Trouble Falling Asleep

Do you have trouble falling asleep, or toss and turn in the middle of the night? Are you waking up too early, or find yourself not feeling refreshed in the morning? If you're having trouble sleeping at night, you have insomnia, and you are certainly not alone. 60 million other people suffer from it too.

 
Insomnia is a symptom (not a disease or problem in itself) that consists of problems falling asleep, staying asleep, early morning awakening with trouble falling back to sleep, or un- refreshing sleep. It is not enough to just have problems falling asleep. Insomnia affects your ability to function at home, work, school or socially. Daytime symptoms that often accompany insomnia include headaches, depression, morning sleepiness, poor concentration, inattention, irritability, anxiety, and fatigue.
 
Medical conditions include substance use and abuse (alcohol, tobacco, caffeine), medications (decongestants, some antidepressants, and certain bronchodilators for asthma or chronic obstructive pulmonary disease), other sleep disorders (obstructive sleep apnea, restless legs syndrome, or periodic leg movements of sleep – though often they lead to excessive daytime sleepiness more than problems falling asleep), and other systemic medical problems involving the heart, lungs, stomach, hormones, and the nervous system.
 
Very common underlying psychiatric conditions include depression and anxiety (thinking about things at night preventing you from falling asleep).
 
Unless you’re suffering from a serious sleep disorder, simply creating a better sleep environment can set the stage for good sleep. By developing a good bedtime routine and designing a plan that works with your individual needs, you can avoid common pitfalls and make simple changes that bring you consistently better sleep.
 
Sleep hygiene
 
The first step to take if you have problems sleeping is to look at your sleep habits, termed ‘sleep hygiene.’ Good sleep routines will help alleviate or reduce problems with sleep. These include:
 

1. Keep a regular bedtime and wake up time, even on weekends and holidays. It is recommended that you go to sleep or get up from sleep within two hours of your usual wake time.
2. Avoid naps as much as possible (preferably completely), but if you do, do it early in the day, and not in the late afternoon or early evening.
3. Exercise regularly, but preferably not right before going to bed. About three hours should elapse between completion of exercise and regular bedtime. This varies for different people.
4. Stop working a while before going to sleep. It will allow your mind to relax, and it will generally be easier to fall asleep. You won’t have thoughts of uncompleted projects and pending suspense dates running through your head.
5. Minimize stimulants for a few hours before bedtime (usually four or more hours). Stimulants include nicotine (cigarettes, cigars, pipes, chewing tobacco, etc...) and caffeine (coffee, strong teas, caffeinated soft drinks, etc.)
6. Do not use alcohol to fall asleep. It can lead to dependence and other complications.
7. Avoid reading, eating, working, or watching TV in bed during the daytime or prolonged periods at night.
8. Don’t watch your clock, because this will keep you awake rather than help you fall asleep. Turn the clock or yourself around so you won’t see it. Do not try too hard to go to sleep.
9. If you can’t fall asleep within about 15 minutes, then get out of bed and do something (not stimulating, i.e. don’t exercise, drink coffee or tea, start watching an interesting movie, video games etc..) until you feel sleepy. But remember, even if you don’t go to sleep until much later, don’t sleep in or take a nap the next day.
10. Drink a glass of warm milk with some honey before bedtime.

Medication Therapy
 
If education about the sleep problem and implementation of sleep hygiene procedures prove ineffective, then there are medication options for transient insomnia. These medications include zolpiderm (Ambien) and others designed for short-term use only. They help initiate sleep or maintain sleep in the right patients.
 
For chronic insomnia, if treatment of any underlying medical or psychiatric disorder has not helped the insomnia problem, there are some medication options. These include short acting benzodiazepines like alprazolam (Xanax), sedating antidepressants like trazodone (various brand names), amytriptyline (Elavil) or nortriptyline (Pamelor), and others. Newer sleep medications for chronic insomnia are also available.
 
Other options include cognitive behavioral therapy, sleep restriction (minimizing time in bed to increase percentage of sleep time in bed), relaxation techniques, light phase shift (light box therapy in the morning or evening depending on your specific problem), hypnosis, and minimizing stimuli.
 
If you have trouble sleeping because you are depressed or anxious, then treating the depression and anxiety with antidepressants, anti-anxiety medications, counseling and/or psychotherapy will help sleep problems.
 
The more you know about your sleep problem the easier and more effective your treatment will be. Set up an appointment with Dr. Mazlen now at 516-869-0717 to discuss your sleep problem and get the treatment that is right for you.