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Non-Drug Help for Insomnia-Part I

David J. DeRose, MD, MPH

 As presented on the Three Angels Broadcasting Network’s Health for a Lifetime

Taped December 2005

Background

Although many people suffer from acute insomnia (short-term difficulty sleeping that lasts between one and thirty days), a variety of studies suggest that between 10 and 20 percent of the U.S. population suffer from chronic insomnia (persistent trouble sleeping—at least three nights per week for one or more months). 

The causes of sleeplessness can be simplistically divided into primary and secondary insomnia.  Primary insomnia occurs for no obvious social, mental, or physical reason.  On the other hand, secondary insomnia occurs due to the direct result of some identifiable process.  Causes of secondary insomnia include stress, poor lifestyle habits, mental health problems (such as anxiety or depression), drug side effects, damage to the brain’s built-in “biologic clock” (resulting from things like stroke or Alzheimer’s disease), and other medical conditions (including sleep apnea, restless legs syndrome, chronic pain, and hot flashes).

The ideal treatment for secondary insomnia involves addressing the underlying cause or causes.  However, even if these underlying causes have not been fully identified or addressed, lifestyle changes can often dramatically improve sleep quality.  The same holds true for primary insomnia: although a doctor may not identify a cause for your sleeplessness, lifestyle changes still may significantly improve your sleep. 

Therefore, if you have trouble sleeping make sure you get a full medical evaluation searching for treatable causes of insomnia.  Additionally, consider the following non-drug strategies that may help improve sleep quality:

1.      Develop a bed-time routine.  This allows your body to “wind down.” Try spending the last 30 to 60 minutes of your day engaged in activities that promote relaxation: avoid thoughts about stress-producing topics (perhaps skip the nighttime news), engage in pleasant social interaction, take a relaxing bath or shower, or enjoy inspirational reading or music.  Your body unwinds most effectively if you get to bed and arise at roughly the same time every day of the week (yes, this includes weekends).  Also try to adhere to the same schedule when traveling.

2.      Beware of late night meals.  Although a late night snack may help induce sleep, it can also interfere with sleep quality.  If your blood sugar is rising at bedtime it can suppresses production of normal restorative hormones like melatonin and growth hormone.  Therefore, it is generally best to avoid eating for at least several hours before bedtime.

3.      Optimize daytime light exposure.  If you have problems waking up in the middle of the night and are unable to fall back to sleep, consider getting more exposure to sunlight in the early evening.  This can help to resynchronize your body clock.  If you can’t get outside, try using bright light therapy.  This requires a special light that is rated to deliver light at an intensity of 3,000 to 10,000 lux for 30 minutes.  If your problem is not being tired enough at bedtime, get your bright light exposure between 6 and 8 in the morning.

4.      Ensure a more optimal sleep environment.  Most people sleep best in a room that is cool (but not too cold), dark, comfortable, and quiet.  Either make changes in the room or employ other strategies to ensure a more favorable environment.  This may include using heavier shades, getting rid of night lights, or wearing a sleep mask at night.  Consider the use of ear plugs if noise is a problem.  Alternately, “white noise” like the sound of a fan, a tape of natural sounds (waves crashing on a seashore, the hum of crickets and other night creatures, etc.) or a radio dial set to a non-station can be used to drown out disruptive noises.  
     Individuals troubled by back pain can decrease stress on their backs by using a pillow to help them sleep with their knees bent.  Put a large pillow under your knees if you are lying on your back.  Put the pillow between your legs if lying on your side.  A small cylindrical pillow or “lumbar roll” under the small of your back can be a tremendous help if you are a back sleeper.

5.      Avoid unnecessary stimulant drugs.  Stimulants interfere with the ability to sleep.  Two common culprits are caffeine and nicotine.  Even caffeine taken relative early in the day can have effects on nighttime sleep quality.  If you feel you must drink caffeine, by all means avoid any intake after noon. 
     Furthermore, stimulants may be found in unsuspected places.  Appetite suppressants may contain stimulant drugs.  Many asthma drugs also have stimulant properties.  On the other hand, many cold and allergy preparations contain antihistamines that can help induce sleepiness; however, they may also include decongestants possessing stimulant properties.  Consult with your doctor if you think a prescription drug is contributing to sleeplessness—don’t make any changes yourself or you may produce greater problems than insomnia (this is especially true with asthma medication changes).

6.      Avoid alcohol.  Alcoholic beverages may make you feel drowsy, but they actually interfere with sleep quality.  Say “no” to alcohol if you want to increase the value of the time you spend in bed.

7.      Watch out for other medications that disrupt sleep.  Diuretics (“water pills”), especially if taken late in the day, can disrupt sleep through increasing nighttime trips to the bathroom.  However, again, do not make any medication changes without your doctor’s approval.  Even a bedtime dose of diuretics may be less disruptive to sleep than significant fluid build-up in one’s lungs due to under-treated pulmonary edema (“water in the lungs”).

8.      Don’t use your bed for normal waking activities.  Avoid reading, watching TV, eating, or performing other normal waking activities in your bed.  This may create an association in your brain between your bed and wakefulness.

9.      Consider putting six inch blocks under the legs at the head of your bed.  Even if you don’t notice symptoms of heartburn, acid traveling from your stomach back up into your swallowing tube or esophagus (technically called “reflux”) can interfere with sleep quality.  One way this occurs is by adversely impacting lung function either directly (by acid traveling into your airways) or indirectly (through reflex mechanisms).  Sleep quality can also suffer due to symptoms of heart burn or acid triggering voice box spasm.  Elevating the head of the bed with blocks decreases the likelihood of reflux problems (using more pillows is not an adequate substitute).  Other reflux decreasing strategies include not eating for several hours before bedtime, avoiding tight fitting garments, and losing weight (if overweight).