What to do About Insomnia

Q: For the past couple of years, I have found it difficult to go to sleep. It takes maybe two hours, and then I awaken early. I am healthy, but feel fatigued and need an afternoon nap to help with the tiredness. Should I take sleeping pills?

A: It sounds as though you have chronic insomnia. The problem is a common one, affecting between 10 and 15 percent of people. It is much more common as we age, and affects women more than men. Sometimes it complicates chronic medical or psychiatric disorders.

Primary insomnia—which we suspect you have—may respond well to reprogramming your sleep habits. We presume you do not have breathing problems or restless leg syndrome. Many people with insomnia have a state of increased arousal, and brain-wave activity confirms this increased alert state.

Though some medications may work, long-term studies greater than six months have generally not been conducted. And we would recommend behavioral changes first.

Some people do not use their bedroom as strictly a "sleep room." Reading in bed, watching television, or sewing and knitting in bed may break down the association between bed and sleep. We think televisions in the bedroom and books in bed are not good ideas.

A second measure you may find helpful is sleep restriction. Cut out that afternoon nap, and voluntarily cut the time you spend in bed.

Relaxation measures such as massage may help, or exercise in the early evening and a warm bath before sleep time may help.

Expectations and anxiety about sleep may also negatively impact sleep patterns.

Many psychologists have programs to assist in developing "sleep hygiene" behaviors. Individual therapy, perhaps for half a dozen sessions, is usually better than group sessions. And 20 to 50 minutes per session may be all that is required.

Avoid heavy evening meals, heavy evening exercise, and exciting TV programs or controversial topics of discussion before bedtime.

We hope you get relief, and wish you sweet dreams—because then you will be getting that rapid eye movement sleep that is so refreshing.

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