Insomnia

Lack of sleep is a common occurrence in our population, one that I will frequently encounter among my patients.  It can have numerous effects on the body and mind and by now most of us appreciate the importance of a good night’s rest.  Consequently, a billion-dollar industry has developed in trying to find ways to improve our sleep, including numerous pharmaceuticals.  While many people do legitimately need medications to assist them to sleep, they are not without their drawbacks.  Many can cause daytime sleepiness or grogginess.  Others can be very habit-forming.  In addition, many of us have heard stories of people sleepwalking due to their sleep aid, waking up in strange places not knowing how they got there.

Therefore, before jumping into using a pill to help one rest, it’s always best to make sure that one’s sleep hygiene is solid.  By sleep hygiene, I do not mean how clean you are when you go to sleep.  Rather, I am referring to the habits that you do prior to going to sleep which can in turn affect the quality of your rest.  There are a great many tips and tricks that you can incorporate into your sleep hygiene to give you better slumber, some of which may work incredibly well for you and others that won’t.  Caffeine after 12PM is something I generally tell patients to avoid, as it can have an unexpectedly long half-life and interfere with your sleep later that evening.  I also recommend avoiding computer, cell phone and television screens within a few hours of going to bed.  If you must be in front of a screen, invest in a blue light filter that you can place on the screen, as blue light appears to trigger the release of histamine (wakefulness promoting chemical) from the brain.  As you go through your evening, gradually turn down and turn off the lights in your home, such that by the time you are about to go to bed there is minimal lighting on.  This helps to simulate the sun setting to your brain.  Avoid any mentally rigorous exercises right before bedtime, doing some light reading is very reasonable.  Taking a warm shower before going to bed can help relax the muscles and promote better sleep.  Once ready to go to bed, make sure the room is as dark as possible, investing in blackout curtains if necessary.  If you cannot keep the room dark, use a sleep mask.  Keeping the temperature cool in the bedroom is also helpful to many people.  Use your bed only for sleep and intimate activities, do not work, eat or read on your bed.  If you cannot go to sleep within 30 minutes, do not toss and turn all night there.  Get up from your bed and sit in your living room with low or no lighting and either flip through a magazine or listen to soft music.  Once sleepy again, go back to your bed.  Some people find that white noise machines or weighted blankets can be helpful, and I feel it is perfectly reasonable to experiment with this.

If you are changing your habits around sleep but are still having trouble, discuss this with your primary care provider.  You may be taking a medication that could be promoting wakefulness and this should be reviewed with your provider.  In addition, you may be suffering from a mental health condition, like anxiety, depression or bipolar disorder, that can make sleep more difficult.  Once treated, sleep can vastly improve.  Perhaps the patient requires a sleep aid, and this can be considered after a careful discussion of the risks and benefits of medication therapy.  Lastly, if you are having significant difficulty sleeping, to the point that both changes in your sleep hygiene and taking medication sleep aids do not seem to help, you really need to consider a sleep study.  You may have a condition that prevents you from either going to sleep or maintaining a deep restful sleep state.  These conditions can subsequently be diagnosed in a sleep lab.  One of these is obstructive sleep apnea, where you don’t take in enough air and oxygen when you go to sleep, interrupting your rest throughout the night.  Another example is periodic limb movement disorder, where your limbs, especially the legs, involuntarily move while sleeping or attempting to sleep.  These conditions and others are generally correctable and once managed, can help you feel much better rested.