I am not insomniac (sleeping 7 hours most nights) still, I do feel asleep reading to my children. Who does not?
24
Melatonin is the best solution for me during bad nights. So longa as I take it before 3:00am it does not impact my performance at all the next day. I wonder why the author did not explore or describe the effectiveness of using your own natural sleep hormone (melatonin) to help you achieve a good night of sleep.
MELATONIN works, is very cheep ($3.00 for a bottle that lasts for months) and is natural.
MELATONIN works, is very cheep ($3.00 for a bottle that lasts for months) and is natural.
15
I don't think the writer even suffered from true insomnia. True insomnia is not where you're staying up relishing alone time. True insomnia is where you fall asleep at midnight after a struggle and wake up at 3 am like you've been shot from a cannon, never to fall back asleep again, until the next night's struggle. If your body is doing that to you, and you don't feel anxious from the resulting exhaustion, then I question your sanity. Try using CBT alone on that condition. Not going to work. Yes, CBT is helpful and necessary, too, but you're gonna need meds or lose your mind.
89
Last week there was a paper published in Nature Neuro Science about a connection between deep sleep and Alzheimer's. Matthew Walker from University of CA Berkeley talked about it in the second part of Science Friday (June 5) What is sleep? The first part was interesting as well.
10
should there be any mention of the recent evidence that pharmaceutical sleep aids hasten the onset of dementia? That little pill isn't so benign after all...
http://www.theguardian.com/society/2015/jan/27/sleeping-drugs-increased-...
http://www.theguardian.com/society/2015/jan/27/sleeping-drugs-increased-...
15
I recently read about a study by Walter Matthews published in Nature- neuroscience magazine about sleep. He was also interviewed in latest episode of Science Friday on NPR/PRI. You can google and read article or listen to interview, but the short is that those who do not get deep sleep in large amounts have a greatly increased risk of Alzheimer's disease. Theory beings that only during deep sleep does the spinal fluid properly bathe the brain and allow recently learned information (short term memories) stay in your brain. Of course more research will come in this area, but I found the article fascinating and it encourages me to seek more quality sleep.
13
One more example of a chronic condition (medical or psychiatric) that is best addressed through lifestyle changes. Of course, everyone knows what they should be doing, but establishing adaptive habits is not easy. There are many powerful biological reasons for out bad habits, and most of the work in CBT is overcoming obstacles to healthful habits.
7
A sleep disorder can be organic. People with certain chronic illness's get them. Autistic children have them.
I know; insomnia was the first symptom I had of chronic fatigue syndrome. Every night I'd wake up at 3:10 a.m. The CDC lists sleep disorders and unrefreshing sleep as a hallmark symptom of CFS.
When my rheumatologist tried to find a doctor for me he was told that "no one wants to work with adult insomniacs. I had already taken a course in CBT and sleep disorders at a world class medical center.
I've seen two wonderful doctors (and some who just pushed pills.) Most meds that would put a city to sleep had no effect.
I'm doing better now because I'm on doxepin (the Australian doctor mentioned it here) and Lyrica for neuropathic pain. But the sleep effects are wearing off.
The most helpful thing I learned in the CBT course was to take a hot bath about three hrs before bedtime so your core body temperature will drop, a necessity for sleep. I add Epsom salts; they relax muscles. I tell everyone this who complains to me and they say they don't take baths. I tell them they don't have a real problem.
Be careful with melatonin if you have an autoimmune disease. It flared my Sjogren's. Also diabetics should be careful.
I'm counting the days until Stephen Colbert takes over night late TV. It helps to go to bed smiling. My late mother watched Seinfeld reruns.
I know; insomnia was the first symptom I had of chronic fatigue syndrome. Every night I'd wake up at 3:10 a.m. The CDC lists sleep disorders and unrefreshing sleep as a hallmark symptom of CFS.
When my rheumatologist tried to find a doctor for me he was told that "no one wants to work with adult insomniacs. I had already taken a course in CBT and sleep disorders at a world class medical center.
I've seen two wonderful doctors (and some who just pushed pills.) Most meds that would put a city to sleep had no effect.
I'm doing better now because I'm on doxepin (the Australian doctor mentioned it here) and Lyrica for neuropathic pain. But the sleep effects are wearing off.
The most helpful thing I learned in the CBT course was to take a hot bath about three hrs before bedtime so your core body temperature will drop, a necessity for sleep. I add Epsom salts; they relax muscles. I tell everyone this who complains to me and they say they don't take baths. I tell them they don't have a real problem.
Be careful with melatonin if you have an autoimmune disease. It flared my Sjogren's. Also diabetics should be careful.
I'm counting the days until Stephen Colbert takes over night late TV. It helps to go to bed smiling. My late mother watched Seinfeld reruns.
25
Good, common sense article by Austin Frakt. I have long been concerned about the clear link between some common mental illnesses and insomnia. I am also convinced lack of sleep plays a big part in low mood and also traffic accidents. I am equally skeptical of medication currently available, although I have come to believe in the importance of melatonin, both in sleep hygiene, as mentioned, sleeping in the dark, and proper exposure to natural light for some of each day. Asphalia is one excellent natural source of melatonin that aids sleep. Worth a try!
5
I've always been a bad sleeper but after consecutive months of being on sleep meds, followed by anti-anxiety meds, and even an anti-depressant, I decided to try a completely drug-free method. Recommended to me by a psychiatrist, Dr. Gregg Jacobs' book, "Say Goodnight To Insomnia" was my cure. It is CBT focusing on positive sleep thoughts, sleep hygiene, and meditation/relaxation techniques. I've recommended it to a few friends, all with some success in improving sleep. Within 2 weeks, I was sleeping again!
9
The best treatment for insomnia by far, in my personal experience, is exercise. A good workout each day improves both falling asleep and the feeling of having gotten a good rest the next morning. When I don't work out, I noticed again and again over many years that I fall asleep with more difficulty and seem to be lest rested the next morning
35
If you need or want to use electronics, try using blue light blockers. Blue light apparently surpresses melantonin production. There is a program and app called f.lux, which can easily downloaded and makes looking at the screen much easier on the eyes, although there is an orangey color distortion. Inexpensive orange or amber glasses are available on Amazon and elsewhere; many fit over your glasses. There are stickon blockers that can be used on Kindle or other tablets also. These 3 products have helped me get to sleep easily even if I use my gadgets in the evening.
14
Thanks
4
It seems well understood, but not discussed here, that our sleep problems tend to increase as we age, however more tired we may feel. Also not really discussed, is the LEVEL of sleep attained, which is important to realizing the value of sleep to our functioning. We particularly need some practical and inexpensive home testing that is fully equal to a good sleep study.
Too, as we age, comfort and the absence of painful interruption is essential. Many of us too suffer from joint/muscle pain, where the body meets the support, i.e. hip, shoulder, etc. Some of us have also long been subject to nocturnal calf, front portion of leg and foot cramps that sharply awaken us, particularly when we get into a, desireable, deep sleep mode. Quinine helped some, earlier when it was available in larger doses, but little else seems to, including increased calcium, magnesium, potassium, etc.
If we could only resolve these (likely) "peripheral nerve" problems, about which the medical folks seem so passive and uncertain, and also sleep in some magical device that would essentially make us feel near weightless, without pressure on any part of the body, we might REALLY sleep well.
Too, as we age, comfort and the absence of painful interruption is essential. Many of us too suffer from joint/muscle pain, where the body meets the support, i.e. hip, shoulder, etc. Some of us have also long been subject to nocturnal calf, front portion of leg and foot cramps that sharply awaken us, particularly when we get into a, desireable, deep sleep mode. Quinine helped some, earlier when it was available in larger doses, but little else seems to, including increased calcium, magnesium, potassium, etc.
If we could only resolve these (likely) "peripheral nerve" problems, about which the medical folks seem so passive and uncertain, and also sleep in some magical device that would essentially make us feel near weightless, without pressure on any part of the body, we might REALLY sleep well.
31
"Insomnia is a condition of the mind that then infects the body"? Perhaps Mr Frakt has never had noisy neighbors. There are many reasons for insomnia and some of the sleep hygiene guidelines are quite laughable. As someone who advocates wellness and natural approaches I would certainly advise these prior to using drugs, but I don't think a one-size-fits-all approach can work. After trying many things, what works best for me is a homeopathic remedy called Rescue Sleep. But NOTHING lets me sleep though one of my neighbors' parties.
9
(from her wife) my insomnia is caused by an antidepressant and is resistant to all behavioral approaches. I think that the cause of the insomnia is important in evaluating the effectiveness of different approaches. I use non-prescription sleep aids, usually melatonin, to get to sleep. The prescription aids give more of an impression of sleep (forgetting the sleepless parts, not sleeping deeply) than a true restful sleep.
3
This article made me MAD. With a history of clinical depression (and yes, feel free to wonder if that's the cause for my insomnia) and two kiddos (5, 7), I need to sleep. If I go light on depression meds, my two saving graces are sleep and exercise. And I don't shortchange myself on exercise - not even when sick or tired. So without sleep, I start to slide. I went through a cycle this year of not sleeping for two weeks solid. After the birth of my first daughter, I suffered from severe postpartum depression, and that's what not sleeping felt like. Being in that black hole again. If I want to be a sane partner, sane mother and sane full-time career woman, I need sleep. I asked my doctor, she prescribed trazodone, and I have been sleeping six to eight hours a night since then, with the occasional wakefeul, anxious night. Sleep allows me to feel right with the world. I know what I'm like with it - and without it - and it can mean the difference between manageable sadness and minor irritation and devastating feelings of hopelessness and raging irritability. Oh - and lest anyone rush to judgment - I have been a longtime participant, on and off, in CBT. It's not the sleep cure for me, but it has helped in other areas. Some folks cannot be helped with good sleep hygiene and thinking their way into better sleeping. Jeez.
59
I don't think that the author said that. He said that CBT is more effective for more people. His preference for CBT over prescription medication seems justified by my experience with sleep meds like Ambien. The side effects are oppressive. If they work for you, though, great.
10
My sleep analysis begins ny first asking myself why I'm emotionally offcenter. Surprisingly, just putting the question into words tends to focus the mind forcefully. Very often the sole reason is I didn't get enough sleep last night. Lack of sleep is usually the sole reason I'm unhappy. Ipso facto, the next analysis is why I didn't sleep last night. Its usually physical, emotional or both. Once I've asked the question, figured out what troubled my sleep, I develop methods of not repeating. Lately its been about what position I sleep in and whether some daytime events are affecting my sleep. I got 8 good hours last night because I discovered some daytime physical habits were affecting me. Like Proust, I'm attempting to go to bed early these days, though I'm an inveterate stayer upper. I know better than to eat and drink late, but sometimes violate. So daytime eating factors play a role. I'm never in despair about getting answers because I always get answers, act on them, and discover whether they're right or wrong. Last but not least, I never blame myself if I didn't get the right sleep the night before. Self forgiveness is a big part of happiness and getting the proper sleep. It will also help you avoid sleep apnea, diabetes, heart problems, getting sick. You have to work on sleeping but the work is easy and natural. When at my best, my head hits the pillow and I'm immediately gone.
11
I really like this reader's comment that "self forgiveness is a big part of happiness..." Wasn't it Albert Schweitzer who said "Happiness is nothing more than good health and a bad memory."?
14
Ah, yes, CBT. I remember the Times running a story about 15 years ago on its miraculous powers. Chronic depression cured in 6 months! Insurers love it! So I went running to the Institute for Cognitive Therapy on East 57th Street. Four years of treatment later I was all out of money and they tossed me out the door, depressed and broke.
27
CBT is almost miraculous for a large number of people. It was for me. Why you think insurers "prefer" it is odd--sleep meds and anti-depression meds are very inexpensive these days, and many physicians will prescribe them and allow you to live in a fog of side effects for years.
3
Hear! Hear! I'm pretty sure that Aaron Beck and his more commercially inclined protegé, David Burns, have never experienced the crushing psychic pain of severe clinical depression. So, they reverse-engineer their patients' anguish and confuse cause and effect: this poor sap's distorted thoughts precipitated his depression. Um, no. His thinking is distorted because of his depression. And all the journals and worksheets and graphs will not "fool" nor otherwise convince the depressed brain that knows with certainty what a collection of excrement the sufferer is.
Though it's been a long time, I do remember remission and when, symptom-free, I would "challenge" my un-depressed brain: "Go ahead. Bring your vile worst. Think yourself into a severe depression."
... After which i'd concede with infinite relief: "Sorry, I wouldn't know how."
For me, CBT might only work for a mild depression. Again, that's me. Others might have found it instrumental in literally saving their lives.
My insomnia is too intertwined with severe depression for CBT to make a dent.
Don't even get me started on mindfulness.
Though it's been a long time, I do remember remission and when, symptom-free, I would "challenge" my un-depressed brain: "Go ahead. Bring your vile worst. Think yourself into a severe depression."
... After which i'd concede with infinite relief: "Sorry, I wouldn't know how."
For me, CBT might only work for a mild depression. Again, that's me. Others might have found it instrumental in literally saving their lives.
My insomnia is too intertwined with severe depression for CBT to make a dent.
Don't even get me started on mindfulness.
12
My insomnia was caused by high cortisol levels which spiked at midnight and 5 a.m. (I had to order the 24 hour saliva test on my own since my health care group would only run one test in the morning). I was waking up every hour and would lie awake for another hour or two before falling asleep for may be forty-five minutes, with that cycle continuing through the night. My doctor was throwing Ambien, melatonin, yoga, you name it, at it. And, even before I took the test I told her I thought it was my cortisol levels, thrown out of whack by years on synthetic thyroid hormones and my dog being diagnosed with cancer and my mom having a stroke one week later. In any case, I was already seeing a therapist because that's what doctors recommend when you tell them you're still having hypothyroid symptoms but your TSH is "normal."
In any case, I stopped the Ambien and the melatonin. Started natural dessicated thyroid hormone. I continued the yoga and started acupuncture once a week. It took about six to seven months, but now, a year and a half later, I sleep on average seven and a half hours a night.
In any case, I stopped the Ambien and the melatonin. Started natural dessicated thyroid hormone. I continued the yoga and started acupuncture once a week. It took about six to seven months, but now, a year and a half later, I sleep on average seven and a half hours a night.
11
I have a favorite poem that I attempt to repeat mentally when I can't sleep. Usually, I can't concentrate so its hard to finish the poem. I keep trying until I can repeat it three times. For some reason this works for me.
7
Strikes me that working that hard to get it correct would keep you awake?
1
A friend working for a manufacturer, Century Foods, complained the new 12 hour day regimen, was radically disturbing his sleep cycle and daytime life. Manufacturers minimize overtime costs by working employees, 12 hours a day, 3 days, one week, alternating with 12 hours a day, 4 days, the next week. This is a violation of a humans daytime living cycle and night time sleep patterns. Government should look into prohibiting it. Another friends who's worked this way for 20 years is a walking sleepless zombie who can't fix the problem on long weekends. Irony: Commenter Marilyn below says she slips lithium in her vitamins, but, in the same sentence, writes that she sleeps drug free night after night.
7
I took the suggestion, found online, of investing in a hammock, which is sometimes recommended for people suffering from fibromyalgia. I have semi-regular sleep issues and also tended for years to wake up stiff and sore every morning, despite not being all that ancient (!) and switching from an old futon to a high-quality natural latex mattress.
The hammock is a Brazilian type, also high quality (try to get the "real thing" - and no spreader bars, repeat, no spreader bars, that is absolutely the wrong idea). It is absurdly inexpensive when compared to even the crappiest bed. It is anchored by sturdy eye bolts (supplied by the seller) in wall studs. It literally revolutionized my life. Not only do I have no soreness in the mornings anymore, I also sleep better - and when I have the occasional bad night, it doesn't distress me as much now because being in the hammock is so comfortable. There's something about being gently suspended that way which just plain reassures the body.
Moreover, many good hammocks can easily accommodate two people. The only issue there is disturbing your mate if you need to get up during the night.
The hammock is a Brazilian type, also high quality (try to get the "real thing" - and no spreader bars, repeat, no spreader bars, that is absolutely the wrong idea). It is absurdly inexpensive when compared to even the crappiest bed. It is anchored by sturdy eye bolts (supplied by the seller) in wall studs. It literally revolutionized my life. Not only do I have no soreness in the mornings anymore, I also sleep better - and when I have the occasional bad night, it doesn't distress me as much now because being in the hammock is so comfortable. There's something about being gently suspended that way which just plain reassures the body.
Moreover, many good hammocks can easily accommodate two people. The only issue there is disturbing your mate if you need to get up during the night.
8
If you can inadvertently fall asleep while reading to a child, then you don't have insomnia. Insomnia is when you can't sleep, not when you choose not to. For those of us with the inability to fall asleep, even in the most quiet, relaxed moments, pharmaceuticals are the only way to go.
22
No, Susan, if you don't get enough sleep long enough you are likely to fall asleep during the day when you least expect it, for example, while driving the car. We all have to sleep sometime.
9
I think the author's point is that his insomnia causes him extra fatigue during his waking hours. It's hard to function if you've been awake all night.
4
By your measure I qualify for pharmaceuticals but chose CBT and it worked, though not completely. For that i had to give up coffee. A cup at 7 A.M. would reduce the quality of that nights sleep, sometimes severely.
5
This method always works for me. Drink a cup of warm cocoa. Within a minute or two, I am sound asleep. Am I so much different from the many insomniacs who have suffered for many years no matter what they do?
Yes, you are!
6
Yes, apparently you are - but then again everybody's different. Although tryptophan in milk might have some sedative value, theobromine in cocoa is a stimulant and is probably not helping you sleep.
5
Very much different, yes. You are not an insomniac.
18
It would be great if the company Zeo could resurrect itself. It's possible to measure sleep, including the time spent in various stages, with data transmitted from a comfortable headband. A graph is also produced. They claim an 85% correlation with overnight sleep studies.
Regarding medications and the corrupt/stupid drug trials comparing to placebo, just read Peter C Gotzshe's book Dangerous Medicines and Organized Crime. It won the British Medical Association first prize.
Regarding medications and the corrupt/stupid drug trials comparing to placebo, just read Peter C Gotzshe's book Dangerous Medicines and Organized Crime. It won the British Medical Association first prize.
8
For me, pills worked. I never engaged behaviors, such as doing anything but sleeping (or trying to) in bed, so I doubt CBT would have done any good. The usual sleep pills, Ambien, etc. didn't help nor did melatonin. What did help was Ropinirole - proscribed for a mild case of restless leg syndrome. I discovered by accident that on evenings when I took Ropinirole, I had no trouble falling asleep and slept well. I now take it every evening and usually sleep well.
Insomnia may be a single disorder, but it has many causes. Mine appears to be some sort of dopamine imbalance - not easily affected by behavioral changes. Bottom line: different strokes for different folks.
Insomnia may be a single disorder, but it has many causes. Mine appears to be some sort of dopamine imbalance - not easily affected by behavioral changes. Bottom line: different strokes for different folks.
43
The fact that CBT significantly outperforms prescription sleep meds should be common knowledge among the public, but if my patients are any indication, it is a closely guarded secret.
A child of the 60s, I remember well the frequent, government-produced public service TV commercials, along with a variety of public service pamphlets that shipped from Pueblo, Colorado. These covered topics such as home fire and safety tips, what to do if tornadoes strike, how to perform the Heimlich maneuver etc.
Then came Reagan, who effectively ended these services, employing some ridiculous "evil, big government" rationale.
Today, with advances in medical care - and advances in peddling dubious pharmaceuticals, supplements, electronic devices that "melt away" fat etc - the public could really benefit from objective, unbiased guidance in medical/health decision making.
Most of my patients are not aware of the necessity to go to the emergency room the minute symptoms of stroke appear for possible administration of medication that can eliminate or lessen the severity of strokes. In fact, some aren't aware of the symptoms of stroke - although they are able to recite lists of the latest pharmaceuticals to treat a variety of conditions.
Unfortunately, with Reagan, and then the Democrat's shift to the right with Clinton, the notion that the government had a responsibility to protect and provide pertinent information to its citizens which trumped the rights of commerce, was erased.
A child of the 60s, I remember well the frequent, government-produced public service TV commercials, along with a variety of public service pamphlets that shipped from Pueblo, Colorado. These covered topics such as home fire and safety tips, what to do if tornadoes strike, how to perform the Heimlich maneuver etc.
Then came Reagan, who effectively ended these services, employing some ridiculous "evil, big government" rationale.
Today, with advances in medical care - and advances in peddling dubious pharmaceuticals, supplements, electronic devices that "melt away" fat etc - the public could really benefit from objective, unbiased guidance in medical/health decision making.
Most of my patients are not aware of the necessity to go to the emergency room the minute symptoms of stroke appear for possible administration of medication that can eliminate or lessen the severity of strokes. In fact, some aren't aware of the symptoms of stroke - although they are able to recite lists of the latest pharmaceuticals to treat a variety of conditions.
Unfortunately, with Reagan, and then the Democrat's shift to the right with Clinton, the notion that the government had a responsibility to protect and provide pertinent information to its citizens which trumped the rights of commerce, was erased.
48
I was intrigued and googled "public service pamphlets Pueblo, Colorado" eventually finding my way here: http://publications.usa.gov/USAPubs.php
Not sure of the quality but was surprised to see you can still order these online. Thanks for the tip.
Not sure of the quality but was surprised to see you can still order these online. Thanks for the tip.
3
Anyone who has the slightest interest in medical issues can find all the information they want or need--or more--online or at the library. And from their physicians. "Reagan" and "Pueblo, CO" have precious little to do with it. Of course, your idea of "objective, unbiased guidance" could be different from mine or another person's. Look at the egg/cholesterol issue. I suspect that the Pueblo people issued pamphlets or the CDC issued dire warnings about intake. Now, that's been reversed in a blink.
Great topic and piece. I am surprised you reference so many papers on insomnia and therapy but then seem to promote a program that does not appear to have been subjected to proper study. There is an online program I easily found that has been subject to proper studies I would encourage you and your readers to look at
http://www.aasmnet.org/articles.aspx?id=1295
http://www.aasmnet.org/articles.aspx?id=1295
This article, like the many others which make a similar argument, parallels the ones which argue against vitamin supplements ."If you maintain a healthy diet" (ie, ten or more servings of vegetables and fruit a day and no meat) you don't need vitamins. If you adopt the lifestyle of a buddhist monk, you will sleep like one of the elect (perhaps because unrelieved virtue makes sleep the highlight of the day).
And, by the way, what about all the clinical trials which did not show improvement in insomnia and therefore were not published?
And, by the way, what about all the clinical trials which did not show improvement in insomnia and therefore were not published?
13
Almost every person I know with insomnia drinks a lot of caffeine, which is in coffee and tea, even decaffeinated, as well as chocolate and most sodas.
Sadly, most people become more caffeine sensitive as they age, so I am down to one cup of coffee in the morning, but there are many people who drink the same 4-5 cups as they did when they were in their 20s and cannot understand why they awaken in the middle of the night.
But then these are the same people who eat the same way they did in the 20s and cannot understand why they are 20 lbs overweight.
Adapt!
Sadly, most people become more caffeine sensitive as they age, so I am down to one cup of coffee in the morning, but there are many people who drink the same 4-5 cups as they did when they were in their 20s and cannot understand why they awaken in the middle of the night.
But then these are the same people who eat the same way they did in the 20s and cannot understand why they are 20 lbs overweight.
Adapt!
16
I completely agree. As a society, we've started taking huge doses of a powerful stimulant throughout the day. Is it any wonder that there's been a corresponding rise in insomnia (and drugs to treat it)?
Quitting or severely restricting caffeine is unpleasant for a couple weeks, but it gets much easier after that. Doing this will make you realize just how dependent you've become. If you're suffering from insomnia, I recommend taking this simple step before going on sleep medications or even embarking on a drug-free cognitive behavioral therapy regimen.
Quitting or severely restricting caffeine is unpleasant for a couple weeks, but it gets much easier after that. Doing this will make you realize just how dependent you've become. If you're suffering from insomnia, I recommend taking this simple step before going on sleep medications or even embarking on a drug-free cognitive behavioral therapy regimen.
2
Benadryl
3
Except that long term use is associated with a higher risk of dementia.
5
Falling asleep one time while reading to your kids was a signal that you had a serious sleep problem? Give me a show of hands: how many parents who read regularly to their kids have fallen asleep at least once while reading to them? I believe I see pretty much everyone with their hands up. Yes, even in the afternoon.
Your article is absolutely true, obviously way better to use CBT and natural techniques to cure insomnia if you can, and the obvious broader point is that Americans rely way too heavily on drugs to fix every problem. Take pills to go to sleep, to wake up, to focus on your work, to cope with stress, you name it. Clearly can't be healthy just as it clearly can't be healthy to eat foods that have been bathed in herbicides, pesticides, etc. Don't need studies to prove it, just common sense.
Glad you're sleeping better and hope some people who have been using sleeping pills will follow your advice and try CBT and other more mentally and physically healthy cures.
Your article is absolutely true, obviously way better to use CBT and natural techniques to cure insomnia if you can, and the obvious broader point is that Americans rely way too heavily on drugs to fix every problem. Take pills to go to sleep, to wake up, to focus on your work, to cope with stress, you name it. Clearly can't be healthy just as it clearly can't be healthy to eat foods that have been bathed in herbicides, pesticides, etc. Don't need studies to prove it, just common sense.
Glad you're sleeping better and hope some people who have been using sleeping pills will follow your advice and try CBT and other more mentally and physically healthy cures.
5
Nothing beats insomnia and depression than a complete and consistent exercise program, a total lifestyle change, CBT, massage, accupuncture, and a healthy diet. Homeopathy also is an ally, but it is Neural Therapy that it really makes the difference. TMS also is excellent. It all begins with body detox, and from there the sky is the limit as the body will respond accordingly. Antidepressants are a mortal trap.
6
Frakt fell asleep reading to his kids, and I just fell asleep reading him.
I may have found my C.B.T.; The Incidental Economist.
I may have found my C.B.T.; The Incidental Economist.
5
The risks of taking benzodiazepines (Klonopin, Restoril, etc) are underappreciated by both the public and physicians - memory impairment is only part of the story. For a credible review of the evidence by an academic psychiatrist, see Kripke's free online book (the link cites his credentials): http://www.darksideofsleepingpills.com/ch11.html
3
I've been an insomniac since I was a child, and it's definitely true that just not worrying about it can help. But frankly I wonder if it's not more a problem of my circadian rhythms (or whatever) being a bad match for the school/work schedule imposed on me from the outside.
I often wake up after 3 or 4 hours of sleep. I'm wide awake, and when I was allowed to work from home those were some of my most productive hours. But in my current 8-5 job, I can't work from 1 am to 4 or 5 am.
Instead I have to go to work about the time I'd be crashing for my second round of sleep were I able to set my own schedule. Then I can barely stay awake after lunch.
I can't imagine keeping the same schedule over weekends, since that's when I can finally catch up all the sleep I miss during the work week.
I often wake up after 3 or 4 hours of sleep. I'm wide awake, and when I was allowed to work from home those were some of my most productive hours. But in my current 8-5 job, I can't work from 1 am to 4 or 5 am.
Instead I have to go to work about the time I'd be crashing for my second round of sleep were I able to set my own schedule. Then I can barely stay awake after lunch.
I can't imagine keeping the same schedule over weekends, since that's when I can finally catch up all the sleep I miss during the work week.
20
I suffered with Insomnia for 11 months following the birth of my daughter. Sleep meds were pushed on me and normalized as no big deal, but I knew that trying to wean off of them was going to put me in the exact same spot I was already in because sleep meds teaches you to not trust that you can sleep on your own which is how insomnia starts to begin with. Insomnia is a sleep phobia causing your heart to race and pound as bedtime approaches. All of that adrenaline rushing through you tells your body there is threat and keeps you awake. And then it's a viscious cycle. Essentially what got me better were the statements in the last few paragraphs of this article--I stopped caring whether I slept well or not because really, the reason I was in a bad mood the next day after a bad night of sleep was because I believed that a bad night of sleep would make me have a bad day. Once I stopped caring about whether I slept well or not, the phobia went away. The reason sleep meds are pushed on us is due to big Pharma, but also because so few therapists and practitioners are trained to understand sleep disorders and if you've never had insomnia, it's really hard to understand how powerful the mind can be. It's easier to prescribe sleep meds than to try to find a rare-trained sleep therapist for a patient that is just desperate to sleep again. Thanks for the article!
10
So much of the advice from sleep "experts" is laughably stupid. Don't read in bed? Why not? The author of this article cites an example where he fell asleep while reading to his daughter. This is a very common reaction. Insomnia is often caused by a wandering mind, stressing over all the things you need to do. Reading focuses your thoughts and, after awhile, you tire and fall asleep.
The same is true of TV. When you ask one of these "experts" why the TV is bad, they say that exposure to the blue light from the TV all night is bad. Well, I can't recall the last TV I saw without a sleep button in the remote control. Set it for 30 minutes, watch some mindless show that takes your mind off your troubles, and you drift off to sleep.
Will these methods work for everyone? Of course not, but enough with this ridiculous expert advice. If your insomnia comes from an "unquiet" mind, as mine does, read, watch TV, listen to the radio, listen to podcasts - It works!
The same is true of TV. When you ask one of these "experts" why the TV is bad, they say that exposure to the blue light from the TV all night is bad. Well, I can't recall the last TV I saw without a sleep button in the remote control. Set it for 30 minutes, watch some mindless show that takes your mind off your troubles, and you drift off to sleep.
Will these methods work for everyone? Of course not, but enough with this ridiculous expert advice. If your insomnia comes from an "unquiet" mind, as mine does, read, watch TV, listen to the radio, listen to podcasts - It works!
28
And add a little pot with dominant indica strain and poof! I wake up fresh and ready for the day.
1
How many insurance companies cover the costs of CBT vs. sleep medications?
14
Melatonin works fine for me.
3
The body naturally synethesizes melatonin. If the cause of your insomnia is a melatonin deficiency, the melatonin helps. If not, its completely useless.
3
I did CBT for about 3 months, keeping a sleep diary and meeting weekly with a psychologist. It added about 10 minutes to my total sleep time. It really wasn't worth the $1500 it cost. As many of the commentators have pointed out, CBT, meds, white noise, etc. may work for one person but not the next. Everyone must find there own unique solution. CBT is not a miracle cure.
28
Proper diagnosis is critical! I had been diagnosed with insomnia and sleep apnea 10 years ago. CPAP therapy was prescribed, and like most I was not compliant. As the author reports, my sleep wasn't that much worse than most, but I was tired a lot. I had just started to use relaxation/CBT techniques, but I still had problems getting back to sleep after I awoke in the middle of the night. I decided to have another sleep study done. This time they discerned that the previous results were probably false positives, in that if I slept on my back, which you almost have to because of all the apparatus that is attached, the rate of apnea's was significant. If I slept on my side, I had no apnea's. So luckily there was no CPAP recommendation. My sleep doctor re-diagnosed me as having a sleep maintenance problem, and recommended that I add melatonin (inexpensive and no wacky behavior risks) to my new sleep hygiene regimen. Since then, I essentially have no problems.
7
What many people and even MDs think of as insomnia is merely the two stage sleep wake sleep cycle normal to adult humans. In our developmental years when we were becoming the gazers in the mirror we are- it was normal for adults to wake after several hours of sleep to "check" to ensure the bears, ants, vultures or wolves hadn't made inroads on the family. One might spend over an hour checking the "locks" and ensuring the boulder used as a front door was bear- tight and wolf free. Maybe take the kids out to pee and make sure everyone was warm-then return to sleep for a another hour or so- The cycle has become confused as the utility of the midnight arousal alarm has been reduced to emptying ones own bladder. Hence we now consider it an error of our timing system rather than a useful part.
44
Mabraun, Your thinking reminds me of my own on that subject. Maybe adolescents are programmed to stay up late to guard and then the old folks wake up early to tend the fire and tend the babies while the rest of the clan sleeps in ready for an active day.
1
My revelation was not to take insomnia personally. That is that it serves a purpose. If you don't resist it, and I admit that this is not always easy, it can serve as a reset for your emotional state. I have come to think of depession in somewhat the same way. And I admit that it is also not always easy. I keep a bottle of halcyon handy for those nights when I just don't want to put up with it, regardless of my rational strategy. Although I usually only drink one beer in the evening, the no-alcohol is an interesting idea that I think I have to consider.
8
In fact, there is good evidence that small amounts of alcohol taken well before bed time can substantially affect sleep architecture and interfere with the quality of sleep that you do get. So, abstaining altogether may be an experiment you want to try.
3
For those who've tried 'everything!' might I suggest a look into the symptoms of Adrenal Fatigue. AF usually follows a period of intense stress and is also commonly related to untreated hypothyroidism. In my case I suffered both. The qualities of the insomnia are specific, being stone cold tired, drifting off only to have a surge of adrenaline wake you up a vicious cycle that can last the whole night. Additionally its very difficult to find a doctor who will treat this as a real illness, symptoms of AF are basically: high/fluctuating or low cortisol. Traditionally trained docs only seem to recognize the extremes of cortisol dysfuction: Cushings or Addison's disease. Leaving a lot of folks, with weak adrenal output to self treat and find support via online groups to get the health care our doctors ought to be better trained at recognizing. The book: Stop the Thyroid Madness is an incredibly valuable resource for those wishing to learn more. Following the books protocol, I'm doing a helluva lot better. Wishing everyone a good nights sleep.
12
Stop The Thyroid Madness is the book that got me on the path back to health after years of suffering on synthetic T4 and T3.
I don't consider myself an insomniac, but a 'night owl' - which has repercussions in and of itself, since the world operates on a sunup-sundown schedule. I don't like sleeping - the period of unconsciousness subtracts from creative output - but I'm beginning to understand it does, indeed, have a beneficial effect on the physical AND mental body.
Thanks for this article; I'll be sharing it widely among friends, especially those for whom the 'bad night' becomes the 'bad day.' Ultimately, it is how one approaches a setback which determines its outcome.
Thanks for this article; I'll be sharing it widely among friends, especially those for whom the 'bad night' becomes the 'bad day.' Ultimately, it is how one approaches a setback which determines its outcome.
7
It is interesting that the author, although a health economist, did not even mention the out of pocket cost of the CBT online program that he used. One of the reasons that medication gets overused for insomnia is that CBT is frequently not reimbursed by many insurance plans.
And a series of educational online pdfs identifying the C and B parts of CBT. while no doubt helpful for some people, still is not the same as receiving the T part, which is the therapy delivered by a trained therapist which is specific to the individual. And part of the reason that online versions are out there is because there are very few CBT trained therapists to meet the huge clinical need related to serious emotional disorders of many different types. Not even to mention that many people struggle to make ends meet and are without the means to even have an Internet connection (I live in a rural part of the country) or to afford such a program online or that at times have issues with reading and writing literacy that make CBT not effective for them.
And a series of educational online pdfs identifying the C and B parts of CBT. while no doubt helpful for some people, still is not the same as receiving the T part, which is the therapy delivered by a trained therapist which is specific to the individual. And part of the reason that online versions are out there is because there are very few CBT trained therapists to meet the huge clinical need related to serious emotional disorders of many different types. Not even to mention that many people struggle to make ends meet and are without the means to even have an Internet connection (I live in a rural part of the country) or to afford such a program online or that at times have issues with reading and writing literacy that make CBT not effective for them.
39
I have tried all the things recommended by CBT. Consistent bed times, consistent wake times, eliminating alcohol and caffeine (and at times even refined sugars), black out curtains, white noise, tracking sleep, improving my attitude, no reading in bed, no screens before sleep, no liquids before sleep... along with various medications. The things that seem to work for me are a mixture of common advice and the direct opposite.
I need a cool room and some kind of white noise or a fan because I sleep lightly and noise will wake me up. One session beer (4% ABV) immediately before bed (no more, no less, and not wine or hard liquor). 50 mg trazodone (doc okayed this with one drink). And, because my insomnia is tied to my anxiety, I need either an audiobook or netflix show to fall asleep to. It has to be something familiar and comforting (like Anne of Green Gables audiobook or Parks and Recreation) so it soothes me, distracts me from my own anxious thoughts but doesn't keep me up wanting to know what happens. With this recipe I can sleep soundly for about 7 hours, waking once to pee and falling back asleep until nearly my alarm. Any other combo and I tend to get up several times before falling asleep after an hour or so, sleep 2-4 hours, wake, and then sleep only fitfully the rest of the night. Go figure.
I need a cool room and some kind of white noise or a fan because I sleep lightly and noise will wake me up. One session beer (4% ABV) immediately before bed (no more, no less, and not wine or hard liquor). 50 mg trazodone (doc okayed this with one drink). And, because my insomnia is tied to my anxiety, I need either an audiobook or netflix show to fall asleep to. It has to be something familiar and comforting (like Anne of Green Gables audiobook or Parks and Recreation) so it soothes me, distracts me from my own anxious thoughts but doesn't keep me up wanting to know what happens. With this recipe I can sleep soundly for about 7 hours, waking once to pee and falling back asleep until nearly my alarm. Any other combo and I tend to get up several times before falling asleep after an hour or so, sleep 2-4 hours, wake, and then sleep only fitfully the rest of the night. Go figure.
16
Your experience is similar to mine.
2
I enjoyed this article, though I wish it was written 10 years ago when my Insomnia started :D
It seems the important piece to pull out of this article, and the subsequent comments and discussion, are to uncover and treat your underlying issues. This in turn will help mitigate the symptoms you experience with Insomnia, though it's likely you'll still have weeks, months, or episodes of it for the rest of your life. These things seem to start, and never fully subside, which leads me to my next thought.
Why can't Doctor's or Health Professionals catch these symptoms sooner?
My only frustration here is the length of time it can take to treat one's Insomnia. My doctor wasn't able to determine that my Insomnia was anxiety related for at least 18 - 24 months, which put me in a position where my Insomnia had progressed to a level that was much more challenging to treat. The further you head down the path of anxiety, depression, insomnia (etc) the harder it becomes to pull yourself out of these things - or at least that's my experience.
It's great to see the stigma of Mental Health dissipate over these last few years, but it seems health practices need to be updated as well.
It seems the important piece to pull out of this article, and the subsequent comments and discussion, are to uncover and treat your underlying issues. This in turn will help mitigate the symptoms you experience with Insomnia, though it's likely you'll still have weeks, months, or episodes of it for the rest of your life. These things seem to start, and never fully subside, which leads me to my next thought.
Why can't Doctor's or Health Professionals catch these symptoms sooner?
My only frustration here is the length of time it can take to treat one's Insomnia. My doctor wasn't able to determine that my Insomnia was anxiety related for at least 18 - 24 months, which put me in a position where my Insomnia had progressed to a level that was much more challenging to treat. The further you head down the path of anxiety, depression, insomnia (etc) the harder it becomes to pull yourself out of these things - or at least that's my experience.
It's great to see the stigma of Mental Health dissipate over these last few years, but it seems health practices need to be updated as well.
5
Every night over 6 years I would fall asleep only to wake 4 hours later. It was awful. So I decided to run my own experiment. I eliminated the 3 main sleep culprits: no caffeine, alcohol, or electronics after 7pm. It took 5 weeks until I started noticing a difference but once the deep sleeping began it didn't let up. I was getting 7-8 deep sleep hours a night. What a difference 7-8 hours made in my mood, productivity, relationships.
After 3 months of glorious sleep I began to reintroduce each of the 3 culprits to ID the guilty party. First, electronics. I started answering emails, watching Netflix, etc. and the sleep continued. After another month I reunited with my beloved coffee. 2 cups in the morning and none after lunch. The Van Winkle sleeping continued. Damn it's the alcohol! As a lover of craft beer and red wine I didn't want this to be the reason. After another 3 months I had my first drink. That night, I awoke at 4am like the bad old days of no sleep.
My research revealed I can't drink at all. It's not that I can simply refrain from drinking that night to ensure a good sleep. I have to cut it completely. It's like the body's tissue holds on to the alcohol remnants which then make it difficult to enter a deep REM thus guaranteeing a shorten sleep cycle.
This was 4 years ago. Today I'm sleeping great but have to watch my alcohol intake over time not just that day. On average it takes about a week of no drinking to get that high-five-the-world deep sleep.
After 3 months of glorious sleep I began to reintroduce each of the 3 culprits to ID the guilty party. First, electronics. I started answering emails, watching Netflix, etc. and the sleep continued. After another month I reunited with my beloved coffee. 2 cups in the morning and none after lunch. The Van Winkle sleeping continued. Damn it's the alcohol! As a lover of craft beer and red wine I didn't want this to be the reason. After another 3 months I had my first drink. That night, I awoke at 4am like the bad old days of no sleep.
My research revealed I can't drink at all. It's not that I can simply refrain from drinking that night to ensure a good sleep. I have to cut it completely. It's like the body's tissue holds on to the alcohol remnants which then make it difficult to enter a deep REM thus guaranteeing a shorten sleep cycle.
This was 4 years ago. Today I'm sleeping great but have to watch my alcohol intake over time not just that day. On average it takes about a week of no drinking to get that high-five-the-world deep sleep.
137
Timely for me! I did not sleep for three years until the past couple of months. I went from truly psychiatrically affected and dangerously sleepy on the road to I can function all day. Always prone to insomnia, past bouts were not as long and I was able to re-set, which I think is part of it. I also think everyone is different and should try anything. For me, medication caused a hangover that made it impossible.
These are the things I’m doing. While still fragile, they are working:
*I cut way back on caffeine. It isn’t time of day but the amount; I had always adhered to the cut-off time thinking I was doing this one. I’ve reduced it to about ½ cup per day, and I allow myself only up to one cup. It’s shocking to see how much caffeine truly affects me and my mood. And the more awake I feel from sleep, the less I want caffeine.
*Keep the temperature precisely the same at night. I need conditioned air – either heat or a/c; no windows, humidity, or chance.
*Go to sleep the exact same time every night.
*I do read in bed. I do many things in bed insomniacs supposedly are not “supposed to” – e.g., work and spend time there. My bed is a peaceful place for me, which carries over.
*No reading or electronic devices when I wake up in the middle of the night.
*No naps.
*Empty my mind. This came last and is so not normally part of my vocabulary or personality. I am suddenly able to tell myself “empty your mind” or “empty," and I am able to stop the so-many thoughts that keep me awake.
These are the things I’m doing. While still fragile, they are working:
*I cut way back on caffeine. It isn’t time of day but the amount; I had always adhered to the cut-off time thinking I was doing this one. I’ve reduced it to about ½ cup per day, and I allow myself only up to one cup. It’s shocking to see how much caffeine truly affects me and my mood. And the more awake I feel from sleep, the less I want caffeine.
*Keep the temperature precisely the same at night. I need conditioned air – either heat or a/c; no windows, humidity, or chance.
*Go to sleep the exact same time every night.
*I do read in bed. I do many things in bed insomniacs supposedly are not “supposed to” – e.g., work and spend time there. My bed is a peaceful place for me, which carries over.
*No reading or electronic devices when I wake up in the middle of the night.
*No naps.
*Empty my mind. This came last and is so not normally part of my vocabulary or personality. I am suddenly able to tell myself “empty your mind” or “empty," and I am able to stop the so-many thoughts that keep me awake.
17
It is really shocking to anyone that caffeine, a stimulant, can keep someone from sleeping well and affects their mood?
What is bizarre is that so many people see no relationship between what they eat and drink and their health and well-being.
What is bizarre is that so many people see no relationship between what they eat and drink and their health and well-being.
My insomnia improved by simply stopping being anxious about it. I went to my GP to get a referral to a sleep specialist and he gave it to me but said that it wouldn't help. He said the idea that we're supposed to sleep 8 hours without stop is just a modern one--one might regularly have woken up to feed farm animals in the middle of the night, for example, in pre-industrial times. Once I stopped sweating it, my insomnia improved a lot. I still get it worse in the winter, which is surely due to lack of sunlight, but even then it's 90% better.
19
Admission: The TV is my sleeping drug. I get out of bed, go to a sofa, turn on the TV to an old movie, roll over on my side, and fall asleep to familiar voices. Pattern of TV-drug use has progressed, to the point that I turn on the TV before going to bed and some nights sleep intermittently on the sofa instead of bed 'til daylight. As a consequence, I read fewer books, hear less music, and am less engaged and active overall. I leap up at daybreak, make coffee, read the NY Times on-line, and thereafter lose self in lighted screens, with short breaks for food, superficial tidying, and walking the dog. Apart from occasional errands or lunches, I laze around, cancel plans, indulge in Netflix selections, or jump from topic to topic (researchsurf) on the internet, preparing to advise on tribal peace in the Middle East from my sofa. Pattern developed in my retirement, now 1 year, 4 months into it. ENOUGH. Thanks for the C.B.T. links in the article. I want a life.
10
Play a Podcast you are really dying to hear. You'll fall asleep in minutes.
16
Try reading "Pamela." Or even "Clarissa," livelier only in comparison.
8
I have a meditation tape by my bed. "body scan" Anxiety keeps me awake, I turn on my tape and in about 15 min. I am asleep. Try it, it works.
5
Buy a really great mattress, one that says, "Come on, lie down, I'm very comfortable, you'll love it here, relax, good, now just close your eyes."
4
A simple remedy that might work for some: White noise from a cheap transistor radio OR a program on it (music, a ballgame, overnight talk show, whatever as long as you really want to listen to it)....use an earphone so as to not disturb your partner. For me, a tab of melatonin, plus a baseball game I really want to follow works wonders. I'm almost always asleep quickly. Much better for me than white noise.
7
After years of suffering insomnia, and after trying many things, a simple 1mg per night dose of OTC melatonin before bedtime solved it. Has been working, without fail, for over 1 year now. If it stops working, and if upping the dosage doesn't restore it's efficacy, I'll try the online CBT next.
1
Melatonin works for me as well. I take 3mg every night (smaller dose doesn't work). Have had insomnia (Circadian Rhythm Disorder technically) my whole life, have tried everything mentioned; meds, CBT, hygiene, sleep apnea testing...but I have slept very well, with Melatonin, for 5 years.
Exercise trumps everything else for a good night sleep.
7
When your brain at 1am says, "You're awake, lets talk", after 15 years of this I now take 10 mg of Lexapro in the middle of the night, serotonin does the rest.
4
Like many people who suffer from insomnia, I've found the best cure to be moderate-to-intense physical exercise.
5
I find the suggestion of not using an iPad almost laughable. What was the reason for my insomnia before the infernal thing was invented?
10
I find that the "secret" to a decent night of sleep is not letting a cat share your bed. Here I sit writing this at 3:45 am, my cat having awakened me forty five minutes earlier. However, as pet lovers know, keeping a cat out of the bedroom is next to impossible.
11
Odd not to give any details on what techniques were employed. CBT is pretty broad.
7
C.B.T. might be more effective (this should be unsurprising, as C.B.T. could deal with the underlying issues that cause insomnia), but that doesn't make it more cost-effective.
C.B.T. is expensive. Therapy might not be fully covered in medical plans, and sometimes the best therapist for a particular patient is out-of-network. Worse still, C.B.T. is time-consuming. Popping a pill every night is easy; showing up for an hour of therapy week after week can pose a challenge.
Of course, plans should be customized for each case--the convenience of Ambien might be best for Albert, Belinda could benefit more from C.B.T., and Carlos could require a daily anxiolytic that addresses both a stress disorder and his chronic insomnia. Solutions are different for different patients. I wish this article acknowledged that.
C.B.T. is expensive. Therapy might not be fully covered in medical plans, and sometimes the best therapist for a particular patient is out-of-network. Worse still, C.B.T. is time-consuming. Popping a pill every night is easy; showing up for an hour of therapy week after week can pose a challenge.
Of course, plans should be customized for each case--the convenience of Ambien might be best for Albert, Belinda could benefit more from C.B.T., and Carlos could require a daily anxiolytic that addresses both a stress disorder and his chronic insomnia. Solutions are different for different patients. I wish this article acknowledged that.
7
After terrible, lifelong anxiety I suffered a two year period of insufferable insomnia surviving on ambien. That was followed by my first major depression at 58 treated with Prozac, clonapin and psychotherapy. I have since learned to better accept life with all its bumps and remind myself of how I survived past difficulties. Now the sleepness nights don't last as long. Changing a mindset actually does work.
11
In 2012 I cured a lifetime of insomnia (that started in infancy!). I placed night lights in the the kitchen and bath rooms of my house, and I let the house get light and go dark with the natural day night cycle of the middle summer. I also put away the smart phone, did not turn on the TV at all, and kept computing to a minimum - ending all electronic activity by early evening (before sunset). Within one month I was sleeping like a little kid - early to bed and early to rise (10 pm - 5:30 am). I kept that schedule as the nights lengthened again and I have kept to it more or less every since then.
I have to be careful about the time change in March as that does a lot of damage to my newly normal biorhythm and sleep wake cycle. So when I look at the effect of the hourly time change in spring especially, I feel what is wrought on society and culture from that, is a horribly disruptive and destructive waste of effort. Just to digress a little, Daylight savings is a bad idea that compounds sleep wake issues. People are cranky and accident prone because of it.
I have to be careful about the time change in March as that does a lot of damage to my newly normal biorhythm and sleep wake cycle. So when I look at the effect of the hourly time change in spring especially, I feel what is wrought on society and culture from that, is a horribly disruptive and destructive waste of effort. Just to digress a little, Daylight savings is a bad idea that compounds sleep wake issues. People are cranky and accident prone because of it.
59
Not only that, but the extra hour of daylight makes the cows give less milk and bleaches out the curtains.
2
The suggestions to avoid computer time - and TV - at night - if possible - seem to be very helpful for me. There are regular times when I am at a place where there are no electronic stuff - and light - no options for continual distraction - and I find that I just read ( a book, not Kindle), get sleepy and fall asleep. But at 68, 6 hours at a stretch does seem to be the maximum, and good enough. Now, the problem is discipline every day .
4
Make the eyes tired, and the rest of the body will also become tired. I do crossword puzzles before going to sleep, but any type of reading would probably work as well. After a short time, I find it impossible to stay awake.
Because of a problem with focusing, I also recently also started doing about 2 minutes of eye convergence exercises immediately after going to bed. The effect is so strong, it is as if I took a sleeping pill. Afterwards, I'm too exhausted to even do much in the way of crossword puzzles, and quickly fall asleep.
Because of a problem with focusing, I also recently also started doing about 2 minutes of eye convergence exercises immediately after going to bed. The effect is so strong, it is as if I took a sleeping pill. Afterwards, I'm too exhausted to even do much in the way of crossword puzzles, and quickly fall asleep.
8
I'm surprised no one mentioned magnesium, which is sleep magic for me and lots of people I know. Magnesium deficiency comes with stress and interferes with sleep. It is also one of the few forms of vitamin therapy that works fairly instantly--you will see its effects in a day or two, if not overnight. There are several different forms of magnesium with different properties of absorption and effect on the bowels, so ask in your health food store.
13
Kale therapy?
An Epsom salts bath works well, too, as the magnesium is absorbed through the skin. Run a hot bath, add two cups of Epsom salts, some lavender essential oil, and the bubble bath of your choice, get in, soak for a while. I find that there's nothing like a bath with Epsom salts and lavender for a good night's sleep.
I am not one who needed a lot of sleep throughout my life. When I was employed I worked 10.5 hour days six days a week. For my 30 years of self employment I worked even more sometimes not sleeping for two days. When I went to bed my wife said I was asleep within seconds. Now 64 and in chronic back pain from spinal stenosis and blown discs. In spite of the pain medications pain is evident all the time.
I still only sleep 6 hours but it is broken sleep. I fall asleep almost instantly sometime between 8PM and 10PM. I wake up around midnight. I then sit up reading until around 2AM, go to bed and wake up between 5AM and 6AM. After letting the dogs out I prepare my breakfast and read the papers. I am productive all day either in the house or outside.
I sometimes feel the need for a nap around 3PM but most days I fight it off by staying busy. When I do nap then I am awake until midnight.
I haven't tried sleeping medications. I limit myself to my pain medication and refuse to take any medication that could bring on a psychological problem. I've already had an incident 5 years ago from Gabapentin that caused a great deal of anguish.
There seems to be nothing to help people like me.
I still only sleep 6 hours but it is broken sleep. I fall asleep almost instantly sometime between 8PM and 10PM. I wake up around midnight. I then sit up reading until around 2AM, go to bed and wake up between 5AM and 6AM. After letting the dogs out I prepare my breakfast and read the papers. I am productive all day either in the house or outside.
I sometimes feel the need for a nap around 3PM but most days I fight it off by staying busy. When I do nap then I am awake until midnight.
I haven't tried sleeping medications. I limit myself to my pain medication and refuse to take any medication that could bring on a psychological problem. I've already had an incident 5 years ago from Gabapentin that caused a great deal of anguish.
There seems to be nothing to help people like me.
6
Try pot.
3
Sorry about your back pain, but your sleep pattern is similar to mine...yet, if I count correctly, your overnight sleep adds up to seven or more hours. Unless my days are compromised, I accept my odd sleep pattern, try to use the midnight hours wisely, and pull my car over for a nap whenever, and wherever, sleepiness seems a problem. I agree the drug solution seems so widely accepted, why is that? There are always unknown consequences for taking these things!
I have body shakes while falling asleep, exploding head syndrome while falling asleep, apnea, and a tendency to wake up gasping on all fours several times a week.
I practice perfect sleep hygiene. I've had multiple studies done. I use a CPAP machine. And I use prescribed drugs to go to sleep.
I would love to have the problems described in this piece and in the comments I've read. But people like me, and there are millions, have multiple conditions that need treatment. Without drugs like Xanax (which I take), or zolpidem, we'd be dead or on disability. I'm not exaggerating at all.
I practice perfect sleep hygiene. I've had multiple studies done. I use a CPAP machine. And I use prescribed drugs to go to sleep.
I would love to have the problems described in this piece and in the comments I've read. But people like me, and there are millions, have multiple conditions that need treatment. Without drugs like Xanax (which I take), or zolpidem, we'd be dead or on disability. I'm not exaggerating at all.
19
What3231 is absolutely correct. Many of us would be dead without sleep aids. I suffered a severe depression that landed me in the hospital. I was unable to sleep, and I mean completely unable. I was told an antidepressant medication would most likely resolve the sleep issue so we tried a series of them without success. The doctors tried everything that was available at the time from Xanax to trazodone. Nothing worked until they put me on klonopin. Suddenly the sleep issue resolved for the most part. I have been on this medication since the 1990s. I now take Zolpidem in addition to it and a thyroid pill every morning. Had these medications not existed when I needed them, I am convinced I would have ended up in an institution or dead. Before the depression I had no sleep problems at all. I still cannot fall asleep naturally because the hyper vigilance that resulted from the depression never left. It's like a permanent scar. I should note that I am also on combined antidepressant therapy as well and have been since suffering the severe clinical depression in 1992. My life has been relatively normal with the help of these medications, I often shudder to think how I might have ended up without them.
9
Haviing been a GP in South Africa over the difficult times, I found patients developed sleep disorders as part of an anxiety disorder.
CBT was then in its infancy.
I prescribed an sedating tricyclic antidepressant - dothipein .
All tricyclics are non additive.
Starting with 25 mg x 3 nights and increasing by 25 mg every third night to a maximum dose of 100 mg , I found that patients responded very well and re -established normal sleeping over a period of 6 to 8 weeks.
At that stage, i would gradually stop the medication over a period of two to three weeks and found that the problem with insomnia had gone.
The reason for this was that the patients now knew that a non additive medication solution was available that worked and this stopped the anxiety caused thinking that imagined that they would not be able to sleep and that the problem would go on forever.
Tricyclics are generally safe for most patients.
CBT was then in its infancy.
I prescribed an sedating tricyclic antidepressant - dothipein .
All tricyclics are non additive.
Starting with 25 mg x 3 nights and increasing by 25 mg every third night to a maximum dose of 100 mg , I found that patients responded very well and re -established normal sleeping over a period of 6 to 8 weeks.
At that stage, i would gradually stop the medication over a period of two to three weeks and found that the problem with insomnia had gone.
The reason for this was that the patients now knew that a non additive medication solution was available that worked and this stopped the anxiety caused thinking that imagined that they would not be able to sleep and that the problem would go on forever.
Tricyclics are generally safe for most patients.
11
I used to have trouble sleeping due to anxiety and my doctor prescribed Xanax and then Clonapin. These worked well, but I don't like being dependent on drugs, so I did a little research and discovered that I wasn't exercising long enough each day. After increasing my exercise regime and adding lithium to the vitamins I take each day, I now sleep 7 or 8 hours every night without any drugs.
6
Natural, unmedicated sleep is best, beyond a doubt. However, therapy isn't as universally effective as many like to believe, and we should resist the temptation to denigrate those who, when needed, are able to make effective use of medication.
In my own case, every single relative on one parent's side has life-long sleep issues, and not a single one on the other parent's side does. Might there just possibly be something genetic at work?
In my own case, every single relative on one parent's side has life-long sleep issues, and not a single one on the other parent's side does. Might there just possibly be something genetic at work?
81
the side effects of ambient and other older drugs are well documented and it comes at no suprise to me that CBT seems to work better. however, the new generation of insomnia drugs such as http://en.m.wikipedia.org/wiki/Belsomra seem to have a much preferable side effect profiles. It would have been helpful discuss these new drugs here as well and put them it he context to CBT.
I'm not saying C.B.T. and other therapies can't be helpful, but as a lifelong insomniac, I decided about a year ago I was tired of avoiding caffeine and other strategies of outwitting insomnia; I began taking a 3 mg. pill of melatonin and it knocks me out within half an hour; I awaken refreshed, not groggy. (Melatonin is a hormone produced by the body; it goes hand in hand with tryptophan, which I would probably also take if it were easier to get in this country.)
I recall reading an article in the Times which discussed DSPS, or delayed sleep phase syndrome, which I'm sure I have; ever since I was a kid, I was never able to get to sleep easily, and have always had trouble waking up in the morning. Left to my own devices—i.e., if I don't have a job or other activity that demands that I wake early—my circadian clock will set itself so I wake at noon and go to sleep at 4 AM.
Melatonin is a cheap and effective drug-free way to get to sleep. If that ceases to work for me, I'll probably try C.B.T.
I recall reading an article in the Times which discussed DSPS, or delayed sleep phase syndrome, which I'm sure I have; ever since I was a kid, I was never able to get to sleep easily, and have always had trouble waking up in the morning. Left to my own devices—i.e., if I don't have a job or other activity that demands that I wake early—my circadian clock will set itself so I wake at noon and go to sleep at 4 AM.
Melatonin is a cheap and effective drug-free way to get to sleep. If that ceases to work for me, I'll probably try C.B.T.
50
I think insomnia is caused by not letting your mind relax when you go to bed. Just cancel out all the thoughts of the day and zoom in on one good thing that happened during the day. I don't think sleeping pills help much. I drink a glass of milk and dunk some peanut butter cookies in it before I go to bed. I told my wife once when she couldn't sleep to think of Hillary and Bill in the White House together again and she told me "I"ll never go to sleep now!!!!!
9
Easy peasy! Not all of us are blessed with your simplicity!
2
Excellent! Even an article about insomnia therapy gets political comments. Great to see the 100% rate of everything online being political is still alive.
2
Didn't work for me and I'm good at thinking about nothing. It gets old laying in bed for hours meditating, but not sleeping.
3
Austin, I am a big fan of CBT for anxiety and other ills, so I will check this out. But you should also consider how sunlight affects sleep. I have long struggled with insomnia and restless leg syndrome. It would often take me hours to fall asleep and then I'd wake up after 4-5 hours, no matter what. But last summer, I read a book about chronobiology, circadian rhythms, etc. and decided to try to use light to change my sleep. I started sleeping in a room with a huge window and did not use shades. Light poured in and woke me up very early. All day, I spent as much time as I could in natural light. At night, I used lamps instead of overhead lights and avoided using the computer as much as possible. Within 3 weeks, I was falling asleep by 11 or 12 pm (my norm had been anywhere from 1-4 am). Also, I was staying asleep for 6 hours regularly. A few weeks later, I was falling asleep by 10:30 and getting about 7 hours - and by the end of the summer, I was getting 8 hours many nights. i ws shocked because I thought I had assumed it was impossible for me to sleep 8 hours like most people.
That lasted well into the fall. Eventually as the days got shorter, my sleep got worse again. I should probably use a light machine in the winter.
That lasted well into the fall. Eventually as the days got shorter, my sleep got worse again. I should probably use a light machine in the winter.
57
As a nurse, I did a lot of night shifts. In my last ten years of work I had to take sleeping pills every night in order to sleep. Within a month of retiring I was waking up at 8 every morning and didn't have to take the pills anymore. I know somebody has to work night shifts, but the older you get the more they screw up your sleep cycle.
21
You retired from nursing-that reduced your stress and restored your circadian rhythm. Happy retirement!
5
For ten years I held an academic position which required teaching at least one night class a week -- not to mention the stress of a heavy load. To get even six hours of sleep, none of it uninterrupted, I'd exercised well, gone without coffee, etc. etc., taken every known herbal and OTC remedy available (all of these possible lifestyle and chemical remedies in various combinations, hoping for the right one) and nothing worked for long. As soon as I left that job for independent contract work, normal deep sleep, at least seven blessed hours, returned like magic, with no assistance. Former colleagues remark they've never seen me look happier or more relaxed, but I don't need anyone to tell me that. I feel great.
11
Get away from wireless devices, including so called "Smart Meters". They are constantly sending out signals that can act like a shot of caffeine. Turn off your wireless routers at night and keep devices out of the bedroom.
3
Make sure your insomnia is not a symptom of severe depression. The latter insists on keeping you up till the wee hours and then awakens you very early just to be absolutely sure you are wide awake to entertain all its hideous torments. Oh, and a severe depression will scoff while kicking CBT to the curb as pollyanna, Norman Vincent Peale that's unsuited for the fight. Ya' can't slay an elephant with a pea-shooter.
If one's insomnia is a standalone condition and NOT a symptom of some other ill, then hopefully the sufferer will find CBTI helpful and/or curative. Per the link, the program is endorsed by Dr. Oz after all, a humble and unimpeachable practitioner who never gets swept up in hype and promotion. Or, does he?
If one's insomnia is a standalone condition and NOT a symptom of some other ill, then hopefully the sufferer will find CBTI helpful and/or curative. Per the link, the program is endorsed by Dr. Oz after all, a humble and unimpeachable practitioner who never gets swept up in hype and promotion. Or, does he?
23
Zolpidem is so easy. After fifty years of sleeplessness, it is heavenly to just take a pill and go to sleep. However you find it, a good night's sleep is really great.
57
I agree. To those who don't "believe" in sleeping pills: Don't take them and mind your own business while your at it.
12
Actually, I found a excellent way to control insomnia without prescriptions, medical examinations or even needing to see a real doctor. Just turn on the prime-time tube. Works wonders ...
3
Turn off all stimuli about 1 hr before bedtime. No TV, no late night news, no iPhone, etc. Get good light-blocking curtains if excessive street lighting is a problem, wear ear plugs to block ambient noise, etc. Limit daily coffee intake to 2 cups or less. There are recordings which will talk you to sleep. Keep a regular sleep pattern. Discuss your sleep issues with your doctor. Get tested for sleep apnea. Take care.
2
Been there, tried them all over the years - nothing has worked.
3
Oh, Geez. So now economists are giving medical advice? Umm, I think some humility on the part of the profession is called for. Despite their glorification in columns like the Upshot, economists really don't know everything. They really don't. Indeed, their errors far outnumber their successes, if weighted by the seriousness of outcomes (see Recession, Great or Crisis, Financial or Economics, Supply Side).
27
I think this is more of a personal take by someone that happens to be an economist than an article that claims to be written by a medical professional.
4
I am a psychiatrist. I have had my personal troubles with sleep and patients often complain about sleep. I try to avoid medicines for sleep. When the writer of this article mentioned data as a cure for insomnia it instantly made sense. Reading a (boring) anatomy textbook (a lot of data) would knock me out like a light in my younger days. I believe Data, lots of it, should be researched as a cure for insomnia. The side-effect, even in cases the data treatment fails, could be a PhD.
143
I highly recommend legal textbooks. Nothing like tiny bits of data hidden in pages upon pages of archaic language about contracts or regulatory agency powers or the passing of estates. Mmmm, paper. So soft. So restful.
35
I'm a psychologist. Excellent night-time reading for the insomniac is any early tome by the aptly named author, Boring. Edwin Garrigues Boring. :)
2
A great sleep inducer in the evening is the magazine The Economist. Lots of complex charts and graphs, lots of esoteric but valuable information that you strain to comprehend. It just knocks me out. Try it.
6
I agree with not watching TV in bed, but not reading? Ever since childhood I have been unable to fall asleep without reading unless I am really exhausted. The secret is to read a book that is not so riveting that you stay up till 3:00AM to finish it.
The summer between college and graduate school, I worked the night shift, which meant coming home at 8:00AM in the summer while everyone else in the household was just getting started. I already knew that I would have to pass reading exams in German and French in the first semester of graduate school, so every morning, I read something from either a history of German literature written in German or a history of France written in French.
Perhaps the extra mental effort required to comprehend a foreign language wore out my brain faster, but I rarely got through two pages before the book fell out of my hands.
The summer between college and graduate school, I worked the night shift, which meant coming home at 8:00AM in the summer while everyone else in the household was just getting started. I already knew that I would have to pass reading exams in German and French in the first semester of graduate school, so every morning, I read something from either a history of German literature written in German or a history of France written in French.
Perhaps the extra mental effort required to comprehend a foreign language wore out my brain faster, but I rarely got through two pages before the book fell out of my hands.
34
I sleep well and have never taken any sort of sleeping pill. I read every night before I go to bed; I notice when I am tired, turn out the light, and am usually fast asleep a few minutes later.
5
Melatonin and Kindle work for me.
5
Ambien (zolpidem) resulted from science, and it has worked for me for years with no noticeable side effects. I'll even admit that the act of taking zolpidem may help me psychologically to relax and to trust that I'll get a good night's sleep, as CBT apparently seeks to do. But it's the scientifically proven chemistry that I rely on to work, and will continue to rely on, as long as zolpidem remains affordable and readily available. Like other scientifically developed medications that work, I am thankful for it every time that I need it.
35
Ambien is an anticholinergic medication. Like all anticholinergic meds, its use is associated with increased risk of developing dementia. Worth minimizing your use, I would think.
5
CBT is often a form of common sense. It is preferable to medication because these meds can have side effects. But CBT is not "magic." The act of having a caring therapist pay attention and advise you is valuable.
The Mayo Clinic website give more details on CBT-I:
http://www.mayoclinic.org/diseases-conditions/insomnia/in-depth/insomnia...
CBT often uses technical-sounding names for rather ordinary changes ("Stimulus control therapy", "Sleep restriction", "Sleep hygiene.", "Sleep environment improvement", "Relaxation training"), most of which are easily understood. An advantage however, is that the insomniac can be guided to use specific, researched behaviors (such as consistent bedtime,a voiding naps, not watching TV or other devices in bed - these are some of what these technical sounding names listed above really mean).
Nevertheless, its good that common sense and structure works better than pills.
The Mayo Clinic website give more details on CBT-I:
http://www.mayoclinic.org/diseases-conditions/insomnia/in-depth/insomnia...
CBT often uses technical-sounding names for rather ordinary changes ("Stimulus control therapy", "Sleep restriction", "Sleep hygiene.", "Sleep environment improvement", "Relaxation training"), most of which are easily understood. An advantage however, is that the insomniac can be guided to use specific, researched behaviors (such as consistent bedtime,a voiding naps, not watching TV or other devices in bed - these are some of what these technical sounding names listed above really mean).
Nevertheless, its good that common sense and structure works better than pills.
7
I would agree with the premise of the article, but oftentimes a very occasional sleeping pill can just take the edge off so that you are then more relaxed about sleeping the next night; it can break a cycle of bad sleeping. No need to demonize very occasional use, which can be quite helpful for many people.
88
Agree about breaking the cycle and getting just one or two nights of good sleep. For insomnia that's not too intractable, even something as mild as a capsule of Valerian can do the trick. You can get this OTC at the drug store. My cats love the smell (yuk).
3
Agree with you, Fritz.
This isn't really news - leading neurology departments have been prescribing CBT for years with success. Medications are a problematic Band-Aid at best, though people shouldn't hesitate to use them for short term relief (dependency fears are overblown).
However, from the patient perspective, the sleep hygiene CBT approach can easily come across as patronizing and dismissive. For a well-informed patient who can order a book from Amazon or track sleep with an app or Fitbit, being lectured about sleep hygiene by a sleep specialist can be madenning. As with many other complex and often stigmatized disorders, the medical profession falls short on true efficacy and empathy for many of us who just want some restorative rest.
However, from the patient perspective, the sleep hygiene CBT approach can easily come across as patronizing and dismissive. For a well-informed patient who can order a book from Amazon or track sleep with an app or Fitbit, being lectured about sleep hygiene by a sleep specialist can be madenning. As with many other complex and often stigmatized disorders, the medical profession falls short on true efficacy and empathy for many of us who just want some restorative rest.
48
I will look up this new report with great interest. Encouraging, but I would caution against the whiff of "it's not so bad," that comes off here. Try going without even a few hour's sleep for three days, yet be able to fall asleep during the day. Some people do best with medication and continue to face a stigma for using it. I also swore I would never resort to a pill. The reasons people suffer insomnia are varied and complicated.
86
All the sleep medications are only meant for very brief periods of use, not extended use. If someone has time limited stresses that interfere with sleep or only occasionally has problems sleeping, medications can be beneficial. However, if the sleep problem is a chronic one occurring frequently, the medications shouldn't be used.
Unfortunately most sleep problems are handled by primary care physicians who know how to prescribe medications but have little knowledge about C.B.T. or other forms of psychotherapy.
Unfortunately most sleep problems are handled by primary care physicians who know how to prescribe medications but have little knowledge about C.B.T. or other forms of psychotherapy.
11
Thank you....I struggle with sleep and have since menopause. Takes me over 2 hours to fall asleep and then it's shallow - I often think I am still awake. This is huge. I was unaware of sleep related CBT. Grateful.
15
I recommend the following resources --
- Interview - "248 - Sound Sleep, Sound Mind With Barry Krakow, MD" - shrinkrapradio.com - Choose podcast or transcript
Discussion includes how to "bring the wave of sleepiness in close to bedtime."
- Article - "Can Orange Glasses Help You Sleep Better?" - blog.nytimes.com
- "Hemi-Sync Super Sleep CD" - (Amazon)
No voice or music - Contains the Monroe Institute version of binaural-beat sounds, said to entrain brain waves (primarily Delta) - plus other subtle pulsed sounds, which make this audio more pleasant to listen to than "raw" Delta binaural-beat recordings.
- YouTube - Video (audio) - "Thunderstorm Sleep and Relaxation Therapy" - Soundtherapy Doc
Steady rain, some wind, minimal thunder - very relaxing
- Article - "Nutrient Density - Dr. Fuhrman"
This style of eating resolved several of my health problems and improved sleep.
- Article - "Psychopharmacology Of REM Sleep And Dreams" - psychologytoday.com
"All the mood altering drugs appear to profoundly alter REM sleep."
- blog.healthjourneys.com - guided imagery and meditation blog
See Categories in right column