What to do when you can’t fall asleep

Posted at 3:50 PM, Jun 09, 2015

Do you toss and turn at night, yearning for a good night’s sleep?

According to the Centers for Disease Control, an estimated 50 million to 70 million American adults have a sleep or wakefulness disorder that can affect their lives in serious ways. Chronic diseases such as diabetes, depression, high blood pressure, cancer and obesity are linked to poor sleep, as are car accidents, industrial disasters, occupational and medical errors as well as reduced quality of life and productivity. It’s so bad that the CDC has pegged insufficient sleep as an American public health epidemic.

Many of us turn to sleeping pills or other medication aids. But a new study touted as “the most thorough review of the data to date” says popping pills might not be the most effective way to get some quality zzzzzs. Instead, try changing your attitude and behavior about sleep.

“We found that cognitive behavioral therapy for insomnia helped patients enter sleep about 20 minutes faster and improves sleep efficiency by almost 10%,” said study author Dr. James Trauer of the Melbourne Sleep Disorders Center.

“While a pill might seem easier in the moment, it doesn’t help you improve the situation overall,” said Nadine Kaslow, a professor in the Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine. “And there are side effects to many of these medications — like a drowsy hangover or having a hard time getting up.”

“But the worst part is that many of these meds are very addictive, and people get stuck on something for life,” added Kaslow. “So I really recommend to people that they try cognitive behavioral therapy techniques first, and see how those work for them.”

Cognitive behavior therapy is a psychological treatment that focuses on changing specific behaviors and thinking processes. For example, when it comes to sleep, CBT would tackle unrealistic expectations about getting enough shut-eye, give sleep hygiene recommendations and offer relaxation techniques as well as stimulus control.

“All of those things fit under cognitive behavioral therapy,” said Kaslow. “For example, if you take stimulus control therapy, what this does it help remove the factors that might condition your mind to resist sleep. You might coach someone to set a consistent bed time and wake time, to avoid naps, to only use the bed when they are going to sleep or be intimate with a partner.”

Turns out one of the worst things you can do is stay in bed if you can’t sleep. Sleep experts such Kaslow and Trauer want you to get up and leave the room if you’ve not fallen asleep within 20 minutes and only go back to bed when you are sleepy.

“If you can’t sleep, it’s better to get up and be productive, or do something relaxing than to be stressed out that you’re not sleeping,” said Kaslow. “Relaxation training is really helpful. You can do meditation when you wake up, muscle relaxation, even sleep imagery, such as imagining yourself in a safe place that is quiet and calm.”

“It works because it gets to the core of the problem which is frustration with time spent awake in bed,” added Trauer.

Good sleep hygiene, say the experts, also looks at your basic lifestyle habits.

So, for example, you don’t want to smoke or drink too much or have caffeine late in the day. You want to be sure you’re getting regular exercise. And it also means winding down before you go to sleep. So don’t check your email or Facebook on your smartphone or computer just before bed because the light can stimulate your senses.

“And avoid having a really stressful phone call or interaction right before you go to sleep,” adds Kaslow. “You want to keep your bedroom quiet, dark and cool — at the right temperature for you. And if you struggle with insomnia, you certainly don’t want to have the TV in your bedroom.”

CBT sleep therapies are especially helpful for the 10% to 15% of Americans that have chronic insomnia, often connected to chronic stress, depression or anxiety, and pain or discomfort at night. But experts agree the techniques should work for anyone who wants to rest easier.

“I’m often surprised by how many different treatments patients have tried,” said Trauer. “From herbal supplements to Internet resources to medications, without ever having tried cognitive behavioral therapy for insomnia.”

“It does take patience, you have to make a commitment to it, but what this study shows is that it has tremendous benefits,” adds Kaslow. “People’s sleep is much better quality and more efficient, they go to bed and [go] to sleep more quickly, and what’s really important is that there are no bad side effects, no down side.”

If you’re interested in giving CBT a try, reach out to your regional psychological association for local resources. The Association for Behavioral and Cognitive Therapies has a tip sheet on questions to ask as you make your decision.

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