Suffering from insomnia? You’re not alone. “Insomnia is one of the most challenging issues patients deal with,” says Shalini Manchanda, M.D., and director of the Indiana University Health Sleep Disorders Center. The key, says Dr. Manchanda, is to determine which type of insomnia you have. Here’s what you need to know to sleep better this season.
People with this type of insomnia have trouble falling asleep at the beginning of the night. Once they do fall asleep, they tend to stay asleep. But the struggle to doze off initially can seem endless. The typical cause? “There is usually an inciting event, which could be psychological or physical, such as a death in the family, anxiety or depression, or a recent surgery.” Dr. Manchanda recommends that patients address the underlying issue, and that they see a sleep psychologist to learn behavioral strategies that can improve sleep. “The cornerstone of insomnia treatment is cognitive behavior therapy—or CBT. At IU Health, we partner with our sleep psychologists to come up with a plan,” says Dr. Manchanda.
Medication may also be a complement to CBT. In fact, the American Academy of Sleep Medicine (AASM) just released guidelines in February 2017 on sleep medication protocols. “The new guidelines suggest that we might prescribe medication to help patients in the initial phase of treatment—to kick start the process while they work on cognitive behavioral therapies. Then, once CBT takes hold, they can wean off the medication.”
Medications that are prescribed for onset insomnia include: eszopiclone (brand name Lunesta), zaleplon (brand name Sonata), zolpidem (brand name Ambien), and temazepam (brand name Restoril).
Generally, Dr. Manchanda does not recommend using over-the-counter sleep aides. Instead, she advises people to see a sleep specialist.
This term refers to people who wake up throughout the night, and have a hard time falling back asleep. Dr. Manchanda recommends CBT as the mainstay for maintenance insomnia as well. And if needed, medication can also be a part of the program short-term. According to the new AASM guidelines, these medications may include a class of drug called suvorexant (brand name Belsomra) or options such as eszopiclone (Lunesta), Zolpidem (Ambien), and Temazepam (Restoril).
“With this kind of insomnia, patients have some other illness as well,” says Dr. Manchanda. For instance, certain conditions—such as backaches, arthritis, or chemotherapy treatment—can trigger insomnia. Once again, Dr. Manchanda suggests CBT and appropriate short-term sleep medications to tackle the problem.
Acute Insomnia vs. Chronic Insomnia
If any type of insomnia lasts for a brief period of time, it is considered acute insomnia. If, however, a person has difficulty falling asleep or staying asleep at least three nights a week for three months or longer, it is considered chronic insomnia. If you find yourself battling chronic insomnia, your best bet is to see a specialist to help you get it under control.
Good Sleep Practices
No matter the issue, Dr. Manchanda says that good sleep hygiene should be a priority—and part of any treatment plan. “If you don’t follow a good routine, your sleep is going to suffer,” she says. Dr. Manchanda suggests these strategies:
- Stick to a set bedtime and wake time—aiming for between 7 to 9 hours of sleep each night. This will set your body’s clock (your circadian rhythms), making it easier for you to fall asleep and stay asleep nightly.
- Keep a sleep log.
- Disconnect from electronics at least an hour before bed; the lights from the screens can disrupt the production of melatonin (which is necessary to fall asleep).
- Keep your bedroom free of distractions, stressful paperwork, and phones.
- Avoid heavy meals, caffeine, alcohol and strenuous exercise before bed because these things can rev up your system and make it more difficult to sleep soundly throughout the night.
- Wind down with a relaxing activity—such as light reading—in dim lighting at least 30 minutes before bed.
- Maintain a cool and dark sleep area. Invest in blackout shades to prevent light from disturbing your shuteye.
- Once you get up in the morning, expose yourself to sunlight, which alerts your body that it’s time to be awake and jumpstarts your daytime clock.
- If you can’t fall asleep after more than 20 minutes, get out of bed and move to another space to do a relaxing activity, such as reading. When you feel sleepy, return to bed. This will help you avoid associating your bed with stress, and will instead help you link your bed to peaceful sleep.
— By Rachel Rabkin Peachman