by Tom Etges
It’s estimated that 50 to 70 million Americans suffer from insomnia on a recurrent basis. Most studies conclude that adults need an average of seven to eight hours of restorative sleep each night, noting that with normal aging less sleep is required. The key issue, according to the American Academy of Sleep Medicine, is that insomnia, or non-restorative sleep, leads to “suboptimal daytime functioning.”
Statistically, more women than men are affected, as are older adults, those who are divorced or widowed, those who have experienced a recent stressor (e.g., loss of a job or loved one), and those who have co-existing medical disorders (e.g., snoring, anxiety, depression or chronic pain.)
Insomnia is often blamed on our fast-paced lifestyles, which can bombard our central nervous systems every day with over-stimulation. Some in the field of sleep disorders believe that our human physiology has not yet adapted to the fast pace of our technological world. For generations we were designed to be active while the sun was up and at rest when the sun was down. This circadian pattern was lost with the advent of electricity. “Daytime” can now be extended with electric lights. Even our work schedules can extend into the wee hours of the night through swing and graveyard shifts.
Insomnia can be secondary to causes that include medical disorders, environmental factors and medications. The following are common examples:
• Sleep apnea
• Restless leg syndrome
• Hyperthyroidism
• Generalized anxiety
• Chronic adult depression
• Pain disorders
• Acid reflux / Gastroesophageal reflux disease
• Menopause
• Asthma
• Medications: alcohol, caffeine, nicotine, antidepressants, pseudoephedrine (Sudafed), diuretics, some herbal remedies
• Noise: a crying infant, a snoring bed partner or traffic sounds
• Work schedules: swing or graveyard shifts
There is agreement that no matter the cause, lifestyle adjustments are crucial when addressing the problem. General lifestyle approaches, designed to improve sleep hygiene, continue to be the first line in treating insomnia:
• Relax in the evening hours before sleep. Encourage your system to be ready for sleep. Avoid watching TV, playing video games, eating in bed, or using the computer before trying to sleep. Avoid worrying about things in bed. Try more calming activities, such as reading a book, meditating or taking a warm bath. Try to make this a nightly ritual.
• Exercise during the daytime. Vigorous exercise even two to four hours prior to going to bed can be too stimulating for many. Try to get your workout in long before you plan to turn in.
• Avoid / decrease the intake of stimulants. These include caffeine from coffee and soft drinks, spicy foods and fried foods, which can be more difficult to digest. Stay away from excess fluids after dinner to avoid extra trips to the bathroom in the middle of the night.
• Avoid eating a large meal too close to going to sleep.
• Avoid daytime napping. This can disrupt your body’s natural sleep cycle, causing you to not feel tired enough for sleep at night. This seems less critical, however, in the geriatric population.
• Try to maintain the same bedtime and awakening time every day. Many sleep experts believe that keeping the same awakening time is even more important than keeping the same bedtime. Maintain your weeknight schedule even on weekends.
• Don’t try to force yourself to sleep if you’re not sleepy. Some experts recommend waiting 15 to 30 minutes until you feel sleepy, preferably in a quiet room other than the bedroom. Worrying about not sleeping can create more anxiety leading to less shut-eye. It’s a reason why cognitive therapy, described below, can be helpful for some people with chronic insomnia.
• Make sure the bedroom is as dark and quiet as possible and that the temperature is comfortable for sleep.
• In Traditional Chinese Medicine (TCM), it’s important to be asleep between 11 p.m. and 3 a.m. This is the time of Liver and Gallbladder. Liver Blood and Yin are important because at night the Blood, in the TCM model, returns to the Liver, which houses, or protects the “Hun” (Ethereal Soul) in sleep. If this fails to occur, the Hun is said to be deprived of its residence, causing it to wander off at night, producing restless sleep fraught with tiring and potentially disturbing dreams. Some TCM authors feel that a fully balanced person has no dreams.
In addition, there are approaches that can help induce more restful sleep and do not always rely on Western prescription drugs. I include the following as examples:
• Cognitive behavioral therapies. These approaches include:
1. Emphasis on the previously mentioned points for improved sleep hygiene.
2. Stimulus control, including the concept that the bedroom is reserved only for intimacy and sleep and not for watching TV, reading or doing homework in bed.
3. Sleep restriction, where attempts are made to improve your sleep efficiency.
4. Relaxation therapy, where hypnosis, meditation and progressive muscle relaxation are applied. Also consider an Open Focus session with Donna Stevens.
5. Paradoxical intention, where fears of not sleeping are targeted.
• Over-the-counter remedies, supplements and herbs. In Western literature, evidence based research has found the most benefit from 0.5 to 10 mg of melatonin at bedtime and 200 to 1,000 mg per day of valerian root. Other supplements and herbs have been reviewed but with lesser success rates, including kava, lavender, passionflower, St. John’s wort, and tryptophan. Benadryl, an antihistamine, can help for short periods of time, especially when the difficulty is getting to sleep, as opposed to remaining asleep.
• Acupuncture and Chinese herbs. Acupuncture input, combined with Chinese herbs, addresses the underlying energetic excesses and deficiencies that can result in restless sleep. For best results, I find it crucial that the approaches discussed for improving sleep hygiene be integrated into the treatment plan and that co-existing medical disorders be addressed and managed.
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