More Than a Sleepless Night
There’s more to insomnia than just trouble falling asleep. Some people fall asleep just fine but wake up in the middle of the night and can’t get back to sleep. Others sleep through the night but wake too early in the morning. And still others appear to sleep through the night with no problem, but never wake rested.
While it’s normal to experience an occasional bad night of sleep, if your sleep problems become chronic, it’s time to do something about them. Lack of sleep interferes with immune function and increases your risk of insulin resistance. Then there are the dangers of trying to get through the day (especially if you have to drive) when you’re overtired.
Various health issues may contribute to sleep problems, including menopause, depression (early morning awakening is a common sign of depression), and just about any condition that causes pain. Other culprits include restless legs syndrome and sleep apnea, in which you slightly awaken dozens of times a night because your breathing stops.
Just as important as the ability to fall asleep and stay asleep is the ability to cycle in an orderly fashion through the five stages of sleep several times a night. This is critical to cell growth and repair and a strong immune system. If something (for instance, alcohol, heavy smoking, or abnormally hot or cold bedroom temperatures) interrupts the progression of these sleep stages, you won’t feel well rested and your immune system, mood, and memory may suffer.
Not being able to sleep can be extremely frustrating. But before you turn to sleeping pills, there are plenty of natural approaches to try.
Prevention and Tips
Maintain a normal weight. Studies find that obesity can make sleep problems like sleep apnea worse. It can also affect important sleep-related hormone levels in the body, increasing levels of the stress hormone cortisol while decreasing levels of sleep-inducing melatonin.
Manage stress. Do it however you can, whether it’s yoga classes or meditation. Check your medications. Many prescription and over-the-counter medications can interfere with sleep, including beta-blockers, thyroid medication, certain antidepressants like the selective serotonin reuptake inhibitors (SSRIs), decongestants, corticosteroids, and medications with caffeine. Talk to your doctor about changing dosages or medication if you’re taking any of these drugs.
Avoid alcohol. Although many people think a glass of wine before bed can help with insomnia, the opposite is actually true. While alcohol might help you fall asleep, it’s often the culprit behind middle-of-the-night awakenings as your body experiences alcohol withdrawal. It also interferes with your sleep cycle, so even if you do sleep through the night, you’ll wake up tired.
Stop smoking. Yet another reason to quit: Nicotine is a stimulant. If you’re still smoking, try not to smoke for at least two hours before bedtime (brush your teeth so you won’t be tempted).
Do This Now:
Getting rid of chronic insomnia will probably involve making some long-term changes to your habits. See the rest of the entry for advice. Meanwhile, on a week when you can’t sleep, take these steps.
1. Go for a brisk 20-minute walk outside in the afternoon.
2. About two hours before bed, take a warm bath into which you’ve mixed 15 drops lavender essential oil.
3. If it’s hot in your bedroom, turn down the thermostat or turn on the air conditioner.
4. Take 600 to 900 milligrams of valerian extract standardized to 0.4% valerinic acids.
5. Before you climb into bed, spend 20 minutes on some form of relaxation therapy, such as progressive muscle relaxation or meditation, or write in your journal.
6. If you don’t fall asleep within 30 minutes, get out of bed. Do something low key like reading or folding laundry until you feel tired. Then go back to bed.
7. If you still can’t fall sleep, take a sleeping pill (if you have them) or an over-the-counter antihistamine such as Benadryl.
Few scientific studies show exercise has much benefit for insomnia, but those studies were conducted in labs, primarily on people who didn’t have sleep problems. In real life with real people suffering from insomnia, we find regular exercise to be critical to people’s ability to get a good night’s sleep. It doesn’t need to be an intense workout — a walk is just fine. We want you to walk outside if possible because natural light helps regulate your body’s sleep-wake cycle. Just don’t exercise within three or four hours of bedtime because it could increase your metabolism and mental alertness.
The bath and the relaxation technique do several things for you. First, they relax tense muscles. And if you do them regularly, they form a nighttime ritual that signals to your brain that it’s time to sleep. Stick to your ritual like glue every night and it will work like a charm.
After you get out of the bath, your body temperature will slowly start to drop — a precursor to sleep. (A cool bedroom also helps induce sleep, which is why we suggest adjusting the temperature.) We recommend adding lavender oil to the bath because lavender promotes relaxation and possibly sleep (see also lavender aromatherapy, under “Other Approaches,” below).
Valerian is the core of our herbal treatment for chronic insomnia. It doesn’t work like a sleeping pill — that is, it won’t “knock you out.” Rather, it works to stabilize sleep cycles, making it ideal for people who wake up still feeling tired or wake in the middle of the night. One study comparing valerian to a prescription sedative found both worked just as well at relieving sleep disturbances, although the valerian had fewer side effects. Be patient — it may take two to four weeks before you see any benefits from the herb. But it’s very safe, with no risk of addiction as with the benzodiazepines, and with no morning “hangover.”
Antihistamines are not a long-term solution to insomnia, but for a night or two they’ll probably help you sleep, since they are sedating.
Herbs and Supplements
Relaxant herbs. In addition to valerian, other relaxing herbs that are excellent for sleep problems include chamomile, hops, passionflower, lemon balm, and skullcap. We don’t have a preference as to which you take, and you may even find all included in some herbal sleeping formulas or teas. We often recommend such teas because the act of sipping a warm drink before bed is, in itself, relaxing (make it part of your nightly ritual, if you enjoy it). Follow the package directions, or make your own tea. Mix 1/2 teaspoon each of passionflower, lemon balm, skullcap, and chamomile tea leaves, and steep in 6 ounces boiling water for 8 to 10 minutes. Strain and sweeten with honey if desired. Sip a cup an hour or so before bed as part of your preparing-for-bedtime routine.
Melatonin. This supplement is most useful for sleep problems related to shift work or jet lag, but some people find it very helpful for insomnia. Start with the lowest dose available, increasing it by 0.5 milligrams a night until you reach the most effective dose (but no higher than 3 milligrams).
5-hydroxytryptophan (5-HTP). This amino acid is a building block for serotonin, a neurotransmitter that plays a major role in sleep. Take 100 milligrams before bed with a piece of fruit, glass of juice, or cracker (it works best when taken with a carbohydrate), but not protein. Or take 50 milligrams a half-hour before dinner and 50 milligrams with your bedtime snack. This supplement shouldn’t be used for more than three or four weeks except under a doctor’s supervision.
Sleeping aids. Most over-the-counter sleeping pills contain antihistamines, which make you sleepy. But they’re also very drying. If they work for you for occasional insomnia, just take a generic antihistamine instead of a sleeping pill; they’re less expensive and just as effective.
Benzodiazepines. These medications include Ativan (lorazepam) Valium (diazepam) and Restoril (temazepam). They’re okay for a once-in-a-while use, but they interfere with the restorative phase of sleep called REM sleep and can be habit forming.
Non-benzodiazepine hypnotics. This newer class of sleep aids includes Ambien (zolpidem), Sonata (zaleplon), and Lunesta (eszopiclone). They work similarly to benzodiazepines, but have fewer side effects because they don’t stay in your system very long.
Tricyclic or atypical antidepressants. These antidepressants, which include Elavil (amitriptyline), Sinequan (doxepin), and Desyrel (trazodone) have sleepiness as one of their side effects. If you have chronic insomnia, your doctor may prescribe low doses to be taken just before bed. They’re especially helpful if you have sleep disturbances (i.e., waking in the middle of the night or early morning) or sleep problems related to chronic pain.
Rozerem (ramelteon). This is the newest drug approved for insomnia and the only one not considered a controlled substance. It works by mimicking melatonin in the brain, dimming signals that might keep you alert and prevent you from falling asleep.
Warm milk. It’s a cliché, but it has science behind it. Milk is a good source of tryptophan, the same amino acid found in turkey and other food sources, which contributes to the production of sleep-inducing serotonin. Plus, the warmth itself is relaxing. Other foods high in tryptophan include chicken, tuna, soy, yogurt, and whole grain crackers. Try a little snack before beginning your pre-bedtime routine.
Cognitive-behavioral therapy. Most people get panicky when they can’t fall asleep, or wake up in the middle of the night and start to focus on how little time they have left to sleep, making it even harder to sleep. Cognitive-behavioral therapy helps you change this thought pattern so you can relax and fall asleep. Look for a psychologist or counselor who’s trained in CBT for sleep problems.
Acupuncture. Several studies find acupuncture can relieve various types of insomnia in all types of people (including pregnant women and anxious people). One study found five weeks of acupuncture increased participants’ own melatonin secretion as well as significantly improved their ability to fall asleep, stay asleep, and sleep well.
Calms Forté. This homeopathic remedy from Hyland’s is one of our favorite homeopathic patent remedies. It contains minute amounts of several herbs, including passionflower, oats, hops, and chamomile. It works well for children with occasional sleep problems, for elderly people (for whom benzodiazepines may be too sedating), and for people who wake up early in the morning.
Lavender aromatherapy. Spritz lavender spray on your pillow and sheets, put a few drops of lavender essential oil on a tissue and sniff it as you’re trying to fall asleep, dab some on your pulse points before you get into bed, or use a plug-in diffuser. One small preliminary study found lavender improved mild insomnia in participants; other studies find it calms people with dementia, attesting to its relaxing effects.
Habits for Better Sleep
“Sleep hygiene,” a term doctors use, doesn’t refer to how clean you are when you go to bed, but to sleep-promoting behaviors. The idea is to avoid habits that interfere with a good night’s sleep and to follow habits that promote it. Studies find that 70 to 80 percent of people with chronic insomnia benefit from non-drug approaches like these.
- Stop drinking caffeinated beverages and eating caffeinated foods (including chocolate), even if you’re sleepy during the day. Don’t forget that some medications, like Excedrin, contain large doses of caffeine.
- Go to bed and wake up at the same time every day, even on weekends.
- Hide the bedside clock. That way, you won’t see it when you wake up in the middle of the night and obsess over how little time you have left to sleep.
- Prepare your room for sleep by buying room-darkening shades or using a sleeping mask (available in drugstores) to block light, placing your bed against an inside wall to limit your exposure to noise, and using a white-noise machine to drown out any racket. And keep your bedroom cool.
- Use the bedroom only for sleep and sex. That way, when you get into bed, your body will know it’s time to nod off.