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The Healthy Doctor Sleep Challenge: How to treat insomnia

800px-Jackie_Martinez_in_B&W_sleeping_with_a_bookInsomnia is a strange concept to me: I seem to be able to fall asleep at the drop of a hat, because I’m a mum and we are chronically sleep-deprived! However, I do occasionally suffer from sleepless nights (that are not because of waking up for littlies) and I did suffer from mummy insomnia when my babies slept poorly, finding it difficult to fall asleep after multiple wakings, and feeling anxious at bedtime because of the anticipation of a wakeful night.

For those of you who suffer from insomnia on a regular basis, here are some evidence-based recommendations for you. There is no magic bullet for treating sleep problems, but perhaps there’s something here that you haven’t tried consistently. Give it a go. Some medical problems can cause insomnia, so see your GP if you’re concerned.

Change your bed associations

I’m pretty bad at this – you’re supposed to only be in bed for sleep (and sex!) but I spend a lot of time in bed reading. Apparently this is a no-no as the bed is then associated with being awake. If you’re feeling insomniac, try only getting into bed when you feel sleepy, and avoid spending longer than twenty minutes lying awake in bed. If you can’t fall asleep quickly, get out of bed, sit somewhere quiet and dark and listen to some music or boring talkback radio (avoid the temptation to start surfing the internet or watch TV).

Restrict your sleep

This sounds completely counter-intuitive for me, but I’m sure it works. If you’re struggling with insomnia, calculate how much sleep you’re actually getting each night (eg 6 hours). Then subtract this from your waking time, and only get into bed at that time. You can then start moving bedtime back by 15-20 minutes every night if you’re falling asleep easily. Try not to catch up on sleep during the day – save your sleep for night times. You should, however, aim to be in bed at least five hours before you’re supposed to be awake.

Sleep hygiene

1. Avoid caffeine six to eight hours before bedtime
2. Avoid nicotine before bed and throughout the night
3. Avoid alcohol before bed – it actually disrupts sleep more than it promotes sleep.
4. Exercise regularly but avoid exercising within 30 minutes of going to bed.
5. Keep your room slightly cool, and dark.
6. Allow an hour to unwind before bed – and try to ensure dim lighting or relative darkness during this time.
7. Maintain a regular sleep schedule – go to sleep and wake up at the same time every day.

Practise relaxation strategies

These help reduce adrenaline and help you sleep. Relaxation strategies might include progressive muscle relaxation, mindfulness meditation, or whatever takes your fancy. Listen to a meditation or relaxation podcast and snooze away!

Do natural medicines help?

The evidence isn’t very strong for the use of natural medicines for sleep, but you could try lemon balm and valerian. Be aware that valerian can cause paradoxical agitation in some people. Melatonin seemed like a promising treatment for insomnia, but hasn’t quite met our expectations yet. However, you can boost your natural melatonin release at night by keeping the lighting down, getting some daylight exposure during the day, and eating foods high in tryptophan (the precursor of melatonin) – such as dairy, oats, turkey, fish, and pork. (This might be the reason why drinking a glass of warm milk helps you sleep!)

References:

Goodie, Jeffrey L., and Christopher L. Hunter. “Practical Guidance for Targeting Insomnia in Primary Care Settings.” Cognitive and Behavioral Practice (2014).
Photo credit: By mark sebastian (Flickr: Laziest. Model. Ever. (#6228)) [CC-BY-SA-2.0 (http://creativecommons.org/licenses/by-sa/2.0)], via Wikimedia Commons
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