Normal Sleep - Insomnia - Health Effects of Insomnia - Behavioral Treatment for Insomnia - Sleep Hygiene - Relaxation - Stimulus Control - Cognitive Restructuring - Sleep Restriction and Scheduling - More Information
Our body has an internal, natural clock (called "circadian rhythm") that promotes a regular sleep cycle. Unless disrupted, our body and mind naturally induce sleep and then wake from sleep on a consistent 24-hour cycle. Our sleep needs actually decline from childhood and level off in young adulthood. Individual, normal sleep needs vary from as few as 5 to as many as 10 hours per night (7 to 8 hours is the norm).
When our natural pattern of sleep is disturbed, we experience insomnia -- a sense of having had inadequate sleep quality or quantity. Almost everyone experiences brief bouts of insomnia, often caused by stress or worries, physical discomfort, medication effects, or a change in our sleep schedule. These acute episodes of insomnia usually last only a few nights and our sleep schedule returns to normal after the situations that caused the sleep disruption have been resolved. About 10% of Americans, however, experience chronic insomnia -- sleep problems that last for months or even years. If a person experiences insomnia for a month or more, some form of treatment is typically needed to restore the person's sleep back to normal. Insomnia can be divided into two basic categories: primary insomnia and secondary insomnia.
Primary insomnia refers to a sleep disturbance that occurs without any specific underlying condition that causes the insomnia. Individuals with primary insomnia experience a sleep problem without having any medical or psychiatric condition that is the cause of it. Primary insomnia is largely due to learned maladaptive sleep patterns and represents the most common form of insomnia.
Secondary insomnia differs from primary insomnia in that a specific condition can be identified as the cause of the sleep problem and should be evaluated by a physician. Some examples of secondary insomnia are:
Although sleeping may not be as critical to our physical health as eating and drinking, insomnia has important negative effects on daily functioning. In addition to feeling tired and fatigued, insomnia affects mental functions including our ability to learn, remember, and concentrate. Excessive daytime sleepiness and decreased alertness from insomnia result in hundreds of thousands of automobile accidents each year. Inability to sleep regularly also affects mood and can lead to depression and other emotional problems.
Despite the distress and impairment from chronic primary insomnia, most people with this problem do not seek formal treatment by their physician. Instead, most people with insomnia try over-the-counter sleep aids. Although some of these medications may provide some temporary relief for a night or two, they are not effective or appropriate for long-term insomnia difficulties. For those few who do consult with their physician, sleep medications called "sedative-hypnotics" are often prescribed. Although these medications are helpful for short-term forms of insomnia, like over the counter medications, they are not appropriate for long-term use and are generally not effective for more chronic forms of insomnia. Many over the counter and prescription sleep medications are habit forming (addictive) if used for more than a few days. People using these medications gradually become tolerant or accustomed to the effects and must eventually increase the dose to get the same result. Stopping the medication leads to withdrawal and "rebound insomnia", in which the sleep disturbance is frequently worse than it was before using the medication. Follow you physician's advice about the use of medication sleep aids.
Although secondary insomnia should be addressed by a physician, people suffering from primary insomnia may be able to help themselves. Sleep disorder experts generally agree that a behavioral treatment is the preferred treatment for primary insomnia. The longer you have suffered with insomnia, the more likely it is that the behavioral treatment is the best treatment for you. A comprehensive behavioral treatment for primary insomnia generally includes the following components:
A number of well-controlled scientific studies have shown that these behavioral strategies are the most effective approach for chronic primary insomnia.
Improving your sleep habits and your sleep environment is the next important treatment step. The following tips will help to improve your sleep quality.
Being physically relaxed before bed has been shown to improve sleep. For many people, all that is required is to do a relaxing activity for an hour or two before bed (take a bath, watch TV, read a book). Some people, however, have difficulty relaxing before bed. Listed below are three proven methods to help you relax.
Try these relaxation strategies to see which one works best for you. Also feel free to experiment with when best to do these relaxation strategies. Some people prefer to do these relaxation exercises an hour or two before bed to start their "wind down" period. Others prefer to use these relaxation exercises once they are in bed to promote sleep. With regular practice, you should find that you are able to induce a relaxed state with your body and mind in a relatively short period of time.
Stimulus control breaks the association between "bed" and "sleeplessness". Many people with insomnia have come to associate the bed with being awake and anxious about sleeping instead of being relaxed and asleep. Because of all the time spent in bed not sleeping, you have learned to associate the bed with racing thoughts, agitation, alertness, restlessness, and sleeplessness. Some people notice that it is easier to fall asleep in a living room chair than in bed. Stimulus control treatment helps you re-associate the bed with sleep. There are three simple rules to follow as part of this treatment approach.
How we think about sleep can play an important role in how we deal with sleep difficulties. For this reason, an essential part of your sleep treatment involves 1) identifying your thoughts about sleep that tend to make sleeping more difficult and, 2) replacing these thoughts with more helpful thinking. One technique for examining your thinking is to treat your thoughts as scientific hypotheses or ideas. You may have had certain beliefs about your sleep for a long time. At this time you are being asked to consider alternative beliefs and determine which of these beliefs is best supported by the information available to you.
As you pay attention to your thinking about sleep and consider alternatives, you will probably notice two paradoxes to address:
Now that you've become aware of the thoughts that make your sleep worse and have considered alternative ways of thinking, the next step is to practice these new thoughts. This challenging of new thoughts replacing old thoughts will take some effort because our thoughts are typically automatic and we are not accustomed to deliberately noticing them. Scheduling a time each day to examine the ways you think about your sleeping will be helpful in getting you to notice and challenge any maladaptive thought patterns. It is important to do this on a regular basis, as it can be easy to fall into old thought habits if you are not actively monitoring your thoughts. Like any new skill, it is important to practice it. Keep a diary of your sleep-related thoughts and your ideas on how to think differently. Once you have become accustomed to examining your thoughts, you will find that this is an excellent skill that will prove useful for helping you to approach your sleeping difficulties differently as well as for learning a healthier approach to other life problems as well.
Sleep restriction regulates your bedtime and wake time in an effort to consolidate your sleep into a shorter and ultimately more restful time in bed. This approach is based on the observation that people with insomnia often try to compensate for their disturbed sleep by sleeping late in the morning, taking daytime naps, and/or spending excessive amounts of time in bed. While catching up on sleep through naps or sleeping-in mornings may be helpful for coping with temporary insomnia, on a long-term basis these strategies actually make insomnia worse by promoting an inconsistent and irregular sleep-wake rhythm.
To restore a regular sleep-wake schedule and increase the likelihood of falling asleep soon after going to bed, do the following:
Sleep information from the National Heart, Lung and Blood Institute: www.nhlbi.nih.gov/health/public/sleep
The National Sleep Foundation (NSF) is an independent nonprofit organization dedicated to improving public health and safety by achieving public understanding of sleep and sleep disorders, and by supporting public education, sleep-related research, and advocacy. www.sleepfoundation.org
A wealth of information and links on sleep, sleep disorders, sleep activism, sleep-related events and much more! www.stanford.edu/~dement/index.html
A CNN article on the importance of getting enough sleep: http://www.cnn.com/2000/CAREER/trends/12/04/napping/index.html
Relief From Insomnia: Getting The Sleep of Your Dreams by Charles M. Morin, 1996
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