"Behavioral factors and poor sleep hygiene are the most common causes of insomnia and sleep problems," says Dr. Supat Thammasitboon, medical director for the Tulane Comprehensive Sleep Medicine Center. "unrealistic beliefs or myths about sleep ... can deteriorate sleep quality. Some patients set a very high expectation of sleep by saying, 'I have to sleep nine hours to perform well at work.' There is no magic number. ... We should not force ourselves to fall asleep when the brain is not ready, since it may lead to more use of sleeping aids or sedatives."
In short, people worry when they can't sleep and sometimes take medication without figuring out why they can't sleep in the first place. The good news is this can change by addressing the root causes of poor quality sleep.
Practicing Good Sleep Hygiene
The best approach to treating sleep disorders that don't have a medical cause is to make lifestyle changes. Because most Americans live with electricity and are not hard-working farmers who rise at dawn and prepare for sleep when the sun goes down, many no longer follow natural circadian rhythms. Too little exercise, too much alcohol and caffeine, and late-night snacking while watching TV or surfing the Internet are other behavioral factors that contribute to poor quality sleep.
"Sleep hygiene is very important for good sleep quality, especially for individuals with insomnia," Thammasitboon says. "I always recommend my patients go to bed and wake up at the same time every day, avoid long naps (or take only 15- to 20-minute naps if necessary), avoid caffeine after lunch and (consume) no alcohol for five to six hours before bedtime."
Thammasitboon also emphasizes the importance of regular exercise, a healthy diet and an appropriate weight. Chocolate and certain vitamins and pain medications are often sources of hidden caffeine. Keep the bedroom environment temperate, not too hot and not too cold, the darker the better, and remove TVs and computers.
prescriptions and over-the-counter medications
The array of over-the-counter (OTC) sleep medications includes products ranging from $3 to $30. The most common are pills containing antihistamines, such as Unisom, which cause sleepiness as a side effect but should not be used in the long term. "OTC sleep aids contain diphenhydramine, which usually makes people drowsy," says Dr. Stuart Busby, medical director of the Ochsner Sleep Center. "Unfortunately, the effectiveness can wear off over time."
Because melatonin levels decrease as people age, melatonin supplements are an option for treating occasional sleeplessness. "Melatonin is a sleep hormone that is normally secreted from our brain to induce sleep," Thammasitboon says. "These supplements can be used safely in certain sleep disorders, (but) may not work very well for individuals with chronic insomnia." However, Busby points out that melatonin supplements only work for certain circadian cycle disturbances. The supplements are ineffective if they are not administered properly and for the correct reason.
Many doctors prescribe sleep medication for patients experiencing bouts of extreme stress or sleep disruption from noise or travel. Regular use of these medications is not recommended because they have potentially harmful side effects and can be addictive.
"If possible, avoid taking a sleep aid every night," Busby says. "Give yourself a break or 'holiday' on days when sleep is less critical, e.g. weekend time off. This may help prevent dependence. It is also important to try to take steps to get to the root of your sleep problem."
Natural remedies include noncaffeinated herbal teas with chamomile, lemon balm, passionflower or hops, and other herbal products, such as valerian. "I do not oppose the use of natural remedies as long as you know the definite ingredient in a particular product," Thammasitboon says. "However, the patient should consult his or her physician if there's any question at all, especially if the patient has multiple medical problems and is on several medications."
People often can't fall asleep because their minds are racing. "Stress reduction is key," Busby says. "Finding healthy ways to discharge stress deserves your attention." Besides herbal teas and natural supplements, breathing techniques, certain yoga postures, journaling and meditation aid relaxation.
"A regular, active yoga practice can help release ... tension in the body and mind so you become more skillful at managing stressful situations," says certified Anusara yoga instructor Laura Flora. "Before bed, doing a few calming poses such as gentle hip openers, forward bends, twists and a simple inversion of lying down with your legs propped up against the wall helps settle the body and quiet the mind. ... (F)ocus on lengthening your exhales ... to bring yourself to a deeper state of quiet."
When Good Sleep Hygiene Is Not Enough
Not all sleep disorders can be cured by lifestyle modification alone, Thammasitboon says. "Some people have the opportunity to sleep, but sleep poorly due to sleep disorders or medical conditions," he says.
Some of these medical conditions, such as frequent urination or coughing and shortness of breath from asthma or chronic bronchitis, can be treated with medication. Depression and anxiety disorders are other common causes of insomnia. More serious health conditions such as heart disease, diabetes, high blood pressure and obesity are often related to sleep disorders such as sleep apnea, which results in loud snoring, choking or gasping during sleep, throat dryness or headaches in the morning, Thammasitboon says.
If you have medical conditions and are having trouble sleeping, it is time to see a doctor for solutions. In some cases, your physician may refer you to a sleep clinic to diagnose a disorder. "It is important to take steps to get to the root of your sleep problem," Busby says.
Contact the Tulane Comprehensive Sleep Medicine Center (1415 Tulane Ave., 988-1657; www. tulane.edu/som/departments/medicine/pulmdis/sleep-center.cfm) or the Ochsner Sleep Center ( 1514 Jefferson Hwy., 842-4910; www.ochsner.org/services/sleep_disorders) for help with sleep problems, or visit www.sleepcenters.org to locate a sleep clinic.