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.”