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Trouble Sleeping?

With the recent time change, I am reminded that everyone has trouble falling asleep sometimes. This is normal. Insomnia may be having trouble falling asleep, staying asleep or not having refreshing sleep. When insomnia becomes a frequent problem there may be several causes.

Short Term Insomnia (3 months or less) is usually caused by stressors including non-ideal sleeping environment, stress in family or with job, pain or recent illness, time changes or jet lag, and medications (use of, or stopping a medication). This type of insomnia is usually resolved with removal of the stressor.

Long Term Insomnia lasts longer than one month. Its causes are often more complicated such as mental health problems; menopausal night sweats; medical illnesses causing pain, stress or breathing problems; medical illnesses such as Parkinson’s or Alzheimer’s Diseases, sleep apnea, restless leg syndrome; medication or illegal drug usage; or may be unknown in cause.

If you think that you have a problem sleeping and have tried the suggestions below without much relief, you should see your doctor for a basic evaluation. Often a review of your medical history and lifestyle can reveal the causes of insomnia and often the solutions are somewhat simple. Most people don’t need medication. We call these suggestions “Sleep Hygiene”.

Good Sleep Hygiene

1. Maintain a regular bedtime and awakening time schedule including weekends. Get up and go to bed at the same time each day regardless of how much sleep you actually got at night.

2. Establish a regular, relaxing bedtime routine. Relaxing rituals prior to bedtime may include a warm bath or shower, aroma therapy, reading or listening to soothing music.

3. Sleep in a room that is dark, quiet, comfortable and slightly cool. Sleep on comfortable mattress and pillows.

4. Use your bedroom only for sleep or sex. Have work materials, computers and TVs in another room. Darken your room as much as possible. This includes all those little power lights from electronic equipment.

5. Finish eating at least 2-3 hours prior to your bedtime.

6. Avoid caffeine within 6 hours of bedtime. Avoid alcohol and smoking within 2 hours of bedtime.

7. Exercise regularly. Finish a few hours before bedtime.

8. Avoid napping during the day.

9. Go to bed only when sleepy. Lay in bed only for sleeping, not for work or watching TV.

10. Designate another time to write down problems and possible solutions rather than right before bedtime. Late afternoon or early evening is better.

11. After 10-15 minutes of not being able to get to sleep, go to another room and read or watch TV until sleepy. Do not watch the clock.

12. See your doctor if you think that you have gastric reflux (heartburn) or severe snoring (sleep apnea) as these conditions may interfere with your sleep.

13. If you think that you may have Anxiety or Depression. This can interfere with sleep. See your doctor.

14. If you take prescription medications or supplements, review these with your doctor to make sure that they are not causing insomnia.

Most people will sleep much better if they use good Sleep Hygiene. Some people may require a little more help and may wish to turn to herbal or other natural remedies. Remember, more is not always better, so take only what is recommended on the package.

Sleep Aids That May Help.

Melatonin: This sleep hormone helps to make you sleepy when it is dark and awake when it is light.

Valerian Root:
Increases GABA (sedating neurotransmitter) levels in the brain.

Lemon Balm: Increases GABA (sedating neurotransmitter) levels in the brain.

Chamomile: Noted for relaxing and antispasmodic properties.

Passion Flower: Noted for relaxing and anxiety reduction properties.

5-HTP: This Serotonin precursor may also help with hot flashes and mood. May prevent early AM waking.

Tylenol PM, Benadryl or Unisom:
These over the counter aids often help.

With the exception of Melatonin, most of these aids should only be for occasional use. They may lose their ability to help if used too frequently.

“But Doc, nothing has worked.”

If your sleep does not improve with the above suggestions or medications, it is time to visit your doctor to evaluate the possible causes. Your primary care doctor is a good place to start. They may either wish to try a medication for insomnia or they may suggest further studies or referral to a sleep specialist for more in-depth evaluation. A description of that evaluation is beyond the scope of this article.

So, if you are having trouble getting enough sleep, try the sleep hygiene first and sleep aids second. If they don’t help much, then see your doctor. Sweet dreams!

For more information, please consult www.uptodate.com/patients and search “insomnia”.