by Amanda MacMillan
Waking up on the right side of the bed can be tough… if you only fell asleep 30 minutes ago. We all know what it feels like to toss and turn throughout the night, but for nearly 10 percent of Americans, insomnia is a chronic problem — lasting a month or longer, and characterized by difficulty falling or staying asleep.
Untreated insomnia can be a dangerous issue, too, says Steven Feinsilver, M.D., director of the Center for Sleep Medicine at Mount Sinai Hospital in New York City. Even if you’re not nodding off behind the wheel, a consistent lack of sleep can still contribute to headaches, back pain, irritability, lowered immunity and other health problems, he says. “People with poor sleep quality have a higher risk of everything from depression to high blood pressure to early death.”
That doesn’t mean that sleepless sufferers are doomed. Talking to your doctor can help you determine the root cause of your disorder and the best treatment to get you back on schedule. (Hint: It’s probably not a pill!) But before you make an appointment, here’s what you should know about insomnia.
1. You may be predisposed.
“Some people are simply better at shutting their brains off at night,” says Feinsilver. Those who aren’t naturally good sleepers could have a biological reason as to why they’re not (having to do with unique brain chemicals, perhaps). They could also have grown up with bad “sleep hygiene” — never having a regular schedule or a consistent bedtime routine, for example.
Even if you are prone to insomnia, though, treatments like cognitive behavioral therapy (CBT) can help retrain your brain. “Sleep is a powerful biological drive and if you don’t mess it up, it tends to work,” says Feinsilver. “And if it does get messed up, it’s usually fairly easy to fix once we pinpoint what the patient is doing wrong.”
2. Look out for the “two p’s.”
When a person who has always slept well suddenly has trouble falling or staying asleep, doctors look for two factors, says Feinsilver: The precipitating cause and the perpetuating cause. The former is a stressful event, good or bad, that creates an initial disruption of sleep. The latter is the reason insomnia continues, even after that stressful event has passed.
Precipitating causes can be anything from an upcoming test you’re worried about and need to study for to planning a wedding. The biggest perpetuator, says Feinsilver, is behavior — for instance, not going to bed and getting up at the same time every day.
3. It’s linked with depression.
“Depression can cause bad sleep and bad sleep can cause depression; it’s often hard to tell which one comes first,” says Feinsilver. A recent Australian study found that insomnia was linked to depression, generalized anxiety disorder, and panic disorder in teenagers, and the study authors note that “having insomnia in addition to anxiety or depression can further intensify the problems being experienced with each individual disorder.” Likewise, a 2013 Canadian study found that treating the two conditions simultaneously can improve symptoms of both.
4. Popping pills won’t get you far.
If you want to kick insomnia for good, medication isn’t the answer. (Sleeping pills may help jumpstart your slumber party, but their effects can wear off if they’re used long-term.) What’s really important is following the rules for good sleep, says Feinsilver. Keep your bedroom dark and cool; avoid caffeine up to 12 hours before bed; go to bed at the same time every night; and don’t sleep in more than an hour on the weekends — even if you broke the previous rule and stayed out late the night before. “You’re better off getting up at your regular time and taking a nap midday to make up for some of that lost sleep,” he says.
And about those naps: They can be very helpful for people who don’t get seven or eight hours of sleep at night. But keep them to an hour or less, and don’t take them within six hours of your bedtime. Plus, if your doctor recommends sleep restriction therapy (which means spending only a set number of hours in bed, whether you sleep or not), you’ll want to avoid crawling under the covers during the daytime entirely.
5. Kitchen “cures” may or may not help.
A recent Louisiana State University study found that drinking tart cherry juice before bed improved insomnia symptoms in older adults, and previous research has suggested that herbal remedies, like chamomile tea, may help as well.
Feinsilver says these probably won’t hurt, but believes that much of their benefit comes from the placebo effect. “That’s not to say they won’t work or that I’m against them,” he adds. “If drinking something seems to help you fall asleep, I’m all in favor of it.”
Sometimes, the calming herbs in drinks and teas can help slow your mind and give you that sleepy feeling. (Even just hot tea or milk sometimes works for individuals.) Give it a try and see if it’s right for you.
6. Attention can make it worse.
Doctors sometimes ask their insomnia patients to keep sleep diaries in order to help identify lifestyle factors keeping them awake, but Feinsilver advises against logging and analyzing your slumber for an extended period of time. “The more you think about it, the harder it is to fall asleep,” he explains. “The best thing you can do is try to ignore it and take your mind off it.”
One way to shut out the worry could be through meditation: In a recent study from Rush University Medical Center in Chicago, insomniacs who practiced mindful meditation for eight weeks reported better sleep and higher remission rates than those who didn’t.
