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By Allan G. Hedberg, Ph.D.
There is little question that insomnia is real. It is a significant problem for 37 million Americans over 55 years of age who do not get enough of the deep, restorative sleep they need to function well. Studies demonstrate that 13 percent of the male population and 26 percent of the female population complain of insomnia. Insomnia is no respecter of person or age. It is found among all ethnic groups. With increasing age, our need for sleep remains about the same. However, the quality of sleep slowly deteriorates. REM sleep becomes erratic and sleep becomes increasingly restless.
Insomnia is generally understood to be a significant sleep disorder if it occurs four or more times per week and is responsible for an adverse effect on one’s life and daily performance. Insomnia calls for a systematic (repeatable and learnable) approach to be utilized to bring about a reasonable sleep pattern.Sleep disorder researchers agree on six factors that contribute to insomnia. These six factors play a role in the sleep patterns of every insomniac and must be addressed if the problem is to be solved. They are:
1. Underlying biological factors (i.e., pain, history of head injury, vascular problems)
2. Underlying psychological factors (i.e., depression, anxiety, worry, anger)
3. The use of drugs and alcohol, including caffeine
4. Disturbing environmental factors (i.e., street noise, barking dogs, stuffy room)
5. Negative learning experiences (i.e., history of all-nighters, changing shift work)
6. Pre-sleep/sleep habits (i.e., emotional talks, TV watching, late night homework)
WHAT TO DO ABOUT IT
There have been many strategies proposed for the treatment of insomnia. For many people, the focus is placed on biological factors; medication therapies are thought of as the “be all and end all” of the problem for this group of people. Unfortunately, medications to aid sleep are not the answer for most people. They can interact with other medications and create other problems. They can hide or cover up other medical conditions needing medical attention. They can impair motor and cognitive functioning if used over an extended period of time. And finally, while they may work for a time, or “fix” the problem on the surface, medication won’t address the root cause of the problem.
For others, insomnia is considered to be a result of learned negative behavior. For these people, there is a need to unlearn certain patterns of behavior associated with insomnia and replace them with new behavioral patterns that promote healthy sleep habits. For example, issues such as engaging in late night activity, talking out personal/emotional problems or going to bed angry need to be addressed. Others approach insomnia with a strong belief in the power of pre-sleep and sleep habits. Some specific home remedies or prohibitions are the answer for them. For example, coffee is not consumed after 6:00 p.m. or certain bedtime rituals must be followed obsessively.
There are as many answers for insomnia as there are people to ask. We all think we know the answer. However, each sleeper must find his/her own answer and then stick with it. Research has indicated that there are some generally accepted strategies that help many people. Each person must find their own strategy. As the saying goes, “One size does not fit all”. Whatever approach is adopted, it is important to start out with the selection of a mattress that fits the weight and frame of your body and your sleep style preference. Bed linens are also a strong consideration. For some, being able to sleep has a strong correlation with the material of the sheets, type of pillow, mattress pad, etc.
HELPFUL HINTS TO HELP SLEEP
1. Exercise in the morning or afternoons but not immediately before bedtime. However, a light evening stroll for relaxation purposes could be helpful.
2. If a nap is utilized during the day, restrict it to one hour and at the same time each day, preferably between noon and 4:00 p.m., as this is the body’s natural down time.
3. Do not consume caffeine beverages such as coffee, chocolate, sodas and tea after 6:00 p.m. Evening alcohol consumption and smoking is not recommended.
4. Use sleeping pills under a physician’s directions and usually not for more than a month or two to break the cycle of insomnia (see medication side bar).
5. Do not eat a large meal within an hour or two of bedtime. A light evening meal is recommended.
6. Develop a pre-sleeping routine such as proceeding through a series of relaxation exercises, listening to music, writing in a daily journal or taking a shower or bath. The use of the radio as part of pre-sleep routine may be helpful to distract interfering thoughts.
7. A bed is for sleeping; don’t use it as a place for eating, watching television, reading or carrying out an argument.
8. If you do not fall asleep within 20 minutes, get out of bed and engage in some relaxing activity for 20 minutes. Return to bed and proceed through your pre-sleeping routine. If you are still not sleeping within 20 minutes, get out of bed again and repeat the relaxing activity. After 20 minutes return back to bed and engage in your pre-sleeping routine. Repeat this procedure throughout the night until you fall asleep. Continue this routine for at least 30 days (see sleep sidebar opposite page).
9. Room temperature and air quality may be important for sleep. Determine what the best temperature is for you and maintain that temperature in the bedroom all night, every night.
10. Sleep the same hours each night of the week. Remember that while 7 or 8 hours of sleep is desirable, the body can function on 6 hours of sleep.
11. Fill out some type of informal log each morning indicating your sleeping pattern from the prior evening, including time to bed, relaxation excercises done, number of awakenings and quality of sleep.
12. Some herbal teas have been found to be soothing and have sedative qualities.
13. If you suspect sleep apnea as the culprit for your insomnia (heavy snoring or gasping for air while sleeping) consult your physician or a medical sleep clinic. Sleep apnea is a dangerous condition that requires intervention.
14. If you are a person who worries and
becomes stressed regarding “problems in living,” do not work on worrisome or stressful projects within an hour of bedtime.
15. Use imagery to your advantage. Select an image that you can focus on while falling asleep. Images commonly used are a burning candle, a favorite vacation scene, clouds, a pleasant fantasy, a waterfall, floating on or sinking into a mattress.
16. Use a muscle relaxation procedure in which five or six muscle groups are sequentially tensed and held tense for 5 seconds, and then relaxed. Do this over a 10 to 15 minute time period starting with the feet and legs and proceeding upward.
17. Should you choose to have a late night snack, it would be best to select foods that are rich in L-tryptophane, an amino acid that may contribute to improved sleep patterns. Examples are milk, eggs, cottage cheese, soy beans, tuna, and turkey.
18. Engage in a mental activity that exercises both sides of the brain simultaneously. The left brain processes linear sequences of information such as saying the alphabet, counting numbers, or lining up objects from simple to complex or from small to large. The right brain processes the visual representation of an activity and creates the visual image of the activity. When both parts of the brain are engaged simultaneously, the brain may be distracted from other activity that interferes with sleep. For example, count backwards or say the alphabet backwards while visualizing numbers or letters being written on a large whiteboard in your mind.
IS A MID-DAY NAP RECOMMENDED?
Some people find a mid-day nap helpful while others do not. It is important if you have insomnia to go to bed at the same time each night and awaken at the same time each day. It is also important if you do take a nap that you do so at the same time each day such as mid afternoon, but only nap for one hour. This is called a “power nap.” Do not sleep for lengthy periods of time. Other than a nap, be sure to program your day so that you will stay awake throughout the day other than the time taken for the power nap of one hour and your regular bedtime.
IS PROFESSIONAL CONSULTATION
INDICATED?
Yes, by all means. Genuine sleep disorders, such as insomnia, require professional evaluation and sometimes, professional intervention. As indicated above, there are many reasons for insomnia. There are many professional treatment approaches that can be utilized besides the informal approaches noted above. Besides consulting a medical sleep clinic, it might be helpful to consult your physician, psychologist, and/or a professional in alternative medicine. A person with insomnia may benefit from any one of a variety of treatment approaches, such as, biofeedback training (learning to use specific information from your body to develop treatment, change habits, etc.), medication, acupuncture, chiropractic services, massage or one of the various medical strategies for sleep apnea. Whatever approach is utilized, it is important to pursue it for at least a few months before considering a different alternative.
IS SLEEP DIFFICULTY AN INDICATION OF STRESS OR SOME EMOTIONAL STATE?
Sleep patterns are enhanced by the general happiness level of an individual. In other words, the better the physical, mental and emotional health of an individual, the better the quality of sleep. Times of stress, unrest and depressing events, such as unemployment or financial hardship are well known to interfere with the quality of sleep. The persistent lack of sleep itself can cause poor sleep patterns to worsen or become chronic: a vicious cycle, indeed.
IS LACK OF SLEEP REALLY THAT BAD?
Lack of sleep is associated with adverse affects that can have long term consequences for all individuals. Sleep loss contributes to feelings of sluggishness, depression, chronic tiredness, and lack of energy throughout the day. Performance will be impaired and an increased level of risk for injury, errors and accidents will prevail. Sleep loss is also known to impair REM sleep. When there is insufficient REM sleep, the insomnia sufferer is prone to agitation, depression, restlessness, anger and similar states of distress. Performance and learning are also likely to be impaired. Furthermore, sleep loss is associated with specific cognitive impairments, such as, dementia, learning difficulties, memory loss, poor judgment, thought disorder and perceptual distortions. Tasks requiring a keen sense of attention, concentration and judgment will be difficult to perform. Any error results in increased cost and lost time.
HOW CAN I GET ADDITIONAL INFORMATION TO HELP ME?
The following Internet websites are good sources to consult:
1. www.talkaboutsleep.com (After accessing the site, click on Sleep Basics.)
2. www.sleepfoundation.org
About the Author: Dr. Hedberg is a clinical and consulting psychologist and maintains a private practice in Fresno, California. He received his Ph.D. from Queen’s
University in 1969. He is an author of
several books and has written over 60 professional publications.
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