“The night is the hardest time to be alive and 4 AM knows all my secrets.”- Poppy Z. Brite
Insomnia is perhaps one of the most frustrating physical and mental experiences that a human being can struggle with. It is estimated that as many as 30% of people struggle with it on a regular basis. The medical world defines it as a difficulty initiating sleep, difficulty maintaining sleep, waking up too early, and in some cases, non-restorative or poor quality of sleep. To meet the formal definition a person must meet the criteria at least three times per week for a duration of at least one month. Whether you meet the formal definition or not, I’m sure you’ve experienced it at some point in your life. Most do not seek out a formal medical intervention, opting for over-the-counter medications or simply gutting it out for a day or two until the symptoms pass.
Most people who suffer from insomnia will initially take some over-the-counter medication that contains diphenhydramine, an anti-histamine that has sedating qualities, is relatively safe and is highly effective. After a night or two however, its effects wear off and the frustrated insomniac turns to his primary care physician for a stronger pharmaceutical solution. The doctor, who does not have adequate time to do a full medical and psychiatric workup, will prescribed a stronger remedy such as a benzodiazepine or a sedative. These medications also work quite well and will work instantly, but they are not designed for long-term use as a sleep remedy. The individual then gets dependent on them and may suffer from daytime side effects such as drowsiness, poor concentration, and moodiness. In extreme cases, a person is more prone to falls, accidents, and difficulties driving motor vehicles. Long-term use of these medications can result in tolerance and dependence, characteristics of addiction and chemical dependence. Even natural remedies, such as melatonin and herbal teas, will lose their effectiveness over time.
Alcohol is often used as a self prescribed solution to insomnia. Use of alcohol for sleep can actually become a cause of insomnia. Long-term use of alcohol causes a decrease in the quality of stage 3 and 4 sleep, the deepest and most restful sleep stages. It also suppresses the brain’s ability to produce REM sleep, the dream stage in which the brain is its most active and most creative. Alcohol, much like pharmaceuticals, works well initially, creating a tendency towards dependence. Over time, a person who relies on alcohol for sleep runs the risk of becoming dependent upon it, and, of course, some will combine this with pills, a prescription for disaster.
Over the past few years there have been numerous studies which have shown Cognitive Behavioral Therapy to be an effective, non-medical, alternative in the treatment of insomnia. A 2012 research study published in the medical journal BMC Family Practice proved CBT to be superior to medications in the treatment and management of insomnia. CBT strategies were compared to medications in the benzodiazepine, hypnotic, and sedative classes. CBT was proven to be equally effective in the short run. Over the long term, however, it was proven to be more effective, giving longer-lasting relief, while the pharmaceutical interventions lost their efficacy over time.
If you are someone who suffers from insomnia it is a good idea to get in touch with your primary care physician and consult with him or her about what steps you might take. If they suggests a sleep medication, then it’s probably a good idea to ask for some other, less invasive, solution. You may be referred to a sleep study, or a sleep specialist. In the meantime, there’s a lot you can do on your own utilizing cognitive behavioral therapy. Here are some CBT techniques have been shown to work:
⦁ Progressive muscle relaxation. Progressive muscle relaxation involves starting at one end of your body, either your head or your feet, and alternately tensing and relaxing those muscles. noticing the contrast of feelings between a tight muscle and a relaxed one. As you move up or down your body, tensing and relaxing, tensing and relaxing, your body becomes deeply relaxed and you will soon get a drifting kind of feeling conducive to sleep. This technique also works very well with people who experience muscle pain and lower levels of physical tension. Progressive muscle relaxation is best done flat on your back in bed while trying to sleep. If you suffer from low back pain, you may want to put a pillow underneath your knees to take the stress off your spine.
⦁ Meditation. If you meditate on a regular basis, then you know how to quiet your mind. Meditation before bed, or even better, while in bed, can help quiet your mind and prepare you for sleep. Meditation following progressive relaxation as mentioned above, is a great combination to prepare your mind and body for slumber.
⦁ Written exercises. Many people wake up at 2 AM, either replaying something from the previous day or previewing something they have to do the next. Some brief writing before bed can help you put the previous day’s worries and concerns to rest, or set you up with a “to do” list for the next day. No need to worry or replay things in your mind because the invasive thoughts have been captured on paper. You can always refer to them the next day after you wake up from a sound sleep.
⦁ Stimulus control. This involves using your bedroom only for sleep, dressing, or sexual activity. You are conditioning yourself that going into the bedroom involves one of these three activities and nothing else. No computer, television, reading, or anything else takes place in the bedroom. You’ll learn to associate the bedroom with slumber, making sleeping easier.
⦁ Sleep hygiene. This involves making some needed lifestyle changes, eliminating or cutting down activities, behaviors, and the consumption of anything that has the ability to negatively impact your sleep. Cutting out caffeine after 3 PM, cutting down your consumption of alcohol, smoking, and eating too much before bedtime, all qualify as good hygiene. You also want to get into a routine of regular exercise, being sure not to exercise too close to bedtime.
⦁ Sleep environment improvement. This involves making your bedroom more conducive to sleep. Eliminating sources of light by window shades, unplugging computers, and shutting off televisions is all part of that. It has been shown that blue lights from iPads, computer screens, and smart phones contribute to insomnia, tricking the brain into thinking that it is daytime. You also want to have the temperature set in a way that is most comfortable for you. Generally speaking, the darker the room the better.
⦁ Paradoxical intention. This involves trying to stay awake rather than sleeping. The logic is that because you are forbidden to sleep, it becomes almost impossible not to. The secret to this strategy is that you are not allowed to worry about not sleeping. It has been proven in numerous studies that worrying about it actually makes sleep more difficult. The idea behind this strategy is to remain passively awake.
⦁ Biofeedback. No, you don’t need one of those machines with monitors and all those sticky things attached to your brain. Biofeedback simply is monitoring your body’s biological signs such as heart rate and breathing. You can simply use your heart rate or rate of respiration as a monitor. Slowing down your heart rate or your breathing is a great way to relax your body and allow sleep to do its thing. Using your breathing as a biofeedback device is a great skill to develop, as it allows you to relax to prepare for sleep, to handle stress, and to control your ability to do work and exercise. Breathing is always available as a biofeedback technique, and you could not stop it even if you wanted to. Learning to control your breathing can help you function better in virtually every area of your life, including sleep.
If you struggle with sleep on a regular basis, then cognitive behavioral therapy may need to be combined with medication initially. If you are an occasional victim of insomnia, then these lifestyle changes are certainly worth initiating. There are no negative side effects to any of these CBT skills and, whether you have insomnia or not, these are lifestyle changes that will be beneficial for you, in some cases bringing immediate, positive benefits. These are not instant solutions, but are some changes to make as part of a comprehensive plan of physical and mental wellness.
“The best cure for insomnia is to get a lot of sleep.”- W.C. Fields
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