RODALE NEWS, EMMAUS, PA—When I speak to groups of guests at Canyon Ranch about improving their sleep, I usually take a brief survey of those in attendance to learn about the source of their sleep difficulties. A few people report that they’re kept awake by a physical problem, such as chronic pain or nasal allergies. A few by factors in their sleep environment—a snoring spouse, a young child. And over half say it’s by stress and an inability to turn off their minds. Many of the guests report they have used sleeping pills, and a smaller percentage relate they are taking them continuously. Sleep and health are so closely connected that it's well worth taking time to address the factors that keep us from getting the sleep we need. But not all sleep remedies are as helpful as they may seem.
THE DETAILS: I am frequently asked whether it is safe and helpful to take sleeping pills. I tell people that sleeping pills can provide welcome relief from a temporary sleep problem. For instance, if you’re in the hospital recovering from surgery, and pain is making it difficult to sleep, temporary use of a hypnotic sedative can help you get much-needed rest.
However, long-term use of sleeping pills has several drawbacks:
• Sleeping pills sometimes lose their efficacy over time.
• Some sleeping pills can negatively affect sleep architecture, producing more of the lighter Stage 2 sleep, rather than the deeper, more restorative rest characteristic of Stage 3 and Stage 4 sleep.
• Some over-the-counter sleeping pills contain antihistamines that block the action of a specific neurotransmitter, acetylcholine, which can lead to cognitive impairments.
• Some sleeping pills have been associated with potentially dangerous side effects, including getting up and walking, eating, and even driving while asleep.
In order to achieve long-lasting improvements in insomnia, I recommend cognitive-behavioral therapy. This approach includes several components, including establishing a regular sleep-wake rhythm, limiting the amount of time spent in bed awake, learning to identify and change anxiety-producing thoughts that interfere with sleep, and utilizing breathing and relaxation techniques to calm the mind and relax the body.
A study published in the Journal of the American Medical Association found that sleeping pills provided modest short-term benefits, but added no additional long-term benefit beyond what patients achieved with cognitive-behavioral therapy. In fact, among insomniacs who received 6 weeks of treatment with both cognitive behavioral therapy and sleeping pills, those who discontinued the medication and continued to use cognitive-behavioral techniques slept better at 6-month follow-up (and even better at 12 month follow-up), compared to people who kept using sleep medication. The authors concluded that for long-term improvement in sleep quality, there was no added value in adding medication to cognitive-behavioral therapy.
WHAT IT MEANS: Medication can be a helpful tool to get you through a short-term bout of insomnia. But in the long run, the way to bring back restful sleep is by investing some time and effort into changing some of the behaviors that influence your sleeping. To learn, or relearn, some basic sleep skills. Many mental-health professionals and therapists can help with this by applying cognitive-behavioral therapy to your particular sleep problems. But you can also try some of basic strategies on your own:
• Follow a nightly ritual. Create a relaxing bedtime routine to help prepare your mind and body for sleep. A hot bath or shower, soft music, dim lights, and pleasant fragrances can help you become deeply relaxed and ready for sleep. And if you follow the same routine on most nights, the ritual itself becomes a cue that tells your body it’s time to wind down.
• Put your mind at ease. Let go of distressing thoughts that can sabotage sleep. Learn to observe your thoughts without becoming emotionally caught up in them. It is especially important to transform negative thoughts about sleep (“I’ll never get to sleep tonight” or “I’ll be a wreck all day tomorrow”) to more constructive thoughts (“I’ll get back to sleep eventually” or “Even if I am up for a little while, I’ll be fine tomorrow. I always manage to function one way or another.”)
• Get out of bed for a while. If you can’t get fall sleep within 20 minutes or so, get out of bed, go into another room and read or listen to music in low light. (But no TV—it tends to keep you awake.) Once you start feeling sleepy, go back into your bedroom and go back to sleep. This not only keeps you from getting frustrated as you toss and turn, it helps your body associate the bed with sleep, not wakefulness.
• Eat and drink early in the evening. Avoid eating during the three hours before bed, and limit alcohol to just one glass (for women) or two (for men) with dinner. Too much alcohol may make you sleepy at first but it will interfere with your sleep cycle later on.
• Treat your bed like a bed. Use your bed only for sex and sleep. As mentioned above, you want to train your mind and body to associate the bed with rest and relaxation, not with watching TV, surfing the net, eating a snack, or working (never use it as a second office).
• Expend some energy. Engage in aerobic exercise on most days of the week, at whatever time is convenient for you. It’s not that you have to work out before bedtime to tire your body. Rather, regular exercise is a general sleep promoter (along with all its other healthy effects).
If your sleep problem persists, consider consulting a sleep specialist, who can evaluate your sleep difficulty and tailor an approach to meet your specific needs. Seeking help is no failing; sleep problems are extremely common. But they’re also responsive to treatment, if you are willing to learn and practice constructive sleep skills.
Jeffrey Rossman, PhD, is a Rodale.com advisor and director of life management at Canyon Ranch in Lenox, MA. His column, “Mind-Body-Mood Advisor,” appears Mondays on Rodale.com. He is the author of The Mind-Body Mood Solution(Rodale, 2011).