Break Habits That Lead to Insomnia

Behavior-based treatments don't involve a prescription and ultimately work better than pills. Hello, there, night owl. Here you are, switching on a light to read the newspaper again — even this story — because you just can't get back to sleep.

Well, don't feel alone. You have lots of wide-eyed company. Like at least 35 million other Americans, you have a condition called insomnia. It can lead to aches, bad moods and eventually an overall feeling of negative mental or physical health.

But you don't have to stay sleepless — in Springfield, Strafford or Sparta, not to mention Seattle and points in between. Unless your insomnia is caused by a condition that requires medical treatment, like sleep apnea, more than one road can lead you back to a good night's sleep.
Sleeping pills can help some chronic insomnia sufferers.

However, other treatments — including biofeedback and positive sleep habits — don't involve a prescription and may even be more effective than medication.

Negative effects

Insomnia could eventually lead to a lower quality of life, according to Dr. Jennifer Lynch, a CoxHealth neurologist specializing in sleep medicine. "You can imagine how you feel after a horrible night's sleep. You ache more, you can't remember very well, you don't want to do much, you can't get as much done.

These (symptoms) all mimic pain disorders, depression and mood disorders," Lynch says, explaining that insomniacs are frequently misdiagnosed as having dementia, depression, fibromyalgia and other medical conditions.

Insomniacs are also more prone to infections, says Dr. John Brabson, a pulmonologist and sleep specialist who directs the St. John's Sleep Disorders Center, and they're more likely to have medical issues requiring office visits and tests. Depression, for example, often occurs along with insomnia, although one is not necessarily the cause of the other.

Types and causes
Primary insomnia is a condition on its own and is not caused by any known medical problem. Secondary insomnia is caused by a underlying condition. The National Institutes of Health says to be considered insomnia, the difficulty getting to sleep or staying asleep must have occurred for at least one month.

Insomnia is considered chronic if you've been having trouble going to sleep or getting back to sleep three nights a week for three months, according to the American Sleep Disorders Association. Primary insomnia is often triggered by specific circumstances.

"The common story of insomnia is that there is usually some type of precipitating event — let's say a divorce," Brabson says. "What happens is the precipitating event can often go away, but the insomnia part stays." Insomnia continues when bad sleep habits begun during a trying, troubled-sleep time of life aren't broken, sleep experts agree.

Retrain your brain, body
That's where cognitive behavioral therapy, or CBT, may come in, Brabson says. CBT, as it relates to insomnia, means practicing stress management as well as good sleep habits or hygiene, says John Essman, a St. John's clinical psychologist and sleep specialist who advocates CBT for his insomniac patients.

Besides avoiding stimulants, both chemical and technological — coffee, tea and too much TV — those with sleep problems can also try banishing stressful thoughts and activities from their brains and bedrooms before it's time to go to sleep.

People develop conditioned responses — and the sleep-deprived, unfortunately, have learned to associate bad stuff with bedtime, Essman says. "Whether it's an argument that we've had or past nights that we've had trouble getting to sleep or staying asleep, that can contribute to the current night's problems," he says.

The obvious solution is to "maintain the sanctity of the bedroom," Essman says. "People use their bedroom and their bed for a lot of different things sometimes, so it's suggested that the bed and the bedroom be used primarily for sleep or sex," he says. "Try to avoid paying bills as well as having distressing pillow talk."

If you're a worrywart, sleep experts suggest penciling time for fretting into your schedule instead of saving it for the end of the day. Bedtime is "not a great time to worry about bills or kids or jobs," Brabson says. Worry often results from a lack of organization during the rest of the day, Lynch says. If it's causing insomnia, then "make a list and adhere to it. Don't procrastinate.

"A lot of people worry about things they have no control over," she adds. "They should make a cognitive decision not to worry about it, or if they're faithful people, pass it on to God or symbolically let go of these worries they have no control over." Unfortunately, after too many nights of frustrated sleep, some insomniacs add worry about not getting good rest to their list of concerns.

"As soon as their head hits the pillow, they get anxious wondering, 'Am I going to sleep tonight?'" Lynch says. "A lot of people get into a bad cycle, and then they can't break that."

It's an attitude called "bed dread," Essman says, and it only digs the insomnia rut a little deeper.
"It's getting close to bedtime, that little voice can pop in," Essman says. "Many people get in kind of a negative frame of mind."

Types of cognitive behavioral therapy can help pull insomniacs out of this rut, including biofeedback. Biofeedback is the use of instruments to give people information about their bodies.
With the equipment, a person can get real-time data about things such as muscle tension, sweating, blood pressure and heart rate.

The person can use this information to help control his or her body's reaction to an event.
Biofeedback has been successfully used to treat insomnia. Some biofeedback devices on the market allow people to monitor their own brain waves, Brabson says.

"You can actually teach your brain to go into certain waves, which are called alpha waves, and you can watch the waves on a computer screen," he says. It's possible to get biofeedback without using a medical device. Insomniacs may monitor their heart rates while practicing deep breathing or other relaxation therapies, Essman says.

"To see that my heart rate went from 100 to 85, it's very tangible, very immediate," he says.
Other ways to calm down before bedtime include yoga, relaxation tapes, guided imagery and visualization, sleep experts say.

Pills do have a place
The American Sleep Disorders Association says sleeping pills can help some chronic insomnia sufferers as well as those with sleep problems caused by acute stress, such as a death in the family or the start of a new job.

Jet lag, shift work changes, predictable stresses and medical disorders are also listed as reasons to use pills. Newer sleep medications like Ambien and Lunesta, which have less of "hangover effect" than older drugs, can help with short-term insomnia, particularly sleeplessness caused by acute stress, local experts agree.

Yet they also agree that CBT works better as a long-term cure. "I think it's unfortunate that a lot of people are given these (drugs) as the first answer, because most medications are somewhat habit-forming and tend to then become an ongoing need," Lynch says, adding that medications don't address the underlying causes of long-term insomnia.

"Studies have shown that working on sleep hygiene and these cognitive therapies are actually more effective for a longer period of time than the medications are."