Almost everyone has trouble sleeping occasionally, but for some it is a frequent or persistent problem. Here is information that may help.
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What is Chronic Insomnia ?
Most of us have trouble sleeping occasionally, but if you persistently have difficulty with sleep, you may have a medical condition associated with sleep disturbances. These include
- sleep apnea
- restless legs syndrome
- depression and/or anxiety
- post-traumatic stress disorder
Some people have true chronic insomnia, meaning persistent sleep difficulty alone. There are various criteria to diagnose chronic insomnia but in general include
- difficulty falling or staying asleep
- at least 3 nights per week for at least 1-3 months
- with impairment of daytime function, such as fatigue/sleepiness, poor concentration, irritability, school or work dysfunction
How is chronic insomnia managed ?
First step in treatment of chronic insomnia as well as occasional difficulty sleeping is identifying and treating any underlying medical issues that might contribute to poor sleep. In addition to the ones mentioned above these include
- pain, of all kinds
- heartburn (gastroesophageal reflux)
- congestive heart failure
- lung diseases like asthma causes nighttime breathing difficulty
- menopausal night sweats
Sleep meds were one of the 7 drugs that are overused in my previous post.
(Read more about Ernest Hemingway’s preserved Florida home at this previous post)
Sleep hygiene management
Experts recommend sleep hygiene , basically lifestyle changes, as the initial treatment.
For optimal sleep you should
- Engage in regular exercise- moderate intensity , tai chi , yoga and low-impact aerobic exercise
- Avoid evening large meals
- Limit caffeine, tobacco and alcohol
- Use the bedroom only to sleep and for sex
- Maintain a regular bedtime-awake schedule
- Avoid daytime naps
- Avoid distracting stimuli at bedtime-watching television, using electronic devices, talking on the phone
- Stay in bed only while sleep
How to dim the lights
The light from electronic devices- clocks, thermostats, televisions, monitors-can disturb your sleep even after you turn off your phone and tablets. This light can be blocked by stick on light blocking covers than can block out the majority of it.
Light from my clock made it hard for me to fall asleep before I discovered these products. With them I fall asleep easier, and can fall back asleep if I wake up.
Maintaining a regular schedule helps to set or reset your sleep/wake cycle. So go to bed at the same time every night and wake up at the same time every morning.
However, if you can’t sleep, rather than lie in bed awake, you should get up, do a non-stimulating activity, then return to bed when sleepy.
If you have persistent sleep loss, consider more intensive therapy by a professional.
Cognitive behavior therapy for insomnia , CBT-I , significantly improves chronic insomnia and daytime functioning and is recommended as first line therapy.
CBT-I combines cognitive therapy with sleep restriction, relaxation training and stimulus control.
Treatment typically requires 5-8 sessions conducted by a health professional trained in its use. Patients need to participate by keeping a sleep diary and writing down daily thoughts in a journal, while continuing with the sleep hygiene practices mentioned above.
Insomnia sufferers can also get help from an online web-based CBT-I, Sleep Healthy Using the Internet , SHUTi.
One study found 70% of those participating improved their sleep, compared with 43% who received education only. If you can’t find a trained therapist or don’t have time for office based therapy, this may be a good option.
SleepPhone by Acoustic Sheep
A physician, Dr. Wei-Shin Lai had trouble falling asleep after being awakened at night by calls from the ER. Her husband suggested listening to relaxing music to help her fall asleep.
She designed a comfortable headphone for her own use, and eventually started a company to make and sell them . You can try her SleepPhone made by her company AcousticSheep.
Manage stress, learn to relax
If you have occasional trouble sleeping due to stress, relaxation techniques can help you. Techniques include meditation, yoga, imagery, abdominal breathing and muscle relaxation techniques . These can reduce tension and anxious thoughts that inhibit sleep onset and maintenance.
You may find these ideas from a previous post helpful .
Expert advice from physicians
Think alcohol will help you sleep better ? Read this advice from a psychiatrist, Dr. Melissa Welby.
Curious about sleep apnea? Dr. Deborah Burton offers this review of another common sleep problem.
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