Q: Although my depression has let up considerably, I still suffer from insomnia. I’m often able to doze off at bedtime (sometimes in the living room before I even hit the bed), but I usually re-awaken an hour later and hours go by as I lay awake, frustrated and wondering how I’ll get through the next day’s trial work. My prescriber has given me Trazodone for sleep — it seemed to work briefly, but not any more, and he tells me that most sleeping pills can be addictive. Must I just bear with the insomnia?
A: Your doctor is correct in cautioning you about most prescription sleeping pills, which are benzodiazepines and potentially addictive. In addition, it’s true that many people find whatever kind of medication they take loses its helpful effect after a while. Pharmaceutical approaches to insomnia tend to be more helpful (and less habit-forming) when used for brief periods of time than a regular regime.
Although, as is often said, “No one ever died from insomnia,” the good news is that there are very effective non-pharmaceutical ways to overcome even longstanding sleep problems. These include:
• Stimulus Control: Make the power of conditioned responses work for you by teaching your brain to associate the bed only with sleep (the bed, not the living room couch). OK, sex too. Don’t use your bed as a venue for snacking or heavy conversation. Don’t bring your laptop into bed. If it’s clear that you are not sleepy, leave the bedroom until you are.
• Exercise: Your body temperature will rise during exercise. When it drops about four hours later, it’ll be easier to fall asleep. Exercise may improve your mood as well, and reduce anxieties that could impede sleep.
• Circadian Rhythm: Your daily sleep/wake cycle may be off, as if you were experiencing jet lag (symptoms of which can include fatigue, loss of concentration, headaches, feeling out of sorts and the inability to fall asleep at the desired time). In this case, scheduled exposure to bright light can make a significant difference.
• Relaxation: Both specific techniques (such as Herbert Benson’s “Relaxation Response” or progressive muscle relaxation) and relaxing activities like long hot baths can help create more sleep-friendly conditions.
• Cognitive Behavior Therapy: You may be amplifying your insomnia through counter-productive thoughts, such as when you tell yourself that you’ll be too exhausted for court the next day. Self-statements of a less dire nature are likely to be both more accurate and more compatible with unwinding and falling asleep.
This is just an overview, and an incomplete list. For more information, recommended books include Say Goodnight to Insomnia by Gregg Jacobs, Ph.D. and The Insomnia Answer by Paul Glovinsky, Ph.D. and Art Spielman, Ph.D. To see a sleep disorder specialist, a number of hospitals offer sleep clinics, including the Sleep Disorders Center at Beth Israel Deaconess Medical Center, where Dr. Jacobs developed his program. If LCL can help, for example, by identifying resources or via any of the self-help books in our lending library, give us a call.
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