Exercise every day 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. Don’t fall asleep in front of the TV in the evening.

If you’ve eliminated a medical condition or medication as the cause of your insomnia and improvements to sleep hygiene haven’t been effective, consider working with a sleep specialist who practices cognitive behavioral therapy for insomnia (CBT-I), a short-term therapeutic approach that focuses on changing the thoughts and beliefs that are driving your behavior and interfering with sleep.

You don’t have to live with insomnia. Simple changes to your daily routines and a short course of therapy can provide a safe and effective solution to sleepless nights.

Bio: 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.

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