Overcome insomnia without drugs
DEAR DOCTOR K: I struggle with insomnia. How can I overcome this problem without drugs or supplements?
DEAR READER: Insomnia is a common problem in which sleepless nights turn into fatigue-filled days. A form of cognitive behavioral therapy (CBT) known as CBT for insomnia, or CBT-I, targets the root cause of insomnia without medication. This short-term talk therapy teaches people to change unproductive thinking and behaviors that get in the way of a good night’s sleep.
Researchers recently looked at 20 trials of CBT-I involving more than 1,100 people with ongoing insomnia. On average, people treated with CBT-I fell asleep almost 20 minutes faster and spent 30 fewer minutes awake during the night compared with people who didn’t undergo CBT-I.
These improvements are as good as, or better than, those seen in people who take prescription sleep medications. And unlike medications, the effects of CBT-I last after the therapy ends.
CBT-I usually involves meeting with a therapist once a week for several weeks. A common recommendation from CBT-I is to get out of bed if you don’t fall asleep within 20 minutes. The idea is to associate your bed with relaxation and comfort, not frustration and worry. Learning relaxation techniques like mindfulness meditation is another key part of CBT-I.
People with insomnia also tend to worry about the consequences of poor sleep. A CBT-I therapist can help you replace negative thoughts (“I’ll be too tired to work tomorrow!”) with more positive ones (“I usually do my work well, even when I feel tired”).
Here are some “sleep hygiene” habits to help you get some shuteye:
n Stay away from stimulants. Avoid caffeinated beverages after early afternoon.
n Don’t nap if you can avoid it. If you can’t stay awake, limit yourself to a 15- to 20-minute afternoon nap.
n Exercise regularly, but not within a few hours of bedtime.
n Set a sleep schedule. Go to bed and wake up at the same time every day, no matter how much sleep you’ve gotten.
n Make your bedroom a sleep sanctuary. Reserve it for sleep, intimacy, and restful activities such as meditation and reading for pleasure. Keep it cool, dark and quiet.
n Don’t watch the clock. Watching the sleepless minutes pass makes it harder to fall back to sleep. Turn the clock face so you can’t see it.
n Establish a relaxing routine before bedtime. Meditate, take a warm shower or listen to quiet music.
I know that some of my patients find advice like this to be simplistic. Basically, they are looking for a pill that makes them sleep like a baby every night, without side effects. If there were such a pill, I’d prescribe it, but there isn’t.
The sleep hygiene habits I recommend really do work. Many of my patients have told me: “Well, I have to tell you I was dubious, and it didn’t happen immediately. But I’m definitely sleeping better, so thanks.”
Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.