I Can’t Sleep Doc, What Should I Do? Part 2
This week I want to focus on basic prevention and treatments for insomnia. If the cause of insomnia is not readily identifiable it’s helpful to keep a sleep diary for 2-4 weeks to share with your doctor. It should include sleep and wake times, naps, and actual time spent sleeping. You can download a blank sleep diary at bit.ly/3KHxjE7.
Poor sleep hygiene is one of the most common things we find when taking a sleep history or reviewing a sleep diary. Sleep hygiene is defined as “daily activities and habits that are consistent with or promote the maintenance of good quality sleep and full daytime alertness.”
When we ask patients what they do when they can’t fall asleep in a few minutes, most people answer that they continue to lie in bed and watch the clock. A key concept to remember is that the bedroom should be reserved for sleep and sex. It should not be used for watching TV, surfing the Internet, playing video games, doing work, exercising, etc. Your brain needs to be trained that when it’s in that room it should be shutting off and recharging.
If you find yourself in bed unable to sleep, you should get out of bed and go to another room. Engage in a low-energy activity such as reading or perhaps doing a crossword puzzle. The room should have the minimum light you need to do the activity. Do this until you become drowsy and then go back to bed. If you find you can’t sleep after 15-20 minutes, get out of bed again and repeat the process. You may have to do this numerous times. However, don’t be tempted to sleep in the following day – the total hours you spend in bed should remain about the same each day.
It’s important to have a ritual before going to bed. This should include quiet “wind down” time for at least 30 minutes before retiring. A warm bath or shower two hours before bedtime can be helpful for some people. A light snack may also promote drowsiness.
It is very important to try and maintain a consistent bedtime. It seems that a consistent wake time is even more important. This is extremely difficult for folks that may work nights Monday through Friday who are then off on the weekends. They need to try and maintain the same schedule as closely as possible and get the same total number of hours of sleep that they get while working nights.
A tip for night workers is to put on dark wrap-around sunglasses before leaving the workplace and wear them until you get in a dark room at home. This helps to keep the brain’s daytime switch from being turned on and allows you to get to sleep more easily.
If you’re still having trouble sleeping, it can be helpful to meet with a therapist to discuss relaxation therapy. Prayer and meditation are also commonly used to help the brain relax. Cognitive Behavioral Therapy for Insomnia (CBT-i) can be very helpful with difficult cases; you can read more online at mayocl.in/2LSrmp8.
I touched on medications last week, but I want to briefly mention drugs that frequently cause insomnia. Caffeine can stay in the system for up to eight hours so don’t consume it within eight hours of bedtime if you’re having trouble sleeping. Cold medications containing pseudoephedrine (Sudafed®) keep the brain awake. Nicotine is also a stimulant, so if you’re a smoker, you should discuss quitting with your doctor. Alcohol is the last thing you want to consume if you’re having trouble with insomnia; it prevents the brain from getting into the deep stages of sleep.
There are some natural products, particularly melatonin, that can help some people. It’s important to start at a low dose, perhaps 1/2 to 1 mg, and to take it at least two hours before bedtime. Prescription sleep medications should be the absolute last resort for treating insomnia. These medications are all very addictive and may cause unwanted or dangerous side effects in some people, particularly the elderly.
An excellent resource for more information on insomnia can be found at bit.ly/39XAkPC.
Dr. John Roberts is a member of the Franciscan Physician Network specializing in Family Medicine.