Published on April 20, 2012

Genesis Sleep Expert Offers Tips For Insomnia

You’ve been lying awake since 2 a.m. Your mind is racing with thoughts of work, kids, deadlines. The clock beside you is ticking. The prospect of going to work without 7-8 hours of sleep has you, well, sleepless.

If insomnia plagues your nights, you’re not alone: Trouble falling sleep or staying asleep affects 1 out of 3 American adults, the National Sleep Foundation says. Insomnia can be intermittent or chronic and comes with consequences: fatigue, problems concentrating, irritability, lack of concentration, headaches and loss of motivation.

There’s a plethora of drugs and medications aimed at alleviating insomnia. But when is it time to grab for a pill to help you sleep?

Not until you’ve tried lifestyle, behavioral and environmental changes first, said Stephen Rasmus, M.D., a board-certified sleep specialist and medical director of the Genesis Sleep Disorders Center in Davenport.

“When I treat an insomniac, I’ll take several office visits to learn the patient’s sleep habits and determine what we can do to help him or her fall asleep and stay asleep. If all else fails, we resort to sleep medications. Medications can be very effective for insomnia sufferers, but it’s a myth that they help everyone sleep.”

Many causes

Insomnia often is caused by poor sleep habits, so lifestyle changes are a first step in treatment. “Limit your stimulation before bedtime as much as possible. Put the clock away, so you’re not looking at it. Establish a bedtime routine that helps you relax before falling asleep.

Limit caffeinated drinks, alcohol and nicotine before bedtime,” says Dr. Rasmus, who also is a boardcertified neurologist.

Alcohol may help you get to sleep, but it keeps you in the lighter stages of sleep. You also tend to wake up in the middle of the night when the sedating effects have worn off. Allergy medications with the decongestant pseudoephedrine also can disturb sleep.

Some insomnia is associated with “sleep state misperception” -- people thinking they’re sleeping far less than they really are.

Jet-lagged travelers and night-shift workers fall into the category of insomnia caused by circadian rhythm disorders. The circadian rhythm, the significant biological rhythm that affects your ability to sleep, is largely affected by light. “Try to avoid daylight exposure to your eyes, as this stimulus is transmitted to your brain, and it ‘wakes up’ your daytime biorhythms,” Dr. Rasmus says. “If the sun is up when you leave your night shift (even if it is cloudy), wear dark wrap-around sunglasses until you are in your home. Get about 20 minutes of daylight after you get up in the afternoon, and hopefully your brain will ‘think’ it is morning.”

Psychological factors like persistent stress or depression can cause insomnia, as can physical problems like chronic pain, heartburn, periodic limb movements, psychiatric illnesses or congestive heart failure.

It only takes a few nights of consistently poor sleep to trigger psycho-physiological insomnia, a “learned” insomnia that has true physical components like increases in metabolic rate, heart rate, cortisol and body temperature. Treatment requires “unlearning” the reminders of poor sleep, and learning new sleep habits.

Breathing exercises can help, and there’s one in particular that Dr. Rasmus recommends.

“Lie there and focus on your belly going up and down, up and down as you breathe,” Dr. Rasmus says. “As soon as your mind wanders, which it will, bring your thoughts back to your belly. Don’t change your breathing...you’re just an innocent observer watching your belly breathe. See whether you can meditate yourself back to sleep.

“If you do this for 15 minutes, and it’s going nowhere, then it’s better to break the spell. Get out of bed and look out the window for 5-10 minutes to break the experience. Don’t go online, read a book or watch TV. If you think you can fall asleep, you will be better at falling asleep. It’s a self-fulfilling prophecy.”

Multiple studies have shown the success of treating chronic insomnia with cognitive behavioral therapy, a specialized treatment offered by psychologist Janis Smith, Ph.D., at the Genesis Sleep Disorders Center. The therapy uses a number of strategies to address the habitual patterns of chronic insomnia.

“Cognitive behavioral treatment overall provides about as much additional sleep as the average patient taking sleeping pills,” Dr. Rasmus says. “There are individuals, however, who do much better with one or the other. The challenge is to find the best solution for each patient.”

Medications

There are many types of sleeping pills, including some you can buy without a prescription. Some are “shortacting” and work best if you have trouble falling sleep. Others are “long-acting” and work best to keep you asleep throughout the night.

One key is determining their “half-life,” or the time it takes for a drug to lose half its strength in the body.

Most over-the-counter antihistamines like Tylenol PM have benadryl and a half-life of about 12 hours. “You can feel fuzzy-headed when you wake up...even cognitively impaired,” Dr. Rasmus says.

Sedating anti-depressants like trazodone and amitriptyline also have longer half-lives. They do a good job of inducing sleep but often become less effective over the long haul.

“If you take a sleeping pill at 10 p.m., and it’s not completely out of your system by the next night when you take it again, the brain eventually becomes habituated to it, and it’s not going to work anymore,” Dr. Rasmus says.

Prescription sleeping pills like Ambien, Lunesta, Rozerem and Sonata have brief halflives, making them more useful for treating sleep-onset insomnia and middle-waking insomnia. However, they can have some risky but rare side effects, such as sleep-walking or sleep-driving.

“The most common dealbreaker is nocturnal wandering with amnesia, where you get up in the morning and you have ice cream all over the kitchen and don’t remember eating it,” Dr. Rasmus says. “I had one patient who drove four blocks and woke up in a parking lot in his underwear. I’ve had patients get up and urinate in their closet and not know they did it. These things are relatively rare, but they can happen.

“Although these medications are a huge breakthrough and can be used on a regular basis by some chronic insomniacs, they’re not good for everyone. That’s why we first try to see if sleep hygiene and other therapies work first.”

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