Dr. Renu Lalwani offers advice on how to treat insomnia so you can establish ‘good sleep hygiene’ - a bedtime routine that will help you get the rest you need!
When treating insomnia, there are two key factors you need to keep in mind
1. Address any underlying cause for your condition, and
2. Establish a clear pattern of good sleep hygiene.
First, if you’ve been diagnosed with an underlying medical condition, psychiatric illness, substance abuse, prescription medications or sleep disorder that may be precipitating or exacerbating your insomnia, work with your doctor to make sure you have the right diagnosis, appropriate treatment, effective pain control or alternative treatment options to treat the condition adequately.
On the other hand, if you don’t quite know what’s causing your insomnia, here are some suggestions on how to treat it.
Generally, relaxation techniques (cognitive behavioral therapy or CBT) are recommended as the first line of treatment because they are safe and equally or more effective then sleep medication. These techniques include breathing exercises, meditation and muscle relaxation to release tension and anxiety.
You also can use “stimulus control” at bedtime to change your behavior so that going to bed is associated with comfort rather than anxiety. This means your bedtime routine, bed and bedroom should only be associated with sleep - not lying awake in bed, not eating, playing games or watching TV.
Here are some simple Do’s and Don’ts to help.
- Keep physically active: try 20-30 min of aerobic exercises, if possible daily and 5 to 6 hours before bedtime.
- Have an early dinner!
- Stick to a sleep schedule. Keep your bedtime and wake time consistent from day to day, including on weekends.
- Make sure your bedroom environment is comfortable for sleeping.
- Keep the temperature comfortable, usually cooler than during the day.
- Make your bedtime ritual a soothing one - have a warm bath, a gentle massage by your partner, comforting music, yoga, transcendental meditation, breathing exercises. Do the one that works best for you and your body.
- Keep the doors closed and the bedroom quiet especially if external noise of any kind bothers you.
- Hide your bedroom clocks or keep them facing the wall; otherwise it can cause a vicious cycle of worrying and keeping awake by constantly watching the time tick by.
- if you’re still awake after 20 minutes, get out of bed and do something relaxing, but in another room; (remember the bedroom and bed is only for sleeping or sex); return to bed when you feel drowsy.
- Play gentle background music or put the fan on if you are bothered by tinnitus, snoring, or try earplugs.
- Try some light reading or listening to soothing music.
- If you’d like to practice progressive relaxation lie or sit comfortably and close your eyes; focus or think of something pleasant or neutral - a word or a place; start with your facial muscles - contract them gently for one to two seconds and then relax, repeating several times. Then progress with same steps down to your jaw and neck muscles, upper arms, lower arms, hands, chest, abdomen, back /pelvis thighs, calves, and feet. Repeat this cycle for 30- 45 minutes, if needed, till you establish a relaxed breathing pattern and body feels free of tension.
- Avoid late daytime naps.
- Don’t eat large meals at dinner (to prevent gastroesophageal reflux and frequent urination).
- Don’t drink caffeine or alcohol in the evening. The caffeine in that afternoon cup of tea can keep you from falling asleep at night. As for alcohol, it may initially make you feel sleepy, but can cause unrestful sleep and frequent awakening.
- Avoid OTC medications or products that contain caffeine or other stimulants, such as pseudoephedrine (Sudafed/Actifed /cold sinus meds like Dayquil, etc).
- Don’t keep computers, electronic gadgets and TV in your bedroom.
- If light bothers you, keep the room dark and use a nightlight which you can switch off when needed.
No snacking, playing games texting or watching TV in the bedroom; if you are already awake, these activities won’t make you sleepy.
- Avoid trying hard to sleep; the harder you try the more difficult it becomes to relax and sleep.
Suffer from jet lag?
- Get back on track by using sleep restriction or partial sleep deprivation techniques ; this will make you tired the next day and slowly help restore your usual bedtime, rising time and the total sleep time.
- Sleep experts and behavioral and cognitive therapists can assist with this; you’ll need to maintain a sleep log/diary to help them help you.
- Also, if you find you’re sleeping too early or waking up too early, you can try Natural day light or artificial Light therapy (Phototherapy) to restore your internal clock.
Insomnia is usually treatable, regardless of your age. The key often lies in a good sleep hygiene and sometimes assistance by your physician. If however, cognitive behavioral therapies fail to restore you to good sleep, then consider medications, but remember, they should be used as an adjunct but never as an alternative. More on medication in our next installment.
The information presented in this article is offered for educational and informational purposes only and should not be construed as personal medical advice. You should consult with your personal physician/care giver regarding your own medical care.