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 treated?
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.
Experts recommend sleep hygiene , basically lifestyle changes, as the initial treatment. Best results include some combination of
- Engaging in regular exercise- moderate intensity , tai chi , yoga and low-impact aerobic exercise
- Avoiding evening large meals
- Limiting caffeine, tobacco and alcohol
- Limiting use of the bedroom to sleep and sex
- Maintaining 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
Maintaining a regular schedule helps to set or reset one’s sleep/wake cycle. So go to bed at the same time every night and wake up at the same time every morning. However, if unable to sleep, it is better to not lie in bed awake; get up, do a nonstimulating activity, then return to bed when sleepy.
Those who still have persistent sleep loss, should seek 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. This can be a good option for those who can’t find a trained therapist or don’t have time for office based therapy.
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 decided to design 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.
If you have occasional trouble sleeping, relaxation techniques can be helpful, especially if due to stress. Many people use meditation, yoga, imagery, abdominal breathing and muscle relaxation techniques . These can reduce tension and anxious thoughts that inhibit sleep onset and maintenance.
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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