Tossing and turning, counting sheep, staring at the clock: Sleeplessness afflicts all of us from time to time, a drag on spirits and energy.
According to the American Academy of Sleep Medicine, about 30 percent of adults have symptoms of insomnia: a hard time falling asleep or staying asleep, waking early, or simply sleeping poorly. About 10 percent of people have chronic insomnia.
“Insomnia is part of the human condition,” says sleep specialist Mark Mahowald, MD, a visiting professor of Psychiatry and Behavioral Sciences at Stanford University in Palo Alto, California. “Everyone has it at some point.”
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Fortunately, with lifestyle changes, insomnia can be overcome. Below are its common causes and solutions for each.
1. The cause: Learned sleeplessness. No matter your initial cause for sleeplessness—stress, grief, pain—your concern about it can morph into its own form of anxiety that keeps you awake, says Mahowald: “After several nights of insomnia, many people start worrying about it happening again. By the time they go to bed, sleeplessness is guaranteed because they expect that they won’t sleep.”
The remedy: “You have to re-associate the bed with sleeping,” says Mahowald. “Spend no more than 15 minutes in bed awake. Get out of bed and do something [not work related] like watching TV or reading.” Once you get sleepy, go back to bed. If you can’t sleep in 15 minutes, get up again.
“After a few nights of this, the pressure to sleep will return,” says Mahowald.
Your doctor may prescribe a sleep medication while you get back on track. Options include temazepan (Restoral), or newer options like eszopicione (Lunesta), and zaleplon (Sonata). All three carry some risk of chemical dependence, says Mahowald, so they should be used as briefly as possible and no longer than three weeks. “Over-the-counter sleep medications do not work,” says Mahowald.
2. The cause: Sleep apnea. Sleep apnea is not a true insomnia: it’s a chronic medical condition that causes a person to stop and start breathing during the night, interrupting sleep. “However, people sleep so poorly that they feel terrible the next day,” says Mahowald.
The remedy: Losing weight may help, although many people with sleep apnea are not overweight, says Mahowald. The remedy your doctor is most likely to prescribe is called continuous positive airway pressure (CPAP). “A mask placed over the nose blows air into the upper airway, which keeps it open,” says Mahowald. An alternative: a mandibular advancement device that resembles a tooth guard. “It juts the jaw forward, pulling the base of the tongue forward too, opening the upper airway,” says Mahowald.
3. The cause: Restless legs syndrome. “This neurologic movement disorder is a common cause of severe insomnia, affecting 5 to 10 percent of adults,” says Mahowald. The condition causes uncomfortable leg sensations—a burning or crawling—halted only by rubbing the legs or moving around.
The remedy: The syndrome may indicate low iron levels, so your doctor may check those through a blood test and prescribe iron supplements. Otherwise, he may prescribe a low dose of medications normally used for Parkinson’s disease, pramipexole (Mirapex) or ropinirole (Requip). “Although restless legs syndrome is progressive, it is not related to Parkinson’s,” says Mahowald. Sleep medications are not effective
4. The Cause: Night owl/early bird. Some people find themselves unable to sleep until the wee hours. Others tend to fall asleep early and wake early.
The remedy: “For a night owl, a low dose of melatonin—0. 5 mg—taken several hours before bed may shift a person’s internal clock earlier,” says sleep-medicine specialist David Neubauer, MD, associate director of the Johns Hopkins Sleep Disorders Center in Baltimore. You have to make the change gradually, over several weeks, says Neubauer.
Melatonin is a naturally occurring hormone that helps regulate sleep and wake cycles. It’s available in pill form at most health food stores.
Night owls should also avoid bright evening light from cell phones, computers, or any source. “But go outside in the morning for 20 minutes without sunglasses to get the light,” says Neubauer “That resets the clock.”
Early birds do the reverse, using bright evening light to alter their internal clock and delay their sleep time, says Neubauer: “Increase the amount of light in your living space in the evening or use a therapeutic bright light box.” Light boxes are available online or at some drugstores.
5. The Cause: Bad habits. Coffee, alcohol, bright lights, working hard until the moment you snap off the lights: All of that is a formula for insomnia, says Neubauer.
The remedy: Clean up your habits. Skip the afternoon latte and the evening alcohol. Move to low lights and relaxing activities an hour or so before bed. “Even a few drinks can disrupt sleep,” says Neubauer. “It’s never a good remedy for insomnia. And the combination of alcohol and caffeine is the perfect recipe for bad sleep.”
The Cause: Stress, anxiety, worry. Emotions can keep sleep at bay, at least temporarily.
The remedy: Obviously, try to lessen your stress: that may involve exercising more and adding relaxation exercises like deep breathing to your routine. Although no evidence suggests that natural remedies—like lavender—work, says Neubauer, try them, if you want: “There’s a huge psychological component to sleep, so from that point of view, if you try lavender and it relaxes you, it may help.”
“But most important is creating a relaxing routine at night,” says Neubauer. A warm bath, changing clothes, brushing teeth, dimming the lights: Done regularly, they become cues that it’s time for bed, says Neubauer: “Then let your body and brain do their jobs while you go along for the ride.”