Carl E. Hunt, MD
National Center on Sleep Disorders Research
No one should underestimate the importance of a good night’s sleep. Sleep deprivation has been linked to an increased risk of depression, weight gain, diabetes and cardiovascular disease.
Nearly half of American adults experience insomnia at some point in their lives. About 15% of the adult population experiences chronic insomnia lasting at least a month. Many sufferers are unwilling to take sleeping pills on a regular basis because they’re afraid that they’ll get “hooked”… find that the pills don’t work effectively… and/or experience side ef fects, such as daytime drowsiness or dizziness.
Recent finding: Cognitive behavioral therapy (CBT) — a behavior/ lifestyle modification and sleep education intervention — was found to be more effective than zolpidem (Ambien), a popular sleeping pill, at helping patients fall and stay asleep. The study, published in Archives of Internal Medicine, looked at 63 young and middle-aged adults with chronic insomnia. About half of those who received CBT, alone or in combination with drugs, were able to fall asleep sooner, compared with about 30% of the drug-only group.
HOW IT WORKS
The goal of CBT is to teach people to alter their behavior and thought patterns to break the insomnia cycle. In some cases, the therapy is initially combined with sleep restriction.
Example: Patients who usually go to bed at 10 pm might be asked to stay up until midnight or later, then get up at 5 or 6 in the morning. They are then more tired when they go to bed on subsequent nights, which helps them sleep better.
A patient typically meets with a therapist for 30 to 60 minutes. One session is adequate in some cases — other patients may require four or more sessions. Not all therapists who practice CBT are trained to treat insomnia, so ask your doctor for a referral to a therapist who is.
STEPS TO TAKE
To get a good night’s sleep…
De-stress before bed. Don’t do anything stressful or stimulating, such as balancing the checkbook or playing computer games, within one hour of bedtime. Insomnia sufferers should give themselves time to unwind and separate from the day’s pressures.
Some patients write down all the things that are worrying them or making them anxious before they go to bed. This can help prevent negative thoughts from intruding when they’re trying to fall asleep.
Get up if you can’t sleep. People with insomnia often get trapped in a worry cycle. They associate going to bed with not sleeping. If they don’t fall asleep right away, they watch the clock… worry about how tired they’ll be in the morning… and get increasingly stressed, which makes it harder to get to sleep.
The solution is to get out of bed if you don’t fall asleep within 30 minutes or if you wake in the night and can’t get back to sleep. Do something quiet and relaxing — watch television, read a magazine, etc. Don’t go back to bed until you feel like you’re ready to sleep.
Exercise regularly. Daytime exercise reduces insomnia and improves both the quantity and quality of sleep. Vigorous exercise isn’t required. Take a long walk… ride a bike … or go to the gym. Exercise at least three days a week — but don’t exercise within two hours of going to bed. It’s stimulating and can make insomnia worse.
Avoid coffee for six hours before bedtime. Everyone knows that the caffeine in coffee, tea or soft drinks can keep you awake. Most people don’t realize that caffeine can stay active in the body for up to six hours.
Don’t drink alcohol late. Even though alcohol is a sedative that can help you fall asleep, it interferes with sleep quality and increases nighttime awakenings. Refrain from drinking alcohol for at least one to two hours before going to bed.
Avoid over-the-counter sleep aids that contain antihistamines. These actually can disturb sleep and make it less refreshing.
SOURCE: Bottom Line/Personal interviewed Carl E. Hunt, MD, a sleep specialist and director of the National Center on Sleep Disorders Re search and professor of pediatrics at Uniformed Services University, both in Bethesda, Maryland.