Posted tagged ‘chronic insomniacs’

What to do if you can’t sleep and don’t want to take drugs

January 14, 2016

Q:  I’ve had problems sleeping for close to 4 years now.  I have been diagnosed with a stress disorder, and am getting treatment for that.  I don’t want to take sleeping pills or other drugs, so what can I do to help myself sleep?

A:  Rest assured there are a number of effective methods you can employ to help yourself sleep better naturally without using drugs.

What works for many is deep diaphragmatic breathing combined with progressive muscle relaxation.  The idea here is not to force sleep — that is usually counterproductive — but to enable it.

Although the process of sleep cannot be forced, what this method does is mimic a sleep-like state characterized by slow deep breathing and relaxed muscles.  Many people find this combination very effective to help them drift off.

There are many other methods people use besides this, so it’s also a matter of personal preference.

Counting sheep is the age-old method of distraction from occupying thoughts that keep you awake.  The twin practices of mindfulness and acceptance counsel that it’s OK to lie in bed in a relaxed state, even if not actually sleeping, and whatever sleep you do manage to get is OK and you will still function reasonably well the next day.  Guided imagery, in which a beautiful relaxing scene is imagined, is yet another method people use in bed.  There are many more.

However, whatever you do will be much more effective if it is framed within an overall lifestyle supportive of good sleep.  Taking a comprehensive approach is the most effective way to deal with insomnia.

With insomnia, sleep is not the real issue.  Sleep is only the symptom.  Something else is invariably going on deeper causing the problem.  In your case, you’ve identified at least one underlying cause for insomnia — stress.  So it’s important for you to continue to treat that root cause, and your sleep stands to improve as you learn to better manage excessive stress.

It’s also important to consider other nonmedical issues that may be contributing to insomnia as well.  Pills will not address any of these.

These may include such overall lifestyle choices such as keeping a consistent sleep schedule.  Especially important is a consistent wake time, which has the profound effect of both regulating your circadian rhythm and synchronizing it with your homeostatic sleep drive.  These are the two most important internal regulatory mechanisms controlling sleep.

Another lifestyle choice supportive of better sleep is getting sufficient exercise most every day.  The body tends to compensate for intense physical exercise by increasing the amount of deep sleep, the most restorative kind.

Exposing yourself to bright light first thing upon awakening is another key.  Light helps start you up in subtle but profound ways, and that’s especially important during the short days and long nights of winter.

Other good ways to help counter insomnia include limiting caffeine (in any form including chocolate and colas) after about mid-day, avoiding alcohol or nicotine close to bedtime, and using a relaxing pre-bed routine to help transition to a drowsy state conducive to sleep.

How you think about sleep — what you believe to be true about insomnia — actually is a key part of the solution.  Negative sleep thoughts are a potent fuel the prolongs and perpetuates insomnia.  Fortunately, there are good proven methods to both identify and then learn to let these negative thoughts go.  Sleep tends to improve as a result.

Many insomniacs are so desperate for sleep they search for that magic pill that will somehow make it all better.  But no such thing exists.  We often hear horror stories about unintended negative consequences from various sleeping pills, including habituation.  So you are wise to look for better alternatives that aren’t habit-forming, and treat the true root of the problem.

After all, why should we need to take drugs, supplements, or any artificial substance to sleep?  In reality, sleep is as natural, normal, healthy, and necessary as eating or breathing.  And we don’t need to take drugs to do those things.

The real answer is to address the true underlying issues, and then your sleep stands to improve naturally and permanently.

Don’t get stressed by your pre-bed routine

September 15, 2015

Q:  I have a very rigid routine before bed that usually helps me sleep better.  Problem is, I’m so locked into this routine I’m afraid if I vary one iota I’ll have a horrible night.  Will I ever reach the point where I can travel or go to late night social events again and not disrupt my sleep?

A:  Short answer:  Yes, there’s a very good chance you can strengthen your sleep system to the point where you can be more flexible with your pre-bed routine.

Prebed sleep routines are important providing they are relaxing and help you transition to a rested state conducive to falling asleep.  However, if and when they get to the point you feel rigidly compelled to follow them — and getting out of line causes you stress — then the idea has backfired.

So no, you shouldn’t feel compelled to do exactly the same thing in exactly the same way every night.  Moreover, the positive stimulation of travel and social interaction at evening parties can help tire you out so you sleep better.  Such mental stimulation is an important part of overall good health.

To help you feel less locked in to your routine, you might begin by making very small changes now and then, just to add some variety.  This will help prove you can still sleep well even when you venture outside the boundaries of your normal routine.  Then you can with more confidence add in larger changes incrementally.

As you’ve discovered, a relaxing pre-bed routine is an important part of good overall sleep hygiene, and represents one of many proactive behaviors you can control to in effect “stack the deck” in your favor for better sleep.  Setting and keeping a consistent sleep schedule, minimizing negative sleep thoughts, controlling stress, and managing anxiety are all part of a comprehensive strategy to counter insomnia and improve sleep.

By diligently practicing these methods with time and patience, your sleep system will strengthen to the point where even if you travel or go to a party and disrupt your normal routine, the result will not be horrible.  By increasing your confidence in your sleeping ability, insomnia tends to diminish.  So even if you significantly vary your routine and your night is somewhat disrupted, it’s easier to respond with a “so what?”  You can let the worry go with the idea that you’ll sleep better the following night.

How do anxiety and stress affect insomnia?

August 12, 2015

Q:  I am battling insomnia right now, and have quite a bit of anxiety about it.  I assume my insomnia is caused at least in part by my anxiety about sleep.  Does anxiety cause insomnia?

A:  Short answer is yes, most definitely, but there can be much more going on.

To better understand this, it might be worthwhile to examine more closely what you mean.  For instance, is what you feel about insomnia stress or anxiety?

Stress typically has a well-defined source, such as the idea of sleep — or in the case of insomniacs, the lack thereof.  For an insomniac, the idea of sleep can be very stressful, no doubt.  This is understandable, considering how intensely negative the experience of lying in bed for hour after frustrating hour with little to no sleep can be.  So the very specific underlying source of the negativity and stressful thoughts is definitely known.

On the other hand, anxiety is much more of a generalized feeling that something terribly wrong may happen.  Compared to stress, anxiety is much more of a vague feeling that tends to just pop up without a specific trigger or definite root cause.

Anxiety, like stress, if left unchecked or unremitting for an extended period of time, most definitely can contribute to insomnia and potentially to depression.

Both anxiety and stress do share at least one commonality, however:  they both involve recurring negative patterns of thought.  And therein lies one potential solution to improve sleep:  identify those underlying negative thought patterns, and counter them rationally.  This is the basis of cognitive restructuring, one of the core tools in CBT designed for insomnia.

The negative thought patterns that underlie both stress and anxiety are potent fuels that perpetuate and prolong insomnia.  By learning how to cut off this negative fuel, sleep tends to naturally improve.  And once these methods are learned, the improvement tends to be permanent.

So the good news is effective methods are available to address both chronic stress and anxiety.  These nondrug cognitive methods, as part of a comprehensive CBT for sleep solution, will enable you to do address both of these issues.  In addition, CBT also includes powerful behavioral tools proven effective for better sleep.

When these methods combine and are used simultaneously, a virtuous cycle may ensue wherein everything gets better.

Taking an anti-psychotic drug to treat insomnia

February 27, 2015

Q:  I am battling chronic insomnia, and have for many years.  Some nights I lie in bed for what seems like hours, and each day is difficult.  My doctor prescribes seroquel, but it’s not helping much.  I am fighting to beat this disease, but am running out of hope.  What can I do?

A:  First, it’s important to understand that insomnia is a symptom, not a disease.  Sleeplessness is only a symptom of something else going on deeper causing the problem.

Seroquel is an anti-psychotic drug approved for treating psychiatric disorders, primarily schizophrenia and bipolar disorder.  Without knowing the specifics of your situation, it’s possible whatever underlying condition you have is also causing insomnia.

Doctors sometimes prescribe seroquel off-label to treat insomnia, and this may be the case with you.  It would be a good idea to find out for sure by talking to your doctor about your situation.  Try to identify why s/he prescribed this drug, and discuss any underlying medical or psychiatric issues causing your insomnia.

If your doctor cannot identify any underlying medical or psychiatric issues, then you are basically using a powerful anti-psychotic drug as a sleeping pill.

Many sleep experts take the position that the use of drugs to unnaturally force sleep in the absence of an underlying medical or psychiatric condition can actually do more harm than good.  That’s because the use of drugs tends to reinforce the idea that the solution to insomnia is external and resides out of your self-control.  Drug takers also risk dependency, both physical and psychological, and the true underlying cause unfortunately remains untreated.

By attempting to identify and treat the true underlying roots of your insomnia, your sleep stands to improve.  If you have no medical or psychiatric issues, then you have what’s known as primary insomnia, which is often caused by some non-medical combination of bad sleep habits and excessive worry about the idea of sleep.

The good news is that the non-medical roots of primary insomnia can be successfully treated.  Cognitive behavioral therapy specifically designed for sleep (CBT-I) is the standard of care for primary insomnia, and helps most people who try it.

CBT-I methods will help you counter the negative sleep thoughts that often fuel and perpetuate insomnia, as well as address behaviors and environmental factors you can control to improve sleep.

So start with your doctor, as this person has examined you and knows your unique medical history.  But rest assured you have a number of proven, effective tools at your disposal to help naturally restore better sleep without drugs.

Can’t sleep without awakening every hour

December 15, 2014

Q:  I have trouble staying asleep for more than a hour.  This has been going on for years.  I started keeping a sleep log, and here’s last night:  bed at 1 a.m.  Awakened 6 times, each approximately 1 hour later than the previous.  Sometimes when I lie in bed I can’t tell the difference between dreams and reality.  What could be causing this?

A:  If you fell back asleep quickly after after each awakening, you could actually be sleeping 7 hours or more, which would put you into a normal category.  But without knowing what time you got out of bed in the morning and the duration of each awakening, it’s impossible to determine with any certainty.

However, you should be assured that the mind-body system is powerfully conditioned to get the sleep it needs, despite these frequent wakeups.

In addition, there is a strong possibility that you could already be sleeping more than you think.  This is suggested by your description of the difficulty telling the difference between dreams and reality while in bed.

In fact, such sleep state misperception is both common and widespread.

The fact that you are logging your sleep is very helpful.  We’d suggest also including the approximate duration of each wake time, and the time you get out of bed.  This will help you more accurately determine how much sleep you’re actually getting.  You might be surprised.

As for wakeups on the hour, that may have something to do with the predictable cycles of sleep we normally experience each night.  Most of us proceed consistently through 4 to 6 such sleep cycles each night, although they are typically closer to 90 minutes rather than 60.  Even normal sleepers will briefly awaken between each cycle, typically after a REM dream stage is attained, when sleep is lightest.  The difference is good sleepers tend to fall right back asleep after a cycle ends, and completely forget about these benign awakenings by morning.

However, if you are in something of a hyperaroused state, sleep can be lighter and more fragmented.  Instead of falling back asleep quickly between cycles, those that are hyperaroused tend to move the other way:  toward a state of worried wakefulness.  Instead feeling drowsy and letting go, you may instead have occupying or worrisome thoughts, especially about the idea of sleep.

Hyperarousal is often caused by excessive or unremitting stress and anxiety.  A doctor can help you determine if you are hyperaroused, and if so, why.  Your solution may be something as simple as getting more exercise, or it may involve management of a legitimate psychiatric disorder.

You should be confident, however, that sleep can be significantly improved by using effective sleep improvement methods, which, by the way, does not necessarily mean drug therapy.  Many of these methods are drug-free and natural.

Anesthesia is not sleep

October 10, 2013

Q:  An acquaintance claimed she had such terrible insomnia that she was hospitalized, and the only way she could sleep was to be anesthetized.  I am dubious.  Is it true that anesthesia can replace actual sleep?

A:  The answer to your question is no, anesthesia is not the same as sleep, and cannot replace it.

General anesthesia produces more of a coma-like state rather than functioning as actual sleep.  One of the key differences is we awaken naturally and spontaneously from sleep, but not from anesthesia.   When anesthetized, we recover only when the drug is removed.  Natural sleep also differs in that we can be awakened to consciousness by loud noises or other disturbances, while general anesthesia produces more of an unresponsive neurological state similar to a coma.

Sleep is actually a very dynamic process both mentally and physically, as opposed to the “switched off” physiologic state produced by anesthesia.  During sleep, electrical activity shifts within our brains, and various chemicals naturally ebb and flow throughout our bodies in regular cycles of distinct sleep stages each night.

Of course anesthesia requires some sort of artificial drug to induce unconsciousness.  In great contrast, sleep as a natural physiologic process is largely controlled by the surprisingly simple environmental cue of light.

During normal sleep, our bodies are replenished with energy, children grow, and our immune systems are most capable of fighting off infections and illness.  Sleep also helps consolidate memory, facilitate learning, and re-set one’s emotional mood for a new day.  These important benefits are largely absent or reduced significantly during the unconscious state produced by anesthesia.

The difference between sleep and anesthesia was dramatically evidenced in the death of entertainer Michael Jackson.  Jackson was using propofol, a powerful anesthetic, to treat his chronic insomnia.  While his death was found to be caused by overdose, testimony from his associates and friends also showed that he was deteriorating in the days before his death, and this could have been caused at least in part from substituting anesthesia for actual sleep.

So anesthesia cannot replace sleep.  A better approach to treating insomnia is to focus on the true underlying root causes, because sleep is invariably only the symptom.  Forcing sleep by any means, including sleeping pills, typically only addresses the symptom and unfortunately the true root causes remain untreated.

There are better ways, and one of the very best is contained in cognitive behavioral therapy specifically designed for sleep.  A good CBT-based sleep training program contains methods that help most people.  Many who try CBT become normal sleepers again.

For more information on CBT for sleep, or to ask a sleep question, feel free to contact us.

Why do I awaken in the night and can’t fall back asleep?

July 17, 2013

Q:   I have no problem falling asleep, my problem is staying asleep.  I awaken most every night about 2 or 3 a.m. and then have a hard time falling back asleep after that.  I sometimes just toss and turn for hours until morning.  How can I sleep better through the night?

A:  To help understand what’s going on, look at the two primary neurophysiologic systems that control sleep:  circadian rhythm and sleep drive.

After about 16 hours of nonstop wakefulness, our homeostatic sleep drive normally sends out a signal that it’s time to sleep. Basically, our brains keep track of how long we’re awake and the longer we go without sleep the stronger the urge to sleep becomes.  Conversely, getting sleep reduces the effect of the sleep drive.

It appears your sleep drive is working just fine to help you fall asleep.  But by itself sleep drive typically will not sustain a solid 8 or so hours of quality sleep.

So that’s when our circadian rhythm takes over.  Over a typical 24-hour period, our natural rhythm produces peaks and dips in what’s known as our circadian alerting system.  During normal waking hours, the circadian alerting system helps sustain wakefulness as sleep drive builds.  Those that are normally active during the day and asleep at night usually experience a dip in the alerting system in the early to mid-afternoon, often making that an ideal time for a short power nap.

More important though is the early morning dip in the circadian alerting system experienced after the sleep drive wanes.  During the night as we sleep, and as sleep drive wanes, our circadian alerting system also is progressively reduced.  This greater reduction in wakefulness is usually experienced in the early morning hours and enables us to stay asleep or fall back asleep after the effect of sleep drive wanes.

So the two systems interact and mutually support one another.  When they are in synch, quality sustained sleep usually becomes much easier, and at times practically irresistible.

To keep the two systems aligned, it’s important to have a consistent sleep schedule.  In particular, a consistent wake time has the effect of aligning sleep drive with the circadian rhythm.  For many of us, a consistent wake time is probably the single most important action we can take for better sleep.

For more on the sleep process, and more on natural drug-free ways to help yourself sleep better, feel free to visit us at