cbt I doesn't work. we are now humans conditioned for instant gratification and our dopamine centers have been destroyed by screens. we are no longer capable of doing dumb cbt-i. I recommend just keep taking medications because we are a broken species and we need to drug ourselves to feel normal again. welcome to 21st century society. ambien and more ambien is the only way to go
1
I've had lots of sleep trouble, take no drugs including caffeine and alcohol, and have found that the only thing that works is strict dietary control: stop eating at least 4 hours before bed, and walk for about an hour after that meal. Eliminate or severely restrict salt intake, which will help moderate ingestion of liquids that can prompt awakening. Together with a sunrise or upon-arising 20 minute walk outside, and additional exercise during the day, these protocols might just do the trick.
I've read so many articles along the same lines, and I have tried everyone of these recommendations. Useless.
3
My traditional western doc put me on amytriptline to sleep until my functional doc told me it would cause dementia. She recommended medical marijuana and I get an amazing night’s sleep and don’t wake up with brain fog.
If you have chronic insomnia, as I do, you'll do and take almost anything to stop the torture.
2
I find these NYTimes articles about insomnia so repetitive and not very insightful. I have battled insomnia for decades, and tried every natural drug possible (CBD, melatonin, valerian root, magnesium, etc.) and all of the drugs possible (Ambien, Trazadone, Xanax and most of the benzo collection). My newest exploration is going to be neurofeedback. There has been tons of research about the success of neurofeedback solving ADD, anxiety, PTSD and reducing symptoms for issues like bipolar. The process starts with doing a 'brain-mapping' to see exactly what your problem is and then creating a treatment program based on each individual's challenges. I would like to see more articles published about these new approaches than dumb CBT (which was the LEAST effective option for me). Come on NYT, get a little more exploratory!
After looking through most of the comments, I am surprised to see no mention of the plant, kratom. Do your own research. Check out the American Kratom Association website. I’ve successfully used it for pain related insomnia without any complications. The FDA has been trying to ban it for years, unsuccessfully, because they have no science to back it up.
Birth control pills gave me insomnia. No one tells you that.
2
I'm curios why the first and second articles have no mention of food, especially what you eat before bed.
Pay attention to this breath, and this one, and this one… When fully focused on this breath, I find it almost impossible to Monkey-Mind over blah and blah.
The discipline required for True Mindfullness is stunning. Our ego wants control. It wants us to be where it lives - in the illusory Past and Future. It doesn't want us to be Here/Now. When we're truly present in this Moment, the ego has no home (OM?) and we are free to Be.
6
We share the need for food with all living things, the need for love (perhaps) with the higher apes, the need for self-actualization with nobody. The higher the need the more specifically human it is, The higher the need the less imperative it is for sheer survival, the longer gratification can be postponed and the easier it is for the need to disappear completely. It is easier to be single-minded about and desperate about safety than about respect. Living at a higher need level means better sleep, appetite, less disease. It has been proven again and again that anxiety, fear, lack of love, domination encourages undesirable physical and psychological results.
This article fails to mention the alternative of OTC sleeping pills. I use (alternatively) both Costco's SleepAid and Walgreens' Walsom, with very good results. In fact I am writing this at 4:30 am, as I forgot to take a pill last night.
I checked these pills with two of my physicians and both told me that these pills pose no danger.
The non-pill suggestions in this article are not always practical, as logical as they may appear.
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@Harry Your physicians have outdated information. These medications contain diphenhydramine, which has been linked with significant Alzheimer’s and dementia risk.
https://www.health.harvard.edu/blog/common-anticholinergic-drugs-like-benadryl-linked-increased-dementia-risk-201501287667
1
@Harry Diphenhydramine is the active ingredient. Don't use it a lot. It's not good for your brain. Some anticholinergic drugs are linked to dementia.
I've had chronic insomnia my entire life. I recall being awake at night at age 3. I'm now 66. I've tried CBT and other therapy. I have excellent sleep hygiene - expensive mattress, blackout curtains, earplugs, noise-cancelling headphones, no electronics in bedroom. etc. Several years ago a wise psychiatrist told me "insomnia is not a character flaw, it's a medical condition. So use the sleeping pills as needed."
9
Something almost never addressed in articles such as these are the problems for women who are post menopausal. Estrogen is important for sleep regulation, and lower levels of it are a problem and are not solved by the remedies suggested here.
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@lotusflower0 Actually it was being prescribed progesterone that made all the difference.
While I share the general outrage about the sleep-drug-shaming in the column, I do want to note that after many years of Ambien, I was dismayed to find I suddenly began experiencing frequent falling and startling memory losses, blank spaces. In the ten years since, I've shifted to other pharmaceutical approaches to the horrific burden of insomnia - there are other categories that are helpful. And all of the daylight exposure, exercise, over-stimulation, over-demanding lives issues - even the over-reliance on driving when we are not physically capable of doing that safely - all of that bears re-engineering when this is our burden.
2
Or, here's a thought public health community and "personal health columnists": mind your own bloody business. I'm tired of being preached at about things that make my life easier/happier but might come with a slight to moderate risk. I'll make that decision for myself, thank you very much, and I'm tired of being scrutinized by pharmacists like I'm a criminal drug addict for taking a legal sedative as prescribed. I have ZERO desire to live past 80 or so and want to enjoy the time I have rather than prolong it and deny myself, so you can hop right off your high horse. Don't trip on your way down...
12
@Live Happy no one forces you to read the articles.
1
it's not you. it's the dumb lawyers who sue evrrytime someone has a side effect. they've scared the doctors into doing anything useful
Flower essences, and sometimes a little protein before bed help a lot!
2
Flower essences, like homeopathy, are a scam.
Why no mention of Melatonin? 5-10mg max. All natural. In the vitamin section. Pop one right before bed.
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@Rufus I so wish melatonin would work for me, but it gives me vivid nightmares.
4
@Rufus
All melatonin is make you drowsy but not necessarily sleepy. In other words, it doesn't work.
4
@Rufus I tried melatonin, but it made me feel anxious, unfortunately. Many swear by it.
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Just would like to offer a couple of tips that might help some.
Onions have many beneficial properties like quercetin that helps with inflammation and it also has tryptophan which is good for sleep.
If you can tolerate about half of a medium onion a day, preferably in the am, this chronic insomniac believes you will find some relief and you will notice an improvement in your joints.
....and one more tip is a cup of catnip tea before bed and if you are lucky enough to fall asleep, you will stay stay asleep longer.
Hope some will find this helpful.
(Ambien makes me incredibly anxious and would not recommend to anyone)
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A few things ring true if understated:
1) Get up if you're not going to sleep.
I wouldn't go sit in front of a computer monitor (or any bright screen for that matter). However, a few minutes wandering around in dark or dim lighting usually reminds your body you really don't want to be awake right now. Think about how cozy bed feels compared to an alarm clock in the morning.
2) Create a sleep pattern. I'm doubtful two weeks is enough time. When I had to switch to an overnight work schedule then back to a 7-4, I was sleeping reliably within two or three weeks but it wasn't all that restful. Three months is realistic. Listen to your body but prepare to take drastic steps. I staid up all night on each reversal. 24 hours awake then 8-10 hours sleep.
If you sleep 10pm-6am and shift to 10am-6pm, you wake up 6am and stay awake until 10am the following day. Do this once then follow your new schedule for at least a week. Things will settle-in by three months. If you need help, over-the-count acetaminophen for no more than 3 weeks. 10 percent the recommended dose. My amateur advice.
3) Read, read, read. Pick a book you can settle into. Something where the fictional world absorbs you. A thriller isn't going to help. Don't try to bore yourself to sleep with anything academic either. I find lowkey novels about another world or universe help.
It took a few years with fresh starts and reversals but no more insomnia.
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Ambien is a benzodiazepine drug that can significantly impair memory. I quit it in 2014 and my memory has been coming back ever since.
3
@Maquis Zolpidem is NOT a benzodiazepine. It acts on a BZ1 receptor, but unlike benzos it has no anti-convulsant or muscle-relaxant properties.
4
Unfortunately, CBT-I is not covered by most insurance and private practitioners in my area charge between $250 and $450 a session! Also - please get your thyroid checked if you have sleep disturbances. This was part of my Hashimotos and went undiagnosed for years.
1
@LJIS What was the cure?
There is no cure, but you can get symptoms under control. If your thyroid is damaged, you have to take daily medication for your endocrine system to function properly. I do a ton of other stuff like follow an anti-inflammatory diet, and stress reduction including daily walks and mediation. Getting to menopause and using low-dose HRT (no more night sweats) really helped as well. I still have bad nights. But nothing like before.
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I know, goes against all medical advice: Knob Creek.
1
@Mike I love Knob Creek but this doesn't work for everyone. Whiskey may help me pass out, but then I will have poor quality sleep and awaken too much during the night. The best quality sleep is achieved without alcohol.
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Ambien turned my wife into a sweaty, sex-crazed tigress! My wife and I had retreated into a very boring, very routine sex life, but everything changed when she went through a bout of insomnia and started taking Ambien. The first night she took it, we quietly went to bed hoping for some good rest in the middle of the workweek. About 15-30 minutes later, she literally tore our clothes off, starting clawing at my skin, jumped on top of me with passionate kisses, and demanded immediate carnal satisfaction. It was fantastic both for me and for her. We've now repeated the experiment many times and with consistent, superb results. Even better, after the evening's exercises, she wakes up in the morning well-rested and ready for the new day.
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The problem of insomnia has many different causes in different people. Altnough this column offers sound advice, there is no one-size-fits-all solution.
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I suffer from chronic pain due to a slipped disc and sciatica. I do use sleep hygeine priciiples but they do not address the pain that keeps me from going to sleep.
Ambien works for me. Doctors and pharmacists should proactively educate patients about proper management of sleep aides such as keeping it separate from other medications and carefully tracking when it's taken.
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Normally I reduce screen time before bed, but when I can't settle down, a Bob Ross or ASMR video provides gentle transition. Sleep quality after one of these videos is noticeably deeper and more refreshing as well.
A cocktail of 3 things: chamomile tea, Magnesium Threonate, and L-Theanine. I've gone from 4 hours of sleep to 7.
3
I take a 1/3 to 1/2 dose of Zoloft most nights-nothing else-exercise, no caffeine/alcohol, cbd, melatonin, meditation, deep breathing, sound therapy, herbal supplements helps. If that doesn’t work, I have a slice of lower carb bread and low sugar jam. That helps!
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@Cynthia McDonough
I agree about the bread.
But the Zoloft causes severe UTI like symptoms for me and I know other people who have the same reaction. I wouldn't recommend that for any problem. ....and it causes many other side effects too that make it a bad choice.
1
When I awaken in the middle of the night, I take Zanex. A low dose, it slows the brain and mind from all the silly trials of life! Once, twice a week- won't kill me!
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Magnesium citrate before bed.
4
My sleep truths:
Reading, or listening to Rajneesh for falling asleep.
No caffeine after 2 pm, no more than a small amount of alcohol in the evening, eliminate before bed anxiety, have enough blood sugar going—a tablespoon of nut butter right before bed can do it—and other healthy sleep practices, like having a cool room, white noise on, etc. all for staying asleep which is my major problem.
6
Without drugs? Exercise, eat healthy, and yoga.
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I relieved my sleep issues the same way I was able to restore my lost senses of taste and smell, relieve my crippling hip pain and make a golf ball-sized bruise go away in two days: I went to my doctor--a Chinese Traditional Medicine doctor to be precise-- and he needled my woes away. Try it. You'll realize the arrogance of Western medicine is keeping us sick.
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@Casual Iconoclast
I wish you would explain that a bit more.
I barely know what needling is so what is needled to help insomnia?
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@Blanche White "needling" likely means acupuncture.
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Two things:
No mention of benzodiazepines? Terribly dangerous drugs. Ask me how I know. Klonopin, for instance - STAY AWAY. It's supposed to be prescribed for a few days or weeks at the most, but many psychiatrists are happy to keep you on it for years. It is incredibly dangerous.
Discouraging to see Hyland's touted - this is homeopathic, a.k.a. free of any active ingredient whatsoever = scam.
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Any suggestions for restless leg syndrome?
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@BlueBird
Well, certainly don’t take Mirtazapine to help you sleep...
@BlueBird ...KICK!! Worked for me!
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@BlueBird try getting up and walking around, take a glass of whole milk...
My wife's physician recommends Benadryl over Xanax.
@Wally Mc
Benadryl is on the Anticholinergic Burden Scale; significant use of it is associated with developing dementia in older people.
https://research.aston.ac.uk/en/publications/the-2012-update-to-the-anticholinergic-cognitive-burden-scale
http://www.idhca.org/wp-content/uploads/2018/02/DESAI_ACB_scale_-_Legal_size_paper.pdf
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@Wally Mc
I read, years ago, that anti histamines have the potential to coat the platelets and the spleen then recognizes them as defective and swoops them up and sends 'em to the trash bin which might lead to a dangerous decrease in platelets.
Would only use it rarely for sleep issues.
1
@Wally Mc Benadryl works great for me -- if I want to stay awake the night I take it, and then sleep the entire next day. (Argh)
I envy the people who get a good night's sleep after taking a dose, because it's an absolute fail for me.
And now we are all suffering from PTSD that's affecting our sleep, more so now that we have the crazies who won't mask and vaccinate...
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@Louise ... One of many reasons! But a prime one!
4
Walk for an hour a day and then see me in the morning and tell me how you slept?
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@Hari S. ... I also put a 'lime in the coconut'!
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@Hari S. I walk 3 miles a day and that did nothing for me during perimeopause and thyroid issues. Some things are chemical. Once I reached menopause and got a proper diagnosis, it got better. And I still walk at least 3 miles a day. :)
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@Chris I hear you. I hope you find some peace whether you sleep or not. It is one night at a time. For what it's worth, I listen to a sleep podcast called Sleep With Me that got me through the worst of it. It is silly rambly stories to keep you company in the night.
I listen to a variety of podcasts. It’s like being read to by a parent. There are special sleep inducing podcasts that are very effective.
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CBT is the gold standard for treatment but getting into therapy now in most places take 4-6 months!!!
Let’s put more funding toward educating and promoting the mental health profession and because of the high demand, insurers must start paying them more. People who deal with suicidal patients regularly are just as important as trauma surgeons. Both patients are often at the precipice of death. Start paying mental health providers accordingly.
4
Like the author, I had a similar experience with bird mites causing intense itching that kept me awake at night. The source of the problem was a family of Phoebes nesting under my porch eave. Fortunately bird mites don't last long on humans.
1
What if you have tinnitus? Which, for me, was made much worse by the Coronavirus vaccine.
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@Roberta
I suffer from tinnitus - widex hearing aides are a life saver. They have a zen mode - different tones in each ear v other hearing aides that only mask the noise. Low dose of Trazadon before bed and a 25 mg Xanax if I wake up middle of the night.
2
Since I started taking vitamin D3 and magnesium I have been experiencing deep restorative sleep. It’s been a real game changer. There is a reason the magnesium product found in some supermarkets and drugstores is called “Calm.” Many of us are deficient in magnesium and don’t know it. I’m so grateful that I figured it out and only by accident. Reading about the benefits of higher doses of vitamin D3, the authors of those studies/books mention other things you should take with it; one being magnesium. It has changed my life.
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A recurring problem in medicine and health is the search for THE answer instead of looking for the answers. This is compounded by the concept of my answer is the answer. Medicine is coming around to treatment existing on a continuum rather than being a singular response. The comments reflect this. Everything works but not for everybody. The problem for many is expectation of quick, simple, easy, solution existing and consultation with family, friends, co-workers as well medical professionals disproving those expectations. The science of sleep has grown and continues to grow but the art of sleep remains very elusive.
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When I start feeling drowsy I avoid light. Anything like a bathroom or refrigerator light wakes me right back up so I do whatever it takes to make my way around in the dark. A glass of warm milk is just enough of a sedative to help my along. And of course clearing my mind of whatever might be spinning around, finding something else to think about and sticking with it. That part just takes some practice.
I had a decade of nightmares due to the violent gun death of a partner. A therapist was very helpful in teaching me about guiding the subjects of my dreams just before bed time, and techniques for reentering and correcting the endings of the really bad ones so they don't ruin the following day.
5
If I am not sleep within 30 minutes, I have a cup of Oolong tea. After sipping the tea, I lay back down and that is the last thing I remember. It works for me!
3
Interesting, it’s caffeinated!
1
Valerian Root works for me, like a charm. Don’t need very much at all. I am thankful for that.
2
My co-worker was hospitalized for months and nearly died after he was hit head-on by a driver on Ambien. He man said he fell asleep in his chair and the next thing he knew, he had the wreck. My mom was on Ambien and wound up in the hospital, disoriented, for four days because of the drug. Another man walked off his balcony and died. Those are cases I know of personally, so I find it hard to believe it's so rare. Don't take it.
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@Sook My sister ordered something she saw advertised on late-night TV--something she didn't need and didn't want--while taking Ambien. And she did it twice! And she had no memory of doing it either time.
2
@Sook
My elderly mother was put on Ambien to help her sleep and had an incident in which she hallucinated badly. EMTs were called since the folks she was with thought she might be having a stroke. Ambien is bad stuff. I agree with other comments here. Just don't take it.
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Sook — It's a truly incredible coincidence that you know personally of three cases of Ambien use leading to serious consequences.
1
Nothing of use here. The problem is that when all of the distractions of the day are put aside at bedtime, the flood of suppressed worries rise to the surface. CBT is a joke, literally: the old Henny Youngman Doctor, it hurts when I do this. Doctor replies, don't do that. Mild tranquilizer and audiobooks only things that help me.
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@Theresa .. I concur!!
3
My sleep greatly improves with Qigong Routine to Relax The Body And Mind - Deep Stretch Before Bed (Follow Along). I have been doing this routine immediately before bed, literally, just before lights out, since the pandemic began. Nothing else compares. Find it at QiGong with Kseny on YouTube. There are also a few 5-minute before bed breathing exercises in her line up. What a difference it makes, adding those to the above routine. Deep, deep sleep. Tiffany M. Field, PhD, Univ of Miami, research on touch is instructive. Just moving the skin, eg yoga, qigong, stretching, is highly beneficial and comforting.
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@Anne I'd expect qigong and yoga to have a beneficial effect on falling asleep, likely due to the focus on breathing. Maybe just sitting for five or six minutes, eyes closed, counting slow breaths would help.
1
You know why I can’t sleep? Noise. I live in NYC apts. Neighbors slam their doors, hit the walls, drop things on their floor, my ceiling, on and off all night. I wear earplugs but don’t make a difference. I can be in a deep sleep and noise pulls me out shaken and trembling, two to three times a night. I can sleep if it’s quiet. Don’t tell me to rent a house in the country. I’m a New Yorker, elderly and don’t drive. Either respect or good insulation would be helpful but that’s not going to happen.
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I feel your pain. Have you tried white noise - either a fan or an app, etc.? Works for me.
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@Ellen McCall Ellen, if you are elderly can you make a move into elderly housing of some kind. Perhaps if your neighbors were elders, too, it might be quiet. I'm sorry you are wakened from a deep sleep so often.
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@Ellen McCall Noise is a serious issue. The way buildings are made is a joke. I use two white noise machines and noise cancelling headphones and I can still hear (and feel!) the helicopters at night.
1
I finally found the solution to my chronic insomnia and wish to share it with you. I'm 61 and have had insomnia since the 1970s. When I was 12, I was woken up, tied up and held at gunpoint for hours. That caused PTSD. Not just falling asleep but staying asleep and sleeping long enough have been the problems. Years of therapy; medication; practicing sleep hygiene; avoiding caffeine and alcohol; getting exercise; having a cool bedroom, not going to bed until I was sleepy and all the other common recommendations did not solve the three-fold problem. Once the pandemic hit, the insomnia grew much worse. After Jan 6, I was lucky to sleep three hours a night. I tried six sleep medications after that from a psychiatrist specializing in PTSD. None of them worked. I finally found three things that did. Microdoses of thc tincture; a weighted blanket and the TRUE miracle, a pair of Spectra479 brand blue light-blocking glasses. I put them on at 8pm every single night, whether I'm reading, using a device or playing the piano. As soon as I start yawning, around 10:30pm, I get into bed, turn over and fall asleep and stay asleep through the night. I have not slept like this since I was a teenager. The glasses are available on Amazon and are very reasonable and comfortable to wear. The blue light of electronic devices blocks the production of the body's melatonin. Good luck falling asleep without it. I hope this post helps someone.
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@Suzanne Absolutely agree about blue light blocking glasses. I've bought several different brands on Amazon, some quite cheaply. For some reason, our local eye glass retailers have no eyeglasses in stock for people - adults and children - who may not need correction but who do want to purchase fashionable blue light-blocking specs for tvs, phones, tablets, and computers. There's a fortune to be made here, with a little information for the public about how important this can be.
5
While I'm not a bad sleeper, it does go off the tracks at times. This caused me to read "Why We Sleep," by Matthew Walker, a PhD scientist. It was a revelation in several aspects, giving sound advice based on science and academic-level research much beyond the contours of this short and good essay. For instance, did you know that caffeine has a half life of 5-7 hours? So drinking coffee in the afternoon has a measurable effect on sleep formation. His admonition? No coffee after mid-day. In the same vein, alcohol has quite an impact on the quality of sleep, hence stay away from alcohol after 6pm. That's hard but it sure works. Lowering the temperature in the bedroom and keeping it very dark are two more. Reading about the effects of even slight sleep deprivation was, well, scary. For instance, there is a demonstrated uptick in traffic deaths, heart attacks, and ER admissions the day after we lose one hour of sleep owing to the switch to winter time. An engrossing read, and if it puts you asleep the author states that he will have achieved his goal. I keep buying copies and giving them away.
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@Michiel
Very much agree about the cool bedroom. Without air conditioning there is no chance I will sleep. A cool bedroom is bliss.
8
i listen to an book on my iphone and fall asleep within 15 min. the narrator must have a fairly even keeled voice. i guess this is my white/pink noise. the books last forever (usually a month) and i do listen during the day when relaxing. i also nap but limit it to 15 minutes of which I probably sleep for 3-4 min and wake up refreshed. i no longer work but always told my boss that if he let everyone nap for up to 30 min, we'd all work many more hours; he would roll his eyes at me. little did he know how true that is. his loss.
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I was diagnosed with Restless Legs Syndrome in the late 90s. I take ropinirole (generic for Requip). I am also a survivor of traumatic brain injury and take Temazapam for sleep. What are the latest thoughts on RLS?
3
@Alan C Gregory I've heard taking high doses of magnesium have significant impact on RLS, ease anxiety, and allow more restful sleep. Definitely give magnesium a shot (get a quality one with high 'elemental' magnesium which means 'real' magnesium in terms of mg). A triple formula one on amazon I am using is the best I've found and has worked wonders for me (it has magnesium glycinate, citrate, and malate), good luck!
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@Jason How much do you take, and at what time of day?
1
Try 1 tab of Wellena Magnesium replenish, 120 mg at bedtime. This along with other good sleep practices, lack of anxiety, good blood sugar levels, etc., etc.
1
I’ve read a few comments about investing in a good mattress. For me, switching to a hammock with a memory foam pad has been wonderful. It won’t work for couples, obviously. If I have a bit of trouble falling asleep, I give myself a few rocking pushes, and it’s very relaxing. In addition, I never have back aches anymore. Another advantage - it’s very inexpensive and very portable!
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We seem to be entering a judgmental “Puritanical” phase with regard to pharmaceuticals, thanks to the opioid abuse crisis. Now people with legitimate need for a few categories of pharmaceuticals are made to feel like street addicts when they request that type of assistance. I’m pretty fed up with it. It’s not rocket science to figure out who is abusing the pharmaceuticals, both doctors and patients. Americans have a childish black/white approach to social problems now, without nuance. It reminds me of how we shut down mental health institutions and orphanages, because some of them were poorly run. No thought given to actually improving them - no, just shut them all down. So the mentally ill languish on the streets or in prison, and children are bumped from one foster home to another, where mistreatment is hidden behind closed doors. Now we are doing the same with helpful pharmaceuticals.
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@Just Curious The shutdown of mental institutions was supposed to be simultaneous with community homes, but all over the country NIMBY kicked in. Hence, the mentally ill mostly landed on the streets. Then homelessness increased and now even with all the work to help the homeless, a lot of them are afflicted with mental illness. One wonders how many generations it takes to do something right in this country!
7
Same old, same old, in this piece. After suffering insomnia my entire adult life (it actually started when I became a mother), I finally have relief: marijuana. Legalization has changed my life for the better.
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@Just Curious
Congrats to you. I never liked the effect of marijuana when I was in my teens so never tried it again. But my considerable insomnia also started after mothering. Maybe will reconsider the pot. Ambien the only thing that helps so far......
Might add that those who don't suffer from lack of sleep seem to be remarkably oblivious.
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@Just Curious Recommendations, anyone? I tried indica edibles, but they had a paradoxical effect -- more anxiety, not less.
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@Just Curious Keep in mind that due to major genetic differences in human ability to metabolize THC, your experience is not going to be like that of others. THC is one of the substances broken down by an enzyme on the CYP2C9 substrate. About 10% of people of northern European ancestry are non-metabolizers of THC (and also many NSAIDs and Warfarin) due to the CYP2C9*3 polymorphism. A similar percentage are poor metabolizers. You are probably a normal, i.e. "extensive" metabolizer. For people like me, drugs like THC and ibuprofen can build up to dangerous levels because our bodies can't get rid of them.
As anyone taking the time to read the comments here swiftly realizes, one size does not fit all. Insomnia is a symptom caused by many, many things. If it were that easy to fix, none of us would be reading this article.
1
The issues that plague our modern condition are systemic. Unless you plan to overhaul capitalism, technology, etc, these problems won't be going away.
6
I am an insomniac. The fact of the matter is that in our society where the work schedule, among other schedules, have to be rigidly observed, cognitive therapy isn't enough. The standard business day requires at least a net 10 hour block of time that the person must be productive and not nap, etc. One the main factors that I early retired (and semi-retired at a very early age) was to remove this requirement from my life.
25
30 min aerobic exercise a day - morning or afternoon, and “ Caleb Treeze Organic Farms Stops Leg & Foot Cramps” ( Amazon under &11.00) works for my sleep issues. Caleb Treeze product REALLY works, and works quickly. I give it as a hostess present. The last bottle that I ordered came with an acupressure suggestion that also works.
10
That link about the quinine and tonic water said quinine is dangerous. It says nothing about mixing the two. Did I miss something??
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@Becca Helen i think they meant that quinine water is tonic. there is already diluted quinine in it
2
Insomnia is a terrible thing to deal with. I had devastating insomnia for many years. It made me feel crazy, unstable, and confused all the time. I took several different kinds of medicine to help me sleep, both prescribed and unprescribed (melatonin). Eventually I turned to healing myself from childhood trauma to a level I hadn't before. I found an inner faith and peace in the process. I've slept well for ten years and am grateful for that every day.
13
There is nothing more soporific than listening to the podcast On Being with Krista Tippett. I always MEAN to keep paying attention but it knocks me out within 5-10 minutes. They speak in soothing tones about the inner life. Put the phone on your pillow, plug in the earbuds so as not to disturb your sleeping partner, and have a great night's sleep! PS I download the podcast so I can then put my phone on airplane mode. Don't want to spend the entire night with my phone pulling data/wireless signals right next to my brain.)
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@Mikonana
I do not think you are a genuine insomiac.But best wishes.
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@Mikonana i totally agree with you. i do the same with a book. if i wake up in the middle of the night, i put the book back on (all notifications off but want my phone to ring if an emergency) and fall back asleep.
2
Sometimes a pair of loose fuzzy socks can help. Poor circulation can cause feet to be cold without that being realized as the cause of not getting to sleep.
10
I tried everything for my sleep-maintenance issues. Meds, tested for sleep apnea, supplements, herbs, hypnosis, sleep tapes, meditation, EFT. BOTTOM line is to uncover the (often) multi-layered causes. This takes time and a knowledgeable health practitioner willing to dig. Please… warm milk, bananas, exercise, sleep hygiene (yes, SH and exercise are important) soft music, even CBT are laughable for the hardcore insomniac.
I figured out after I did hundreds of hours of research and ordered online saliva tests (later confirmed by blood work ordered by my holistic MD) that I had severe adrenal fatigue. Warning: conventional doctors won’t diagnose AF. They’ll smirk and tell you that only Addison’s and Cushing’s are legitimate adrenal issues, aka adrenal insufficiency. But my endocrinologist who saw me for a life-long pituitary disorder (Empty Sella Syndrome, thus my adrenal issues are likely related to HPA functioning) did NOTHING to help me sleep. Zip.
Conventional medicine (to which I’m not opposed, my doctor combines conventional and alternative) views adrenal fatigue as outright quackery designed to take advantage of the misinformed, desperate and vulnerable. But after my doctor worked with me my sleep and overall quality of life radically improved. I still struggle a bit with sleep-maintenance, but I know the causes now. I wrote about it on my blog: Laura-owens.com
3
if everything fail like me sleeping just 4 hours for my entire live tried all pills to sleep nothing work till I TRIED CBD cannabis oil in drops 5000 mg under my tongue 1 hour before go to bed $25 buck in amazon...has been one the best 5 things in my live, sleeping now 8-9 hours deep sleep its a milagro plain and simple !!
15
@Alex Lesl which brand cod oil did you buy?
19
I have a trick that works for me. I place my phone on the pillow next to me and start listening to an audio book. This takes your mind off of whatever is preventing you from falling asleep, or from just thinking "I'll never get to sleep".
I set the timer on my audio book player to go off in 15 minutes. The next morning I rewind to see how much I can remember. Often I discover that I fell asleep in just a few minutes.
If you sleep with someone next to you try using an earbud, just one is enough.
13
@Ken Morgan
thanks, that is solid good advice , i am going to try that
3
@Ken Morgan i do it every night too. works for me!!! if i wak in the middle of the night, it goes back on and i'm back to zzzzzzz.
2
There are a lot of foods which help lull you to sleep, bing cherries or cherry juice being a great one! Physical activity always knocks me out. I slept like a baby all my life but once I hit my 50’s I was not as active as I was in my younger years, so I try to really burn out during the day so I can get a good rest at night!
4
@Eileen
Like many comments, very well meant but not effective for true chronic insomnia. Might add that I did step aerobics five days a week for years. Was thin as stick but didn't help my sleep. Ambien did at last. Worth the supposed trade-off.
Cherries?? Like milk, in terms of annectodal solutions.
10
You can tell people are not getting enough sleep when they exhibit poor judgement. Like those that support the failed policies of trump....I may need a sleeping pill when I wake up in the middle of the night and realize what he is doing to our country and the world! Why are red states the one that use the most drugs? Anti-Depressants and opioids are used heavily in trump country!
26
@RDW of course you insert Trump into an apolitical conversation. Textbook TDS. Get over it. I sleep rather well knowing he’s in the Oval Office!
5
Just FYI, lavender soap in the bed relieves leg cramps. It’s a miracle. Sleep with a bar in the bed, and every once in a while hack the soap a little with a knife to let out the scent. After six months or so, replace it.
3
Ms Brody: thank-you for writing a column not pushing Big Pharma treatments. Hylands is a homeopathy brand. Imagine that!
This is a step in the right direction.
8
@lechrist Every night I thank God (and pharma) for the pill that helps ease my pain and allow me to sleep.
2
Snoring bed partner is often mentioned as a reason the other person can't sleep. This used to be my problem. Then my close friend, a recent widow, mentioned that she kept waking up in the middle of the night thinking she heard her husband snoring, and how much she missed him. This led to an attitude adjustment: I now think how lucky I am to have my dear husband snoring by my side. He still wakes me up, but now I can go back to sleep instead of stewing about it!
24
A dark enough, cool room..... helps but
When do you take your old-age meds? When I took the large dose of Atorvastatin in the evening, I would wake up and not go back to sleep in the early AM hours. Now I take it in the AM with the first dose of Metformin.
Put the orange light on on the computer.
No caffeine -- tea or coffee after??? 6PM? for sure. No alcohol.
You might want a bedtime snack - possibly with sugar content or turkey with tryptophan.
No phone calls after 9PM. Also limit conversation. (People can be upsetting.)
I used to take an aspirin and St. John's Wort if I awakened in the nite. A snack then might work as well.
Ambien only allowed for about 5-6 hours of sleep NOT enough.
4
@Auntie Mame
Thank you for this comment, Auntie Mame. I will start taking my atorvastatin in the morning since I have the same sleeping difficulties you mentioned.
2
@Auntie Mame A glass of wine works for me. Ambien is dangerous.
1
Eating turkey to experience the effects of tryptophan is considered useless, because the protein in turkey prevents the body from absorbing much of the tryptophan.
1
I'm so glad to see that most readers reacted like myself to the judgmental, patronizing and frankly clueless bromide served up by Jane Brody who usually does better. However I'm surprised that almost no one mentions the elephant not just in the room but in the bed with the insomniac. My husband has early Alzheimer's, restless leg syndrome and fasciculations, and prostrate adenoma which makes him get up about 5 times a night. Without 5mg of zolpidem I would be unable to cope psychologically or physically. As mentioned by many, the dangers of chronic sleep deprivation are much more serious than the rare dangerous side effects of some drugs on some people. Thanks to those who actually offered constructive suggestions.
30
@ex-pat Pat Thank you for allowing those of us sleeping with the help of 5mg of Zolpiderm to have a voice. I tried reading, bananas, milk, music, melatonin, you name it, nothing works. Will check out CBD to see if it helps but for me Zolpiderm is a life saver!
14
@ex-pat Pat After a hysterectomy, I became an instant insomniac. I call it "surgical insomnia." So, after fruitless hormone testing, cognitive therapy, meditation, melatonin (more than 1 mg caused serious gut problems for me), no caffeine after 3pm (that helps but is not sufficient), blue light glasses (that also helps but is not sufficient), Benadryl/diphenhydramine (caused nose bleeds), I've been taking Zolpidem 5mg sublingually for years. One nibble to fall asleep, and two more nibbles around 2am and 5am. It's my own "timed-release" system and it works great. I truly would have gone nuts from lack of sleep if I hadn't figured this out over the years. The only problem is, as others are mentioning, is the demonization of soporifics like Zolpidem. I now must see my doc in person every 3 months to get a refill and have to be drug tested once a year. Luckily, she sees that I've never increased my dosage and treats me like an adult. Above all, she doesn't regard insomnia as a character flaw as some doctors seem to do.
10
Let cramps are best when potassium levels are well maintained. What quinine flavored water might do isuse body fluid. The author made a personal comment based on something but,lacks facts concerning the water. Sleep issues are far more complicated for many people. Heritary brain structure issues, spinal cord injuries are two very diffucult areas that neurologist are still exploring because both effect sleep in negitive ways in post injury and heritary ways. The typical person may never have a problem of course.
1
The author is kidding herself if she thinks that quinine-containing tonic water help with nightly legcramps. There is quinine in tonic water -- as a flavoring. According to Wikipedia, "As a flavoring agent in beverages, quinine is limited to less than 83 parts per million in the United States, and 100mg⁄l in the European Union."
Regardings Hyland's Leg Cramps drops, she is downright delusional. Hyland's is a homeopathic so-called remedy. According to Hyland's website, "In homeopathic medicine, we deal with micro-doses of active ingredients – in this case 0.0078 mg of quinine per tablet...".
Ms. Brody should consider talking to a licensed medical doctor.
11
If this works for her, even if it isn’t real, and yet she is “delusional,” so what?
2
So this: In case the author's advice stems just from her experience of the placebo effect (I cannot judge), then it's not something that others should be advised to follow.
@fred agree about tonic water. years ago one was able to get prescriptions for quinine pills for the leg cramps; then it was decided to reserve same for malarial cases. having had to pull over to a deli and just managing to get a bottle of [canada dry] tonic, i had to drink down nearly the entire thing to be able to safely drive the rest of the way home, which was one mile.
Click-bait headline. This article doesn't deliver on the promise in the headline, "Getting a good night's sleep without drugs." There were actually very fuew solutions offered, and I didn't find anything I could use.
23
The daily assault of the horror of our current politics are one of the main causes of insomnia. VOTE.
24
@Rp why must you bring in politics to an apolitical story? I sleep quite well knowing Hillary is not in office. You’re in for a long 5 years of insomnia. Be proactive and employ sleep hygiene measures.
3
@Deplorable Leigh Ann
You said it. Why not be kind?
3
@Deplorable Leigh Ann I think he said it because it's true. The events of the day do indeed contribute to insomnia. You were certainly wrong about the 5 years. The traitor didn't manage to pull off his little coup.
5
Why is the disruption of a loudly snoring bed partner never mentioned? It isn’t apnea, and the doctor there’s nothing he can do to quiet ‘monumental snoring’ or the whole jungle, from howler monkey to wild boar to buzzing mosquitoes, a mere foot from my ear. Insomnia isn’t always endogenous. Sometimes it is snoring right beside you.
9
I read in bed for about an hour. It provides a gentle transition to unconsciousness. When I begin yawning, I turn off the lights. This technique takes my mind off other concerns, such as business. And peaceful sleep usually follows.
9
@Michael This is my exact routine and it works!
3
Lots of physical activity and reading in bed for 15 minutes does the trick for me every time..
4
Very odd that there's no mention of physical activity activity to relieve mental stress and produce tiredness in the body. Mental stress presents itself in the physical body, physical exertion helps alleviate that, as well as distract the mind by focusing on physical activity, whether through running, yoga, cross-training, etc.
7
@Troy Because I can only do limited exercises due to medical issues. Wish I could.
2
As a bad sleeper who is hesitant to take any prescription meds or melatonin, I've finally found a combo that works and is also pretty innocuous.
1. L-theanine, for relaxation. This one is optional. A small amount, about what's found naturally in 2 cups of green tea
2. Magnesium. So safe it's often recommended for pregnant women
3. Glycine. Equally safe! Pretty much a dietary supplement
I sleep like an angel when I take these 30 min before bed. Try it!
9
@Maomao Mag. isn't always safe for people with kidney issues. please check with doc before taking supplements.
1
I'm surprised that no one has mentioned trazodone, an anti-depressant that in low doses is helpful for insomnia but has none of the side effects of sleeping pills.
10
@Bonnie Allen
Works for some, I believe, but did absolutely nothing for me. I wish it had. Interestingly, my mother finds the same result vis a vis trazadone is also is true for her.
Trazadone gave me some of the most vivid, bordering on nightmare dreams that I have ever had in my life. Vivid enough so that I'd rather not take it again. Back to Ambien for me. Thank god my MD is okay with that.
5
I find that Ambien alone works for my chronic (five years now, I'm 65) insomnia. But not in prescribed doses -- as a virtual placebo as well. I cut my 5 mg tablets into quarters with a (very) sharp knife. I put one under my tongue at bedtime, and another on my night stand in case I awaken at, say, 3 a.m.. The neurological harm caused by Ambien is likely cumulative, in which case I'm still in trouble. But I find that just the knowledge I have a bit of the cure under my tongue works wonders -- and though I'm not eliminating it, I'm successfully cutting down my exposure to the maligned "Zs."
6
@Jeffji Me, too...sublingual Zolpidem (Ambien) also works great for me.
1
@Jeffji Many people on Ambien have terrible reactions with devastating consequences for themselves and others.
What is the evidence that it's "many" people?
If it was as easy as the write discusses to cure, we wouldn't all be reading an article about the issue.
25
I have not read all 642 comments, but wonder if anyone has suggested the SLEEP WITH ME podcast. Dearest Scooter is my salvation during my frequent night-time wakenings. Works nearly every time. Give it a try -- it's totally nontoxic and completely free!
4
@mim
I find it too stimulating!
@mim I tried this but didn't work for me. Instead, I love the sleep stories from Headspace. (I believe the other meditation apps like Calm or 10% Happier offer similar ones). Not free but works every time!
1
(Works for me, I mean -- I can't speak for everyone!)
1
Nothing here even remotely helpful.
28
Interesting that a number of comments pick on Jane Brody's article--but look at the comments the article generated-obviously the subject touches many people-so good job for her to generate the comments.
And just to throw in my 2 cents--I was typically waking up at 4:30am to 5am whether 5 hours of sleep or 6 hours of sleep.
Started taking full spectrum CBD 25mg(no THC) -I now sleep to 6:30 to 7am -7-8 hours of sleep--(except for now writing this comment at 5:30am because I've been up for an hour already--because I ran out of the CBD capsules!) Does it work for everyone--probably not---but I wish I knew about it sooner!!
10
I cannot believe this essay does not mention regular physical exercise. If I miss my daily walk or bike ride, I usually sleep very poorly. I know this is anecdotal evidence, but I'm sure many of you will back me up.
I believe you need to be somewhat physically tired to get a good night's sleep.
23
Insomnia my whole adult life. Have tried every good sleep hygiene tip and non-pharm solution. They have all helped mildly, but nothing essentially changed. Until ...
Neuro feedback. It's been around for a while, but is only recently becoming more known. It has been a miracle for me. I don't know if it works for everyone, but I was desperate, so I tried it. I had forgotten what it was like to get 8 hours of sleep straight through in a single night. I can now tell you, not surprisingly, that it is bliss!
I know that I sound like a convert, but I really think this procedure could be the wave of the future for treating insomnia (and other issues too). I really recommend finding a good practitioner in your area if you can, and see if it helps. It has truly, as the saying goes, changed my life.
1
My issue is not falling asleep -- it's staying asleep, staring at the gaping expanse of my mortality. Any suggestions?
6
@mfor
Put on headphones (if you sleep with a partner) and listen on YouTube to Yoga Nidra for sleep from Tripura Mandala. There are several versions in different lengths. Also some sleep hypnosis sites on YouTube also have excellent recordings to help you sleep whether you're just going to sleep or waking up in the middle of the night.
2
I struggled with falling asleep for as long as I can remember, but a couple of months ago per Dr suggestion I purchased 1mg melatonins (literally, designed for kids) and take one around 9pm on work nights, and stop doing stimulating activies. I'm usually falling asleep reading / playing a game on my phone by 10:15, and I sleep pretty soundly. Best sleep I've gotten...
Of course nothing anyone suggests will work for everyone, and some of the holier-than-thou comments below are disappointing to see, albeit not entirely unexpected. My Dr does not prescribe sleeping pills, but I've taken them in the past. They were really nothing more than a band-aid for me, but if it's what works for some individuals...who are we to say otherwise.
12
@B. M. Sandy. Ditto here.
2
Really nothing new here. And Brody's advice to drink tonic water for leg cramps is downright laughable. As someone who has been plagued by leg and torso cramps, Charley horses - whatever you want to call them, I can tell uncategoracally tonic water, with its microscopic amount of quinine, does absolutely nothing. If she finds it helpful it's the placebo effect. I excercise, do yoga twice a week, drink plenty of fluids and still have foot cramps. The fact is no one knows what causes them and therefore no one knows how to get rid of them. Current research suggests vitamin D but nothing conclusive yet.
2
@Hazel Try drinking vinegar. Seriously.
@Hazel I keep a bottle with Magnesium oil by my bed and massage my leg thoroughly when the sometimes very painful leg cramps happen (also drink a bit of tonic water which has always helped despite what other readers are saying!). Pain subsides in a few minutes.
2
Nothing mentioned here about room temperature. Falling asleep when it's too warm (in any season) is really difficult and staying asleep even more so. Keep it cool.
13
Insomnia has many causes, and hence many 'cures', just because Ms Brody suffers from leg cramps doesn't mean tonic water will help others sleep.
My insomnia was cured once the causes were identified:
1--Loss of Progesterone in menopause--solution: daily progesterone.
2--Alcohol use--solution: you know this one
3--Insufficient exercise--ditto
Since I got serious, stopped drinking and started exercising daily I sleep through 7 hours straight. Curing (my type of) insomnia is like curing obesity, it requires major, difficult life changes that few are willing/able to maintain.
10
I am 82 years old. My general sleeping pattern for the last 20 years: 5 hours sleep in bed, then 1 to 2 hours up, followed by 2 hours or so of sleep in a reclining chair. I usually have a 1 hour of nap during the day also. I have a fairly active and happy life.
I take no medications. Have leg cramps (I'll be trying that quinine water, Ms Brody - thanks).
The thing that kept me from trying sleep aids was reading how indigenous peoples have a sleep patterns similar to mine, and then the Brother Cadfael TV series came along. It reminded me that monks in Monasteries had a similar sleep pattern (4 to 5 hours of sleep, then up for an hour or 2 for Matins, then back to bed).
Anthropological writings exposed me to the idea that our present sleep patterns are actually learned, rather than embedded in our genes. The 8 hour pattern seems to date back only to the beginning of the Industrial Revolution.
Tho old ways work for me.
24
@Brian
My dog actually forced this sleep pattern on me. He gets me up at 5 am every day. I take him for his walk, have a light breakfast and then go back to bed until it's time to get ready for work. Up until the time I adopted him, I always had sleep issues. As a result of this schedule, I have no problem. (I've had him for 12 years now...)
11
The dangers of prescription sleeping meds seem tiny compared to the dangers of lack of sleep. The downside is the building up of tolerance. Maybe the US can stop messing around with the clock twice a year to give us a running start on solving America’s sleep issues.
28
Stuff that works:
A small amount of Tart Cherry Juice right before bed guaranteed to knock you out. About 2 ounces. Do not confuse with Dark Cherry Juice. It comes in pill form also; cut the pill in half.
YouTube has lots of sound videos that are guaranteed to lull you to sleep: ocean waves, rain, mountain stream.
Try meditation or visual imaging something very serene.
6
what’s an “invasion of bird mites?” - the solution for intense itchiness. All of the article was interesting and helpful but wondering what the heck that meant.
1
@Judy
The author meant the prescription was for medication to treat intense itchiness that was caused by an invasion of bird mites.
Bird mites invaded my home and I just about went crazy trying to figure out what was biting me. My itching was right at the area of my navel. I traced it to my kitchen. I had white counters and the mites were white and very tiny but I saw a dark colored one (they darken when they eat blood). I went online with my symptoms and images of the mites and I was able to diagnose the bird mites. I then found the likely source--a bird nest on a structural ridge beam that extended outside my log house. And it was right above my kitchen. If a chick dies, the mites that normally feed on it no longer have a source of food so they migrate from the nest. The mites must have traveled onto the structural beam and down into my kitchen. Then they migrated onto my clothes every time I leaned on the counter. The mites don't like human blood but they still bite once to see if their host is a bird. I washed my clothes every day and changed my sheets every night. I prepared food out of the kitchen. I sprinkled diatomaceous earth on my counters and any surface they could contact. But they are self-limiting without an adequate host. Once the fledglings left the nest, we brought the nest down with a pole and sure enough there was a dead chick in it. I love birds and I won't harm them or their eggs, but that was a lesson to deter nest building on my house as best I can.
13
@FRITZ Thank you for sharing this interesting information. Learned something new today.
6
People with lifelong insomnia have tried all this many times. I find Lunesta (as needed, not every night) works great, and has done for the last three years. Behavioral therapy is stupid and a waste of time. Tried it for years. Melatonin doesn't work for everyone. Tried that, too. Sometimes medication is a good thing. Our puritanical anti-drug culture singles out the outliers--e.g, people who sleepwalk on Ambien--really? What's the percentage on that, relative to people who have been helped? No media outlet will ever post those stats. This attitude is also at the foundation of the anti-vax movement. You don't want drugs, fine. But they aren't all going to kill you, make you crazy, etc. Not everyone is a potential abuser, and sometimes they work just fine, as they were supposed to. I guess there's not much of a story in that.
36
Insomnia Remedy in 4 easy steps:
1.Determine your maximum heart rate by doing a supervised functional threshold protocol (FTP) test.
2.Determine your average resting heart rate over 1 month.
3.Exercise every day maintaining 3X your resting heart rate, not to exceed 80% of your maximum heart rate, for at least 20 minutes, preferably more like 30-45 minutes.
4.Eat only plants, from known sources without chemicals, etc. & quit/take no prescription medicine.
The above works almost every time. But we’re so addicted, literally, to what we otherwise rationalize doing that prevents us from enjoying a restful night’s sleep. Until I did 1-4 above, lot$ of doctor$ had lot$ of $uggestions but none as effective as 1-4 above!
Sleep well!
Sound
4
@ScottB Are you joking? What about all the people who take hypertension medicines?
Great that it worked for you, but really?
10
Stop eating three hours before you go to bed. Really, really helps.
4
A lifetime of insomnia was stopped for me by a 3 mg tab of melatonin. No mention of it here?
7
The suggestion of quinine for leg cramps is a new one to me but I will try it. I’ve been till now the only thing that has worked is rubbing the muscles with arnica.
Yes, this article is a bit simplistic. I’ve done the “sleep hygiene-CBT” routine with mixed results. For me, the best answer is if my co-op board would fix non-isolated ceilings and enforce rules about carpeting and excessive noise.
8
My message had a typo. It should have said “non-insulated ceiling.” I wish it was “isolated”. without hearing upstairs stairs noise late at night, I’m sure I could fall asleep.
1
@Naive Earplugs and an eye mask--essential sleep devices for me, every night.
4
The typical corporate workplace is a major contributor to insomnia.
23
Jane Brody is recommending Hyland’s,which is homeopathy with no detectable active ingredients. If it works for you great, but it is a placebo.
12
@Kathleen. So's tonic water which has pretty much no quinine in it either.
3
thank you for another informative Jane Brody coulumn. I was wondering how she treats those pesky leg cramps that have been keeping her up. I'm looking forward to her next column about how she keeps her bowels regular. Have you ever considered having medical doctors write about medical problems rather than lay people? Perhaps i should write a column about how i would fly a plane if i knew how. Let me know if you're interested..In the meanwhile, Jane, how would you remove that obstructed gallbladder if you were alone on a desert island? The readers want to know.Perhaps using a product sold by one of your family members?
17
Ms. Brody recommends having a pad and pen next to the bed to write down errant thoughts that pop into your head I agree with the principle but not her prescription. One usually has to turn the light on, and then boost oneself up to write something that will be legible in the morning.
My alternative, which has served me well for 40 years, is to keep a small voice recorder at one's bedside, which can be operated with one hand - turn it on, hit record, talk, hit stop and turn off. All this with one hand and without turning on the light or adjusting one's position in bed.
There are a lot of voice recorders, but many are too complicated to use at night. The one that I have used for many years is the Olympus VN 5000 (I have and had no connection with this manufacturer.) It's also great for dictating notes when driving in a car. You can keep one hand on the wheel, eyes on the road, and operate the dictophone (or "voice recorder") with just one hand.
The one problem is price. I used to pay around $30 or so until fairly recently when the price has sky rocketed. The last one I purchased on Amazon was around $80. I think that the manufacturer may be phasing out this model. I looked a few years ago for similar devices but didn't find anything like it - one hand to operate - but you may have more success now.
If you can afford it, forget the pen and paper and switch to voice recorder that you can operate with one hand. You won't be sorry
5
@Berkeley John
"switch to voice recorder that you can operate with one hand. You won't be sorry"
But your spouse, or bed partner, might be. The advantage of pen and paper is not waking the other person.
4
There are also recorders that turn on when there is a sound and turn off when there is none: Look, Ma — no hands!
I was disappointed to discover, on following the link in your column, that Hyland's Leg Cramps is a homeopathic "medicine". In other words, it contains no quinine whatsoever. If tonic water with quinine is actually helping your cramps, the only relief you're getting from Hyland's is from a placebo effect.
10
I used to have difficulties falling asleep but ever since I stopped smoking I find it much easier to fall asleep. Today, I can sleep 8 to 10 hours without waking up at all.
If you guys have difficulties falling asleep and if you are a smoker, try going cold-turkey for 3 days and see if you are able to sleep better.
Nicotine leaves our bodies very quickly so 3 days should suffice for this little experiment. The truth about nicotine withdrawals can be found here: https://quitwithnerd.com/nicotine-withdrawal/
If so, smoking might be the caused of you not being able to fall asleep (another big reason to quit).
Jeremiah
3
@Jeremiah Say: my insomnia began immediately after quitting smoking.
3
@Jeanette
Love the wistful lyric in Sam Smith's Burning:
"Wish we could smoke again, just for a day..."
The comments are the most interesting. For those of us with insomnia, we can pick those of you without it- as if warm milk and a banana would ever put an insomniac to sleep. I’ve struggled since childhood- can’t fall asleep or stay asleep. Pregnancy was the only time I really knew the feeling of tired, which actually sucks, so I have to be thankful to not feel chronically fatigued. I just feel chronically awake. The best remedies I have used were sleeping meds, but when I read about the connection between certain drugs and Alzheimer’s, it kind of freaked me out. https://www.health.harvard.edu/mind-and-mood/two-types-of-drugs-you-may-want-to-avoid-for-the-sake-of-your-brain I also don’t understand why that wasn’t discussed. My current regimen that usually gets me close to 6hrs of sleep (if I’ve gotten enough activity, not taken longer than a 30min nap) is 2hrs before bed about 9pm I take 600mg gabapentin for restless leg, 500mg magnesium, no blue light, 1hr before bed, 1bag each of yogi kava and bedtime tea steeped 15min, warm shower, air filter and fan for allergies/sound, lavender lotion, no snacking, various mantras believing I will sleep. I usually fall asleep by 12:30- if i wake up at 2 or 3, i’ll get up and read in the other room, then go back to bed until 6:30 or 7. When I was taking wellbutrin for my adhd/depression, it made my insomnia worse. ssri’s give me terrible headaches. if there is a med, i’ve tried it. good luck out there!
14
I'm having a hard time sleeping enough lately. I never had problems when I was younger. Now it seems I go to bed feeling really sleepy, but oddly the moment I feel myself drifting off I suddenly snap to attention... then lie awake for an hour or two. It's weird, like I'm afraid to let myself sleep or something. Never ever used to have this happen. I'll try imagery and see if that helps, I hope so... it's like I need a way to trick myself into not noticing that I'm falling asleep.
14
As a former resident of Portland, I find it revealing that Portlanders comments often rise with votes on the comments.
Yes, the current state of politics, starting with the stuff in the WH, contributes greatly to my insomnia. I am so sleepy but I can't sleep past 5 in the morning, which is when my SO often gets started. She can't shut her mind down before 11pm because of a bad work situation so I am held captive to that also. She stays awake looking at things on her cell phone. Those items are the background while the local Muslim calls to prayer at 4AM are finally not awakening me.
I am also addicted to the news of the day as well as tech so I am somewhat cursed.
6
According to a research, 70% of Americans are deficit of vitamin D, below 20 ng/ml in the serum. There is a study saying, "vitamin D supplementation in treatment course of chronic insomnia with melatonin works. How exactly vitamin D acts on melatonin synthesis and functions needs still to be understood.
Based on our clinical case we suggest to make consider vitamin D deficiency as a probable cause of sleep disturbances and check the levels as a routine test.
Combined treatment of vitamin D with melatonin will accumulate the therapeutic efficacy and help to avoid high doses and long term treatment courses in chronic insomnia."
https://n.neurology.org/content/90/15_Supplement/P5.320
However there is a research telling, "Although the functions and synthesis of vitamin D and melatonin are contrary to each other, both are involved in the immune system. While melatonin synthesis is affected by light, vitamin D deficiency may be involved in melatonin secretion."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6232868/
6
why absolutely NOTHING about herbal remedies?!
5
I have read that each person has a different pattern of sleep and that insomnia is often caused by our inability to sync up our sleep patterns to our standardized work schedules. For me the best treatment for my insomnia would be a nap at about 1PM, but my boss has a problem with it.
9
I suffer from major depression and PTSD. I have found that the very small dose of clonazepam I take each evening to offset the over-stimulation of my antidepressant helps me to sleep better, especially since I have the recurrent nightmares that are a hallmark of PTSD.
But I recommend this only as a last resort. There are many behavioral approaches to insomnia that work very well, including setting a bedtime and wake-up time consistently, skipping caffeine and writing down disturbing thoughts or nagging to-dos.
5
Marijuana works wonders for insomnia.
25
@NH - I find that today's cannabis is so overloaded with THC that the opposite occurs. When I was a teen in the 80's I could doze off after a joint. Now I could (and do) go for a 5 mile run after ingesting. Or clean house, or wash my car. Maybe my chemistry has changed, but I really feel like its the cannabis that isn't the same.
2
@Julie It depends on which strain of cannabis you take. I have PTSD and have been helped by Indica. I never take Sativa as that is activating.
That lovely graphic looks almost like a stack of luscious meringues. NYT regularly publishes wonderful graphic images.
6
I've been taking two scoops of collagen powder before I go to sleep. I don't know where I read to do it, but it really has been helping me sleep.
3
In all of the advice about sleeping, I have never seen anything about elderly males who have to get up during the night because of enlarged prostate or other urinary problems that cause nocturia. Where is the advice about this situation?
12
Far too many whacked out Americans think the best way to solve a disagreement is to grab a gun.
Far too many semi-rational Americans think the best way to solve every problem---weight, insomnia, etc... is to reach for a bottle of pills.
People want the easy way out. They don't want to make the required decisions and take the steps to address the underlying problem. Get out, exercise, and dramatically change your diet.
Come spend a week working with me. Keeping my hours. Working outside.
I flat out guarantee you that you will have no trouble falling asleep. No drugs required.
4
@Concernicus
This is ignorance talking, and as usual, very loudly and confidently.
31
Tell me something I didn't know.
16
When I was very young, around 8 I believe, I had a period of intense insomnia and even a fear of sleeping. I would lie awake panicking, thinking that I would never sleep again, and throw fits that lasted until midnight. I don’t know what would have happened if not for the patience of my mother. She taught me to calm the spiraling thoughts in my head. My trick was to go over the events of Harry Potter books, a comfort at the time, until I was lulled asleep. I’ve had many anxious nights when sleep is hard to come by since then, but now I always know what to do about it. The answer, at least for me, has never been drugs. Thanks, mom!
10
@Tori
When one of my sons complained that he couldn't sleep, I'd send him back to bed with the notion that it was okay not to sleep but to just rest. Inevitably, he fell asleep very quickly after that reassurance.
7
Before resorting to more extreme measures, I would suggest listening to audio books. I have a 30-year track record of waking up after about 4 hours of sleep. I tried many things, regulating early evening activities, chemicals, herbal, over the counter and prescription.
Nothing worked very well and anything medicinal usually left me groggy the next day.
About 3 years ago I started listening to old short stories (sci-fi for me) through earphones made for sleeping. It has been amazing, except for infrequent times when I am experiencing more extreme anxiety, I can turn on the stories within are few minutes of waking up, turn on a timer for 20 minutes and fall back asleep within a few minutes.
I choose old stories because the pace of the narrative is more relaxed. Happy zzzs
9
@james willis Same here. I use Big Bang Theory episodes, 20 min each. Set player to ‘play once’ and ‘play in the background’.
Chronic insomnia is a brutal problem that can lead to even worse illnesses and emotional and mental challenges.
From personal experience, I've found many of the non-drug processes and interventions might work for some, but when a patient needs psychological, psychiatric, pain, or even general medical treatment, it becomes too expensive and prohibitive. Many insurance plans don't cover it and if the problem is a result of undiagnosed problems the patient is at risk for a spiraling event. And you just can not tell someone suffering from this problem to not think about it, read a book, or stay up until you're sleepy, etc.
23
Listening to the CD "Healthful Sleep" by Belleruth Naparstek helped me be able to sleep better. I also sleep in a room with curtains that block out light.
3
If I may, I'd like to add to my comments. The notion of checking levels of potassium, thyroid functioning, all kinds of potential physical deficiencies or imbalances can also be a crucial element in all this.
13
Some of the comments seem unduly critical. In general we tend to argue about the one approach or one answer, when our job is--to my mind--to add to each other and to collaborate.
Jane Brody is a stellar contributor who has shared immense knowledge, personal life experience and deeply painful experiences as well.
Although I'd like to add my take that depression can be a crucial cause for insomnia and the combinations of psychotherapy and anti-depressants can help, I'd prefer to add this to the discussion, rather than emphasize it's one thing Ms. Brody didn't mention.
This is about our whole world, our putting the emphasis on who is our favorite celebrity or politician or expert, rather than working together amongst ourselves and looking for leaders and consultants who don't need to be charismatic gurus covering everything.
This should be the part of a fascinating conversation, allowing us to open our minds and share opinions. Thanks for the piece. It clearly has been provocative to many and helpful as well.
8
If you are not allergic to walnuts. They are a good natural sleep remedy. They contain melatonin. A natural substance the body produces to help us fall asleep. You only need a small handful before you go to sleep. The results are immediate. Within a half hour you will be asleep. Plus they also lower cholesterol. And have omega-3. Give them a try. You will be pleasantly surprised.
8
Some of the comments criticizing Jane Brody for citing ideas about sleep deprivation that have been said before, are disturbing. In the first place, obviously she only has a certain amount of space to address this issue.
Second, her column cannot speak to every reason and every solution for those of us who have sleep issues, and it's surely not the purpose of this column to do so.
But she provides ideas on how to address the issue, what may work and what may be harmful.
So lighten up, those who try to disapprove of her writing here...and be thankful that she has written such terrific columns for so long. One day, she may retire...and then you'll regret it.
18
I do three things for better sleep everyday. Walking/ running mix in the morning, At dinner I tend to eat either eggs,fish or chicken rich in tryptophan, a precursor for melatonin. Also I drink banana peel tea, rich in magnesium, potassium and other minerals before sleep and even in the middle of night (I wash my mouth for the prevention of teeth staining ). Cramps while sleeping occurs when sodium/potassium balance changes and magnesium is a cofactor to adjust this problem. Magnesium also calms us.
2
I forgot to mention about vitamin D that I take during/after dinner with good fats. Vitamin D triggers melatonin synthesis in the brain as Dr. Rhonda Patrick found out in her research, "Causal link found between vitamin D, serotonin synthesis and autism in new study"
https://www.sciencedaily.com/releases/2014/02/140226110836.htm
"Autism linked to vitamin D deficiency during pregnancy"
https://www.youtube.com/watch?v=xkIHgybB7uI
2
I swear I have had insomnia since I was a child. I can remember lying in bed listening to my older sister breathe and then making noises to wake her up to talk. Now, however, it is not getting to sleep but staying asleep. I’ve tried numerous fixes from medication to meditation to white noise machines. My current strategy is if I can’t go back to sleep within 30 minutes I get up. I read, do a puzzle, or listen to music or a pod cast. Sometimes I drift off again and sometimes not. And I’ve changed my approach to napping. If I haven’t slept well I take a nap at whatever time I feel sleepy. I’m retired now and most days have the luxury of doing that. I just give in to sleep and quit worrying about it. I figure some sleep is better than none. All of that has resulted in me getting more sleep albeit not in a traditional way. I've resigned myself to the fact I am not a good sleeper and just try to live my life and not worry about it. It is a daily struggle.
13
@Dee K
It sounds as though you may benefit from a CPAP - a sleep apnea machine. It changed my life. Check with your doc. You can take the test at home (the rule seems to be no machine without the test) and then get the machine. Good luck.
1
Thanks for the diagnosis but I’ve been evaluated and it is not sleep apnea.
4
An elderly neighbor in his 90s shared his advice with me when I was a sleep deprived parent of young children. Walk 10,000 steps everyday. Obviously, depending on weather, physical ailments, where you live, work schedules, etc this is not always possible, but I find I sleep much better after walking 10,000 steps, especially after dinner closer to bedtime.
2
As a nurse, many people that ask me about insomnia. Unfortunately, there is no one-size-fits-all solution. I have experienced it myself. I found no consistent root cause. Maybe it was my diet. Did I drink caffeine after 3pm? (that is a no no for me). Am I worried about something? Gee, I am always worried about something. But most nights I sleep anyway. But not always. Did I go for a walk? No. But when I did I still didn’t sleep. Did something like hip pain awaken me? (Yes). So different nights may have different reasons. But my insomnia is sporadic.
However, chronic insomnia is different. Many things can cause it or exacerbate it. Grief causes it. But people poo-poo that. I see it a lot in hospice. The inability to stop thoughts at bedtime cause it. But again, they tell you to relax or drink Chamomile tea. The medical field tries to fix it with a pill, of course. That is the plan for most ailments. Insomnia is an ailment, but it can be a symptom of an underlying issue. Like sleep apnea or dementia. Or a hundred other things, too.
Sometimes nothing works. Chronic tiredness is a plague on our society. One thing I did try was reading Dr. Herbert Benson’s book The Relaxation Response. It helped. I had to keep practicing what it said for a week until it worked. Not looking at the blue light of my phone two hours before bed also helps. No Kindle either. I did find one tea that helps. Traditional Medicinals Nightly Night before Chrismas. I love this stuff. Better than Xanax.
7
@Janice Badger Nelson
Where do you get the tea? All I see on their website is Nighty Night and Nighty Night Valerian. Thanks for great advice!
4
Melatonin works very well for me. My MD recommended it.
Another thing that works well: an orgasm.
And, around 20 years ago I wrote an article in an alt med journal about what alt med providers recommend for insomnia. I interviewed several of them from different areas of alt med (acupuncture, herbal, and I forget what else). They all recommended a hot bath. And I think that was all they recommended. And, yeah, that works for me, too.
8
5 mg works great for me 10 mg is too much, bad dreams.
My father an artist and musician would wake up at 2 or 3 am and play with his creative toys ,put on the radio (this was the 1940's) and pitter patter with little purpose in our apartment.
When my mom suggested that while he was awoke and "caroused like a cat during the night" he do the laundry, he amazingly was cured and slept all night.
25
@Carlyle T.-love your mom’s remedy!
7
All insomniacs know the "sleep hygiene" rules. I have been told them many times, as though I do nothing to help myself sleep. To wit: dark, cool, quiet room; white noise if useful; no screens in the bedroom or within an hour of bed, at all; no alcohol or caffeine within hours of bedtime; routine bedtime and waking time. Being an insomniac sometimes makes me feel like a Victorian woman accused of hysteria. It must be emotional or "in my head." It is in my head - I can't fall asleep. It's actually a disorder.
33
@Reader Try Spectra479 blue light-blocking glasses. They have eliminated nearly 50 years of insomnia.
Why does no one ever talk about the disruptive effect of a bed partner’s snoring on sleep? Insomnia is simply a logical response to the racket less than a foot from my ear!
7
@organic farmer
Try sleeping in separate rooms. My husband and I decided many years ago not to measure the quality of our relationship by the hours spent sleeping in the same bed. That improved the quality of our relay. We’re plenty affectionate before we say good night and go to our rooms.
Also - sleep apnea is serious and is often present with snoring. I recommend he get checked for that.
7
Wow! Another informative article about insomnia that doesn't address or even mention the hormonal surges experienced by MANY middle-aged women that keeps them up at night and their partners. Amazingly, when the surges go away sound sleep is possible. Will someone write an article about that?
21
@Man-O-Pause When menopause hit, I woke up at 2:10am every single night for months and often didn't get back to sleep until I found a doctor to prescribe hormone replacement therapy. Even then, the ob-gyn was woefully uninformed as to the effects of low hormones, especially progesterone, on sleep and sent me to a sleep specialist who confirmed the connection. I no longer have low hormone induced insomnia.
1
I may be a little biased, but hypnotherapy can be extremely effective for insomnia. I'm a certified clinical hypnotherapist in Los Angeles and most of my clients for insomnia get great relief from a combination of suggestion, relaxation techniques, letting go of the emotions or thoughts that are keeping them up.
First lesson? Slow belly breathing to move into the relaxation zone.
There are some wonderful practitioners all over the world who have been trained in many helpful techniques, including those of NYC's own Melissa Tiers.
This is the kind of problem mind-body practices excel at. Because programs that focus on one or the other rarely bring true rest.
4
Nowhere does Brody mention sleep apnea as a potential cause for insomnia — and it can affect younger adults as well. If you have severe apnea, you may feel as if you are not really sleeping, as you go from one period of wakefulness following a breathing lapse to the next. Without knowing what is wrong, you come to feel exhausted, dragging your way through the day, and anxious, too — a common side effect of chronic lack of sleep. Then the anxiety can hurt your ability to fall asleep. I was treated for severe apnea and my world changed. I only have to get up once during the night to go to the bathroom. I use meditation after I get into bed to relax and go off to sleep, by focusing my thoughts on deep breathing. It works. Having put my TV on a timer, I'm never still awake when it goes off and now I stay asleep. If you suffer from insomnia, please don't consider medication until you've been tested for sleep apnea.
4
I don't agree with Ms. Brody's use of the term "insomnia". To me, insomnia is what you're left with after exhaustively investigating and eliminating the many usual causes of not getting enough sleep. This includes good sleep hygiene: regular bed time, screens off and no looking at email or Facebook at least one hour prior to bedtime, eliminating bright and especially bluish light in the hours before bedtime, reducing noise (earplugs), as well as no coffee or tea (stimulants) after lunch. Now, if one has done all that, dealt with painful conditions etc., and still cannot get restful sleep, then it is "insomnia", which is a serious and debilitating condition. Pharmacological sleeping aids such as the ones mentioned are for the treatment of that, not the inability to fall asleep after staring at a screen and texting furiously until 2 AM. Also, there is insomnia early, middle and late - can't fall asleep, waking up frequently after short bouts of sleep, and waking up and being unable to go back to sleep. These can have different causes, and may need very different approaches to deal with. Lastly, the one "cure" for insomnia that's definitely not a good idea is the infamous night cap (or two or three). Alcohol will reliably prevent restful sleep, and may end up causing all kinds of other problems.
11
@Pete in Downtown
Yes. It's like confusing clinical depression with being a little sad sometimes. Insomnia is not "I had trouble falling asleep last night" now and then, or "It often takes me half an hour to fall asleep." Those are perfectly normal occurrences, insomnia per se is something much different.
7
@DW Speaking of depression, it can be one of the major causes of insomnia and combinations of therapy and anti-depressants can help a lot.
1
For leg cramps make sure you are getting enough fluids. That works for a few other things too, headaches, fussiness etc sometimes too.
1
I find that two aspirin and a mug of steamed milk reliably gets me to sleep. The aspirin lowers your body temperature which is the key, and heated milk has "freely available" tryptophan which converts to melatonin. I have ambien just in case, but I rarely take it.
2
@OSS Architect I'd be careful with the aspirin. Recent studies have shown that even the long-heralded "one baby aspirin (just 81 mg)" for prevention of heart attacks may be dangerous for some people due to the potential for stomach problems and also because of its anti-coagulation properties. In addition, aspirin doesn't lower the body temperature of people who are not running a fever.
That being said, if you tolerate 650 mg of aspirin every night, more power to you! Maybe it decreases some of your aches and pains, and that's what helps you sleep.
4
As a 30-year psychotherapist certified in CBT, I would like to offer up here that never once in 30 years have I ever seen CBT be effective in helping insomniacs sleep; indeed, CBT seems to be the medical profession's "go-to" remedy for any problem they're tired of treating with medication (e.g., insomnia, anxiety, obesity, depression, among others). That being said, good old sleep hygiene, which is what the author partially describes in the second part of this article, works fairly well. Go to bed and get up at the same time, no matter what. Use your bed for sleep (and sex) and nothing else. No TV in the bedroom, and certainly no computer. If you don't fall asleep after 20 minutes, get up, leave the bedroom, and read, or knit, or do something else non-electronic. All CBT does for people trying to sleep is to inspire more rumination about the problems that are keeping them awake.
32
@Rick Thank you. I was about to google CBT and insomnia and I can see how it could backfire. I appreciate your comments.
4
Agreed and it's about time someone was honest here. I tried CBT three times once for a solid three months. All it did was make me far more exhausted.
13
@Rick thanks for telling the truth about sleep deprivation (aka CBT for insomnia...) some of our brains just don't do sleep as naturally as society suggests it 'should' be. Not worrying about it has been the best choice for me. Of course, it doesn't help me sleep any better.
5
I find that telling myself comforting sleep scenarios (without turning on a light) really helps me get back to sleep when I awaken in the middle of the night.
3
I have been taking Ambien for twelve years. The reason - death anxiety. I saved a friend's life twice within a month by dragging her to the ER against her will.That made me aware of the precarious nature of life. From that point on anxiety caused me not to sleep, fearing that sleep was akin to death - at least metaphorically. Nothing beside Ambien worked but that only gave me four hours of sleep; I would remain awake for twenty hours a day. This caused consciousness overload. How do you spend that time, especially when you have arthritis, a heart condition and lack of energy (due to lack of sleep) and you are 76 years old? I have six hours when I can function; the remaining time I cannot focus without Adderrall or Nuvigil. Fatigue doesn't do it either. I could work in the Russian salt mines for a week but the moment my head hits the pillow my eyes pop wide open. CBT is great for fear of flying but doesn't cure existential dread. Any suggestions?
9
@Andrew Billek
I can't address your anxiety about death and sleep, but I have found that CBD drops, taken about 1 hour before desired bedtime, are helpful at bringing on drowsiness to a level that I can more easily ignore my aches and pains ( that are frequently substantial).
CBD oil that is extracted from hemp is legal in states where cannabis isn't legalized. I slept about 3.5 - 4 hours a night prior to trying CBD drops. I'm now sleeping 7 - 7.5 hours per night and it's wonderful!
4
@Andrew Billek A suggestion, but you probably won't like it: prayer? a spiritual connection, within a spiritual community? It's not a question of "asking God to let you sleep"; more of a gradually coming to trust in God's surrounding love - that it exists in good times and bad. Don't give up! I am praying for your relaxation and trust - in God, the universe or whatever - as I type this, and will continue to do so. Good night, Andrew!
6
@Andrew Billek Could you stop fearing death? I don't mean embrace death, I mean stop fearing it. Buddhist meditation comes to mind. In any case, I'm sorry for what you're going through.
4
Question for insomniacs:
Are to able to sleep for 6-7 hours at non-traditional times, say 4am to 10am?
I can’t imagine what it’s like to have insomnia, but I’m a night owl, always have been, and I resent the pious attitude that we all must sleep from 11pm to 7am and then be perfectly awake and happy for work from 8am to 5-6pm. Why do we have a world of 9-5 that only functions for a percentage of people?
22
That’s me. Extreme night owl but able to reliably get about five hours of sleep a night. My question - even when doing this, it seems I have a tendency to fall asleep later and later so that a 3 am to 8 am regime slips to 4:30 to 9:30 am then 5:30 to 10:30 am and on and on.
Could it be that my body clock is longer than 24 hours?
In any case, it remains difficult to sustain a work schedule with this pattern.
One solution: continue to travel west by one time zone each day!
4
I am going to have to try some the remedies for getting a good night's sleep that others have suggested in these comments.
But, I do have one suggestion that might help anyone who wakes up with leg cramps during the night: Ivory soap. But, I don't put a bar of soap under the sheets. I smear the bottom sections of both the top and bottom sheets with lathered Ivory soap bubbles once a week when I do laundry. It is kind of tedious, but I hate leg cramps.
I rarely have leg cramps at night and it usually happens when I pull my legs up out of the "soaped" zones and turn on my side.
2
@Marilyn I always use a fresh new bar of Ivory soap each week for my lathered soap bubbles.
I experienced terrible leg cramps for a long time. The “quinine cure” has long been debunked as an old wives’ tale. Now I take magnesium at bedtime and have no leg cramps. I have two diagnosed sleep disorders and sleep well with a carefully titrated cocktail. Medication works for some people and ought not be dismissed out of hand. One of my cousins has serious insomnia and absolutely nothing works for him.
And, while Ms Brody drinks diet tonic, she should be aware of the dangers of artificial sweeteners! I expect better of her than this piece.
6
@Susan Kaplan Not only what you said, but doctors are no longer suggesting quinine for cramps, as the potential side effects of quinine far out weigh the benefits (if any). Magnesium certainly works for me, along with good hydration. My wife and I also keep mustard by the side of the bed (don't laugh). She is an RN and they use this in the kidney dialysis unit of the hospital where she works. At the first sign of a cramp, open an individual mustard packet or put a teaspoonful on the back of your tongue and let it sit for a minute before swallowing. Works every time!
4
@Susan Kaplan in addition, I find it amusing that Ms. Brody uses a homeopathic remedy that contains quinine as an “active ingredient” — homeopathic drugs don’t contain enough of anything to be active! That is what homeopathic remedies are — the ghost of a memory of an ingredient. Another recommendation to be ashamed of. Is she being paid by that company to plug their sham products?
3
@Karen
You are so right! I wonder if Ms. Brody is aware that Hyland's Leg Cramps also contains poison ivy and mistletoe -- homeopathic ingredients are nonsensical and are listed on the label in Latin, so few people even know what they are taking, or not taking, as it is highly unlikely that homeopathic remedies contain a single molecule of their supposedly active ingredients. Hyland's Leg Cramps is not a "herbal remedy" either; it's legally classified as a drug and is regulated by the FDA, which has never evaluated its safety or efficacy or approved it for marketing to the public.
My insomnia was of the middle-of-the-night variety: bed at ten, wide awake from 2 until . . . 3 or sometimes 4. Finally realized I was going to bed too early. Now my husband says good night at 10 and I sit up with needlepoint or a sketchbook and an audio book until 11:30 or 12. I almost always sleep through the rest of the night and wake between 7 and 7:30 refreshed.
13
"Cognitive behavioral therapy is now considered the best treatment for insomnia, especially for older adults. It teaches people to challenge disruptive negative thinking and replace it with positive thoughts that counter arousal and induce relaxation."
This means we can't read the news...ignorance is sleep bliss.
9
I have a procedure I go through when I can't sleep. I picture the kitchen of a home I lived in 30 years ago, the large window over the sink, the dark tile floor, the dining room set, and the cabinets. I go through the steps to mop that dark tile floor. First, I set the chairs upside down on the table, then sweep the floor. Then I make up a sinkful of soapy ammonia water and put the string mop into the hot soapy solution, then wring it out. Next, I mop the entire floor, and then leave the floor to air-dry.
I haven't been able to get past putting the chairs up on the table for almost 30 years now; that must be the dirtiest kitchen floor in the Western Hemisphere, but I do get to sleep!
21
@George Barton
This is an interesting remedy, I will try it, I’d like to avoid the mopping part, too! Thanks.
5
@George Barton --- I'm getting sleepy just visualizing your kitchen floor.
3
@Devon Talley Good luck! I almost feel guilty about not completing that task, but it's nice being able to sleep!
2
I suffered from insomnia for about 20 years. I stayed away from sleep medications as I have always viewed them as short term solutions only. I have tried just about everything else including CBT.
Fortunately, my doctor suggested I try Mirtazapine. I break the 15mg tablets (the lowest dose they make) in half. Haven't missed a single night's sleep in 15 months since I started taking this medication. There is no hangover in the mornings and the medication is not habit forming, so there is no need to increase the dose. It has changed my life.
5
The fact that there are many suggested approaches to minimizing (not curing) insomnia is strong suggestion that there are many causes, and therefore many targeted treatments which won't work for those who have a problem different from what the treatment is designed to treat.
Am I the only one, reading through this laundry list, who felt that the Cognitive Behavior Therapy discussion should have been fleshed out more? It was mentioned barely in passing, without any amplification of what is really involved and whether or not it would be worth (usually an expensive) trial of therapy?
12
In December, 2018, I was super-fortunate to get into a FREE CBTI program for older adults. A study sponsored by NIH and University of Virginia, it was called SHUT-I OASIS (I think this clunky acronym means Sleep Help Using the Internet, Older Adults Sleep Study or something like that). I had bought a book about CBTI but didn’t think I could pull of the discipline and record-keeping. I have no insurance, so being accepted into this study was a godsend.
I received the MOST current education and therapy, and the online program was interactive and fun. It was really a slog, but my chronic insomnia (30 years, drugs, et all) has improved. I still use their site to record sleep data every night. I can see how efficient my sleep has been, and can return to parts of the program I need when sleep is bad or non-existent. This daily process of recording is important to me.
Another commenter told me that the study is no longer accepting volunteers, but I think it’s worth looking for yourself if you want the most current CBT-I (which is NOT “sleep hygiene”, although that is a small part of the approach).
2
I have also been frustrated with this incessant CBT chant. Sleep restriction requires you to go weeks in a state of sleep deprivation before results (if any), an impossibility for anyone with a regular job and/or child care responsibilities. Anyone with a mobility disorder may find it difficult to get up or down frequently in the night when unable to fall asleep. I'm told to just limit my sleep every night to the few hours of dozing that I get without medication. I would have to take weeks off work. CBT is a slow, possibly effective, demanding, and very expensive therapy in terms of lost work time. When I don't sleep, I can't function. When I take 5 mg of Ambien, I DO sleep, and wake up refreshed and effective at work. I have NEVER had side-effects. Yes, some people do have side-effects - I've seen them, and they can be serious. But blood-pressure medications and antibiotics have serious side-effects, too.
33
I did the full course of online CBTI while running a full-time business, traveling a lot, etc. Yes, it does involve sleep deprivation for a few weeks, which is super-weird. And I had many horrible, sleepless nights as I worked through the program. However, I learned over and over that it IS possible to function productively on 2-3 hours of sleep, even though it feels horrific. CBTI also allowed me to challenge my existential despair and deep fears about the effects of sleeplessness.
I am glad I put myself through this, as my sleep has improved. It was not easy. Nothing is perfect, but now I feel I have more control over my life. I have more skills than I did before, and will always be incredibly thankful to that study.
6
@Reader thank you for pointing all of this out about the good effectiveness of Ambien. I have taken 2 1/2-5mg for years. I fall asleep and get up just fine. I don’t do any of the crazy things that some people say are side effects. For example, one person got up at night and raided the refrigerator?? Maybe, she did that anyway? Who knows?
3
@Reader
Xanax! Maybe not for everyone, but for me, it works great!
6
The men in my family have trouble with waking up in the middle of the night.
My brother solves it by smoking too much (my judgement) weed.
My dad solves it by getting up and doing his morning routine at 3am, then taking a long nap on the couch.
2
I created a free app called The Breathing App which has been helpful for a lot of people for falling asleep more quickly. In fact, I created it to help me sleep better, which it did, and I continue to use it. It's on the iTunes App Store and Google Play. It's not the Calm app, or Breethe, which are both expensive apps - this one is free, and works just as well. The Breathing App. Check it out if you have a hard time getting to sleep. It works best if you use it in the morning time for 10-20 minutes, and then for a few minutes before bed. It doesn't work well if you only use it when you can't sleep. It is a gradual training of the down-regulation of the sympathetic nervous system, which results in greater levels of calm.
27
@Eddie Stern
Thanks for the suggestion.
I also recommend a free app called Insight Timer, which has a huge selection of short, medium and long guided meditations/mantras, as well as just soothing music.
There are also some wonderful sung mantras (I love anything by Premal Deva, especially the Gayatri mantra).
2
@Eddie Stern Thank you! There is good science behind regulating the nervous system using breathing techniques. I just downloaded this and look forward to trying it.
I am in my 60s now and I've had insomnia since I was a teenager. I used to hide books under my bed and read for most of the night with a flashlight, then go to school on two or three hours of sleep. I tried exhausting myself with physical exercise, melatonin, reflexology, yoga, GABA, Sleepytime tea, meditation, warm baths, hot milk. Nothing worked. When I was at work, I often threw up in the bathroom because I was so tired. I hallucinated more than once. Insomnia is horrendous. I finally got a prescription for Ambien. I sleep. This article makes me angry because the author seems to have no comprehension of what true insomnia can do to one's life. These little "tricks" simply don't work for some people, and there's a moralistic high ground that she's taking that makes me feel guilty for needing medication.
228
@Joanna Stelling This response makes me feel so much better. I too have tried all the remedies Ms. Brody recommends, including behavioral modification therapy for insomnia, melatonin, etc. etc. I think there must be something else that medical science has yet to discover, because my insomnia is so intractable. Ms. Brody indicates that sleep-inducing drugs have a limited time benefit. I am entirely sceptical of that conclusion. with Ambien, I sleep.
43
I agree. I’ve had insomnia consistently since childhood. I’ve tried all the suggestions in this article and then some without success. People who have never had long-term, intractable insomnia don’t understand how debilitating it is. It affected every aspect of my life. It’s probably not much of a stretch to say that a caring provider and Lunesta saved my life.
21
@Joanna Stelling Same! Have had insomnia since I was a teenager, tried CBT, hygiene, meditation, melatonin, exercise, everything. Ambien has truly been life saving. I still have to do the sleep hygiene on top of that but I don’t regret taking it for a day and also feel extremely angry at this article for not acknowledging how debilitating insomnia can be.
24
How can an article on non-prescription sleep remedies not even *mention* melatonin, which is the hormone which the body produces to help you sleep?
20
@PaulSFO, melatonin is a powerful liver toxin and should be used only short term, for jet lag and similar, not for real insomnia. Not all supplements are "harmless."
5
@Kristy - I don't know where you get you information, but this is what the NIH say about melatonin and liver toxicity.
"Hepatotoxicity
In several clinical trials, melatonin was found to be well tolerated and not associated with serum enzyme elevations or evidence of liver injury. Despite wide scale use, melatonin has not been convincingly linked to instances of clinically apparent liver injury."
https://livertox.nih.gov/Melatonin.htm
Becuase melatonin is broken down by the liver, it can apparently be problematic for people who have pre-existing liver disease or injury. But I could find no evidence that melatonin is exacerbating for those with liver disease or injury. It is likely that melatonin is not recommended for people with liver disease or injury becuase compromised liver function would increase the half-life of for clearance of melatonin from the body.
10
I dislike Jane Brody's insufficient research on almost every topic she's addressed for 25 or so years. I am constantly astonished by her lack of curiosity, narrow-mindedness and promotion of conventional Western medicine. She often reports on "new" evidence that was in the non-mainstream conversation in the early 70's, when I was a granola-head opposed to most Western ways of thinking, medicating and being. I took Ambien briefly when I had Lyme and for the first time in my life had insomnia because I was debilitated by pain and fatigue and slept most of the day. A combination of Melatonin and Tryptophan has give me peace for 10 years with no side effects. I had my DNA analyzed and found I had no Circadian rhythm, or a disruption, that makes me prone to being most alert and creative in the evening, so this is how I cope.
11
I took melatonin for several years and noticed that when I didn't take it I felt like I'd just had a pot of coffee at bedtime-nervous, antsy, racing mind. I slowly decreased the dosage until I stopped using it entirely and sleep better w/o it. Things that help me sleep better include-
-No tv in the bedroom! Never ever!
-An hour of quiet time to wind down before bed (I know not everyone has the luxury of this time tho)
-Same bedtime every night
-I use my ipod and listen to relaxation or sleep apps w/earbuds if my mind is preoccupied. I thought they were stupid and wouldn't help but they really do help me stop obsessing over whatever thing went wrong that day.
-Chamomile tea-it tastes awful to me but it really does make me drowsy and helps me fall asleep.
I hope I never have to resort to rx meds for sleep, mainly bc so many people end up needing them basically forever.
11
@Jo M
also journal every night get those thought on paper and out of your head.
Yes Chamomile tea too..relaxing
and a quite down routine every night.
No TV in bedroom.
2
@Jo M
I do the exact same and also meditate, sometimes using the Calm app.
8 rounds of the “478” breath is also very relaxing.
3
@Jo M I wish some or any of these remedies worked for me. Tried each and every one for months at a time, including sleep apps, scheduled bedtime and waking time, chamomile tea (it does taste awful), etc. etc. If only.....
I BLAME IT ALL on MSNBC. Watch at your own risk! And BTW, why don't the Democrats hold a bunch of big rallies? I mean, fill up football stadiums, bring the kids, with beautiful blue hats and flags with stripes and the words "UNITE" in big white letters on a blue field. Invite some great bands to play, have some fireworks, and ask the audience if they would please put a few bucks in collection bags to aide the DNC and the environmental defense fund. Naturally have some speakers, but keep it short and positive- like "let us HELP YOU with your problems". Show pictures of purple mountains' majesty, and have Ray Charles sing "America The Beautiful". Yeah, that vision sure would help to put MY mind at ease...
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@flyinointment
Yes, if only Lawrence O’Donnell were on earlier, I could get to bed earlier. But I have to watch Lawrence, and then it takes me at least an hour to wind down.
And by the time I’ve flossed, it’s very late.
Solution: put Lawrence on at 7 pm and move Chris Matthews to 10.
6
I’ve tried every “natural” remedy there is. If a sleeping pill helps you sleep- then that works for you. The authors of pieces like this story probably aren’t plagued with insomnia. It’s very easy to say stop taking pharmaceuticals for sleep if you sleep well. Use common sense, avoid stimulants,etc. Nothing works better than one Ambien before bed- for me! Don’t be “shamed” to try something else if pharmaceuticals get you a good sleep!
37
@Noel I find that I can use only half (from 10 mg to 5 mg.) by chasing Ambien with a 1 1/2 oz. shot of your choice.
6
This could have been written five to 10 years ago. Nothing new here. Insomniacs are seeking new remedies and would be better served without a rehash of the old methods that work only for some.
68
Thank you! I have yet to read a piece where Brody has done her homework. Melatonin and Tryptophan work for me.
6
I don't see the podcast Sleep With Me mentioned anywhere. Listen to Drew Ackerman droning his boring, meandering bedtime stories that are basically all non-sequitur and no plot gets me to sleep in minutes!
7
Stress, trauma, addiction, depression, and anxiety add to the reasons I have sleep issues. It may not be popular, but Trazadone has worked wonders for me. Lack of sleep is a health and quality of life issue. I trust a proper doctor with full knowledge of my medical history to give me the best advice. In a perfect world, I would remove all stress, meditate, etc., but I don't live in a perfect world.
14
@Amanda
Trazadone is associated with increased arrhythmias and is not really safe for anyone with cardiac issues.
1
It is unfortunate that Ms. Brody suggests traffic accidents are a result of taking medicine. She should compare those to traffic accidents caused by sleeplessness.
25
Hot milk with honey. Works like a charm. In case it doesn't, I listen to certain kinds of music or certain kinds of talks with my earbuds. Also, my late husband showed me how to hypnotize myself. I have never taken drugs for insomnia.
3
Or golden milk---coconut milk, ginger, turmeric and honey warmed a little.
1
@nanoF.
Thank you for the beautiful suggestion. So you put turmeric, ginger, and honey into coconut milk?
I take 3 grams of glycine daily. It helps with fatigue and promoted restful sleep. No thanks to my doctor.
2
Caution: The FDA recommends against using quinine as a treatment for leg cramps citing the side effect of internal bleeding. A quick editorial web search would have revealed this.
19
I take melatonin and read if I can't fall asleep. The reading is on my ipad since I don't want to keep my spouse up, but I put the blue/night filter on and set the background to sepia/reddish. I may stay up too late but once I'm asleep I stay asleep until daylight.
5
My Eisenhower Primary Care MD took me off Xanax for chronic back pain and consequent sleep issues and put me on an anti depressant, Remeron, without adequate disclosure. I became a zombie. I stopped the Remeron and the doctor. Why did he do that? Xanax necessitates too much paperwork as a controlled substance! Anything to convenience the doctor.
20
CPAP therapy, involding no drug stronger than distilled water, is a literal life (and sleep) saver for many. Omitting CPAP from the article was a curious choice.
12
I agree with the opinion of many. Ms Brody’s articles tend to lean left and trite, although well meaning, and she seems among the many neurotic worried well I see in my office daily. Anyway, I think she misses a HUGE factor in our medicalization of what is usually a symptom with an underlying cause (pain, anxiety, illness, drug) and sometimes a primary disorder. We live in an Amazon Prime culture, health care is now “consumed” like any other good, and patients rarely have the patience or time to do the things she suggests (CBT in particular). Folks suffering want a fix - yesterday. They are rarely willing to change their lifestyle (alcohol before bed, change a stressful job, exercise more) and want the pill their neighbor gave them. It’s difficult to counsel the correct approach (ie argue) when swimming against the cultural tide.
10
A good sleep without prescription meds? Tell that to my Ehlers-Danlos Syndrome and autonomic nervous system dysfunction. I tried every herb, supplement, creme, sedative, sleep medication and wives tale out there. They dont work. The only thing that does is Trazodone - an old school antidepressant that allows me to sleep 5-7 hours a night, a miracle drug! People with chronic or genetic conditions often suffer from profound sleep disorders. Hypnotics like Lunesta Or Ambien do not address the underlying cause. More research is needed to help formulate effective drugs that dont make you eat everything in the fridge or feel like youve been eating socks.
12
Agree more research needed. Trazodone put me to sleep and then I would wake up 3hrs later with a splitting migraine. After two months, headaches never stopped. So what works for one doesn’t for someone else.
1
I appreciate the sentiment, but this article is trite, stale and simply falls in-line with the wave of new age medicine.
64
Another article recycling suggestions for people with mild, transient insomnia. For those folks, these remedies can work, I know people for whom they did work. But they are of limited value for severe, chronic insomniacs--mine started with Chronic Fatigue Syndrome in 1992. Sadly, the article does not make this distinction clear, and most doctors are similarly misinformed. BTW, drugs marketed for sleep (e.g. benzos, Z drugs etc) ALL carry significant risk of dependency and abuse.
15
A GABA supplement can help. I take 100 - 500 mg. They are available on Amazon. They are backed up by some scientific evidence:
https://www.healthline.com/health/gamma-aminobutyric-acid#effectiveness
2
@Cathy No they aren't. GABA does not cross the blood-brain barrier. You can take as much as you want and it does not do anything.
Gabapentin, Lyrica, and Benzos all effect GABA which is why they make you feel sleepy.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684331/
5
@Cory Glad you mentioned that! However, it sounds like there isn't a scientific consensus on that question. Some studies suggest that a small amount does cross the blood-brain barrier (see below). I can say I have a very pronounced feeling after taking 500 mg. Maybe it's an awesome placebo effect. Either way, it helps me sleep. Here's a link to the 2018 study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6031986/
I never required a lot of sleep. I wasn't worried about losing sleep when my first child was born.
But I am a light sleeper and I wake up easily. I wouldn't fight it but do something mundane or read until I was sleepy. I am an early riser because i want some time to myself.
My sleep loss these days is my 13 year old nocturnal cat that attacks my windows to come in for a snack and then wants to go out again.Watching too much news at night disturbs my thought and I find myself dreaming about what I heard so I make sure I read before I sleep.
I bought a new mattress, adding an additional window, added a ceiling fan. Haven't found the best pillow yet. I always spray lavender on my pillows. But I love the
alexa app, Sweet Dreams. You can do a meditation or listen to sound. If you choose the sound , like forest, it goes on until you wake up and turn it off. My dogs love it. Now if we could get the cat from coming home for a snack.
4
An alternative not mentioned in the article: plants like passion-flower and valerian, known for their sedative and calming effects. Valerian does it for me every time.
3
Two things really help me. First us an Android app, Relax and Sleep, that has many ambient sounds that can be mixed at different volumes. At a very low overall volume, it not only helps me get to sleep, it helps me stay asleep all night long.
Second: melatonin. Just seems to help take that edge off awareness, and the anxiety of not being able to give it up.
1
@Observor
I agree. I use 10mg of melatonin. However, the app I use is
"Slumber." I'm asleep in minutes. I have been doing this for about a year and it has really helped.
1
I am a physician assistant with 35 years of full time practice. I have taken care of over 165,000 patients. I am also a chronic insomniac. I have ample motivation to learn all about this complicated and varied problem. this article may be well intentioned in its creation and publication but is grossly simplistic and at times inaccurate.
Let’s all agree that it is best to treat or prevent a problem without medications if we can. Let’s also agree many medications can have both minor as well as major problems. However, we need to put things into perspective. The Z drugs can cause driving accidents and embarrassing “sleepwalking” events, however, they are much, much more safe than everyday risky activities that society is fine with. Ibuprofen kills many, many more people every year. Accidents when cars tailgating other fast moving cars in traffic on freeways are tolerated and have many more consequences than the insignificant numbers of Ambien related deaths.
Meditation, mindfulness, exercise, sleep hygiene (please google this if you are at all interested in insomnia) are all ideal. As well as discontinuation of alcohol use, achieving an ideal weight and having a restorative sleep environment. However, there are many situations where sleep medications are significant adjuvants to well being. Be careful of simplistic , rosy ,wishful thinking...
Life is not black and white and one needs to dig a bit deeper to get a full picture of things.
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@brian begley
Totally agree Most of these articles are written by people without, or mild, insomnia.
Properly used, medications can improve quality of life
inmany resposible insomniacs
40
@brian begley Well said. I trust a PA much more than someone who says right out loud, in print, in the New York Times, that they take and recommend a homeopathic non-medicine for anything at all.
6
I used to have problems with leg cramps. Then, on the suggestion of a basic family medicine text, I tried flexing my foot at the onset of these cramps, and it resolved the problem completely, with no need for quinine treatment.
2
My body mass was within normal limits, I slept on my side, but my sleep apnea was so bad my husband threatened to sleep in a different room. A laser procedure to tighten my soft palate didn’t work (actually two procedures, but when a third was suggested, I said no.). CPAP saved my life I tell people and my marriage. I regularly sleep between 7-9 hours.
But I still occasionally experience waking in the middle of the night.
What has worked are two things: 1. Exercise during the day, and 2. Understanding sleep one and sleep two. The brief version of the theory (not mine) is that this is a natural occurrence and that it’s manageable. When I wake in the middle of the night and start ruminating, I can get back to a deep sleep within an hour by reading. Caution: it may take longer if I’m near the end of a good book.
5
I have had what I consider amazing results with Aunt Zelda's Full Spectrum CBD and ThC oils. Thankful these products are now available with the new laws in California, I had tried every prescription and OTC drug and nothing gave me a full night of restful sleep like Aunt Zelda.
4
Mathew Walker's book, "Why We Sleep" is helpful on this subject.
1
Puts me right to sleep, in s good way!
2
Jane Brody writes of using quinine for leg cramps at night.
My leg cramps stopped when I began to take magnesium chloride, the only magnesium absorbed by the bodies of those who lack stomach acid.
9
@Annette Katz
My physician suggested magnesium for my leg cramps and it has changed my life. My leg cramps were so severe that I had to be taken to the hospital once, now i very rarely get a cramp and if I do, I can walk it off. One caveat though, too much magnesium can have the side effect of diarrhea, so be sure to start with a low dose.
1
White noise machine.
4
My new Rx for arimidex, the estrogen reduction drug for post menopausal women trying to prevent a cancer reoccurrence, came with debilitating insomnia. Hardly ever have I been unable to go to sleep before 2am. I have whole days of patients ahead of me during the week. This was not a condition that cog therapy could touch. I refuse to take Ambien etal and discourage my patients from using it also. The insomnia caused other damage to me. Currently, I take 2 mg melatonin two hours before I want to fall asleep. It is working for me thank goodness.
Everybody has very different reasons for their lack of sleep. One approach does not fit all. But our sleep is fundamental to our health so reading what other people do is helpful.
7
These columns always seem geared toward people who don't have real world jobs or responsibilities. They say things like "sleep until you're not tired anymore" and "go to bed and get up at the same time every day."
You mean, like retirees do?
30
When I awake in the middle of the night with my mind racing, I put in ear buds and turn on a podcast. I set the timer and let a soothing voice, at low volume, lull me back to sleep. One of my favorite voices is Shanker Vedantam's. The Hidden Brain podcast is great, so I usually listen to it the next day, having gone back to sleep quickly the night before. Podcasts help me go to sleep, too.
10
I absolutely agree about The Hidden Brain podcast (I wonder how many other kindred spirits there are out there!). The subjects are interesting enough to act as a distraction, but not distressing emotionally. He is highly insightful and empathetic, and has the most mellifluous voice. I set up a playlist, and find that I can listen to some of the same episodes numerous times because, by the following night, I don’t remember what I listened to.
What works for me: before bed, one 200 mg. capsule of phosphatidylserine, two capsules of standardized curcumin, three capsules of magnesium threonate, and one teaspoon of glycine powder (can put it in a little applesauce). This is sleep magic, 100% safe and good for you.
1
Re: Quinine Recommendation
How odd that you report success with the use of quinine, then link to a previous NYT article that states quine "has such severe side effects that the Food and Drug Administration warns against using it for leg cramps." My first search on the web found this report: Quinine for Leg Cramps Tied to Increased Death Risk - Adults under age 50 had threefold greater mortality risk. https://www.medpagetoday.com/neurology/sleepdisorders/65178
7
@Mark The side effects are generally associated with quinine at Rx doses. Not the much smaller "dose" in tonic water. (Though effectiveness at that smaller dosage hasn't really been studied.) That said, if you *are* very sensitive to quinine, even tonic water is dangerous.
4
There is a CBD made for sleep, its by a company called Gossamer and the product is called Dusk. It is one of the only things in twenty yrs that has worked for me. It helps you sleep deeper and you do not wake up in the night as much, at all.
13
This column is not very helpful. Platitudes such as address pain problems with a doctor or psychological problems with a psychologist, etc. are common knowledge. Insomniacs like me have tried everything and still wake up in the middle of the night and can't fall back asleep, no matter how tired. If you're living with other people, getting up to take a bath at 3 am or setting the alarm for that hour so you can spend weeks extending it 15 minutes at a time is a ridiculous suggestion. No wonder we turn to sleeping pills!
71
@Roberta
My thoughts exactly! My husband would kill me if I started roaming around at 3 am and he's trying to sleep. This would only work for those who live alone. I would appreciate a more well thought out and practical article on the subject.
29
exactly. not helful at all. makes us feel worse to be patronized.
25
@Ellen I'm a psychologist, and none of this works for me either. Ambien for 15 years, no problems, works great, no side effects.
3
Advil PM lets me sleep 6 hours. What it does to my liver is certainly better than what prescription drugs could do. Or so goes the scientific consensus. Prescription drugs are bad, right?
I wonder how people get all these prescriptions. I saw it on TV Doc. I can't and I'm white so it should be easy for me, right? I must fit some profile. It must be hard for doctors. Do I look like this because of lack of sleep or am I a crack head? He must have seen the hour-long training film.
1
A sleep hygiene schedule helps. Mine is so suited to just me that I can only conclude you have experiment. Mine is: 9:30 - a glass of milk and 2 fiber cookies. Tooth care and 1 melotonin. Retire to smoothly made bed. Do 1 puzzle from the NYT Monday (Easy) Crossword collection. (I keep the volumes and a pencil with a good eraser on the bed-side table.)
I am a worrier. Somehow, the half hour crossword seems to unhook my mind from its worry center. I think there's some real brain effect going on. Obviously, many of you might prefer either an easier or a harder crossword. Also obvious is that at the moment I am not in the middle of a crisis. But I'm hoping this is one of the habits that will help me weather a storm.
11
I was an insomniac for years( (or so I thought) and one day decided to not drink any caffeine to see what would happen. It changed everything. That's not to say that I don't have nights where I can't get to sleep - but that is usually b/c I'm obsessing about something and can't stop thinking.
Caffeine can stay in your body a long time. Even drinking a decaf coffee at 6:30 am will affect me. So, sadly, I can't have any chocolate, either. But, it's worth it. I'd say, give it a try and see what happens.
12
@Lori
Lori, thank you for posting. I totally agree with you. This sounds exactly like me. About 2 years ago, I discovered that caffeine was a big problem for me even when I had only a small amount early in the day. ...And you're right, it changed everything. I don't sleep enough but usually now, unaided except for 1/2 onion every day, I get 3 to 5 hours a night and that's miraculous to me.
1
I discovered that too much sugar during the day led me to have prolonged wakeful periods at night during which I would sweat profusely. Besides cutting out obvious troublemakers like caffeine and chocolate after lunch, there are many dietary choices I make that significantly improve the quality of my sleep. It took a while to discover which foods and drinks helped or hurt, but it was worthwhile making the effort to figure them out. I stopped using Ambien years ago after I felt like I was becoming dependent on it for a good night’s sleep. I now only use it occasionally for exceptional situations such as dealing with jet lag, and long haul overnight airplane trips.
3
After reading an article about it in the NYT some years ago by a psychiatrist who suggested we put it into public drinking water, I began taking low-dose lithium orotate (about 1/100th the dosage used for psychiatric purposes, less than is found in the water in many locations). It has no negative side effects, no health issues, no addiction concerns, and gives me night rest and a sense of inner calmness like I remember as a child. My holistic doctor tells me that many people don't get much effect but that there's a percentage for whom it dramatically raises quality of life. Available cheaply on Amazon and other places.
7
@Paxguy in Ashland, OR we are known for our natural lithium water. We have Lithia Park, and other places named after it. We have a Lithium Water fountain on our plaza . Nasty taste, good for what ails you!
1
Agree with those who dismiss the oft repeated solutions in this article. For anyone who regularly struggles with getting to sleep this list has been tried and tried again. The article simply repeats an ongoing mantra that most insomniacs gave up on long ago. Don't go to bed too early is one thing I have learned, but the best solution for me has been marijuana - not too much, but when a pattern of wakefulness takes over I find a little can go a long way, or an edible. I am in my 60's and this seems to work best. Unfortunately, Big Pharma in the US knows this and has done its best to lobby consecutive governments to keep it off the market. One of Trudeau's good moments I must say...now if only we could get him to recognize that climate change also keeps some of us up at night and pipelines are not the answer ...!
23
Marijuana is the cure for me for close to 50 years. If you just have an average active life with basically good food and not too many stimulants, marijuana not long before bed will help. I work long varying hours and often have little time to sleep. I seek help often in time crunches to try to get 5-6 hours before I have to get back to work.
6
My Fitbit informs me that my off-season jogging results in 5 hours (or less) average weekly sleep while the jogging season of 15-20 miles a week results in 7+ hours. At 78, it's now too hard to start up each year so I jog year around. It's easier that way and my memory requires that extra sleep
4
CBD_20 mg capsules. My wife uses it to help her fall back to sleep after waking. Another friend uses it for the same reason.
Quite effective. No side effects and no THC for those who might be subject to drug testing.
10
@Jim Dwyer - Marijuana gives me a horrific hangover. Of all the things I've tried to get to sleep when I've had trouble over the years, including alcohol, marijuana is by far the worst in terms of side effects.
I'm actually sleeping pretty well these days, but if I find my mind racing, half a cup of coffee will actually allow me to get to sleep quickly, and it's a good sleep. Another thing that used to help was a few milligrams of Adderall. Not taking it anymore for a variety of reasons but it was a godsend when I needed to get to sleep.
Point being, not all inability to sleep is created equal. For those of us with ADD and other issues related to abnormally low dopamine, taking things that lower dopamine even further (and marijuana is in that category - it increases prolactin which decreases dopamine) is the last thing we need.
5
A few years ago I was living in Santa Monica. Having trouble sleeping. My doctor RX'd me Ambien CR which worked fine until one morning (at five a.m.) I found myself walking on PCH in Malibu- having no idea how I got thereJ's. I wrote it off until a week later I put in the refrigerator. The next morning, to my surprise, I found the sandwich gone (along with a soft drink). I was a bit dumbfounded until my daughter-in-law suggested that I might look at the side effects of a drug prior to taking it
3
These work for me:
- Benadryl
- Valerian
- Melatonin
I use one of these per night.
4
@Kurt VanderKoi For some people, valerian can cause intense dreams and/or terrifying nightmares. Please be careful if you decide to try it. Thank you.
1
@M.S.
Most of the strange dreams I have had were with
Melatonin.
1
Valerian gives me heart palpitations. Look out for paradoxical reactions if you are a sensitive type!
2
I suffered for years from insomnia and recently, at the suggestion of my nutritionist, tried Vitamin B (P5P) and Magnesium. It works! It knocks me out and I have slept 7 to 8 hours straight. It will give you vivid dreams but I don't see that as a downside. I bought them on Amazon. Not all vitamin/ supplement companies are the same. Buy from a good one like Jarrow, Source Naturals or LifeExtension for example.
3
@Kat I'm game! Are Vitamin B (P5P) and Magnesium two separate products or do they come in one capsule?
1
@Allison--- 2 separate products. Integrative MD says that P-5-P (not just any vitamin B)is most bio-available. Research what kind of Magnesium you'll respond to best. This combo is also great for constipation...you take enough Mag with the p-5-p until "bowel intolerance" then back off 'til you're normal. Been on this regime for decades.
Get up at 4:30 am. Do yoga for an hour. Do this every day. You'll never have trouble sleeping again.
1
@APH
Unless you want to sleep until 8.
8
Magnesium relieves night time muscle cramps and cramping in general. Magnesium glycinate is the only form of magnesium that does not tend to cause loose stools, (as in Milk of Magnesia, used for constipation) Take one capsule a day, more if needed...it is a good stool softener as well, but causes no diarrhea.
Good source: Pure Encapsulations...see their website
4
@susan paul...there is also magnesium available as a spray...try that.
2
Instead of taking a bath or a pill, try "medicinal" marijuana which will quiet your dreams and offer no hangover. Even better, grow your own which will offer the benefits of exercise.
9
I’m a very light sleeper. What mostly heads me into dreamland is reading.
2
Before you start chugging quantities of quinine water, Google the potential complications, particularly for people with heart rhythm issues.
4
I must say that anyone with chronic insomnia can only roll their eyes at this. We've all tried all of these techniques, sometimes again and again to no avail. Is this predictable litany of bandaids all that "sleep therapists" can come up with?
72
@John
Seriously. I don't suffer now, but I've had insomnia in the past. I can only imagine how infuriating it is to true insomniacs to read the usual list of "Go to bed at the same time every night" and "No TV in the bedroom" over and over again.
If such simplistic - insulting - advice - actually worked for most people, insomnia would go out of existence tomorrow. Turn the TV off, fall asleep, yay!!
OF COURSE anyone with true insomnia has tried these things.
4
Exercise deserves far more than the passing mention it receives in these two articles. The "sleep onset" signal for most people is generated by a relative drop in core body temperature. As we age, core body temperature varies less from day to night and yields a less potent sleep signal in the brain. Moderate exercise to raise core body temperature about 1.8 degrees F — think 25-30 minutes of light aerobic work, enough to break a good sweat for a little bit — will yield a subsequent relative drop in core temp 4-6 hours later large enough to cause a clear sleep signal. Time this particular round of exercise to catch the sleep-onset wave for your own bedtime. The effect is strongest if you keep fit and have a regular exercise routine. (By all means also keep your morning workout intact too if you have one.)
5
theres nothing new in this piece. i went for ten years with chronic insomnia waking at 2 or 3 am every night. i tried absolutely everything. i ended up in a psych unit after severe insomnia led to a nervous breakdown. there they put me on trazadone and seroquel which both gave me the worst night terrors and racing heart etc. then last year a psychiatrist prescribed a low dose of hydroxyzine, an anti histamine with sedative effects. next to no side effects that I'm aware of or have experienced. i now sleep 8 hrs a night consistently. its a complete life changer. i can't overstate that. ive been taking it for 6 months and its still effective. no amount of CBT, sleep hygiene, herbs, exercise, diet changes, or even other medications had anything close to this effect. its crazy that it took the 6th dr i saw to figure this out.
22
@mkc I've used all three meds with some success. Trazodone was effective for a while, then lost it's effect, even with increased doses and eventually I became dependent on it, very bad. Hydroxizine was the least effective, but it was OK, minimal side effects. I now use 25 mg of Seroquel + 6 mg of Melatonin + 200 mg theanine and it has worked well for several years. I am retired now, so can go to bed late and get up late, my natural rhythm.
1
Daily physical exercise is hugely helpful when sleeping is difficult. For the large number of older people with orthopedic issues and pain from OA and related conditions,this poses a Catch-22 situation. Pain (and related risks of falls, joint damage) interfere with exercise needed to promote sleep while inadequate sleep exacerbates the underlying conditions causing pain.
5
I have been using the comforting hum of an electric fan to help me sleep at night for sixty years. It does wonders, addictive but drug-free.
10
Insomnia can also be caused by Lyme Disease and it's many co-infections. These diseases infect the brain and create inflammation which makes it impossible to sleep. Millions of people have no idea they even have Lyme/Co-infection because it is NOT diagnosable via the blood test their doctor might tell them is the way to diagnose. This is misinformation. Learn the signs of neurological Lyme and co-infections like Bartonella and Babesia. Then find a Lyme Literate doctor. And take melatonin in the meantime to help with insomnia.
5
As an insomniac, if I read one more article from someone without it who advocates "going to sleep at the same time", or "sleep restriction therapy", I'm going to scream--at 3 in the morning, when I'm usually up.
"Quinine water?" Right. "Only use your bedroom for sleep?" I live in a studio apartment.
Yes, Ambien is awful. What works for me is Xanax. No more than one at bedtime, and no hangover. No, I don't get a full night's sleep, but like most insomniacs, I'll take what I can get!
60
Five years ago, I was on the verge of being diagnosed with Restless Leg Syndrome--a diagnosis I now consider absolute garbage. To help me relax and sleep, I was having a cup of camomile tea WITH MILK before bed.
Then one day, I noticed that a cold glass of milk, something I seldom drank, made me itchy with a very fine rash. I thought, "gee, I wonder." The next time I had milk, I watched for symptoms, sure enough, a fine rash and breathing distress. I was itchy all over, but I was awake, so no "restless legs." My restless legs were itching from an allergic reaction.
I took Benedryl for years until I discovered that it has excessively bad effects on memory and brain function (anticholinergic) and that took care of any itching at bed time, but I also got rid of major food allergens in my diet.
Unfortunately, NOTHING reduces the serious, chronic insomnia due to Fibromyalgia, which has worsened as I've aged and as I approach 50 is reaching crippling proportions. Reducing blue light from electronics helps, but my 4th gen iPad doesn't had light shift support (Apple, get with the program and and introduce this critical need to older iPad, it's SOFTWARE for crissakes!)
Sleep? I wish.
3
@My sister-in-law used Benedryl for years and developed dementia. I have been taking 1/2 of a Unisom Sleeptab that works quite well for me. Still worried somewhat about side effects with taking it for long periods of time.
1
I am not an insomniac unless I expect to sleep more than six hours a night and stay in bed disappointed when awake at 4. How much sleep do I need? How much do I expect? How much do I get. For some people (clearly not all but some) simply changing expectations will rid them of the label and worry of insomnia. As long as I keep the wood fire going (I live in the Antipodes and it's winter) no problem getting up at 4 and starting the day. In fact it's an excellent time, a quiet time, a special time to see the stars go out one by one (clean air and dark in my little town in the South Pacific) and occasionally to understand that it is a miracle that there is live on earth and it's only experienced when awake (and well rested too!).
22
Hyland’s Leg Cramps with Quinine used to be a sure fire way to alleviate restless legs at bedtime. The formulation has changed and it no longer contains that ingredient. My understanding is that the government required them to remove it because quinine interacts with many common prescription drugs. I wish they had just put a warning on the label. Sadly, the new product doesn’t do anything.
5
@Annie Have you tried magnesium citrate (or one of the other chelates)? It works for many people with RLS.
5
@Annie Quinine IS NOT an appropriate drug for restless leg syndrome. Fortunately, for you, if that is indeed the correct diagnosis there is highly effective pharmacologic treatment available. Visit your personal primary physician and he/she may be able to help you or refer you to a physician that can. There is ZERO evidence that any magnesium helps. In some patients, iron supplementation may help as RLS is associated with a deficiency of BRAIN IRON, not necessarily systemic iron. But again you need to be tested and evaluated properly. I am a physician and I am giving you sound advice.
5
I just do not understand health professionals. They like to talk about what to do before you go to bed and CBT-I has a lot of stuff to say, but once you close your eyes, you are pretty much on your own. All their suggestions are down in the minutia of the real problem. The problem is that the short period of time between wakefulness and sleep (5 to 10 minutes) is a very peculiar time where the mind is in a state of liminality and susceptible to all kinds of emotional distractions. This period is called sleep onset by sleep professionals and hypnagogia for psychic experts. The simple fact is that anyone, who doesn't have an actual medical problem, can easily control their thought process and guide themselves toward sleep. It is a solution that can work for anyone who is conscientious enough to spend an hour or two to learn about it and persistent enough to try it for a couple of weeks. It may even solve your problem the first night. Then you have the solution with you and can use several times a night if you wake up for any reason. You can even take it with you on the road because it is right there in your mind. It's called the Transition Trek and it is free. http://InPursuitOfSleep.com
5
was using .25 alprazolam prn. Then someone gave me cannabis. When I wake up, one hit and 30 minutes later...zzz.
10
I'm a life-long insomniac suffering from hyper-vigilance, the byproduct of a traumatic childhood. Right now I'm on cymbalta (daytime) and sleep at night with two prescription drugs (600 mg Gabapentin), (.25 mg Xanax), and two non-prescription drugs (15 mg melatonin and an expensive herbal called cortisol calm). Clinically, I suffer from chronic exhaustion. The witch's brew I take every night usually knocks me out for7-8 1/2 hours but it's not the same as a good night's sleep since it surppresses various sleep cycles. Consequently, I have bouts of fatigue during the day and often need a nap that can last an hour. My life is good overall but i'm certain drugs will not cure my insomnia. I'm trying cognitive behavioral therapy but so far no improvement. Any suggestions?
2
@Harry B — Many people with Adult ADHD do not know they have it (and it often co-exists with depression, anxiety, etc.)
ADHD is associated with many types of sleep disorders, including delayed sleep onset. One issue is that the brain needs to be “organized” in order to get to sleep (and stay asleep). There can also be issues with Restless Leg Syndrome or sleep apnea.
Hypervigilance is common with ADHD, and given the high heritability factor and the adverse effect that ADHD can have on mood regulation and effective parenting, trauma is a factor for many people with adult ADHD. Unfortunately, the underlying neurogenetics are typically missed by trauma therapists.
Good luck to you
7
@Harry B Wow that sounds very difficult and I'm sorry you're going through that. I know this will sound incredibly silly and basic, but I also have trouble sleeping and read about techniques "experts" (like spies) use to fall asleep quickly. One included relaxing one's eye sockets. I know that sounds so strange, but if you can imagine slightly stretching the muscles behind and around your eyeball it relieves a weird kind of pressure. I didn't even realize the pressure was there until I tried it. Don't use your fingers just your eye muscles, and do it gently. Also relaxing one's jaw muscles can provide significant relaxation. You may also consider a float session - sensory deprivation. It says you're in DC, there's a floating place called Soulex downtown. Good luck!
3
@Harry B, you asked for suggestions - if you are open to therapy, I highly recommend seeing a therapist trained in Internal Family Systems (IFS) therapy. CBT can be helpful, but it doesn’t get to the core issues. You mentioned childhood trauma - IFS is an evidence-based approach focused on healing parts of us that have taken on extreme roles to cope with trauma, and they keep doing their job even after the actual trauma has ended. Insomnia is a symptom, as you note. Like all therapy, a skilled and well-trained therapist is key. Best of luck to you.
2
Here are some ideas that may work for different people depending on the source of the insomnia either difficulty falling or staying asleep or early wakening. 1. Breathing short inhale and long exhale 2. Melatonin spray high potency by mouth about 20 minutes b4 bed May need to get it from a homeopathic clinician 3. About 100-200 mg Gabapentin 4. A few drops under the tongue of Indica THC tincture. Night Nurse is helpful. Be careful to ascertain how much is needed so as not to have extended somnolence next day or hyperemesis 5. Stop electronics use including TV b4 bed. 6. Occasional use of Tylenol PM or similar. 7. Spray lavender scent over bed 8. Definitely use an eye mask particularly if you waken early and it is light out or use black out curtains. 9. Write down your worries so you can forget about them tonight and take them up again the next day. 10. Alternate use of various techniques and don’t depend on any one especially with supplements and meds.
5
I've suffered from insomnia for 25 years and the recommendations in this article are, though they have a little merit, are mostly laughable and an insult to a real insomniac.
I take no medicine now (by my own choice) but I was on ambien for a long time. 5 mg would sometimes, but not always, let me get 4 to 5 hrs. of sleep. ...But 2 yrs. ago, I came to realize that ambien was the culprit in making me EXTREMELY anxious and then I began to think back and realized I had been having this feeling for a long time, though it had not been as awful as it became as I continued to age. I stopped taking it immediately and began to feel more normal than I had in a long time. I won't take ambien again unless I become completely desperate.
What I want to tell all of you out there is that I have 2 small recommendations for you to think about. I have discovered that onions can induce sleep and I have 1/2 of a medium to large onion sautéed and scrambled with eggs every morning. When I discovered this effect I researched it and found that onion contains tryptophan.
The other offering is that a cup of catnip tea, if you are lucky enough to fall asleep, will help you to stay asleep longer. Good Luck, my dears.
12
Several months ago, a friends husband was giving a talk at a neighborhood gathering about his (university professor) research. He started by saying that his wife's sure-fire cure for when she was having a hard time falling asleep was to ask him to tell her about his research.... it never failed, she was out in less than 20 minutes! A friend and I (who both have professor husbands) were sitting in the back of the room and, because we completely understood, started laughing and just got completely hysterical. We finally apologized to the room when we got ourselves under control again. Not to belittle people's real problems with not sleeping well, just thought it might give someone a laugh!
18
@rocksinmyhead
A TED talk on climate change is my go to noise for a mid-day nap. Turned down as low as possible but where you can follow the lecture.
1
I fall asleep very nicely when spouse watches "Jeeves and Wooster" on YouTube.
All those soft, beautifully inflected speaking voices. Everyone so upper-class Britishly well behaved. Nice to know somewhere there is still civilization. Very soothing. Doesn't matter that it's only a TV show.
6
My go-to when I have difficulty falling asleep is the BBC broadcast on the WNYC app overnight, which I have loaded on my phone and listen to using earphones so I don’t disturb my husband. British radio voices seem softer and put me to sleep when I have a restless night.
6
Long-time insomniac here. Nothing new in this piece. No single magic cure, not suprising given the numerous reasons for insomnia. First step is to consult an MD with specialized training in sleep med, and have a sleep study done. I consulted several docs over 20 years before one finally ordered a sleep study, which showed that I have apnea. CPAP helped with that, as can a mouthpiece that moves the lower jaw forward to clear airway. With apnea controlled, doc addressed circadian issues. All house lights are now on dimmers and turned to lowest setting at 9:00-10:00 PM. NO screens after sunset! Get outside in morning for daylight exposure. Take 1/2 mg melatonin between 10-12; helps sleep onset. Some aspects of CBT are useful, like not lying awake in bed beyond 20 min, going to bed and rising at same times, and writing down your worries, but I agree that by itself it doesn't resolve long-term insomnia. Sleep restriction can be effective, but is rough on schedules. Vigorous exercise before midday helps, and no caffeine after lunch. Eat dinner early, have a light snack (banana, good for potassium) 2 hrs before bed. Keep your room cool and dark. Can't say I sleep 7 hours yet, but all of the above have improved sleep for me. Good luck to all!
13
For many of us with sleep issues, the problem could not be simpler: our internal chronotype is longer than 24 hours. I laugh out loud reading sleep advice that suggests, so innocently: “Go to bed only when you are sleepy.” That would be, in my case, after 18 or 19 hours of wakefulness. Do the math on how that works out throughout the week with a regular 8 hours of sleep each night.
And please stop calling people like me “night owls.” I happen to be more alert and productive in the daytime; my struggle has nothing to do with day or night, and everything to do with trying to squeeze a 27-hour chronotype into a 24-hour world. Surely I am not the only person with this problem. How is it that sleep scientists manage to pretend we do not exist?
25
@Marty I have heard similar from members of an adult ADHD group that I moderate.
Circadian rhythm issues are associated with ADHD, and they often improve with dopamine-targeting medications that improve signaling (sunshine to pineal gland. Etc.)
If you’re in the PNW, maybe that’s a weak sunshine signal for much of the year.
2
@Marty, fellow longer-than-normal chronotype here, with ADHD as well. I can either choose to have an office job or be well-rested; pick one. Thus I'm always exhausted. This book was eye-opening to me: https://www.amazon.com/Internal-Time-Chronotypes-Social-Youre/dp/0674975391
@VThank you; I have put the book on hold.
Gina: I will see what the book says, but wouldn't it make sense that the PNW summers - too much sun - are the problem for someone like me? That is when I am most sleep deprived, as I can't make myself go to bed until midnight or 1 am, but despite blinds, heavy curtains, eyemask etc can't help but wake up when that early sunlight breaks through.
Had really pernicious insomnia after a health crisis back in 2005. Was still working but getting no sleep. Going for long walks at night and sometimes blacking out. Went to my old friend Marshall Wilensky Phd for 12 EMDR treatments(eye movement desensitization reprogramming) usually used to treat PTSD in returning vets. I have been sleeping soundly since. Thanks Marshall
4
I sleep well, but occasionally, if I am traveling or preoccupied mentally, I use this strange method that works like a charm for me.
I learned it in the 1970's at a Silva workshop:
Lying on your back: In your imagination or minds eye, pick up a piece of chalk and draw a large circle on a school-type blackboard, (complete with a shelf at the bottom with pieces of chalk and a blackboard eraser.)
Write the number "100" in the center of your circle.
Next, draw a big "X" over "100", out to the edge of your circle.
Pick up the eraser and erase the big "X" and the number "100", without erasing your circle.
Then write the number "99" in your circle.
Cross out "99" with a big "X out to the edge.
Erase your big 'X" and "99" completely, leaving your circle.
Write the number 98.........you get the picture.
Following these instructions carefully, and with a little bit of practice, you will be asleep, usually, by the time you get to 97.
I don't think I have ever gotten past 90.
This method is that boring and that effective; but rather magical.
14
I agree that this article omits a significant number of other solutions that are well-known to many readers here. I'll add mine to the list: a weighted blanket. I too suffer from the kind of insomnia where I'm unable to fall asleep because my mind is racing, I have plenty of energy left, and I just don't "feel tired." Other suggestions here helped, including exercise and meditation, but the weighted blanket has been great. It calms my body down enough to be able to breath deeply and quiet my mind and drift off.
11
I nearly always have insomnia traveling. I took Ambian daily during a trip to Africa and was one of a few travelers who wasn’t sleep deprived. I slept fine without it when I got home. Now when I travel I am a sleep deprived zombie because the FDA decided to turn a traveler’s salvation into a controlled substance. Underlying cause? Time change. 24 hr flight. Late nights and early mornings.
8
I have shrieking case of tinnitus, which has plagued me for over fifteen years. Think smoke alarm with no battery to change or wire to cut, 24/7. I have used zolpidem tartrate for years, but mindful of adverse positions like Ms. Brody’s, I quit for six weeks. I managed a sort of doze, but no real sleep, and decided whatever the quality of sleep obtained by , it was better than trying to function in an exhausted state. More importantly, having no respite whatsoever from the hellish noise of the tinnitus was unbearable. The best moment of my day is taking that pill.
And yes, I know about re-training therapy and all the other expensive and unproven and blame-the-victim if it doesn’t work therapies that are pushed by otolaryngologists with associated hearing aid and therapy deals. And I have tried meditation, which is great but does not induce sleep. I went back to the sleeping pill, and dread a night without it.
It surprises me that a responsible columnist would ignore the really large population that have intractable, incurable conditions that defy the options offered so often in a frankly platitudinous way.
50
@Janet Van Sickle You highlight the underlying ignorance of the article by mentioning zolpidem, a benzodiazepine, like alprazolam(xanax) and lorazepam. These sedating drugs (primarily known for their anti-anxiety effects) , though potentially habit forming, do not have the often dangerous properties of the "Z" drugs that get people sleepwalking and doing other risky things at night and the next day. A good doctor will prescribe these drugs and teach you how to use them safely.
16
@Janet Van Sickle. I’m amazed too that tinnitus wasn’t even mentioned despite the fact that millions like us suffer from it, in my case for the past 33 of my 63 years. My remedy for the past 5 years has been a near daily 2-3 mile brisk afternoon walk, a warm shower before bed, a 5mg zolpidem tablet to jump start sleep, and a CD of soft music or white noise that shuts off after an hour. I’m usually asleep before then. I can get about 5 hours with this regimen, maybe 6. It’s not perfect, but it works for me.
2
Meditation helps me because my problem is racing thoughts and stress. When I am traveling to different time zones I have found melatonin helps. I read a book called "Why We Sleep" that said that sleeping pills do not provide beneficial sleep, but melatonin is a natural substance that the body produces and it is the only supplement recommended for normal sleep. When you are in a different time zone your body will produce it naturally at the time you normally sleep which is why I induce it artificially by taking the supplement when I travel.
2
@RAR try one Adivel pm and and 2mg melotonin fast dissolving before bed
For every crazy story of people behaving bizarrely or dangerously while taking zolpidem, I'm guessing there are many more stories, like mine, of it being the only thing that works after decades of chronic insomnia not fixed by any of the less chemical 'treatments' advocated. I'd vastly prefer to meditate myself to sleep, believe me...but it just ain't ever going to work for a guy like me. Far more dangerous would be a completely sleep-deprived person behind the wheel or navigating the other aspects of life. Any drug can be abused...but adults should be allowed to make determinations about their treatment.
48
I was surprised the article didn’t mention the following three well-documented methods to assist sleep and counter insomnia:
1) Regular physical exertion, or exercise, almost always drains the body of energy by the end of the day, thus making it easier to fall asleep at night.
2) Limit exposure to blue and white light emitted from computer or phone screen time, which wakes up and keeps the brain active precisely when circadian rhythms are working to the naturally wind down mind and body.
3) Limit food intake at night, as the bodily energy required to digest excess food acts to keep the body (and mind) awake.
3
@Nick Exercise is not a guarantee. I had insomnia for a while and exercised quite strenuously. It made no difference.
6
@Tim I found that exercising in the late afternoon or evening did not help, but early exercising--even going for a walk--in the mornings made a difference. Worth a try?
1
@Nick I'm with you Nick...if I don't manage to get a workout in of an hour or more...the sandman skips past my door each night.
1
Totally non-drug, but I'd recommend audiobooks. My issue is waking in the night, and being unable to sleep again because my mind races with all my problems. What works for me perfectly is putting an audiobook that I have previously listened to on my phone or iPod shuffle. It needs to be a book that will hold my interest for a short while but is not too exciting. Then, I go to sleep. When I wake up, I put the earphones back in, and listen to the soothing voice. It keeps my mind from whirling in the night, and it soothes me back to sleep. No need to turn on the light, read a book, disturb my husband.
18
@Jennifer
I do something similar - only with public radio. I tune in with ear buds and no matter what the program/topic, because my mind is engaged, it is not racing with my anxious thoughts and worries so I soon find that I have fallen asleep.
10
@elenifer I see that lots of others have recommended audiobooks, or public radio, or podcasts. There's a bit of a consensus to try that approach.
5
@Jennifer
I use a fan combined with YouTube documentaries that meet the same criteria-interesting but not too stimulating. I find it quiets my restless mind .
I’ve had insomnia most of my adult life, and it got worse when I became a parent. I tried so many interventions and nothing worked until I had fair success adding magnesium supplements - in particular I use magnesium glycinate. But the biggest success has been thanks to the legalization of marijuana in my state. I use a combination of edibles, smoking bud, and/or vaping the concentrate. I don’t remember ever sleeping so well in my life! For me, marijuana is a miracle.
19
@Just Curious ..my comment too...:) It is amazing how much it helps. I am in my 60s and don't smoke, so prefer edibles...but it all works.
1
I don’t have leg cramps. I don’t have sleep apnea. It makes no difference if I exercise or not, or when I eat. Melatonin is worthless. CBT doesn’t address what’s wrong with me. Sleep hygiene is laughable.
I have bipolar disorder. If I don’t sleep, it provokes a mood episode that can last weeks or months. NOTHING affects me worse or faster than not sleeping, and I have had intractable insomnia since grade school.
I take Ambien every night, and have for years. I consider it the most important medication in the cocktail of anti-psychotics, anti-seizure, anti-depressant and mood stabilizing pills I take every day of my life, because I prefer to stay alive, and not put myself or my loved ones through the hell of another manic or depressive episode.
Articles like this feed the anti-sleep medication fad that is currently engulfing psychiatrists everywhere, and threatening access to life-saving medications for people like me.
104
@Eloquaint
You make the same point I was about to. I've been through every 'preferred' treatment too but for some of us, zolpidem is what ensures we'll actually be unconscious for at least a half-dozen hours. I hate that it's so...and I'm sure it's not good to take anything all the time, but for me, it's so, and I've been at this battle for over
15 years. My doctor is going to reduce my dosage...read, allotment...by half net month and I'm quite apprehensive about how that's going to work out.
18
Thank you for sharing your powerful story.
1
Magnesium oil, rubbed on skin, helps getting a good sleep. It is just magnesium salts in water, and many folks are short of mg and other minerals so it is safe for most everyone.
4
the article from the American Journal of Medicine is from 2005, 14 years old, and notes that Ambien (zolpidem) is "well tolerated and safe in the elderly" which is not at all the current recommendation (it is considered highly dangerous for falls and injuries in the elderly). an article 14 years old is outdated- and the suggestions for leg cramps- that is a vexing problem but the suggestions here are anecdotal.
this is not as good as the NYT does- I am a family physician and I like it when the NYT has a good article on health that I can give to my patient. this could be better- hope the second one has more 'meat' as another comment here noted
11
@Debbie Murphy my dad just turned 80 . he has been addicted to ambien for many years and has had numerous falls, including one that led to 4th degree burns and a 6 month hospital stay. he has found himself in the bathtub in the middle of the night, has trashed his apartment in his sleep, has cooked an entire fry up in his sleep..its terrifying. and when he tries to get off the detox is horrendous.and ironically he can no longer sleep more than an hour at a time.
2
What about those hot flashes???? Altho not as intense as they were 20 years ago, I still get them - about 3 times each night. Melatonin, exercise, regulated sleep time.... all those things are fine, until you wake up in a sweat.
12
@Angela
Try 1 or 2 capsules of the herb, Black Cohosh, every night. Some people take the herb vitex and "chaste Tree berry" with it.
I have been using it for 20 years, has many benefits including ending hot flashes.
“Sleep” medications don’t induce sleep. They sedate you. Sedation looks like sleep, but it’s not. Sleep is essential for all kinds of physiological functions like tissue repair, memory consolidation, etc. That doesn’t happen when your sedated. So these sedatives actually impair sleep function when your zonked out and you end up getting less actual sleep. Keep the same sleep and wake times. Learn meditation techniques to quiet a busy mind (it’s a practiced skill so it won’t work well right away), avoid screens and bright light a couple of hours before bed (to allow your natural melatonin to surge, light inhibits it). There are a number of sleep hygiene practices and if you do enough of them you may find a critical mass of habits that do the trick.
5
@Philip You don't know what you are talking about. Many people use "Z" drugs or benzodiazepines correctly and safely (under a physician's direction) and it helps them get a good night's sleep. But usually not night after night for long periods of time, the exception being people with extreme pain problems.
6
Minimize fruit/ sugar within 2-3 hours of [trying to] sleep. No apple or dates or chocolate. Nothing greasy or spicy. Not too much fluids, tea, water, soda, alcohol. Sleep well. No dreams/ nightmares. Remember ‘herbs’ can be similar to Rx ‘drugs’.
After awhile melatonin doesn’t work. BUT meditation works and it’s free! No side effects but peace and sleep. Also, Brody is correct use the bed room only for sleep and sex....a TV in your room messes with your sleep.
@Mari life long meditator, with chronic insomnia. saying "meditation works" is condescending and based on nothing. clearly you have never experienced severe insomnia.
8
I'm a worrier and often have trouble shutting it off at night. I have one little trick that usually works. I pick a category and then, in alphabetical order, think of items for that category. Girl's names: Alfreda, Beatrice, Cassandra... Foreign countries: Argentina, Bolivia, Canada... Vegetables, flowers, foreign cities. It forces me to focus on something other than whatever it is I'm stewing about. Hopefully, I fall asleep before I get to the XYZs.
26
@Prodgerm I have the same issue. I really appreciate your method and will try it. I once memorized a short (2-3-page) story by Virginia Woolf and would repeat the lines of this story, line by line, until I fell asleep. The story itself was rather dreamlike and descriptive, so that helped too.
3
@Prodgerm
Yes! Thank You these are great! Asleep in 90 seconds.
1
My daughter is a train driver and must do shift work including rising at 4AM, sleeping overnight out of town in less than quiet places then working late shifts. She is having increasing problems sleeping as she ages. What advice do you have for shift workers?
9
The first article did a decent job of explaining the circadian rhythm and stated the fact that amount of sleep declines with age. The second article contains some decent information about limiting exposure to computer screen light and controlling behavior.
But the author failed to mention the reasons for less sleep among the aged: the normal decline in melatonin secretion in the brain with age.
The evolution-driven start of sleep and the overnight hormone cascade starts with melatonin. Less melatonin = less sleep. Less melatonin = disruption of other physiological repair factors that only occur during sleep. Artificial light after sunset disrupts the circadian rhythm.
Melatonin is available over the counter, very inexpensive. it became legal because scientists found the only way to make it legal was to talk about jet-lag (which politicians understood).
The author and the doctors who prescribe drugs do the public a dis-service by failing to tackle the root cause of sleeplessness: natural decline of the natural hormone melatonin. Take it every night and forget about the drugs.
6
I’ve always wondered something that none of my colleagues seem to be able to answer. Melatonin is a hormone. Hormones are proteins. Put a protein in an acidic environment and it denatures, essentially unravels and in losing its macro molecular structure it loses its function. This is a basic fact of proteins. When we eat them we hydrolyze them into constituent amino acids and then reassemble then into proteins directed by our dna. So how does eating melatonin make you synthesize more melatonin?
4
Melatonin is a small molecule, not a protein. Hormones can be proteins (large molecules consisting of many amino acids), which are often degraded into their constituent amino acids by stomach acidity. But they are very commonly smaller molecules that are readily absorbed and used as therapeutics (eg thyroid hormone). Briefly, see: https://en.m.wikipedia.org/wiki/Hormone
Not an endorsement of melatonin (which seems to be more effective for jet lag than insomnia, if anything) in particular, but it does reach pharmacologically active levels with oral administration.
3
@Svirchev Melatonin is a joke, like most over the counter sleep remedies. There is no serious evidence that it will provide or help provide a good night's sleep to people with real insomnia problems.
4
what the heck...I got nothing out of this as far as meat and potatoes...just a headline...strange for the nyt.
16
I'm a big fan of Jane Brody, and I always find her to be thorough and never noticed a condescending tone, but this article and the promotion for it on the front page of the Science Section: "Treating insomnia without RESORTING to medication," left me feeling unnesessarily guilty.
How about people who are on medication to prevent a recurrence of cancer? Difficulty sleeping is a common side effect. I finally gave in and took a low-dose sleeping peal and it has been life-changing. Melatonin, pain relievers (I have no pain), changing the drug to prevent a recurrence of cancer - all not options.
Come on, Jane - there are many of us out there and you usually are more inclusive.
44
@Maury - You bring up a very good point. Every medication I take affects sleep, but I can't do without them even though I spread out my blood pressure medication throughout the day so they have a lesser effect on my sleep. I didn't begin having chronic sleep issues until post thyroid surgery and having upper shoulder discomfort most of the time, especially at night. I take one-four to one-third a 5 mg. Zolpidem tablet that helps me get to sleep, and doesn't cause side effects. I believe the small dosage I take reduces the chance of side effects.
3
I heard a woman speaking in some medical context say that pain pills are exaggerated as to their effect, and that a single pill of ibuprofen and another of acetaminophen will do the job. So I began taking a generic "pain relief PM" tablet (500 mg acetaminophen and 25 mg diphenhydramine) and 200 mg ibuprofen and damned if it doesn't work! Take it one hour before you want to sleep. I use it 2 or 3 times a week.
6
Yeah
2
@Spike
It's the diphenhydramine, not the acetaminophen! The antihistamine is the component that makes you drowsy.
12
Liver. Side effects.
8
Eat a light dinner, early (before 7pm). No snacking or alcohol after that. It will probably get rid of reflux as well
9
Marijuana solved it for me. No more marijuana now; my supply dried up. A bowl before bed and I can consistently sleep the whole night through. I don't wake up groggy. Go to bed at 10, get up around 6 feeling as rested as I ever have. Mix that with the ambient soundscapes of Witcher III (a video game by CD Projeckt Red): the wind through the tree branches, the sounds of the shore being graced with gentle waves, and that subtle orchestra in the background.
But my supply dried up. I go to bed at midnight and wake up at 3am now. Thanks. Sleep deprivation is like alcohol intoxication for me. It muddles the mind, and makes me quick to anger.
I have absolutely no faith in therapy. Therapy is for weaker-willed folks more easily swayed. I found what works. The problem is everyone drug tests and the worst part is THC is the only thing that sticks around in your blood and urine long enough to test positive for it. Furthermore, I am morally opposed to the invasion of privacy that is drug testing. Marijuana has been with us for thousands of years. It's time the rest of you folks simply accept that some of us burn plants to relieve our ailments for I absolutely refuse to just go along with your invasion of my privacy. It is absurd and it's about time someone stands up and says so.
18
Try meditating, it’s easy and free! It works!
1
CBD CBD CBD. Really.
2
@OnABicycleBuiltForTwo
1) Are you saying you're so strong-willed and obstinate that you'll persist with terrible insomnia rather than bow to a therapy that would "sway" you into curing it? If that's the case, then you deserve it!
2) If you want to smoke pot and work legally, just move to a state where it's legal. And work in any industry except for the federal government or a handful of others. Problem solved.
Sorry, I've got no sympathy for you.
4
I'm always amused by these "don't used the bedroom for anything but sex and sleep" suggestions.
I live in NYC in a tiny apartment!
Btw, melatonin and CBD oil work for me. So does weed but it's not legal for everyone obviously.
19
Leg cramps should be evaluated by a health professional, as they may be due to a significant health condition, including electrolyte disturbances, musculoskeletal abnormalities,
and a variety of neurological disorders, to name a few. There are many non-pharmacological treatments available, if no underlying illness is present, such as stretching, exercise, proper hydration, and good footwear. Quinine, however, is no longer recommended for nocturnal leg cramps, as it has been associated with potentially severe, and sometimes life-threatening complications, including cardiac rhythm disturbances, low platelet counts, and other hematologic side effects.
Here is a link to an FDA statement on quinine:
https://www.fda.gov/media/84506/download
I find it somewhat irresponsible on the part of the New York Times to recommend a medical therapy to its readers, without deeper research into the implications and potential dangers of that advice.
15
@Ailurophile
What you are referring to is off-label prescription strength quinine normally used for the treatment of malaria. Tonic water by comparison contains far lower amounts of quinine and is hardly dangerously.
3
@James from the online medical resource UpToDate on this topic authored by John W Winkelman, MD, PhD:
https://www.uptodate.com/contents/nocturnal-leg-cramps?search=quinine&source=search_result&selectedTitle=3~95&usage_type=default&display_rank=2#H74260295
"Because of safety concerns, quinine is generally not available for prescription or over-the-counter use for leg cramps in the US; thus, the author prefers the use of 6 ounces (180 mL) of tonic water, rather than prescription quinine, and only if cramps have persisted or are severe and disabling. We use such treatment rarely and do not use it on a daily basis. In patients in whom the use of quinine or tonic water-containing quinine is under consideration, the patient should be informed of the potential adverse events and understand the level of risk relative to the relatively benign (although painful) nature of leg cramps."
@James And tonic water does not contain enough quinine to do much of anything biologically. My doctor admitted as much when he suggested it.
Buy a really, really, really good mattress.
It's an all natural, non-addictive place to start.
15
What about using so called PM tablets, that contain tylenol or ibuprofen, with 25 milligrams of diphenhydramine hydrochloride, an antihistamine? I use them occasionally and they work.
3
@Jacob Opper, diphenhydramine (Benadryl) is anticholinergic and very bad for older people. It hastens cognitive decline and dementia.
9
@A Good Lawyer-Problem is, sleep deprivation does the same. But I would use it cautiously and infrequently.
1
@Jacob Opper PM tablets bad for the liver. i just take hydroxyzine, an anti histamine.
A supplement capsule of magnesium does it for me. I take one a day as recommended on the bottle every night before going to bed. If I forget, I wake up four hours later, my mind filled with anxious thoughts..if I take it I sleep through the night.
14
@CM
I started using magnesium a couple of years ago when I started getting severe muscle cramps. The cramps could appear night or day, but could wake me up from a sound sleep. This small addition worked for me.
9
I had terrible insomnia for more than 25 years, starting in my early teens. When in my late 30’s I developed a medical problem that I struggled to recover from, my doctor told me my sleep issues were probably preventing recovery because sleep is essential for muscle repair. Ohhhhhhh, I said. Right.
So I did a bunch of research and now, a few years later, I sleep basically normally. It is AMAZING to feel so rested. I need fewer hours of sleep because my sleep quality is so improved. My productivity is higher.
I should note the origin of my sleep issues was trauma, but my cure did NOT involve CBT or other therapy. Years of CBT had helped in other ways, but not sleep.
What I do now:
- Go to bed and wake up at same time every day - I try not to vary by more than an hour even on weekends
- Cut way back on drinking. You might fall asleep faster but alcohol will wake you in the night
- No TV and minimal phone use after 8pm
- Beds are for sleep and sex and that is IT.
- No work in the bedroom. Ever. If I work from home I don’t enter my bedroom
- Meditate. Even just 5-7 mins before bed makes a huge difference
- I carry a lot of tension in my face and shoulders. Just the thought of consciously relaxing the tiny muscles behind my eyes (or wherever) helps
- Blackout shades
- Sound machine
- Exercise in morning, not evening
There are a lot of books out there with great advice. This approach really changed my life.
25
CBT = cognitive behavioral therapy. This is not CBD, the drug.
I almost forgot:
- Cut way back on caffeine. I now have 1 cup a day and only before 10 am.
- These habits take weeks to months to be fully effective. I would have said previously that I’d tried all this —but I hadn’t done all of these things together and consistently. Trying this for a few days won’t be enough.
1
My mother, her mother, her maternal grandmother, both siblings and I suffer from intractable, chronic insomnia - the kind where you can't fall asleep. I recall as a young child, forced to stay in my bed with the light off, I'd hear my mother pacing around the house downstairs, not even with the TV on for fear of disturbing her family. It's like having migraine in that those who don't have the affliction simply can't grasp the terrible impact on a person's life.
Most insomniacs have heard the (IMO) infantilizing suggestions in this article. But the type of generational, chronic insomnia my family has and continues to suffer from has to have a genetic/physical basis of some kind, which leads me to believe some type of drug will eventually be found to cure it.
107
@Cal
"But the type of generational, chronic insomnia my family has and continues to suffer from has to have a genetic/physical basis of some kind, which leads me to believe some type of drug will eventually be found to cure it."
100% agree. For some people behavior and diet changes work (like Type 2 diabetes) but for others, including myself, there is some physical basis for insomnia (like Type 1 diabetes.) Even my very smart doctors buy into the sleep- hygiene-is-the-best solution mindset. I tried CBT-I (to make my doctor happy) and there was nothing there that I hadn't tried, except for sleep restriction, which I refused. Someday they will look at that concept as medieval and dangerous. He finally prescribed Belsomra which he feels doesn't have the long term problems of zolpiderm. I hope he's right, but sleep deprivation is awful and I think Belsomra helps. By the time they figure out it has awful side-effects, it won't matter to me!
5
Physical exercise is the best "drug" for sleep. We are animals that are biologically wired for much greater physical activity than most modern urban people get. Try long workouts and see how well you sleep.
11
I can exercise until I'm exhausted and this makes no difference in my sleep. As Cal said, intractable, chronic insomnia does not respond to the numerous remedies noted in the article and in the comments.
25
For occasional use the generic versions of Sominex and Benadryl always work for me although the similar ingredient in each has been implicated in one study I've read about causes of dementia. In my experience neither produce any of the bizarre effects of Ambien and its ilk, only drowsiness.
2
The headline would suggest an examination of the range of alternatives to prescription drugs to treat insomnia yet leaves a big gaping hole omitting any mention of herbs.
I have struggled with sleep for years, mostly due to an overactive mind. Meditation and yoga and body-centered practices that help me get out of my head have helped, and so have herbs. Melatonin, Valerian, Gaba, Ashwaganda, some combination of all of them.
So does exercise during the day and a wind-down routine at night - no digital screens, a warm shower, low light, a dark room, reading, a cool room, white noise (a fan and/or app - their are many that even remind you its time to wind down), chamomile tea, herbs as a pill or liquid (in the tea)...Omitting alcohol and not eating late or too much is important, too.
Generally evaluating how much you are doing in your life and asking if it is too much and too stressful is a good place to start. We are only capable of managing so much and generally overloaded. What can you scale back?
Though I think curing insomnia is more an art than a science, and does take a commitment to change how you do some things, most of all, do your best to not beat yourself up. Be gentle.
The first Brody article has a comment that reiterates some of the best advice I ever received. "Relax, don't fret, if you are awake at night that's no problem. Your body is at rest."
Good luck and good night!
12
I haven't seen anyone else mention this. Wherever guided meditation recordings are available, look for ones labeled Yoga Nidra for Sleep. These usually feature guiders with soothing voices set to a background of soft music with a slow rhythm. Yoga Nidra is a body scan practice in which you direct your awareness to different parts of your body for brief periods before moving on to the next, which turns out to be amazingly relaxing. I have never stayed awake through one of these recordings, and if I wake up in the night I simply repeat. Cheap or free, no side effects. A good pair of headphones helps.
8
@Mark
I listen to audio books, often titles I've heard/read before so I'm not too engaged in the plot. Currently I use a Kindle and set the timer for 30 minutes. Generally works like a charm as long as I like the narrator's voice. Recorded nature sounds don't work as well for me.
I agree with you, inexpensive and no side effects.
5
A teddy bear. Really. Look at a little kid who is soothed by a stuffed animal or doll. It is a little embarrassing to admit that I got a teddy bear - and it helps. Hold it close to your chest and do some steady, quiet, soothing breathing.
I've got ambien and tylenol pm. And a day with serious exercise helps, too. The teddy bear is a part of the mix.
11
@kbw What a great idea. Don't be embarrassed. I'm fortunate to have a sweet cat who likes to sleep with me and purrs in my ear until I'm fast asleep. Best sleep remedy ever!!
4
I find that there's nothing as effective as the droning voice of a non-fiction, preferably unexciting, audiobook, for getting to sleep. Listening to the narrative prevents your brain from circling around your personal problems, and at the same time after a few moments, your brain stops reaching for the meaning and just lets consciousness go. I hardly ever get to the end of the snooze period (usually 15 minutes before the narration stops) before actually falling asleep. Gardening books are great, as are biographies, or histories. House of Morgan was 30+ hours, and got me sleeping for over four months, lol.
18
@Lily, same here. God bless Audible.
6
As I have gotten older, I sometimes have trouble falling asleep. I am scared to death of Ambien and similar drugs, which affect the brain. Instead, I will frequently take a decongestant before bed, which seems to help.
1
@Mark Siegel if you mean an antihistamine, know that they are linked to vertigo
1
I do so dread waking up in the middle of the night, worrying and being plagued by those ugly twins, Remorse and Regret. I think many of us unfortunately subscribe to fears primarily of our own imaginations. As Michel de Montaigne once observed, “My life has been filled with terrible misfortunes, most of which never happened.”
37
Try enjoying a small bowl of cereal while on the computer viewing wallpaper and quilting material sites . . . it's never failed me.
4
I wonder how many Ambien were consumed before these bizarre night excursions? Because of this rare aberration my doctor will only prescribe 5mgs- which is pretty useless in getting a good night sleep. I've been an insomniac since i was a child and I can assure you that the accidents I've suffered because of lack of sleep are far more dangerous than an occasional sleeping pill.
32
@Marion Francoz
Agree. Ambient is nearly impossible to get these days because of the widely shared tales of strange events. However, for the vast majority of chronic insomniacs, it works. Living a life of deprived sleep is much worse than an extremely rare incident such as described in the article. Much more frequent is the driver who falls asleep at the wheel because his doctor refused to prescribe effective medication that has become taboo.
34
@Herman Villanova: I agree with you completely. My doctor made me swear never to take more than 5 mgs. It might have more to do with his medical insurance than with the patients well being.
13
@Marion Francoz
Same here with the sleep disorder. I always read these articles hoping for a new, earth shattering remedy. Very disappointed that once again, it is the same old, same old story. I, also, have had insomnia since childhood. I would be up half of the night counting lightning bolts, reading under the covers by flashlight, listening to old radio shows. I have been taking Ambien for yrs. It works at 12.5 mgs ER. 5 mgs is worthless. I gave it a go. I follow all the "sleep hygiene" practices. No phone/computer/tv in the bedroom which is only for sleep. No caffeine except in the morning. No food after 7p. Limit on liquids after 7p. No alcohol at all. Do not smoke. No health complaints. I am not plagued by deep dark thoughts, worries, responsibilities, financial concerns, time management issues and am retired. Yay. I love my awake life. I am active, involved in social activities, community service, environmental issues, hike, camp and stay well informed. Still I cannot sleep w/o Ambien. Insomnia is very real, can be very chronic and this article diminishes the extent to which it interferes with one's life. I envy those who can treat occasional sleep problems with some CBT, a cuppa herbal tea or a nice warm bath.
26
After decades of terrible sleep disturbance, I manage it with doctor-prescribed and monitored supplements: GABA, phosphatidyl serine, 5-HTP, and a proprietary supplement called Optizen 24 (probably enough by itself for most people) as well as Rescue Remedy Sleep Melts if needed. In the past I've also used valerian, hops, & a few other things. Drugs have generally only made me stupid or hungover or caused pain in my feet & have not helped me sleep; Ambien was a horror. (As my cousin's beloved husband was killed in an Ambien-sleep-driving accident, I can't believe it's still on the market.)
These things I take haven't completely solved the problem as it's severe, but they've helped a lot. I've learned that I cannot have any stimulants, as they have a delayed reaction in me - 1/2 cup of green tea may have no discernible effect at noon, but will keep me up the following night.
Pleasant dreams to you all!
2
Leg cramps?
Try a shot glass of pickle juice.
For me - works faster and more consistently than tonic water. And less liquid.
4
Yes, I tried the tonic water remedy for leg cramps, and sometimes it worked and sometimes it didn’t. Then I moved into phase II of my remedy research, to pursue and perfect what I wanted to believe. Through that process, I discovered that 8 oz. of tonic water contains approximately 22 grams of sugar (most brands use high-fructose corn syrup), 30 mg of sodium, 87 calories, and negligible quinine. Though diet tonic water has approximately 70 mg of sodium, zero sugar and zero calories, its flavor is made tolerable with artificial sweeteners, many of which have long been questionable (aspartame and saccharin). Natural tonic sweeteners are available, but can get expensive (stevia) or end up over-refined and just as high in fructose as regular sodas (agave syrups).
Lately, I find that long stretches before bed or during any wake-up periods have eliminated my cramping problems. It’s sodium/calorie/sugar-free, cheap, always available … and for now, I hold the belief it is working just fine.
1
Sour cherry juice or capsules. Give them a week or two, they help arthritis and naturally contain melatonin.
3
The author is correct about CBT-I: Cognitive Behaviorial Therapy for Insomnia works.
My guide is a CBT-I book called "End the Insomnia Struggle." The authors are Ehrenstrom and Brosse. The method they endorse is labor intensive. I had to read sections of the book a few times. You have to do homework and fill out a bunch of forms when you're getting started. This is all to help you understand that YOU, the Insomniac, have to change your ways. You've got a long-standing, miserable habit, and you won't cure yourself by saying a few incantations and crossing your fingers. I had to change my routine in some dramatic ways, but it was all for the better. I sleep now. As someone who's tried everything, and I do mean everything, I consider this a miracle.
6
Both the Mayo Clinic and Johns Hopkins argue that melatonin can help deal with insomnia and is especially good for minimizing jet lag. I used to have an intercontinental flight every two weeks or so and I found that melatonin was a life saver. It doesn't knock you out but it helps you to sleep more deeply once you do fall asleep
5
@ianstuart
I found melatonin and valerian root taken together work.
If I know I'm going to have trouble sleeping I take them an hour or so before going to bed. You can also get melatonin supplements that contain chamomile and other relaxing herbs.
Also, computer and phone screens emit a blue light that researchers find can effect peoples ability to sleep. They found that blue light suppresses melatonin more than any other type of light. Google: How blue light suppresses sleep. You can program many computers, laptops, phones etc to switch to a yellow emitting light at a certain time of the day or evening every day. I have mine switch 4 hours before my regular bedtime.
6
@ianstuart: Melatonin keeps me awake all night and depressed the following day.
6
Restless sleep has been a constant in my life for as long as I can remember. The only remedy which has always worked is to listen to Public Radio. Somehow the steady atonal delivery is perfect to take one's mind off whatever troubles it, and replace those thoughts with questions like . . .What is the latest pest to threaten sheep grazing in New Zealand. Within minutes, back to sleep ready to dream. IN very rare instances, a story can be riveting which captures my attention, but with the new technology (fast forward to the next story), problem solved. Also don't forget the earbuds so as not to disrupt your mate . . .
16
I’m surprised that you just learned about diet tonic water for eliminating leg cramps. I’ve been drinking some before bedtime for at least fifteen years. If you happen to get a leg cramp during the day a spoonful of mustard stops it immediately.
1
Breathe. Deeply. Again and again. Hold your breath at the "top" of the inhale for just an extra second or two.
Repeat. Again and again.
Not a cure-all, but surprisingly effective.
6
@Cary
For some of us, that results in a panic attack.
I have a quick manual fix for leg cramps, but you have to act fast: the minute you feel the cramp starting, pull back (up, not down) the big toe of the affected leg, fast and hard. Keep it pulled back. The cramp will be stalled. Not sure why, but it seems impossible to have a leg cramp while your big toe is pulled back hard. Even if the cramp has already started, pulling back the big toe sometimes helps ameliorate it quite a bit.
6
I have found three things that help:
Listening to the radio. I have a choice of various stations but prefer BBC International. There are others, some talk stations and one from New Zealand specifically for insomniacs, that plays mellow trance music.
CBD (cannibdinol) oil works well too. Just a few drops under the tongue before sleep. Its mostly legal or if not legal, widely available nowdays.
Deep, rythmic breathing combined with conscious body relaxation - from toes to tip of the head - also works. Its a kind of a meditation really.
5
I'm surprised that Jane Brody did not mention sleep apnea. I had insomnia for several years until I had a sleep study, was diagnosed with sleep apnea, and treated with CPAP. Now I sleep very well. If there are times I'm under a lot of stress and have trouble falling asleep because of worrying, a few drops of CBD/THC does the trick.
6
As I am reading this article I can't help but agree with most of these methods. Though I do not suffer from insomnia, I have days where I find myself just laying in bed trying to fall asleep. During these periods, I either lay there thinking or am on my phone. This also happens in the morning when I will lie in bed too tired to get up but not able to fall back asleep. Now, I will put on a ten minute timer and if I do not fall back asleep by then I will get up. This article has enlightened me in new ways to fall asleep and explained that there are different ways besides drugs to fall asleep faster. I will look into all of the points the article talks about, but I will focus on cognitive behavioral therapy.
2
In my experience, (as a lifelong sufferer of insomnia), herbal remedies, so-called "sleep hygiene", and cognitive behavioral therapy are as effective as snake oil was in the old days. I found old-fashioned biofeedback to be helpful in relaxing for a time, but that didn't last. The only thing that has given me any real, lasting relief is a tiny bit of zolpidem every night.
43
@Sydney Same here. I suffer from 2 chronic illnesses which have in common the symptom of chronic insomnia. It's caused my lesions in the sleep center of the brain and aggravated by chronic, widespread pain from arthritis and fibromyalgia. For years, the chronic pain was made tolerable with Tramadol but a few years ago every doctor recoiled in horror at the very idea of Tramadol because, you know, "the opiate crisis". Ditto for sleep meds, even though I have tried every one of the methods mentioned in the article, and more. CBT was useless, melatonin gave me nightmares, valerian was also ineffective as was deep breathing, meditation, giving up caffeine, etc. But the good news is I'm in constant pain and chronically sleep deprived...the drug-free way!
16
I do deep breathing; take five deep breaths, hold for five and exhale to the count of five. It relaxes me enough to drop off. For leg cramps I take one tab of magnesium glycinate 400. Stops the cramps and helps me to sleep through the night.
5
I had sleep problems for decades. In my case, I fell asleep easily but woke at 3 A.M. each morning without being able to fall asleep again.
I tried Lunesta and Ambien. Each made me feel groggy in the morning. I've been told by a physician that these two medications disrupt the natural sleep cycle.
I tried a sleep clinic. No finding of sleep apnea but I was prescribed Klonopin. This was only effective for a few days. It's not a safe drug anyway because it is addictive.
I tried sleep hygiene -- in bed at 10 each night. No electronic devices in the bedroom. Lots of exercise each day and meditation, as well as no eating before bedtime. Again, no relief.
There is a happy ending to my story. I was treated for a painful GI condition a couple of years ago. The gastroenterologist took a special interest in my insomnia. He told me that a lack of sleep affects pain perception, and he prescribed two medications off label to help me sleep. One was Seroquel -- a very low dose of 50 mg. per evening. The other was Mirtazapine, again, off-label at a very low dose of about 4 mg. per evening (i.e., splitting a 7 1/2 mg. tablet to get the 4 mg. )
This combination of two medications has allowed me to get 8 hours of restful sleep each evening without a groggy feeling in the morning. It's improved the quality of my life immensely over the past couple of years.
6
@Richard
NO KLONOPIN - NO - dangerous drug!!
3
@Richard
I was on Seroquel for insomnia. None of my doctors knew it can cause cataracts. I got them at a very young age after being on Seroquel.
1
For years I have taken Trazodone as a sleep aid, which is an off-label usage, but it just gently helps you fall asleep and wears off completely by morning with no after-effects or side effects at all.
8
I’ve recently learned it has side effects if taken long term...
I looked it up when it was tried for my mother, for anxiety and sleep issues. It just made her too lethargic, and increased her tendency toward low blood pressure. Reactions can be so different -- and especially for something like Trazodone, developed as an antidepressant but hardly ever used for that purpose.
@CatPerson
I was prescribed Trazodone and it gave me very strange unpleasant dreams--- not exactly nightmares but not a lot of fun either. Took me a little while to realize the Trazodone was the culprit. People have differing reactions to the same drug....in fact, I should say that twice to emphasize. People have differing reactions to the same drug....
4
I am finding the comments here to be infinitely more helpful than the article that spawned them. Hyland's???!!! Ms. Brody, homeopathic meds are bogus and are literally nothing but sugar pills.
As I have gotten older, I do suffer periodic bouts of sleeplessness. My various remedies, in no particular order, applied separately or together:
-Get exercise during the day (never before you sleep- that just wakes you up)
-Melatonin (not for everyone but effective for some)
-Read a REAL book with a low intensity book light
-hot bath before bed
-cool room
-banana (for potassium to combat leg cramps)
-slice of cheese before bedtime (helps induce sleepiness)
-small glass of coconut water (for the electrolytes to combat leg cramps)
-Make sure you are actually sleepy. If not, stay up and do a gentle activity (like reading or knitting) until you are
29
@Larry Schwartz. Of all the remedies I’ve seen here yours work. Not for all but most, along with relaxation breathing. Imagine that every time you exhale a little more tension runs out of you body through your feet leaving you more relaxed. Deep slow breaths and concentrate on relaxing not on other things. I can and do fall asleep within 2to 5 minutes.
4
Oh for goodness sake - eat a quarter of a gummy (about 2.5 mg of THC) and you'll sleep like a baby.
24
The biggest trigger of my insomnia is my snoring bedmate.
11
@AnnieEm
Earplugs!
3
@AnnieEm: Ear plugs are a blessing!
1
@AnnieEm
Hopefully you can convince your bedmate to get a sleep study to diagnose whether he has sleep apnea, in which case CPAP may help you both sleep better
6
My husband and I have suffered from insomnia for years. But since the legalization of pot we are doing much better. Edible pot will kick in about an hour after taking it and last for a good 6 or 7 hours. A bit of CBD with just a touch of THC to make it last does the trick for me without hallucinations or side effects. My husband takes more THC and doesn't suffer any hallucinations.
So far so good after 3 years.
17
@Lincat I am hoping and praying that NYS makes it legal....and soon!
Zolpidem works absolutely fine for me, it’s terrific, and provides me with a solid, peaceful 5 to 6 hours of wonderful reenergizing, restorative sleep.
I wake each morning with no after effects and it has no side effects for me.
If you do t have chronic insomnia you really can’t imagine how damaging a night or two can be to you health.
52
This may sound like a weird way of getting back to sleep but it works for me--most of the time. I have no trouble falling asleep but sometimes wake up after three or four hours and my mind races with worries. I tighten my muscles, both face and body, and tell myself to stop thinking. Usually I must do this a number of times--tightening and loosening my muscles--but most of the time it works. Told you it was strange.
13
@MH Not strange at all. My yoga teacher at the end of class would have us tighten just the legs and lower torso, then just the arms and upper torso, and finally say "squeeze your brain," which makes you squinch up your neck and facial muscles. It always made me drift off, so now if I wake up in the middle of the night and start ruminating, I do that sequence a couple times and it usually works.
I do that too. I discovered it in an ASMR sleep video which work for me
All the vitriol aimed at cognitive behavioral therapy might reflect some root causes of insomnia: anger, and the desire to avoid looking inward.
9
@Elizabeth Malloy
Not for me
It just plain didn’t work
3
@Elizabeth Malloy I think CBT-I, with its time-in-bed restrictions, sleep windows, challenging the self-talk, sleep consolidation, etc, means the user has to be very self-disciplined. It was super-hard for me to get through the program, but I was desperate. CBT-I has helped me tremendously. It would be so much easier just to pop a pill!
3
Leg cramps run in my family. Turns out we don't absorb magnesium well and taking magnesium (and potassium) supplements has markedly cut back on leg cramping. I was told my statins also interfere with magnesium absorption so had to increase the amount I take daily. I have all but eliminated cramps.
Consult with your doctor first!
2
Magnesium didn’t do a thing for my leg cramps but stopping drinking got rid of them totally.
3
With regard to the leg cramps portion of this article, I suffer them too. My own doctor recommended tonic water. The amount of quinine in tonic water is minuscule and far, far below what's considered toxic. At any rate, my doctor also recommended magnesium citrate supplements. One pill three times a day. The supplement, taken regularly, not only prevents leg cramps but promotes overall relaxation. It really helped me with my insomnia and it's not expensive.
5
Or as says our most-mellow-ever neighbor 77-year old Ed, "With the late-evening news I have a shot of brandy and a toke of herb, and I sleep like a baby."
One wonders whether the oft-admirable Ms. Brody or other health columnists here have ever tried same, or be permitted to recommend such in NYTimes.
18
Well, the writers of Big Little Lies did their homework!
From the FDA: "Known risks associated with use of quinine, in the absence of evidence of safety and efficacy of the drug for treatment or prevention of nocturnal leg cramps, outweigh any potential benefits for this unlabeled indication"
I'll note that Ms. Brody is not a doctor. So why is she pushing medical advice? Particularly, why is she pushing HARMFUL medical advice upon readers that trust this newspaper to publish facts?
Nevermind that the prescription drugs mentioned by Mrs. Brody are safely used by people worldwide everyday without any of the ludicrous side effects she reports others have had.
To blast Ambien, a safe medication, only to then recommend a solution that the FDA itself says causes more harm than good is just the latest irresponsible tripe to come from Mrs. Brody.
19
@James Stewart. I am a health professional (Nurse Practitioner who can prescribe medications). I agree with Ms. Brody’s suggestions to try tonic water and/or magnesium supplements. As far as Ambien, there are not black box warnings (the highest level warnings by the FDA) due to sleep walking, sleep driving, and other related activities. In addition, Ambien can be addictive. It is not a safe medication for many people.
7
@James Stewart
Do you work for PHARMA or just an individual drug company?
5
Thank you, Dr. Samantha of Rhode Island! As a life-long sufferer of insomnia (over 50 years) who routinely follows all the tenets of “good sleep hygiene “, I can truly attest to the fact that some people simply sleep very poorly. And I would like to stress that when used properly, medication can be your friend. None is meant to be used long term, because tolerance to the effects develops in short time. But we also know that not getting sleep over time puts us at risk for some serious medical conditions that can shorten lifespan and cause significant morbidity. It’s also important to look at the numbers of people who experience chronic pain over the course of their lives, and the myriad disabilities, caregiving responsibilities, and other medical and mental conditions that contribute. This is a serious condition with serious health consequences. Treatment is necessary for some over the course of their lives. Yet it is often still poorly understood and treated by many health care providers, and it can be frustrating to sufferers when treated as “drug seekers” or worse. I personally use various combinations of prescription and over-the-counter medications for short intervals followed by a “drug holiday “ where none is taken, with approval by my provider. This allows for me to experience increased effectiveness, and ultimately, relief. I agree that insomnia is a complex medical diagnosis, not to be taken lightly by the public, the medical providers, or health journalists.
19
Cranberry juice, the modern kind that is diluted with other juices, not sugar. One or two little juice glasses when needed. It's supposed to soothe the urinary tract, but it may do more, who knows? Most of the year, I like to have a fan blowing, bringing fresh air to my face. These are harmless things unless I would have a woman who resented the fan.
For 72 years I slept prone which impedes breathing. In 2016 I fractured my left humerus and the treatment mandated sleeping in a recliner for a few weeks. Now I am able to sleep on one side at least, which is better. But I don't recommend breaking an arm.
Many thanks to those who recognize that there is not one solution for all and that drugs and supplements dangerous for some are not dangerous for all. It's good to know I am not alone out here!
24
Everyone is different and as many people have commented, there are a wide range of issues related to sleep. To the extent that it may be helpful, here are some things that have worked well for me - recognizing that some of these may not work or appeal to everyone:
1) Yoga nidra. If you are not familiar it is an easy to learn relaxing meditation that anyone can do. It costs nothing and it is non-addictive. The more you practice it the more you learn - it's cool! I first tried guided yoga nidra options on YouTube to help me learn. A helpful tip: find a voice and style that is relaxing to you. Now that I've got the hang of it, instead of listening to a guided yoga nidra, I like to listen to Deva Premal and pair that with self led yoga nidra. In under 10 minutes, I am out and sleep really well.
2) Reading (but NOT anything on a screen, an actual book or magazine).
3) CBD. When you really need a nudge into sleep. (recognizing that this is a medicinal approach that is not for everyone!)
4) Edible marijuana candies or lozenges. If you are really really having trouble, one dose will send you off into dream land and you will get a great nights sleep. (again, recognizing that this is a medicinal approach that is not for everyone!)
10
I have a prescription for Trazodone for my inability to maintain sleep throughout the night. I Used to take Ambien but as you know it’s habit forming and can have some nasty side effects.
Trazodone seems to quite my subconscious so I can get a good night sleep. If taken during the day it’s considered an anti depressant but I’m not depressed; I just take it at night. I’m lucky to have a supportive physician who let me “experiment” with different sleep meds before finding the right one.
I travel to Asia regularly so I also maintain my prescription for Ambien only to combat jet lag. On a 17 hour flight from Singapore to San Francisco it’s nice to pop a 10mg Ambien and lose about 8 hours.
2
@Democritus
I second Trazodone and I wonder why it’s not used more widely. I’ve been using it for over 20 years. It doesn’t work for everybody, but it has no side effects and it’s not addictive.
8
@Kati Rader
That's not true re side effects. I tried it for a couple of weeks and had priapism. It is a stated side effect of trazadone but my doctor had never heard of it.
@Democritus
Trazodone has made a huge difference in my life. I have been taking it nightly for a decade now. I get 6-8 hours of great sleep and I wake up without drowsiness, and it's not habit-forming. I know some people can't take it, but I am very lucky that it works for me.
2
1) Older folks should accept that likely they will sleep in 3 to 4-hour spurts and this is normal, 2) Use short wake time to distract yourself with a book or writing a letter, and 3) eat a cookie with warm milk. You will not need insomnia drugs.
7
I generally like Ms. Brody's articles and have learned plenty over the years. However, this insomnia article leaves me incredibly dissatisfied. Did you speak with a few people who actually have long term insomnia? Honestly, the examples cited are pretty simplistic.
As one can see from the comments, it's a complex problem. The trite answers from the medical professionals interviewed are so high level as to be just about useless. For someone who has suffered from insomnia that appeared just before menopause, I have learned that physicians know very little about sleep. Good sleep hygiene - been doing that since childhood, apnea - don't have that, sleep-restriction therapy - how does that help when you are waking at 4am and can't sleep at all during the day, CBT - Hopkins charges $5K, it's not covered by insurance, and really this is just somebody's idea of common sense.
Actual sleep meds didn't work for me at all so I have had to cobble together my own program through 7 years of many visits to all sorts of medical professionals and my own trial and error:
- magnesium, calcium, & potassium in pm (btw this eliminates cramps too)
- oral prescription Progesterone in pm
- ashwaganda, holy basil and gotu kola in pm
- proteolytic enzymes in pm
- Fisher-Wallace Stimulator in morning (FDA approved for insomnia, depression & anxiety)
- bacopa & ashwaganda in am
Also still need the occasional .25mg of Ativan or 12.5 of Atarax to get to sleep. Not ideal, but sleep is essential.
8
Two words: facial massage. It works best after a tense day and sleep is elusive. Using my knuckles, I press and roll them along the jawline and the cheekbone areas, where the muscles are usually stiff. As the same time, I focus on slowing down my breathing as well. Try it now, and you'll probably notice that your facial muscles feel tight.
3
"Although extreme reactions to these sleep drugs are thought to be uncommon ..."
And what does the word "uncommon" mean here? One in 10? One in 1000? One in a million? We are left in the dark.
10
Some of these are proven strategies for dealing with insomnia. Others such as quinine for leg cramps and the Homeopathic remedy Hyland leg cramps are not evidence based. The author should be more careful about recommending personal nostrums in an article like this from a major news outlet!
17
As an aside...
This article has generated many helpful comments!
My guess is we'll all sleep better after being reminded that kind and generous people abound!
14
Any parent will tell you there's no sleep aid like knowing your kids are doing ok, and no disruptor like the suspicion that they are not.
18
@K Yates
Oh God yes. This should be the top comment. Some of us slept fine until kids, then never again.
5
I'm trying to wean off cannabis for sleep, mainly because it effects short term memory and it inhibits the ability to dream and to remember dreams. As a transition I'm using an FDA approved device called cranial electrotherapy stimulation. It is helping.
2
How does melatonin fair as a sleep aid?
7
@426131
My partner uses it a couple times a week. It definitely helps.
2
@426131 You can look it up, but I have read that melatonin is not a sleep aid. What I believe it does is prepare the body for sleep - signals that it's time to start shutting systems down for rest. For that reason, it's very useful for jet lag & resetting the sleep clock. But it won't help you actually sleep. For me, it does little, & if I get too much my head feels like it'll explode, so I usually avoid it.
1
@SH
For you it does little? That is NOT evidence for "...it won't actually help you sleep."
You can look it up: for many people, melatonin IS a sleep aid. My spouse swears by it--and not to "prepare the body for sleep"; she only takes it in the middle of the night after waking and having trouble falling back to sleep. And she's never had a hangover from it.
Everybody's different, SH. Hence the wide variety of solutions in this comment section.
5
I listen to podcasts with earphones on when sleep eludes me. Someone with a soothing voice is especially effective. Kinda like hearing a bedtime story and works most of the time.
11
For the 'hard to get to sleep' people. When you decide 'I must now go to sleep', try to put your mental focus on one memorable and happy event in your life and the joys it brought you. Stay focused on that memory and, before long, you will fall asleep with your good memory.
3
You need to stop the sleep shaming until you have walked in the world of insomnia.
181
Hear hear. It's astonishing to read how many people say, do this, and you will...
No, YOU will! I have a different body & brain chemistry!
33
I use alcohol as a mild hypnotic before bed. Rarely fails.
Scold me, insomniacs.
6
A quick toke of indica before bed does the trick for me.
3
@Freshpavement
Has the opposite effect on me.
2
I suspect Jane Brody has no real idea what insomnia is like. Why is most of the article consist of an attack on helpful prescription medications and only small part offers simplistic, useless and well known suggestions. This is a complex problem that needs serious attention. Expected more from Brody.
77
ASMR videos really help with insomnia. I don’t even look at the screen- just put on my headphones and drift off.
3
Of course everyone is different but I find a white noise machine very helpful. It blocks out all external sounds (house creaks, birds, crickets, etc) and helps keep you asleep. Just make sure you get one that doesn't repeat on a loop. The Lectrofan is a good one.
If I do wake up, I find deep breathing to be helpful. Four seconds in, hold for eight and exhale for seven. Do that maybe 15 times.
9
While I haven't read every comment I've seen no mention of a white noise machine. I turn it on next to me last thing before I go to sleep. It does a pretty effective job of canceling out other noises (e.g., snoring) and when I wake in the middle of the night with anxious thoughts it helps greatly to focus on the purr of the white noise. Non-addictive and under 50 bucks on Amazon.
9
@Judy
I have one too and I find it very helpful, especially when I'm travelling.
I love this column. In the early 1980's, when I was active in the New York County Medical Society, we gave her an award for this kind of writing.
Re quinine water: when I was an intern at St. Luke's Hospital we used to Rx quinine for leg cramps. It was removed from the formulary of all US hospitals because of a rare allergic reaction, I believe, in India. Let's bring it back.
5
Brody mentions Hyland's Leg Cramps but fails to mention Hyland's Calms Forte and Hyland's Sleep. Like meditation, I've found that Calms Forte doesn't induce sleep, but it helps shut down the mind. More important, unlike meditation the effect lasts about 6 hours which makes it possible to fall back to sleep if you wake up in the middle of the night. As for Hyland's Sleep, its a powerful herbal sleeping pill. The bottle says take up to three, but for me a quarter of one brings on a full night's sleep with only a minimum of morning grogginess. Ironically, while I live in Wisconsin I was introduced to Hyland products at C. O. Bigelow in New York's Greenwich Village.
I enjoy your columns very much. However, you recommend an herbal preparation, Hyland's, without also recommending that folks speak with a Pharmacist first before taking it. Some of the herbal ingredients in Hyland's may cause adverse side effects on their own, or when taken in conjunction with prescription medications. Many herbals are not benign. Gingko biloba, for example, can cause bleeding, and so should not be taken by anyone on a blood thinner. Pharmacists have access to a large database of herbal preparations. It's prudent to always suggest consulting with one before starting an herbal.
12
Self medication is a fact of life. So is distress. So is quack medicine. Sleep better if you can learn to distinguish web clutter from credible medical information, and if you can’t, ask a pharmacist. Jane’s anecdotes may not represent the best balance of opinion and evidence. (Wasn’t that a polite way to say it?)
11
I know this will sound strange, but my husband’s and my bedtime routine is to stop watching our daily dose of the MSNBC political shows halfway through Brian Williams’ The Eleventh Hour and switch to The Late Show with Stephen Colbert. After the first few jokes about Trump, my body relaxes and I fall asleep.
Of course I used to sleep better before the 2016 election and when Letterman was still on. His show was the best relaxant for me.
To respond to a comment about trying a mantra, when I wake during the night I often try the mantra of counting back from 99 to 0. A few of these often wipes out other intrusive thoughts.
17
@Barbara
I too have Brian Williams as part of my sleep routine! However, I find him so calm and relaxing, I sometimes don't get to the end of the show.
Sometimes issues on MSNBC are so agitating though!
8
NY Times is at it again. Addresses a very important health issue and then at best presents incomplete information. Effective sleep is critical to health. That has been well established by many studies. The problem is likely being exacerbated by poor diet and blue-light exposure that disrupt hormones. There are several excellent books to read including Mathew Walker's "Why We Sleep" and Ariana Huffington's "The Sleep Revolution." I highly recommend both but there are others including Satchin Panmda's "Circadian Code." NYT PLEASE do a comprehensive magazine style article on this topic and seek out these resources. There is great health benefit to be obtained by often costless interventions.
13
These articles never include noise (e.g., from construction or the street) and/or rude near-by neighbors as the source of sleep deprivation/interruption. Love the comment below about getting physical activity in each day, too!
5
I have had insomnia problems since childhood, and have devised various strategies for dealing with it. Getting a good night's sleep is very important to me. Exercise helps a lot. If I ingest a dose of pot (edible) in the early evening, I easily fall asleep, and generally sleep through the night. Otherwise, if I wake up in the middle of the night and can't fall back to sleep in a half hour, I take a shot of whiskey (no more, no less), which puts me to sleep for the rest of the night. None of the drugs normally prescribed for sleep are any more effective for me, and have side effects I don't like.
5
@David Be careful with the edible pot. I ate one square of pot-infused chocolate, and had such a horrible reaction that I would have gone to the ER if I hadn't been embarrassed about "grandma overdosing on pot."
4
On occasions when I can’t fall asleep, an audiobook does the trick. Quite a few people have shared this remedy. I started listening to the audiobooks for sleep not to fall asleep but when I had constant shooting pain during the night which would keep me awake for hours. Listening helped me relax as I would concentrate on the story and ultimately be able to rest and then sleep.
8
I've learned that sleep is unbelievably important (the mental and physical health benefits are incredible), and Americans are not getting nearly enough. Our great-grandparents slept an average of something like 9 or 10 hours a night, and they were far healthier and happier than we are. This article is a good start. Here's what I've found that has helped (and I used to have real difficulty sleeping). Getting off screens and reading a physical book (while not sitting in bed) at least an hour before bedtime. Going to bed early and at the same time each night. Exercising (usually lifting weights or walking) at least 25 minutes each day to get my heart-rate up. Keeping the room very cool and very dark. Sleeping with multiple fans. Having enough covers on me so it feels a little heavy. Getting off of a beta-blocker. Using a micro-dose of melatonin. Putting a little lavender oil (essential oils or similar) under my nose and in a small diffuser by my bed. All these things together have worked wonders.
8
@Jeff These are all good ideas for leading a healthier and more balanced life. I'd do all of them if I had more discipline.
I must take exception to one point. Our grandparents were most certainly not far healthier than we are. Average life expectancy of a newborn around the year 1900 was just under 50 years. Today it is over 76. All-cause mortality declined by 54% since then. We are healthier now, despite popular belief.
Happiness is a more personal decision.
9
@Jonathan Hutter Yes, if you're evaluating health by how long we live, you're right, modern medicine (and just basic hygiene) has increased the number of years we live in a huge way. And I thank God that we live in a time when medical advances have made that the case. Good point. But, compared to previous generations--on average, we're less happy and more depressed, we're lonelier and more isolated, we're more obese, we're less active, we eat a massive amount of processed stuff that shouldn't even be called food, we sleep less, we have fewer ties to our families and communities, and the list goes on. That's what I was thinking of.
4
@Jeff Our great-grandparents slept an average of something like 9 or 10 hours a night, and they were far healthier and happier than we are.
Nope, they were not. There lives were hard, dirt poor (to include housing that had packed dirt floors and no plumbing), and many lead unhealthy lives too. They were in the old country, starving and had to send their kids to America to eat.
9
How ironic that in recommending treatment for insomnia, one of Jane Brody’s solution for nocturnal leg cramps is to recommend a strong drug - quinine. Quinine is very much an ototoxic drug. Consumed on a regular basis, even in tonic water, it can cause persistent tinnitus and lead to permanent hearing loss. Not exactly something conducive to a good night’s sleep.
12
One more: use a red-light flashlight and amber/neon nightlights when you wander around the house in the middle of the night.
4
Pushing 80 - here's my remedy: Make sure to get exercise, eat an early and light supper, read a book or watch a dvd, then take 2.5 - 5 mg. melatonin. And use a sleep mask to hide any light that's hanging around. Result: zzzzzzzz.
As for the FDA finally requiring boxed warnings on the drugs mentioned - the agency is usually about five years later than it should be requiring warning labels, so they should be taken seriously.
4
@Ellen
I'm 81. Here's my take:
Exercise: definitely
Early and light supper: definitely
Read a book: yes
Watch a dvd: maybe (late screens can be a problem.
Melatonin: If you do the above, you probably don't need this.
Sleep mask: No. A dark, cool room is way better.
3
I have found that what and how I eat makes a dramatic difference in sleep quality. Eating before bedtime as well as eating excess carbs and/or alcohol are sleep destroyers. Since adopting low carb eating combined with intermittent fasting (often just one meal a day) I have found that my insomnia and sleep disturbances have been vanquished as well as overall improvements in overall well-being.
6
Hot milk before bedtime. I'd long known that hot milk induces sleep. But now I'm finding it preserves sleep. I'd also stopped drinking tea in the evening because my wife, a physician, said tea was a diuretic (I'll let readers de-construct the term and project the consequences). And my oldest son at home finally moved out. So my wife's dog adopted me and is allowed to sleep inside my bedroom rather than outside my son's door. So no more howling-at-the-moon events 4x/night. 3 factors. I think the hot milk at bedtime is the most effective.
7
Want to fall asleep? Read this article a few times, that should do the trick.
Actually, there was a sleeping medication available in the '70s, Quaalude, that was very effective. Problem was that folks quickly realized that by fighting the urge to sleep, it produced a very pleasant high. But when Playboy magazine declared Quaaludes the 'downer of the decade, it got the Feds attention. And when car accidents rose, it got the attention of the Insurance companies. Roer, the drug manufacturer sold the drug to Lemmon and soon after, it was RIP for Quaaludes and hello to a far more dangerous drug, addictive barbiturates. Go figure.
9
"Although extreme reactions to these sleep drugs are thought to be uncommon..."
I'm not sure they're that uncommon. Once, I took an ambien and, at some point during the night, got up & turned on the bath water. The damage to my apt cost me about $10,000. More than half of the people I told about it had similar (but less costly) experiences. I was lucky I had renter's insurance which covered the damage to the two apartments below me.
Ambien should be banned.
4
@bu "banned" is a strong word. this is the only thing I have found to help me sleep after dealing with insomnia for 20 years. Not everyone has the same experience.
12
@bu I have been using Ambien for 12 years. I take 5mg at night - absolutely no side effects.
17
@bu Sorry you had a bad time, but it worked great for me. And others, as a temporary measure
8
I struggled with terrible insomnia for nearly two years. I finally came to understand that the drugs used to treat insomnia can in fact exacerbate it if used too long. For example, I was using an OTC sleep aid made by Tylenol but without the tylenol. After a few weeks it was waking me up at around 2:30 am and causing manic thoughts. It took me months to figure out it was the drug doing this. Once I stopped it I regained normal sleep.
1
Most of my life I could sleep just about any time or any place, on a train or in a plane. When I was a teenager living at home and Mother said Supper in ten minutes, I'd say Will you wake me up?, lie down on the couch with the TV going for Brother and be off to sleep.
That's changed with age. I took 1mg of melatonin for a while, but quit that a couple of years ago. I usually still sleep well, but if I don't I try to have no thoughts at all. If a thought does pop up, I think No thoughts. Or I spell increasingly longer words backwards in my head. If I really can't sleep, I'll read. A real book, not a screen.
I agree with another commenter that both the current political climate and impending climate chaos are disturbers of sleep. I'm very fearful, not for myself personally--I've already had more than my share of a full life--but for the grandkids. Their future looms horrifyingly. So I make these comments, donate what I can to worthwhile causes, write my reps, recycle, etc.
For those with insomnia, I sympathize and wish you success on your journey to find healing and restorative rest. It makes all the difference. Sweet dreams.
25
CBT? Really? Only a therapist would suggest that for insomnia, which can be overpowering.
One has to be careful about caffeine intake and when you have it. I have to cut off consumption at noon, because it takes up to twelve hours for coffee caffeine to clear my system. A bit less if it's from tea or chocolate.
Zaleplon is inconsistent, but sometimes works well. Restoril (temazepam) is fairly reliable. Ambien destroyed my short-term memory. What I rely on now is Mirapex for restless-leg syndrome, with 6 mg of melatonin, and one capsule of 5-htp, which is the single most helpful remedy. I used to take quinine capsules every night, which controlled the RLS very well, until the FDA took them off the market. Tonic water is not strong enough for me. Hyland's product does nothing. I'm not sure it actually contains any quinine because homeopathic remedies generally only contain the suggestion of the active ingredient.
2
Am unable to sleep without sleep medication since heart attack at age 44. Learned meditation and mindfulness to relax as part of rehab. With age comes other health issues which keep me awake. Also, city noises make it necessary to wear ear plugs to block ambient noise. It is a constant din of sound (airplanes fly nearby too). But keeping to a sleep routine does help.
I have been using a form of cognitive behavioral therapy almost every night for as long as I remember. I imagine myself in fictional/fantasy situations in which pleasant things of my choosing happen to me. An easy one would be what would I do if I won the Powerball. It diverts my attention from the trials and tribulations of daily life that otherwise might get between me and falling asleep. Who knows, one of these might result in working out a plot for a bestselling novel - another fantasy situation to consider. Be creative. Anything you want can happen.
11
@Charlie Porters
I think of puppies and kittens until I relax a bit, then count backwards from 10 again and again, a technique I learned in meditation 1A. Exercise, light supper and ending alcohol consumption hours before bed have also helped.
1
I was very interested in Jane Brody's advice about drinking 8 oz. of diet tonic (containing quinine) either before bed or at dinner to help with night time muscle cramps. The conventional wisdom on the internet is that such a small amount of quinine cannot have any effect on muscle cramps. And it is known that large amounts of quinine can be dangerous.
However, I started mixing some diet tonic with plain seltzer several times a day for my leg cramps. In addition, at the advice of my PCP, I also started taking 250 mg. of magnesium with dinner. Between these two things, my muscle cramps which were quite frequent have become very rare.
Of course, none of these will help with the many other causes of insomnia, which fortunately I do not have, and it is impossible to know which works, but at least together they seem to have mostly relieved my waking up at 4 AM in excruciating pain.
4
It's unfortunately not a solution but using audio books makes nighttime waking less frustrating for me. I fall asleep listening to an audio book every night (book on my phone, use the sleep feature to stop its playing after a designated number of minutes).
I fall asleep within a minute or two after going to bed and sleep soundly for about 4 hours, but then wake several times before morning. Every time I wake up, I restart the audio book, and listening to it keeps my brain from the hamster/wheel routine; I fall asleep again within a minute or two. Still feel exhausted in the morning, but at least I'm not lying awake tormented by not being able to fall back to sleep at 2:00 and 3:00 and 4:00 . . .
I keep a vade mecum nonfiction book on my phone all the time for the more recalcitrant wakenings. : )
10
Me too - I’ve been listening to audiobooks for 30 years to redirect my brain at bedtime; used to be expert at repairing the library’s cassette tapes.
8
During baseball season, nothing beats the radio call of a night game, heard on a pillow speaker.
5
@Lorem Ipsum
Baseball on the radio always reminds me of summertimes long past.
Ms. Brody:
If pain from a chronic condition is the problem that prevents sleep and opioids are the only way to effectively treat the pain, would your expert medical sources prefer Ambien or more opioids for a long term solution to inability to sleep?
4
@glee102
There are better medications for this situation than either one you mention.
A sedating serotonin-norepinephrine reuptake inhibitor like amitriptyline is a good analgesic which, unlike opioids, don't disrupt normal sleep architecture, and continue to provide benefits long after the sedative effects of any of the Z drugs disappear.
3
A couple of drops of full-spectrum CBD, a great deal of exercise each day and a positive attitude seems to do the trick.
Even though I have OSA, I refuse to let it get the best of me. Each person has to find what works for them. My suggestion: stay away from prescribed sleep aids and find another, healthier way.
5
Exercise is key - a long walk, jog, or whatever gets you outdoors. We also find that, since 2016, not watching or reading the news late in the day helps tremendously. We also avoid intense TV shows. We are sleeping a lot better!
24
Another no-drug alternative is to sleep in a room that is completely dark and quiet, and free from interruptions.
If that's impossible then use a comfortable sleep mask and silicon earplugs (available at most hardware and drug stores). Avoid squeezable foam earplugs as those pass low frequencies (because they are meant for work environments where people are expected to talk to each other). For best adhesion, clean the wax off the plugs and your ear canal at bedtime.
For environments with high ambient noise (such as a hotel, hospital, dorm room or homeless shelter), cover the earplugs with headphones and play white noise (hiss) at low levels. Earplugs reduce sound pressure at your eardrum, and white noise confuses your brain so that it doesn't recognize sounds, such as spoken words. Use the 30 minute sleep function on your MP3 player so that the hiss shuts off after you fall asleep. I ripped my hiss off a YouTube video and made a MP3 file out of it (note that hiss is not a copyrightable work, as it does not have any original content).
3
Same old tired blather about insomnia - not one new thought here. I'm a lifelong insomniac who knows all about 'sleep hygiene ' and CBT. Thought if it was worthy of a New York Times article there would be something new....
217
@Nancy G My thoughts exactly! Not a thing in this article that I haven't heard and practiced for some 40+ years.
But hope does spring eternal, doesn't it? Still read this article really hoping that there might be something new that could help alleviate the daily routine of waking up exhausted. Nope.
64
@Nancy G
Agree. If you can fix the problem with a cold dark room, crackers, an audio book or 'clearing your mind,' you don't have chronic insomnia.
Psychotherapy, sleep therapist, sleeping pills, marijuana, melatonin, ear plugs, you name it. It didn't work. I've slept 3 -4 hours a night for years. It's h -e- l - l.
17
@AlwaysAsk
To Nancy G and AlwaysAsk:
Not everyone is a lifetime insomniac who knows everything about sleep problems and solutions. This article might be helpful to many people.
14
I discovered a method of going to sleep which is infallible for me: extremely boring mantras. We think of a mantra as a repeated subvocalized phrase, but they may include visual or auditory elements. I have found that if I can force my mind to do no thing other than repeat a boring mantra, the resulting boredom invariably induces sleep. It's hard work, forcing sleep -- the mind fights fiercely against boredom, but I can invariably go to sleep in less than five minutes, even starting from a perfect snit. Nonsense syllables will work as the mantra.
5
Don’t forget to get outside daily. Sunshine helps set your clock. I like to include dusk, but dawn is okay for others. Ideally, get into a green space, as city streets tend to rev people up.
8
Quinine is a drug. And many people are or will become allergic to it after repeated use. This is utterly irresponsible. My mother was hospitalized and almost died after a quinine prescription written by her doctor was at first unrecognized as the cause of her life threatening reaction (she had an anaphylactic reaction to a gin and tonic later on as well). Have a doctor pass on Jane Brody columns in the future.
8
So far, no comments about valerian. I (briefly) had a Russian immigrant doctor who gave the stuff a personal recommendation, so I tried it. Couldn’t tell if it had any effect on sleep, but my cat tried to bite my lips off.
Anyhoo, folks, the comments are at least as useful as Jane’s article this time, and I hope some of these suggestions are helpful.
9
A totally, completely, comprehensively unhelpful article that belies its headline. Brody tells what doesn't work but nothing about what, in the absence of the sleep drugs she disavows, actually works. That's the culture of sleep specialists who generally have no solution other than what used to be deemed snake oil.
107
@Golem18
Try reading the whole article. The last 6 or 7 paragraphs are all about nondrug habits and therapies.
2
Three letters: CBD
17
@Steve which is a drug...
4
Not just a drug - the Elon Musk of drugs!
2
My bedroom is my man cave. I am in there all day with books, iPad, iPhone, Kindle and read constantly. I go right to sleep at 8:30, pee at 12 or 1 go right back to sleep until six. I also have been retired for 25 years so there is minimal stress in my life. I never get up if I can’t get to sleep I try to focus on not thinking. Not working is the key.
5
Does anyone find that motherhood affects their sleep? My kids are 7 and 4. So, they don't wake up nightly like they used too, but my brain is finely attuned to their every whimper and cough. Even with our white noise machine I hear it all. And when they do wake up in the middle of the night, my husband sleeps through the entire episode. I really think motherhood makes my sleep less deep and that I wake up more easily.
58
There are so many excellent recommendations in the comments. Things that work for others may work for us and may not, however, we should be careful to not judge others for how they choose to tackle very difficult problems in their lives.
Insomnia is one of the more challenging and intransigent issues that someone can deal with in life as it makes everything harder and can seem endless and incurable. I encourage everyone here to be grateful if you've found a way to address yours and to be compassionate to others who are struggling.
Also, if you are experimenting with any of the solutions offered here or elsewhere, take care to follow the plan with fidelity for at least two or three weeks--provided no significant adverse effects present--before rendering judgment about its efficacy. If you don't see something through then you may have prematurely removed something from the list that could work for you and it may be years before you try it again.
16
I use magnesium citrate every night before bed. It’s calming and provides needed nutrients. Melatonin led to constipation but magnesium citrate actually makes it easier to go. The only negative is the giant size of the pills. Not sure why they have to be so large but I’ve learned to take one at a time. I take 2 pills, 500 mg and sleep well.
@KY Katie
Thank you so much! Magnesium is also recommendef for RLS (restless leg syndrome) which I have. I am going to get the magnesium pills immediately!
I bought a nook: no blue light. When I can't sleep, I turn over and read without having to turn on a light. It helps my mind to focus and usually makes me sleepy. OTOH I have read a lot of books that way.
First of all, nothing new about any of this. Guidelines dating back at least 15 years made the same recommendations Ms. Brody cites in the article. All said non-pharmacologic management was the way to go and no sleep med has ever been shown to have long germ efficacy.
Although Ms. Brody highlights problems associated with the use of the Z-drugs, it is worth mentioning the worse problems associated with the use of the benzodiazepines which are still frequently prescribed for sleep despite repeated studies showing they are more likely to make sleep worse than better and are highly addictive.
Finally, with regard to cases like the Georgia woman going the wrong way. It is true that the Z-drugs can cause some activities for which the person is amnestic, every case of serious, potentially life threatening behavior of which I have heard has involved the person taking the drug shortly before the behavior. Every drug carries the warning that they should be only taken when the person is ready to lie down for a full night's sleep. Unfortunately, people often take these drugs and think they have at least an hour to do other things such as drive to a store before the drug kicks in with resultant accidents.
16
I’ve suffered from insomnia off and on for years. All those non-medical interventions work—if you can completely control your schedule, your food intake, avoid stress, etc etc.
The problem is other people! They thwart my efforts to Follow all these protocols. These 20-somethings & their late night dinners; these airlines & their early flights; and children constantly mess it all up. And don’t get me started on the neighbors.
I’m guessing that this is why most people fail to do all those things were supposed to do to enhance sleep.
12
@MaryC
What has helped in situations like you describe (which can indeed be frustrating) is developing, over time, an attitude that the noises and happenings are evidence of the richness of life around us rather than mere irritations.
Unfortunately, this doesn't make them go away. But "reframing the situation" and turning it into a positive eases its impact on the nerves. This takes practice, as do most things worth doing.
Please know that I wish you well. ....and I love Nashville!
5
@W. H. Post
My post was ironic. I enjoy my family and pals...and accept the usefulness of the occasional sleeping pill.
Glad you like Nashville!
30 years ago my immigrant wife told me the bedroom is only for reading, sleeping and sex. No TV, which I assumed was because she didn’t have electricity growing up. As a result, I don’t go in the bedroom except when I’m exhausted or hopeful. In either situation, I sleep like a baby. I have friends that take ambien almost every night because they have sleep issues and, yet, they still rarely get a decent sleep. When they do, they credit the drug. It makes no sense.
16
@Billy Bobby- I used to take z drugs every night, but I learned that if I don't sleep well, I will the next night. You cannot take z drugs every night as they lose thier effectivness. Now i only take them if I need to get up for a flight, or my mind feels like a washing machine. It helps if you don't need to get up for work everyday, as you stress about the time and hours slept. I have a dog who wakes me like an alarm, but I can always tell him I'm tired and I need more sleep.
One word: Melatonin.
It’s already what your brain uses to regulate REM sleep, it’s sold over-the-counter, and it doesn’t typically result in episodic sleep-driving.
11
@ubique I would have liked to see Ms. Brody discuss the effectiveness of melatonin and any potential (long-term) effects from using it.
10
Unfortunately melatonin is not an option for people with certain kinds of autoimmune issues. Melatonin can overstimulate your body's immune system, so it's not a viable option for me.
5
I’ve been taking 5 mg of melatonin every night 30 minutes or so before bedtime for twenty years and it works like a charm.
Melatonin is a hormone; babies produce a lot of it (that’s why they sleep so much). We produce less as we grow older.
I take my pills, get a good book, get in bed and read until my body tells me to turn the light off.
3
HEY!!!! Weighted. Blanket.
My husband and I bought one over a year ago and having been raving about it ever since. He runs rather “hot” but for some reason the blanket doesn’t trap heat. It’s filled with tiny glass beads. Doesn’t work for everybody, apparently, but if you think you’d be happy with the weight it would probably work.
Our smartwatch sleep charts are so deep blue now. Occasionally I’ll have a weird wakeful night but not nearly so many as before.
8
Sleep restriction therapy described here was confusing. Could you re-state it? Set the alarm for 7am and stay in bed even if you wake at 5am?
3
@anonymouse NO! It should be called time-in-bed restriction. If you set the alarm for 7 am and wake up at 5:00 am, you get out of bed after 10-20 minutes of no sleep. And you stay out of bed.
2
I was plagued for many years with insomnia. I am now sleeping like a normal person after using alternative means: scheduling an herbal/melatonin supplement so that it is reduced over time; receiving acupuncture treatments for insomnia, which actually change the brain cells; working on emotional issues such as FEAR, which drives so many of our problems in life. This all coupled, of course, with the physical setups you must do: a dark room, no devices, diet, creating that "sacred space" for sleep; and realizing that sleep is where we are reinvented and connect with the higher part of ourselves. You have to work at it.
5
I use chamomile tea (strong) and sometimes CBD a couple of hours before bedtime. Either one works like a charm.
4
Strange that not one word about deep breathing exercises and sleep. If you are able, physically, to do deep breathing exercises, it can take up to 15 to put you to sleep. I use
this all the time. The same deep breathing exercises can
bring down blood pressure as well.
25
@Becky Saul
Yup! Related to this I've recently discovered Yoga Nidra. It helps me fall asleep in 10-15 minutes. I've also noticed that its deeper sleep and I wake up more refreshed. Wish I had known about it earlier!
2
My funny quip: going by the sleepyheads that I see in my math classes, I, an academic, often joke that after retirement, I will sell audios and videos of my lectures, marketing them as harmless sleeping pills and get rich that way!
But seriously, I find that thinking too deeply about (math) problems in bed ruin my sleep. Also as a senior citizen, more frequent than normal bathroom trips that do not end quickly at night also do me in.
12
Interesting that this column recommends quinine for leg cramps, then links to an article that specifically says the FDA does not recommend quinine for leg cramps.
11
Any sleep experts care to comment? I fall asleep easily each night and sleep deeply for exactly four hours. I am refreshed and wide awake, so usually read for 2 hours and sleep another 1-2 hours. This started about 3 years ago and I figured it was part of aging. Because I telecommute, most days I can take a nap if I want. I guess for me, it's the new normal.
13
@Eli You seem to be experiencing biphasic sleep. If you Google "first sleep" you'll see that two-phase sleep was fairly common in the past. Learning that this sleep pattern isn't unusual or new might help people who worry that their sleep pattern is unhealthy.
29
@Elizabeth A
Thanks! I worry about this kind of thing and have to address more important issues in the 15 minutes I get with my primary care. I am lucky to telecommute where if I miss a call or email because I am napping, I can say I was in a meeting.
1
@Eli If I get on the internet when I wake at 4am (I know, I know) will see postings from many of my female friends who are also up. I usually fix myself a cup of Sleepytime Extra tea and a slice of buttered toast. Read for an hour or do some light housework then go back to sleep for another 4 hours. For me the trick is to get back to sleep within 2 hours. If I stay up longer it doesn't matter how much sleep I get. I'm dragging the rest of the day.
I suffered from chronic insomnia after my daughter was born and it lasted for 11 months. I tried everything, researched like crazy and spent so much time stressing out over how little sleep I was getting that I was making myself miserable. One thing the article doesn't mention is an unintended consequence to sleep meds in that it becomes your crutch and you believe that the sleeping pill is the reason you are sleeping which makes it terribly difficult to wean off since you don't believe you have the power to sleep on your own. What finally got me better was a sleep Psychologist who got to the root of the issue. He told me I had to stop caring if I slept or not. I had developed a sleep phobia--the adrenaline pumped every night as I feared not sleeping and this kept me awake. I had to stop dwelling, researching for a cure, fretting and instead think like a "normal" sleeper (who forgets all about how they slept once they wake up each day). Insomnia is largely psychological. Surely pain may be what's keeping you up, but that's not insomnia--that's pain that's the problem. "The Effortless Sleep Method" book is the best book you can read for overcoming insomnia and I highly recommend it.
10
@Kate - So here's what I have learned about insomnia - it is individual. Your sleep problems may have been psychological, but that is not the case for every insomnia sufferer.
8
I often experience fragmented sleep for reasons that seem arbitrary. However, I do seem to sleep better when I have had a productive day and go to bed with a sense of accomplishment.
4
@Bello Sleep Restriction Therapy is ideal for "fragmented sleep." Try it!
Many women lack hormones in the last third of their live and because of that sleep is compromised. Progesterone is a great help.
Magnesium helps somewhat, so does limited alcohol consumption, no TV/computer way before bedtime.
Getting to bed at the same time each night.
I think more than 20% of people are having issues with sleep!
13
One word: Mirtazapine. Its an antidepressant that my MD prescribed as an off-label cure for insomnia. It works like a charm without fail with no side effects or pill hangover. My 71 year old mother was prescribed this 10 years ago and after I tried every pill available finally asked my MD for it 5 years ago.
2
@SoPo Native. It is also highly addictive and tough to discontinue. Forget the mirtazapine. You will regret ever taking it.
6
@Brookhawk I'm definitely addicted - short an alternative that would work as well I'm okay with taking it forever.
4
@SoPo Native I am really glad it works for you. My doctor prescribed it and yes, I slept. I also gained about 20 pounds in a month. It was crazy! I discontinued and I am now trying to shed the weight. We are all different, so I am glad we have options.
Would that it were true. So there are anecdotal examples of different non-prescription solutions, the facts are that most non-sleepers have tried all those techniques without relief. I hate using a prescription solution, but I have tried all these remedies and many more besides, without relief. Some techniques never worked (e.g., tonic water) and some worked for a period (e.g., melatonin). Phooey, nothing new or helpful here.
27
@Kent Kraus. True. This stuff never worked for me, so I tried mirtazapine and have regretted it an every other prescription med I've tried. They are highly addictive and I still can't get rid of the withdrawal effects even though I've been of the meds for some time. So now it's withdrawal effects keeping me up at night. I listen to an audio book to fall asleep and let youtube videos of Jay Leno run when I wake up and need help going back to sleep. I don't know why they work, but they do.
5
@Kent Kraus- I left an earlier comment, but I forgot to mention the cool to mid-warm shower I take before I go to bed every night. works very well.
Sleep evaluations and treatment are now a growth industry. Another way for hospitals to claw in big dollars with their sleep centers. And, my licensed psychologist colleagues are in the business of getting a steady stream of referrals from the hospitals to have canned CBT sessions. Cash only. Jane Brody has an MO. She goes to the "professionals" and reports what the say, as if gospel. The reality is that we still do not know much about sleep. It's not just length of sleep, but quality of sleep. Have you ever seen a sleep study evaluate quality, not just number of awakenings, and then follow up with a treatment program supported by empirical evidence that can be used to improve quality of sleep? The real low hanging fruit for improved sleep is socialization, exercise and weight reduction. Obesity is rampant in a sleep study center. These are all life style issues and the science of sleep is in its infancy. The article by Brody is helpful, it just lacks context and skepticism. I think that the comment section points that out.
29
I'm 65 and use Melatonin regularly. It is especially helpful when I wake up in the middle of the night which is when I have trouble returning to sleep. I keep a 5mg tablet at the ready and within half an hour I am sleeping again. Concentrating on my breathing, as in meditation, is helpful in trying to drive out intrusive thoughts.
12
I read somewhere that in sensitive folks, like me, sleep can be impacted by full moon. Sure enough, if I have nights where I’m wide awake I’ll check lunar calendar and it’s almost always nearly full or full. I hope that doesn’t make me a witch - it does give me peace of mind to know why.
36
@Kate Maybe a werewolf? ; )
1
As a senior citizen and a frequent traveler, I’ve found two things that work and are doctor approved; 1) time released Natrol melatonin (5 or 10 mg) and 2) CBD —35 mg...Charlotte’s Web, Papa Barkley or Elixinol ...all tested and my NYU doctor recommended ( not CBT...useless).
After many years of subpar sleep and many attempts at prescription medications, these simple compounds work.
And also no caffeine after noon, limited chocolate, no exercise late in the day and no screen-time right before bed, add to aa successful night’s sleep.
Zzzzzzzzz!
15
These alternate medicines have a well known mechanism of action. It is know as the Placebo effect in the Pharma business. For serious diseases, you need serious treatment that has been studied in clinical trials. Yes, these medicines have side effects and do not suit everyone and the dose has to be adjusted. If the Hypnotics (Ambien, Lunesta) do not suit you, try the next generation DORA (Belsomra) which is on the market now.
3
I have suffered from insomnia for my entire life. Like most chronic insomniacs, I have tried all the natural remedies in this article—CBT, meditation, and yoga—and already practice all the sleep hygiene recommendations given here. Sleep hygiene and natural remedies may work for people with short-term sleep problems, but for intractable insomniacs, they are utterly ineffective at stopping the brain from spinning like a hamster on its wheel at 2am. Telling an insomniac to try harder to relax is like telling someone suffering from depression to just look on the bright side. Our brains simply won’t let us.
I do have cause for optimism, though. I recently started using CBD oil for acute back pain, and since my first dose, I have, for the first time in years, been able to fall back asleep when I wake up in the middle of the night.
We Americans tend not to trust solutions that are “taking the easy way out,” preferring arduous self-examination. But perhaps the easy way out is actually the most effective way. CBD oil is non-psychoactive and non-addictive and has few if any side effects. Who knows? It might work for you too!
56
@Mari Now that I've retired, I've found my natural sleep cycle to consist of to bed at 5AM, up around 3pm. I have struggled over 60 years to fit into someone else's cycle. I've discovered mine works just fine for me. Maybe everyone else would like to adjust. They can use Brody's hand tips!
1
Thanks for this article.
You mention that you have benefitted from using Hyland's Leg Cramps. This homeopathic combination remedy is very useful for leg cramps, as you describe. The ingredients are regulated by the Homeopathic Pharmacopoeia, the FDA standard for homeopathic medicines in the US.
As a physician who helps patients with insomnia I have also found that hypnosis is very useful. I use this successfully for my own needs and that of others. Before I go to sleep nightly I give myself hypnotic suggestions for restorative sleep as well as for a great day upon awakening. Hypnotic suggestions have a cumulative effect and by doing this nightly my sleep has become very deep and healing.
We all have allowed ourselves to accept negative, unhelpful suggestions so why not reverse that process?
At one point I was on a high dose of Ambien. It was the only way I could sleep and I was not happy with this situation but as anyone with insomnia will tell you, you will do anything to get sleep. I was able to get off this drug using non-drug alternatives.
Exercise is also very important for good sleep. I walk each morning before work. It makes a huge difference.
Keep in mind that each day is different and that we must find a way to effectively deal with the ups and downs of life without totally crashing. For me, mindbody therapies such as hypnosis and mindfulness meditation have been a great help.
Great sleep is possible. I found what worked for me. So can you.
16
No chocolate either.
6
It is best to think of insomnia, not as a root problem, but a message from your brain that something is not quite right with your medical health, stress, environment, or circadian timing. In that framework you’ll want to find the cause and fix it rather than cover it up with sleeping pills. Sleeping pills barely increase sleep time but give you amnesia so you do not recall being up and they will not alleviate causes of stress. Moreover, most causes of insomnia are quite fixable. Heed your brain.
9
Thank you Ms. Brody for pointing out many useful practices for improving sleep. The problem is what to do with the large remaining population for whom these things simply do not work.
A few points I would add:
- Consider the substances you are using: alcohol, caffeine, MJ, nicotine, and many prescription drugs may be interfering.
- Get a diagnosis. See your doctor. Depression is probably the most common cause of refractory insomnia, along with a host of other disorders, such as PTSD. These can be treated without Z drugs, or benzos. For example remeron is effective in improving sleep and is relatively safe in seniors.
-Stop blaming those who require sleep meds! Refractory insomnia is a heritable brain disorder. The admonition that sleep meds may only be used in the short term is based on the observation that their safety has not been established for long term use. I have patients who continue to find relief with the long term use of benzo receptor meds. Leave them in peace.
And finally, recognize that the morbidity and mortality of insomnia, as Ms. Brody herself has pointed out, is huge. Sleepiness is likely the biggest cause of motor vehicle crashes.
112
@A Doctor Indeed, my GPs have, for years, suggested that I use over the counter diphenhydramine or doxylamine tablets, and I have. But every few months a pharmacist tells me not to use them over the long term. Sometimes I ask why they say this, but none has an answer.
@A Doctor
PTSD true. Ativan & psychotherapy.
Sleep phase disorder also. Light box.
Ambien is not good for me--I rewired all my tv, dvd,vcr, cable connections, when I got out of bed in am nothing worked. I doubt my cat had the dexterity. [I sleep-walked as a child. Should be considered when prescribing.]
I use Ativan when I absolutely have to sleep for an early wake up, it is completely predictable timing-wise.
4
Long term use of anticholinergic medicines like diphenhydramine (as well as benzodiazepines and z-drugs) have been found in some studies to be associated with dementia. These were not randomized controlled trials, so it is not clear if these medications actually cause dementia. However, given the possibility, it is probably best not to use these medications over the long term if it can be avoided.
2
Dinner at 5:00pm, breakfast between 6 and 7am. The only thing that works for me. I've tried every other sleep strategy and this is the only one that works.
6
As a practicing physician, I find Ms. Brody's columns immensely frustrating, as she continually dumbs down the issues, whether to appease her own need for oversimplification, or to address her belief that the public needs simple solutions to health care problems. It brings to mind H.L. Mencken's quip that "for every complex solution, "there is always a well-known solution to every human problem—neat, plausible, and wrong."
I treat insomnia regularly in my office and to summarize, there is one solution that always works -- treating the underlying cause of the insomnia. Ms. Brody seems to make a basic mistake in understanding the nosology of medicine: insomnia is a symptom, not a disease. As such, it warrants further investigation, to uncover the underlying health problem to which the insomnia is epiphenomenal. To just turn to CBT or the latest fad, or sleeping pills, for that matter, undercuts the whole purpose of medicine -- to find the causes of symptoms and treat the underlying disease processes that create these symptoms.
How foolish to think that by just treating symptoms, we are somehow addressing health problems -- and how disruptive to the basic mission of medicine! Among the more common causes of insomnia are pain, drugs, drug abuse, anxiety, depression, hormone imbalances, interpersonal stress, dietary imbalances, and nutrient deficiencies. Each of these causes, may have multifold causes themselves, which require investigation. This is medicine, Ms. Brody.
570
@Samantha
I'm glad you know more than the leading sleep experts since apparently you can do something none of them can: identify the underlying cause of insomnia in every case.
Most people have primary insomnia for which there is no identifiable underlying cause for the insomnia. Every classification of sleep disorders includes this very important difference.
53
@Samantha
Very well articulated. I once worked at a school where Jane Brody gave a talk and it was a huge load of nonsense delivered in a very confident, smiling manner. Second rate.
88
@Samantha
There isn't always a physical underlying cause of insomnia. Sometimes, as was in my case, insomnia was how sub-clinical anxiety was showing itself. So CBT-I actually IS the way to treat plenty of cases of insomnia without rushing to medication. I appreciate that you are a physician, but I think your point of view here is misguided, however well-intentioned it might be.
34
These tips (from 'Why We Sleep' by M. Walker) helped me: A) 'decaf' still has 1/3 the caffeine of regular coffee .. and caffeine takes 8 hours to metabolize .... so not even a decaf for me after 12 noon. B) no alcohol after 1PM (easier said than done). C) since I rise very early, any napping I do is before 1PM. After 1PM I just 'tough it out' and stay up.
7
How can you tell someone to only use their bedroom for sleep in NYC where so many people live in studios? Or to anyone but especially children and adolescents who study, play and sleep in their bedrooms or dorm rooms. Not everyone is rich enough to have 3,000 square feet to spread out in. Time for some more research
274
Not everything applies to everyone. This is just one suggestion for those who are able to do it.
7
@Patricia
Thank you! I was just thinking that!
-from my bedroom/office/kitchen/living room!
10
@jas The problem is that it’s not presented as a suggestion. It’s presented as gospel and absolutely necessary for managing your insomnia.
4
Here is what worked for me (a scientist who read up on sleep):
1. Entrain the circadian rhythm:
- bright light in the morning
- low light, and blue light removed, after 8 or 9 pm (i.e. TV, computers, phones)
- early and small dinner (biggest meal at lunch time)
- coffee or tea only before lunch (I'm super sensitive); little alcohol.
2. comfort while sleeping:
- CPAP machine for apnea ie air
- magnesium citrate (to stop heart palpatations)
- potassium chloride (to stop leg cramps; added often in low sodium products like low sodium salt or low salt soy sauce)
- good temperature of covers/PJs so not too cold, not too hot.
3. setting my mind at rest:
- podcasts (i bought some bluetooth ear plugs so I can listen without disturbing my husband)
4. CBD oil rubbed into any sore parts.
- it reduces inflammation and also promotes deep sleep. Low dose fluoxetine/prozac can also help with sleep if taken at the right time of day (AM for some people PM for others).
I hope some or all of these pointers are helpful to others. I spent a few years figuring this out, after I hit perimenopause and was unable to sleep through the night. If you are desperate, HRT can help but I found it was not necessary with the above changes.
57
@Susan
I forgot to add exercise - walking 10,000 steps daily improved my sleep, but probably any exercise would work provided it's not too late.
and for a wonderful, relaxing source of magnesium, try an Epsom salt bath.
15
Perimenopause also brought on insomnia for me. I’m on HRT but still struggle to sleep well. I hope it gets better when I finally hit menopause.
The only problem with these non-pharmacological remedies is that in my experience, they don't work. I've so far avoided sleep medication owing to its association with dementia, but I can well understand why some people have to resort to it and if my age-related insomnia continues to get worse, I may have to resort to it as well.
29
With regards to leg cramps, I had them on occasion until I got a vaccination against tetanus. Those vaccinations last 10 years and then they have to be renewed. I had not had one for 20 years but after I had it renewed my leg cramps disappeared. Maybe of use to someone.
4
@Morten Bo Johansen
Low potassium chloride is one reason for cramps. If you buy products that are 'low salt' they often include potassium chloride e.g. Low sodium salt, low salt soy sauce etc.
5
I usually read the overnight news on my iPad in bed and that makes me drowsy and I go to sleep. Also, no food or alcohol after 5 p.m.—at the latest.
2
Concerning leg cramps at night, I find them correlated with days of hard exertion... sweating. Sports drinks generally do not re-supply calcium salts, lost in sweating. I don’t use them anymore. Whole fruits and vegetables in the diet help a lot, but if I still get cramps, taking one or two Tums occasionally really helps me prevent leg cramps.
3
OMG, if you haven’t had insomnia, you can’t imagine how trite things like CBT sound to combat it. I went weeks without sleep. I learned I should think of something boring to put me to sleep. I tried — AND FAILED MISERABLY — imagining myself folding endless clothes, night after night. Those who haven’t experienced insomnia cannot imagine how it tears one’s soul and life apart at the seams. I went for the drugs. Gabapentin is non-addictive, but it works. And when you need it, you need it.
345
@Sarah Conner
Gabapentin is (according to the medical world, "non-addictive," as is paroxetine which may help with anxiety). But for some people (as many as a third), either is nearly impossible to wean off of. Just try it.
2
@Sarah Conner
CBT-I was the only thing that helped with my very severe, months-long bout of insomnia, actually. Don't rush to judgment here; just as you say, those who haven't had your specific experience might not have had, well, your specific experience :)
12
@Sarah Conner Gabapentin helps me sleep because it addresses underlying anxiety. It is cheap and non-addictive.
2
A psychologist friend once told me "if everyone followed the sun, i.e. rise when the sun rises and go to be when it sets, like our ancestors did before artificial lighting, I'd lose a lot of patients and a lot of people could go off antidepressants."
Maybe the same wisdom can be applied to sleeplessness?
21
@Rune Some experts believe artificial lighting - the interfering with solar rhythm for decades - contributes to the high rates of cancer, diabetes, heart disease. Hard to prove (esp. because before electricity people died young from other causes), but not completely implausible (i.e. cumulative long term impact on the immune system).
4
@Rune
Been there, done that, and no, if you have insomnia it's not likely to fix it. However, it is known that having lights on and being exposed to blue light late in the evening will keep you awake.
5
@Rethinking
Blue light tells your body that it is daytime and that you should be awake. Yes, this has been proven and in a multitude of organisms. In fact, scientists working on circadian rhythm, as it is called, won the Nobel prize in medicine a couple of years ago. It is very much tested and proven.
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I took zolpidem for about 10 years for sleep issues due to chronic pain with absolutely no ill effects. Slept like a baby when I did. Yes, I had to wean myself off it gradually and there may have been a psychological dependence, but easy to get over. I REALLY miss those sleep-filled nights. I'd take zolpidem again regularly without hesitation if it were easier to get. Used appropriately, I think the Z meds can be essential for some of us for whom nothing else worked. CBT? Who can afford that? Drugs are covered by my insurance, CBT is not.
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Mental health treatment, including CBT, is covered by many health plans. Don't be discouraged from checking.
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@Pam Franklin
CBT can be practiced by yourself if you have a good book to follow and the tenacity to stick with it. The caveat is that it's not for everybody. You really have to work on it and it can take a long time. It hasn't totally "cured" me -- I've been an insomniac since childhood, for over 60 years -- but it has helped me a LOT.
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I really appreciate your comment. Among my many 70 year old friends (many of whom are retired health care professionals) a major topic of conversation is how to obtain Z drugs for sleep. At 65 you're cut off from them (if your PCP ever prescribed them to begin with) just at the time when retirement, financial and health concerns, BPH, loneliness, and widowhood arrive to keep you from falling asleep, or worse, wake you at 4:00 AM to stagger thru another day exhausted. You begin dreading approaching bedtime, when you know you will experience the same inability to sleep for more than 4 hours.
Some of my elderly friends resort to alcohol and MJ, knowing that neither are safe or desireable drugs, and don't work well, but other options are not available. A few of us have figured out that "boutique" medical practices are more amenable to writing scripts for Ambien and Xanax. Sometimes travel outside the US can lead to a supply. In the end, we share with each other.
I believe the refusal of MDs to provide these sleep meds has more to do with liability fears ( i.e. they will be sued if a patient falls or drives a car down a street the wrong way) than any real concern about addiction. Such is the practice of modern medicine.
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The pot cookies in my fridge do the trick at 3am when my thoughts are spinning around. It puts me back to sleep within 30 minutes, every time. Just sayin'.
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@michele - You betcha'!! Try home-made tinctures. No sugar.
Sorry but please don't advise people to use quinine for nocturnal leg cramps. It works no better than placebo and is potentially dangerous. The FDA issued a warning more than 10 years ago about the inappropriate use of quinine for nocturnal leg cramps: https://www.fda.gov/media/84506/download/
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@Doc Bellingham My wife had the middle-of-night leg cramps pretty often until she starting drinking a small can of V8 most days, and she rarely has those bad cramps now.
@Frank - She might have been potassium and/or magnesium deficient. Is she taking any medications (e.g., thiazide diuretics for hypertension) that cause potassium loss? Is she eating sufficient amounts of vegetables and fruits? (Bananas, tomatoes, potatoes and citrus fruits are rich sources of potassium. The tomato content of V8 might explain why it worked.)
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@Doc Bellingham Plain water is a cure for leg cramps - in my experience - dehydration being the cause.
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Amitriptyline, a tricyclic antidepressant that's not really used for depression any more can be very help full for chronic insomnia as well as for chronic pain. It's used at a very low dose as compared to when it was used as an antidepressant in the pre Prozac era. 10-25 mg at bed time as apposed to 250-350 mg. Not addictive or abusable. Patient typically get tolerant to it. I've prescribed for years before turning to the Z drugs.
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@Dr. G
Not that great for insomnia unless there is also chronic pain. Then it is an excellent drug.
We started eating dinner very early for my husband's GERD. I immediately started sleeping better. I also eat more of my day's calories earlier in the day. On the rare occasions that I eat a later, larger meal, I flip and flop and can't figure out why I'm having trouble sleeping.
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@Stella B
How interesting! I have found this to be true for myself. If I eat dinner earlier, and limit carbs (have a keto-style meal) I do sleep better. I have not seen anything on this in the clinical literature, though. But I think its worth a try.
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Try one of these, or a combination:
magnesium
warm bath
reading a book before bed
exposure to daylight before noon
And although getting up at the same time each day is a very good idea, it may be worthwhile to try different bedtimes. One elderly person I know can regularly sleep 6-7 hours straight after going to bed at 11, but wakes after 5 hours when going to bed at 9.
Also a short 10-20 minute nap during the day can relax a person and make it easier to stay relaxed until bedtime and thus easier to fall asleep.
Finally, insomnia isn't fun, but worrying about insomnia makes it worse.
Sweet dreams to one and all!
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New Age music is a wonderful hypnotic. There's a reason you don't see many concerts for this genre of music. It puts the audience to sleep. It takes a melodic music line and repeats it over and over and over with slight variations. Get a CD player with an automatic shut off feature and play it every night for 2-3 weeks and you'll be looking to shut it off sooner as time goes on. Very effective.
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My wife swears by melatonin when she can't sleep. What's the word on this?
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@Lutoslawski
Word is that it works, and it seems to lack the deleterious effects of sleeping meds.
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@Lutoslawski
It works for me. The Mayo Clinic reports favorably on it. It does not have all the side effects of sleeping pills.
https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-melatonin-may-help-you-sleep/
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@Lutoslawski
I have multiple (chronic pain, menopause, central apnea, GERD) that complicate my sleep. I can fall asleep very quickly but have difficulty staying asleep.
Melantonin didn't work for me until I tried an extend release formulation. I take 10 mg one hour before bedtime and it has helped me immensely.
Sleep restriction (a.k.a. sleep diet) has helped my insomniac husband tremendously.
1
Waiting, waiting, waiting for new remedies. Been there done that...
If Z drugs work for you, go for it--at an older age, "addiction" is not the problem, sleep deprivation is! There has been no mention of CBD which is safe and legal.
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As a lifetime insomniac, I began getting better sleep by:
waking up early in the morning
exercising
reducing anxiety with faith
a little Benadryl, a little melatonin
no caffeine after noon
no naps after 2 pm
avoiding screens a few hours before bed, reading instead.
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Why is there nothing in this piece about eliminating caffeine? If you’re consuming caffeine and not getting enough sleep, cut out the caffeine. I guarantee you’ll sleep.
Some people are extremely sensitive to caffeine. If I have so much as a cup of decaf in the morning it will interrupt my sleep. Try completely eliminating caffeine. You’ll be amazed.
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@MaraMDolan
"Guarantee" is a strong word that I'd encourage you to use sparingly. Some people already limit or eliminate caffeine but are plagued by invasive thoughts, mysterious (or well-understood) physical pain, environmental issues, or trauma that no amount of lifestyle changes or diet modifications will address adequately to "guarantee" sleep.
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@MaraMDolan
No to chocolate as well, for the same reason. If I succumb to chocolate in the evening hours, sleep is difficult.
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@MaraMDolan. Also alcohol, even one glass of wine can be a big sleep disrupter. As we age, we become much more sensitive to these. I’ve had to remove both coffee and wine from my diet. Bummer! But helpful.
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Marijuana works wonders
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@Richard Jones
for some
2
I don’t see this mentioned much in articles about insomnia, but consider the age of your mattress/box springs. I replaced my 12 year old mattress and box springs last week and I can’t believe the difference in sleep quality and how much more energy I have! Not to sound like a commercial but it’s worth considering when trying to pinpoint the cause of sleeplessness.
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If it's possible to wear oneself out with physical exercise, that gets my vote. An evening walk can make a big difference. I prefer that to a meal, which is often eaten mostly out of habit vs hunger.
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Say no to CBT. Just say no. It’s a much hyped thing, whatever it actually is in practice, which is absolutely useless for most problems including insomnia. If you can’t sleep, and this is not due to a physical problem or some major acute psychiatric problem, then I hate to break it to you, but there is no good solution to this. Exercise + relaxation are the key, i.e. physical fatigue plus mental calm, but how hard this is to achieve! Especially getting your mind to calm down. No need to guilt trip all the people who can’t do this. Life is full of compromises.
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@NWwell.com
CBT-I works. Years ago, after suffering for months of a terrible bout of insomnia I did a 6-week program of CBT-I that saved my health and my sanity. It included keeping a sleep diary, sleep-restriction (tough, but it works), techniques for conquering negative-thinking, and guided meditations to help relax. Even today if I experience a bout of insomnia, I use those practices and I've never experienced a long-term bout of insomnia since.
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@NWwell.com
I'm sorry, but your blanket condemnation of cognitive-behavioral therapy (CBT) is a disservice to those who benefit from it. Learning to intervene in one's own thought process and challenge thoughts in order to calm one's mind is a skill that can be taught and nurtured to great effect in many people. Combining that skill with new actions and habits can lead to meaningful changes in many aspects of one's life, including sleep.
There are many therapists who claim to be using CBT and are not. Your prescription of "exercise + relaxation" is a good one and CBT can aid with the relaxation part. You seem to see therapy as necessarily involve guilt and shame. I'm sorry if you've been the victim of poor practice by some unskilled therapist(s), but CBT shouldn't involve any blaming; rather, CBT should support the patient/client in choosing new ways of thinking about challenging issues so they can change some behaviors while also learning to accept themselves. CBT should, in fact, help someone develop more compassion for themselves and adopt a more relaxed mindset.
Please encourage people to explore personal solutions rather than saying that something can't work for someone. Also, maybe find someone competent who is really doing CBT before you judge it so harshly.
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@NWwell.com I'm one of the roughly 20 percent of insomniacs for whom CBT was of no use. (I know folks in the other 80 percent, so I'd still urge people to give it a try. Better than a coin flip.)
But here is what's amusing about Ms. Brody's two column series. One says, literally, "Insomnia Can Kill You," but CBT says, just chill, don't worry, relax, do sleep hygiene, you'll be fine, sleepless nights, no big deal.
Right.
Cognitive Dissonance is the flip side of chronic insomnia.
7
My psychopharmacologist of 30 yrs says my anxiety and insomnia can be helped by NO AMOUNT of sleep hygiene or CBT (which has never worked on me). Nothing but "Z" drugs help. All this newfangled 'get off the Z drugs,' like the don't go near opioids, is a bit too much. Some patients need one or the other (or sometimes both), and Drs should recognize that there are valid uses for these drugs.
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@J
Thank you for saying this! The idea that some medications (or other types of treatments) are terrible for everyone is belied by the fact that those medications are actually critical for some, have some time-limited utility for others, and are useless or even harmful for others.
The gold-standard treatment for mood disorders (anxiety, depression) is medication plus therapy, though for some it may be all of one and none of the other. We all need to encourage individuals to seek the most beneficial supports for them and to not judge them for choosing what works.
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@J
In fact, every one of these drugs carry a warning that they are not meant for use for more than a few weeks. If your psychopharmacologist believes this is incorrect information I suggest he or she should publish a study demonstrating the fallacy of this information.
9
@J
Try melatonin. My MD suggested it. She said it had no side effects (and it doesn't). It works very well for me.
Other things that work for me: a hot bath, and having a big O (with or without a partner).
5
All these articles anti-Z drugs (along with anti-opioid ones) toe the current party line which may, in fact, not work for everyone. I have taken benzos in many types over many years for anxiety and insomnia. Nothing else helps me-no amount of "sleep hygiene" or CBT. That is selling the public a bill of goods. Our parents, occasionally, took barbiturates (which are almost impossible to obtain now except for dogs) and no one batted an eye. This is my second attempt to say that one size does not fit all. Benzos and opiates have a real place in our pharmacopeia.
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That Hyland "remedy" is homeopathic, meaning it contains very little active ingredient. In the case of the quinine, it's listed as "3X", which means the dose is supposed to contain a milligram or two, at best; maybe it's as low as a few micrograms. (It's a little fuzzy, since homeopaths don't use actual measurements in ingredient lists, probably because it'd be too embarrassing.) In comparison, an 8oz glass of Tonic water will have about 20mg.
And with Hyland, it's *especially* unclear how much active ingredient is in the medicine, because they are bad at manufacturing; that company was famously responsible for "homeopathic" Belladonna teething drops that accidentally had *way* more Belladonna than they were supposed to, and several infants died. (It took *years* for the FDA to kick that product off the market, Because Natural.)
The NYT should know better than to *ever* suggest a homeopathic remedy for anything.
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@SirWired
Having used homeopathic remedies for 35 years and seen them work effectively and safely for myself, friends and relatives, children, and my pets (when correctly chosen, or recommended by a practitioner), I wouldn't throw out the baby with the bathwater.
11
@SirWired Indeed, the FDA has gone after those who push quinine for restless legs and "leg cramps".
To quote, "Known risks associated with use of quinine, in the absence of evidence of safety and efficacy of the drug for treatment or prevention of nocturnal leg cramps, outweigh any potential benefits for this unlabeled indication. Serious and life-threatening hematologic reactions, including thrombocytopenia and hemolytic uremic syndrome/thrombotic thrombocytopenic purpura (HUS/TTP), may occur if quinine used for treatment or prevention of nocturnal leg cramps"
7
@SirWired Agreed. A consumer asked on the Hyland site, and this was their reply: Hyland’s Leg Cramps tablets and caplets contain Cinchona Officinalis which is the natural source of quinine. In homeopathic medicine, we deal with micro-doses of active ingredients – in this case 0.0078 mg of quinine per tablet.
4
What about Tylenol PM? My doctor says it’s fine and I’ve taken it for years, but is there cause for concern?
3
@Mary The sleep-inducing ingredient in Tylenol PM is Diphenydramine HCl (better known as Benadryl; a "1st-generation" anti-histamine (allergy drug))
If you do not require pain-relief for sleep, you are better off just taking the Benadryl (or one of the many generic equivalents, both in the allergy and sleep-aid aisle) alone, without the Tylenol. (You may also want to try one of the other sleep-aids in this class of drugs, Doxylamine Succinate; I find 1/2 of one of those and I'm sleeping like a log.)
The OTC sleep aids do not have the (thankfully rare) zombie-like behaviors in the middle of the night, but most people also don't achieve much in the way of sleep-aid effects after a couple weeks. (It's how people with allergies can actually take Benadryl during the day once they get used to it.)
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@Mary
As an occasional insomniac, I also take 1/2 or 1/3 Benadryl every night and the insomnia is almost entirely eliminated! Rarely do I override it with my racing thoughts! Also, as I live in an area where allergies are a problem for many, the Benadryl also helps in that regard.
2
@SirWired I agree with your suggestion about Doxylamine Succinate! I found an insomnia blog that recommended a sleeping aid from Coscto (Kirkland Sleep Aid) that has DS in it. I take 1/2 a pill an hour before bedtime, and it makes me nice and drowsy. I wake up feeling refreshed, with no "hangover" of any kind. Initially I took this due to some neck pain that was causing sleep problems. The neck pain went away, but I still take my sleep aid nightly because it works so well.
I think the 800 pound gorilla in the bedroom negatively affecting sleep is the current state of politics in this country, not to mention the reality of global climate disruption. I know that my ability to sleep and general sense of well being have been adversely affected. As suggested in the picture, meditation is a very good approach to mitigating sleep-deprivation but for me, there are political solutions as well.
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@A Goldstein
a consistent (time, place) meditation practice over time can ease the mind's restlessness and de-tense the body's muscles to let go & drift off to sleep.
No one can get proper rest when their mind is busy thinking over the day or anxious about tomorrow-
deep slow relaxed breathing along lowers stress & relaxes the sympathetic nervous system ( fight & flight hormones)
warm Epsom salt baths, a de-fuser with lavender oil, a dark bedroom, and no electronics ( computer, tv or phone) no night light or noises help promote sleep-
certain teas like chamomile tea which has calcium helps relax muscles -
no caffeine after 1pm and no food after 6pm,
don't drink any liquids an hour before bedtime and go to the bathroom right before lying down.
of course if you have kids, or cats sleeping with you, are caring for an elderly parent that needs attention during the night, those issues can hinder sleep.
restorative yoga - legs up the wall & massage help also
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@A. Goldstein — I agree. But I’ve found that, when I wake up in the middle of the night thinking worried thoughts about a particular thing (usually domestic politics), I can listen to world news on our 24-hour Portland public radio station (using a small radio with earbuds so I don’t bother my spouse). Although there is sometimes worrisome news, it’s a way of “changing the subject” and moving me away from the thing that was keeping me awake. I usually drift back to sleep after just a few minutes of radio listening.
17
@A Goldstein
Indeed worries and the thoughts that go with them are my issue, both in getting to sleep and waking up with a racing mind trying to problem solve. It helps me to sort out what I can control, and what I can’t. When I get a clear plan, sleep usually returns. Call it meditation, call it faith, no matter, the mind works at night and go with it.
8