Articles

Insomnia? Tips to Get Back to Sleep

By Tiffany Spudich, Pharm D.

Poor sleep habits (referred to as hygiene) are among the most common problems encountered in our society. We stay up too late and get up too early. We interrupt our sleep with drugs, chemicals and work, and we over-stimulate ourselves with late night activities such as television. Getting a good night's sleep is something often taken for granted - until we do not have one.

Sleep is as important for good health as nutrition and exercise. Sleep appears to affect memory and learning, repair damaged cells, and maintain a strong immune system. With inadequate sleep, people suffer physical and psychological consequences that can be dangerous. People who do not get enough sleep are more likely to have driving accidents, have trouble concentrating, are more likely to be irritable, and have reduced energy.

The need for sleep varies, but most adults need 7 to 8 hours. Older adults tend to sleep more lightly and for shorter time spans. Yet, they generally need the same amount of sleep as they did when they were young adults. The body will try to compensate later by sleeping late on another day (for example, on a weekend day) or napping.

Insomnia is inadequate or poor-quality sleep. It is generally due to difficulty falling sleep, waking frequently during the night, waking up to early in the morning, and un-refreshing sleep. Insomnia can be transient, lasting only a few days, which may be related to stress or schedule disruptions such as travel or middle-of-the-night emergencies. Insomnia can also be short-term, lasting up to 3 weeks, which may be induced by stress from situations such as the death of a loved one or a divorce. Insomnia can also be chronic, lasting more than 3 weeks, often resulting from complex causes such as disease or depression.

Insomnia is a symptom and not a disease. The cause may be as simple as drinking too much coffee or as complex as a brain disorder. Common causes of insomnia include stress, anxiety, depression, pain, medication, drugs, alcohol, tobacco, and caffeine. Keeping a sleep diary helps identify sleep patterns, diet, exercise, medication, and other activities contributing to insomnia. Your physician may conduct a medical assessment and order blood work. Your sleep partner might need to answer questions about your snoring or leg movements. For some sleep disorders, specialized testing at a sleep clinic may be necessary.

There are several treatment options for insomnia. First of all, have underlying medical or psychological conditions diagnosed and treated. Identify behavior related to insomnia (for example, diet, including alcohol and caffeine, or prescription and over-the-counter medications) and making proper changes. Behavioral techniques such as relaxation and stress management can help to improve sleep.

Sleeping agents are sometimes an option, but their use should be under a doctor’s supervision. These medications are generally prescribed only for a short time and at the smallest dose possible to relieve symptoms. Some non-prescription supplements that are an option for treating insomnia include valerian root, 5-hydroxytryptophan (5-HTP), and melatonin.

Valerian root is derived from the plant Valeriana officinalis. Certain components of the valerian root are thought to naturally have sedative properties and may affect certain brain transmitters such as GABA. Two to four weeks of the valerian therapy is usually required for onset of effect. 5-HTP is a compound produced by the body from tryptophan. It is naturally found in many foods and most commonly extracted from the seeds of the Griffonia plant. 5-HTP can increase the brain’s serotonin levels, helping to make sleep more restful and rejuvenating while also helping with depression and anxiety. Melatonin supplementation can also to help adjust to changes in sleep schedule. Melatonin, a naturally occurring hormone secreted by the pineal gland, is thought to affect circadian rhythms - the biological rhythms that take place over a day, such as the sleep-wake cycle. Supplementation with melatonin can be helpful in inducing and maintaining sleep in both people with normal sleep patterns and those suffering from insomnia. It is also useful in banishing jet lag.

Balancing one’s hormone levels can also improve sleep. Bioidentical progesterone therapy at bedtime can have sedative effects, and balancing estrogen levels can alleviate hot flashes and night sweats that often contribute to difficulty sleeping. Below are some additional tips to help maintain good sleep hygiene.

Tips to Improve Sleep
1. Set a schedule. Go to bed and rise at the same time each day, including weekends. Try to keep daytime naps at a minimum.
2. Avoid caffeine. Caffeine is a stimulant, and even a midday cup of coffee may have effects lasting into the night. Beware of chocolate, soft drinks, tea, and some prescription and over-the-counter dugs that contain caffeine.
3. Avoid tobacco. Nicotine is a stimulant, and many smokers are light sleepers, partly due to nicotine withdrawal.
4. Reduce or eliminate alcohol. Although a glass of wine or a nightcap before bed may send you off to sleep more quickly, that same alcohol is likely to interrupt your sleep cycle later on in the night.
5. Exercise regularly. Daily exercise (20 to 30 minutes) about 5 to 6 hours before bedtime promotes healthy sleep. Exercising just before bedtime has the opposite effect.
6. If you cannot go to sleep, get up and do something quiet. Worrying about not falling asleep only contributes to insomnia
7. Develop a relaxing bed routine. Avoid potentially stressful activities prior to bedtime (for example, talking to unhappy friends, paying bills, reading work assignments, or checking messages). Take part in activities you enjoy and find relaxing (such as listening to music, reading, or watching TV). Consider learning relaxation techniques. Don’t let your overwhelming schedule or an impending obligation keep you up at night.
8. Limit bedroom activities to sleeping and intimacy. Avoid working or studying in bed.
9. Watch what you eat and drink in the evening. Spicy foods may lead to nighttime discomfort. Drinking a lot of fluid may results in frequent bathroom trips. To prevent bedtime bloating and discomfort or waking at 2:00AM with indigestion, finish your last meal of the day at least four hours before going to bed.
10. Create an optimal sleep environment. Most people sleep better in a cool, dark environment. If light is a problem, consider light-filtering shades or an eye mask. Reduce noise. If the source of the noise is beyond your control (for example, street traffic), use earplugs. Sleep on a high-quality, comfortable mattress.