Insomnia: When You Can’t Fall Asleep
Insomnia is well-known to many Americans, and is often discussed when we have trouble sleeping for a night. But what is clinical insomnia, and how is it treated? Insomnia refers to when individuals have difficulty falling asleep or staying asleep. This may involve being unable to fall asleep in the beginning of the night, waking up in the middle of the night and not being able to fall back asleep, or waking up too early in the morning.
In 2008, the Institute of Medicine reported that 50-70 million people in the U.S. suffer from insomnia. Among these people, the disorder has varying degrees of severity. There are three main classifications of insomnia: transient, acute, and chronic. Transient insomnia occurs for days to weeks. Acute insomnia lasts from three weeks to about six months, and chronic insomnia can last for years. Short-term stress or changes in the environment generally affect transient and acute insomnia, as opposed to chronic insomnia. Women are 1.4 times more likely to suffer from insomnia than men.
While there are numerous drugs on the market that claim to relieve insomnia, the best way to combat the disorder is through behavioral treatment. Sleeping pills often come with the risk of dependency and usually only cause people to fall asleep 10 minutes before they normally would without the medical assistance. What’s more is that sleep quality can be negatively impacted by these drugs. Cognitive behavioral therapies have no risk of dependency and can be more effective than medication.
CBT includes the methods listed below combined with health practices and environmental factors that can promote or inhibit sleep. Factors like caffeine consumption, exposure to light, and room temperature can all affect sleep quality.
1. Stimulus control therapy
Stimulus control therapy means associating your bed and bedroom with sleep, and only with sleep. When we read, watch television, or do other non-sleeping activities in our bedroom, our brain associates this room with being awake and active. By re-associating the bed and bedroom with sleep, our brains then adjust to going to sleep and staying asleep when in bed. Stimulus control therapy can be very helpful in establishing a consistent sleep-wake schedule. The following steps are designed to create the association between sleep and your bed.
1. Go to bed only when you are sleepy
2. Get out of bed if you are unable to sleep
3. Use the bed/bedroom for sleep (and sex) only (no reading, watching television, talking on the phone, etc.)
4. Create a bedtime ritual, such as playing a certain sound or music when you go to bed or meditating
5. Go to sleep and wake up at the same times every day
When experiencing insomnia, it’s helpful to relax your body as well as your mind. Relaxation procedures aimed at relaxing both body and mind include progressive muscle relaxation, autogenic training, imagery training, meditation, and ambient sounds. Trying several of these techniques can help you find the ones that are best for you.
3. Paradoxical intention
Worrying too much about if you will experience insomnia or continuously checking how long you have been awake will impair your ability to fall asleep. It can be difficult to ignore your insomnia, but thinking about it will only further impair your ability to fall asleep. Reducing the amount to time that you think about or monitor your insomnia will help you to conquer it. When you find yourself worrying about if you’ll be able to fall asleep, try one of the relaxation methods described above such as focusing on breathing or relaxing your muscles. If you can’t sleep, be sure to get out of bed until you are sleepy again so that you don’t associate your bed with wakefulness.
What is an ideal environment to induce sleep?
Studies have shown that elevated body temperature can increase sleep onset, so you want a cool environment. Having a bedtime ritual is also important. Cognitive behavioral therapists will often say that the process of going to bed starts about a half hour before you actually get into bed. Meaning that it is useful to have bedtime rituals to tell your body when to relax. In the digital age when people are always on their devices, this can be particularly problematic. Leave the device in the other room and don’t be around too many bright lights. Sometimes a meditation ritual can help for those times that the mind is racing.