{"id":18735,"date":"2020-06-03T12:05:00","date_gmt":"2020-06-03T17:05:00","guid":{"rendered":"http:\/\/thepapergown.zocdoc.com\/?p=18735"},"modified":"2023-03-06T09:56:52","modified_gmt":"2023-03-06T14:56:52","slug":"a-former-insomniacs-guide-to-getting-sleep","status":"publish","type":"post","link":"https:\/\/www.zocdoc.com\/blog\/guides\/a-former-insomniacs-guide-to-getting-sleep\/","title":{"rendered":"A Former Insomniac’s Guide to Fixing Your Sleep"},"content":{"rendered":"

Over the years, I\u2019ve tried every non-pharmaceutical trick in the book to overcome my insomnia: White noise. Room-darkening shades. No caffeine after noon. No screen time before bed. Meditation. Yoga. Journaling. Melatonin. CBD. And on and on, ad nauseum.<\/span><\/p>\n

Sleep has always been elusive for me. At its worst, five years ago, I was getting by on just a few hours of shuteye each night. For months, I was running on fumes, and I needed help, which led me to an online insomnia treatment program that thankfully made a lasting impact on my sleep for the better.<\/span><\/p>\n

Everyone experiences the occasional sleepless night, and that\u2019s especially true during a period of increased uncertainty like a pandemic<\/span>. But when a few restless nights turn into a pattern that hurts your quality of life, it\u2019s time to seek help, says Dr. Jennifer Martin, professor of medicine at the David Geffen School of Medicine at UCLA and a member of the American Academy of Sleep Medicine board of directors.<\/span><\/p>\n

\u201cA bad night of sleep when you\u2019re experiencing stress is a normal response,\u201d says Martin. \u201cClinically, we think of insomnia as an actual sleep disorder if it happens at least three times a week and goes on for three months or longer.\u201d<\/span><\/p>\n

If you\u2019ve been tossing and turning for weeks, months or years, here\u2019s what experts suggest when it comes to finding help and starting treatment for insomnia.<\/span><\/p>\n

Working with a sleep specialist<\/h2>\n

\u201cDon\u2019t ignore sleep problems,\u201d says Terry Cralle, a registered nurse and sleep educator based in Washington, DC. \u201cWe sometimes characterize it as, \u2018Oh, if you need sleep, you\u2019re weak, or you\u2019re not ambitious, or you just need to power through.\u2019 None of that\u2019s true. Sleep is a biological need. We need sleep like we need water.\u201d<\/span><\/p>\n

You can talk to your primary care provider about insomnia, but your general practitioner might not be well versed in the latest treatments.<\/span><\/p>\n

\u201cFor a lot of regular doctors, [medication] is the only thing they know about,\u201d Martin says. But these days, <\/span>cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment for insomnia<\/span><\/a> \u2014 not pills.\u00a0<\/span><\/p>\n

You can ask your PCP for a referral to a sleep specialist, or you can search for one through the <\/span>Society for Behavioral Sleep Medicine<\/span><\/a> or the <\/span>American Academy of Sleep Medicine<\/span><\/a>. Sleep specialists, who\u2019ve all been trained to treat sleep disorders, can be <\/span>physicians, psychologists or even dentists<\/span><\/a>. Most medical doctors who treat sleep issues specialize in internal medicine, psychiatry, pediatrics or neurology, <\/span>according to the AASM<\/span><\/a>. Therapists and <\/span>psychologists <\/span><\/a>can also specialize in treating sleep disorders.<\/span><\/p>\n

If you can\u2019t meet with a specialist in person or you don\u2019t have one in your area, many providers provide treatment for insomnia via telemedicine, and <\/span>a recent study<\/span><\/a> shows that telemedicine is as effective as in-person CBT-I.<\/span><\/p>\n

\u201cWith the pandemic, telemedicine is now becoming the norm, so it would not be difficult at all to find a specialist,\u201d says Bill Fish, managing editor of SleepFoundation.org and a certified sleep science coach.<\/span><\/p>\n

Online program for insomnia<\/h2>\n

Self-guided, online CBT-I programs like <\/span>Sleepio<\/span><\/a>, <\/span>SHUTi<\/span><\/a> and <\/span>CBT-I Coach<\/span><\/a> are another avenue for people interested in a DIY approach. When my insomnia was at its worst, a Google search led me to Sleepio\u2019s online program. It was a godsend. I followed the six-week regimen to a T, reading articles about sleep, watching weekly videos and following the guidelines laid out in the program, like getting out of bed when I couldn\u2019t fall asleep and waking up at the same time each morning.<\/span><\/p>\n

\u201cThere\u2019s <\/span>data that they actually work<\/span><\/a> for a lot of folks,\u201d Martin says of online programs, but she warns that they don\u2019t offer the individualization of in-person or telemedicine therapy. An online program also requires a lot of self-discipline.\u00a0<\/span><\/p>\n

\u201cBe really honest with yourself,” she says. “If you\u2019re the kind of person who can do a program on your own, if you sign up for P90X or whatever and you actually do all the workouts and that\u2019s your way of doing things, there are really good online programs.”<\/span><\/p>\n

Breaking down CBT-I<\/h2>\n

CBT is a therapeutic approach that aims to <\/span>change negative or unhelpful thinking patterns<\/span><\/a>. CBT-I specifically is designed to help insomniacs understand their broken relationship with sleep and then rebuild it, replacing irrational sleep beliefs and habits with ones more conducive to a good night\u2019s rest. That includes letting go of the notion of \u201ctrying\u201d to sleep, which can create a vicious cycle: The harder you try to sleep, the harder it becomes to fall asleep.\u00a0<\/span><\/p>\n

\u201cIt\u2019s kind of a rip-the-Bandaid-off approach,\u201d Martin says. \u201cWe try to fix everything that might be making a person\u2019s sleep worse.\u201d<\/span><\/p>\n

Whether you work with a specialist or go the self-guided route, you\u2019ll begin CBT-I by keeping a sleep diary to track how much sleep you\u2019re getting at night. Then, your program will include a combination of the following <\/span>strategies:<\/span><\/p>\n

Sleep restriction<\/strong>
\n<\/span><\/i>If you spend hours every night tossing and turning in bed, it eventually creates an association between the bed and being awake, which feeds into the cycle of sleeplessness. During <\/span>sleep restriction<\/span><\/a>, you limit your time in bed to <\/span>only<\/span><\/i> the time you\u2019re sleeping: Use your sleep diary to determine how much sleep you get per night, on average. Then you restrict your time in bed to that amount, plus about 15 minutes.\u00a0<\/span><\/p>\n

For me, this was the hardest part of CBT-I. During the first week of my program, I was only able to be in bed from 12:30 am to 6 am, based on the 5 or so hours of sleep I was averaging each night and the time I needed to be up for work. To limit my time in bed to that narrow window, I stayed up late when I was exhausted and got out of bed at the same time every day, even when I felt tired enough to sleep for a few more hours. The days were brutal, but at night, I started falling asleep not long after my head hit the pillow \u2014 a far cry from tossing and turning until 4 am.\u00a0<\/span><\/p>\n

\u201cThe sleep restriction is hard, and it works,\u201d Martin says. \u201cI usually tell people we shouldn\u2019t do it during final exam week. Let\u2019s pick a time to do that when you can get through it. The beginning is harder, and then it gets easier.\u201d<\/span><\/p>\n

And I can assure you, it <\/span>does<\/span><\/i> get easier. Each week that you maintain good <\/span>sleep efficiency<\/span><\/a> \u2014 meaning that at least 80 to 90 percent of time in bed is spent sleeping \u2014 you can add another 15 minutes to your sleep window. Over the course of several weeks, I worked up from my 5.5-hour sleep window to a full 8.5 hours.\u00a0<\/span><\/p>\n

Stimulus control<\/strong>
\n<\/span><\/i>If lying awake in bed creates an association between the bed and wakefulness, so will any other waking activity in bed (aside from sex).<\/span><\/p>\n

\u201cDon\u2019t do anything else in the bed. Don\u2019t argue with your partner, don\u2019t pay bills, stay off the electronics. We\u2019re just going to associate that with being awake and not being asleep,\u201d Cralle says.<\/span><\/p>\n

Stimulus control therapy<\/span><\/a> includes eliminating all waking activities from your bedroom, along with avoiding daytime naps and maintaining a regular wake-up time (even on weekends and after nights of poor sleep).<\/span><\/p>\n

Cognitive therapy techniques
\n<\/i><\/strong>Cognitive therapy<\/span><\/a> challenges our false or misunderstood ideas about sleep. Learning how sleep works makes it less elusive, Martin says: \u201cWhen you have facts and information it\u2019s a little easier to change the way you approach sleep in general.\u201d\u00a0<\/span><\/p>\n

For me, learning that <\/span>most people underestimate how much sleep they\u2019re getting<\/span><\/a> was a turning point. Instead of panicking after a sleepless night, I felt reassured knowing I probably got more sleep than I remembered.\u00a0<\/span><\/p>\n

Many CBT-I programs also introduce relaxation techniques to \u201cwork on what\u2019s going on in our mind when we get in bed at night,\u201d Martin says. This could include writing down negative thoughts about sleep and then rewriting them as positive statements or listening to a relaxation meditation.<\/span><\/p>\n

Sleep hygiene\u00a0<\/strong>
\n<\/span><\/i>CBT-I programs emphasize good <\/span>sleep hygiene<\/span><\/a>, which includes all the things you should do (and avoid) to promote good sleep, like avoiding caffeine late in the day and cutting down on alcohol.<\/span><\/p>\n

\u201cThe other thing is just really developing strategies for winding down at the end of the day, so your brain and body are relaxed when you get into bed,\u201d Martin says. If you usually watch an action-packed TV show before bed, for example, you might try swapping it for a lighthearted novel.<\/span><\/p>\n

\u201cSome people feel that a glass of warm milk helps them sleep, when maybe it is the custom of the action that is actually telling your brain to relax,\u201d Fish says. \u201cIf something works for you personally, stick with it. Consistency is key.\u201d<\/span><\/p>\n

Give it time<\/strong>
\n<\/span><\/i>Shifting long-held beliefs and habits takes time. The average length of CBT-I treatment is four to eight weeks, Martin says, which is <\/span>relatively quick compared to therapeutic programs for other conditions<\/span><\/a>. While some parts of the approach (like sleep restriction) can be unpleasant, <\/span>CBT-I works<\/span><\/a>: <\/span>Studies show it\u2019s effective in the long run<\/span><\/a> for keeping insomnia at bay.<\/span><\/p>\n

What about sleeping pills?<\/h2>\n

For chronic insomnia, experts say sleeping pills aren\u2019t a great option. In the long run, they can lead to dependency.<\/span><\/p>\n

\u201cOne of the challenges when people start taking a sleeping pill is they work for a while, but then they work less well,\u201d Martin says. \u201cGetting off sleeping pills requires slow, methodical dose reduction supervised by a physician. So, do people get addicted to them? Not in the traditional sense that we think about drug addiction. But is it hard to stop taking them? Absolutely.\u201d<\/span><\/p>\n

As for melatonin, \u201cit\u2019s not really a sleep aid; it acts on your circadian timing system,\u201d Martin says. Melatonin is better for dealing with jet lag or changing your sleep schedule than for treating insomnia.<\/span><\/p>\n

When CBT-I fails, rule out other conditions<\/h2>\n

Studies show CBT-I has a <\/span>success rate of around 70 to 80 percent<\/span><\/a>. But if you complete a CBT-I program and still struggle with sleep, it could be a sign of another condition.<\/span><\/p>\n

\u201cThere is a lot of overlap between insomnia and sleep apnea,\u201d Martin says. Your doctor might order an overnight diagnostic test to rule out sleep apnea or other conditions.<\/span><\/p>\n

Ultimately, whether you\u2019re dealing with insomnia or overlapping conditions, it\u2019s worth talking to your doctor to get to the root of your sleeplessness.<\/span><\/p>\n

\u201cPoor sleep is not inevitable,\u201d Cralle says. \u201cThere are many ways to help your sleep, so always bring it up.\u201d<\/span><\/p>\n

\n

Ready to book a doctor’s appointment? Visit Zocdoc.<\/span><\/a><\/span><\/h1>\n","protected":false},"excerpt":{"rendered":"

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