Probably the biggest problem in treating sleep problems is that of overtreatment, especially overuse of sleeping pills, which usually makes matters worse. The first step is to reduce expectations to realistic proportions.
Need to sleep?
Many of us are too obsessed with the idea of getting a perfect night’s sleep every night and being able to function at our best the next morning. This ideal state is simply not achievable for anyone every night and is not even remotely achieved by most people most nights.
Part of the problem is that we evolved in an environment that was much more sleep-friendly than the modern world. Before the age of candles and electricity, the night was dark, quiet, dull and relaxing. Before clocks, people slept more according to their own schedules, obeying the mysterious guidance of their own body rhythms.
They were also not in the habit of working their brains with stimulants and rarely enjoyed the luxury of bingeing just before going to sleep. The heating, air conditioning, mattresses and blankets may not have been as good then as they are today, but everything else was infinitely more sleep-conducive than the bedtime world is today. In the modern world, sleep is almost an endangered species.
We have too much light, noise, distractions, things to do, fun to have, problems to think about. We expect our brains to keep working overtime at full speed and then immediately shut down when we turn on the light switch. It doesn’t work that way. A warmed up engine must cool down. Add to this the reduced sleep efficiency in old age, the use of various substances or the transition between time zone classes, and it should come as no surprise that so many people need help sleeping.
Relaxation
Start with the simple things. Perhaps most importantly, get used
to preparing for sleep slowly and don’t view it as a battle you have to face. Maintain a bedtime that is as consistent as possible, one that suits your biorhythm rather than one that is constantly intrusive. Before bed, do things that slow your pace, calm you down, and calm you down. Anything that relaxes or causes boredom is probably good preparation. Put the worries of the day where they belong on the refrigerator.
You will have plenty of time to look at it tomorrow and the soup is never eaten as hot as it is served. A calm and gradual approach to sleep, in accordance with your natural rhythm, is the best protection against insomnia.
There are some other simple things that come with good sleep hygiene. Don’t indulge in a huge amount of sleep during the day in the form of extra naps unless this is part of your natural rhythm. Do not train or exercise vigorously after sunset, as this will probably wake you up again. Do not use any substances. Choose a room temperature that makes you feel sleepy. Keep light and noise out or provide soothing sound if you need it. Don’t stuff yourself late at night, a light snack is nice.
Stimulus control
Many people, through years of insomnia, become conditioned to associate bedtime and the bedroom with tossing and turning and struggling with a sleep that won’t come. Stimulus control therapy aims to break this negative link and restore the status quo by re-associating going to bed with restful sleep.
The instructions include not going to bed until you are asleep, using your bed only for sex and sleeping (not for reading, watching TV or eating), and getting out of bed and going to bed. to go to another room if you cannot fall asleep within twenty minutes and not to go back until you are sleepy. Some people consider this the perfect time to do overdue administration, if you are lucky you will fall asleep at the thought alone. For others, reading a long novel or watching a movie or listening to music works best to make them sleepy. Some do relaxation or meditation exercises to leave the day behind and prepare for the night.
Poor sleepers sometimes stay in bed longer to give themselves more opportunity to sleep. This is a terrible strategy that only leads to nervousness and lost sleep. Sleep deprivation therapy counters this by more closely matching the time you spend in bed and the time you sleep. The first step involves staying in bed for the duration of the time you expect to sleep each night, plus fifteen minutes.
For example, if you always sleep five hours at night and normally get up at six o’clock, you should not go to bed earlier than a quarter to one in the morning. Once you manage to sleep around 90% of your allotted time, extend your stay in bed by going to bed 15 minutes earlier. This process is then repeated until the desired sleep time is reached, which usually takes three to four weeks.
Sleeping pills
Although sleeping pills may help for a few days to a few weeks, they do not do so in the long term. They are best used for short periods of time in people who need immediate relief from their insomnia because it is a symptom of a mental disorder or medical condition. The sedatives/hypnotics, tricyclic antidepressants and antihistamines all have their advantages and mainly disadvantages. Most of the sedative/hypnotics, the most commonly prescribed sleeping tablets, belong to the same chemical class, the benzodiazepines.
Some are marketed specifically as sleep aids (Dormicum, Normison, Loramet, Imovane) and most of the others (such as Xanax) are sometimes used as such. These medications, although only in the short term, can induce sleep with minimal hangover afterwards, but in the long term they are ineffective and can lead to a physical or psychological addiction. People develop tolerance to the sleep-inducing effect and must continually increase the dose to maintain the effect. Abruptly stopping the drug (because you forgot to take your pills while traveling) leads to reactive insomnia that can be worse than it was initially.
Memory loss is common with these drugs, making them impractical for use by people who unexpectedly have to respond in the middle of the night. Finally, elderly people must be extra careful because these medications can cause confusion, delirium or falls. Various antidepressants are also used in some cases to induce sleep due to their sedative side effect; Tryptizol is an example of this. Although they have the advantage of not causing addiction, some people notice significant after-effects of feeling groggy the next day. Many cold and allergy medications that contain antihistamines cause excessive drowsiness as a side effect and are used by many to help them fall asleep. Antihistamines are the most commonly found active ingredient in over-the-counter sleeping tablets. Unfortunately, a hangover is very common.
Hypersomnia
Hypersomnia is even more difficult to treat. Behavioral therapy attempts to shorten sleep time or reduce daytime sleepiness have not met with much success. Usually, treatment focuses on combating daytime fatigue with stimulants such as Ritalin.
Circadian sleep disorder
Circadian sleep disorder can be treated with all kinds of maneuvers to adjust the internal clock so that it better matches the demands of the environment. Problems with late (night owl) or early (early bird) sleep can be improved by exposure to bright light at the right time of day: in the morning for the owl and in the evening for the early bird.
Exposure to bright light does not work particularly well for people who work shifts because it is slow to change the internal clock, an hour or two per day, which does not keep up with the rapidly changing demands of rotating shifts. If you have jet lag, exposure to bright light at the right time can help reset your internal clock to the local time. For example, if you are traveling from Europe to New York for a few days, you could try to advance your clock with exposure to bright light in the mornings before your departure.
Since this usually requires several days, for a shorter stay it is better not to adjust your sleep pattern back to local time but instead stick to your usual sleep times, if your program allows it. The health food supplement melatonin appears to have some effect on shifting the internal clock in the opposite direction of bright light (i.e. a dose of melatonin in the morning shifts the clock to a later rather than earlier hour). Because accidents during sleepwalking can be life-threatening, safety measures are absolutely necessary.
Sleep on the ground floor, lock doors and windows, and remove potentially dangerous items from the bedroom. Sleepwalking and pavor nocturnus only occur during REM sleep.
