Insomnia

According to the Nielsen Media Company, which tracks television viewing habits in the United States, some 20 million Americans are watching TV at 2:00 in the morning. But that's only a fraction of the people who are kept awake by insomnia.

Perhaps you fall asleep easily, but wake up at 3:00 A.M. and can't fall back to sleep. Or maybe you wake up and fall asleep several times each night, but rarely get one lone, uninterrupted stretch of restful, refreshing sleep. All these problems are insomnia.

"People think that insomnia just means trouble falling asleep," says Peter Hauri, Ph.D., director of the Mayo Clinic Insomnia Program in Rochester, Minnesota, and co-author (with Shirley Linde, Ph.D.) of No More Sleepless Nights. "Actually, it's any problem with falling or staying asleep."

It is estimated that 30 million to 60 million Americans-mostly women-experience chronic sleeplessness, and 10 million consult doctors for the problem. Half of all American adults have taken sleep medication at some point in their lives, and millions use sleeping pills frequently.

Insomnia's costs extend beyond the bedroom. Compared with normal sleepers, people with insomnia are less productive at work and have twice as many auto accidents. They also report generally poorer health, because sleep is critical to immune function.

"Insomnia is so common that it's accepted-mistakenly-as a normal part of getting older," says William Dement, M.D., Ph.D., director of the Stanford University Sleep Disorders Clinic and chairperson of the National Commission on Sleep Disorders Research.

But there's hope. Sleep specialists typically help about 80 percent of even chronic insomniacs fairly quickly with a program that combines home remedies, mainstream medicine, and alternative therapies.

Best Choices

Nutrition

Eliminate caffeine. "Caffeine causes more sleep problems than most people realize;' says Katherine Albert, M.D., Ph.D., director of the sleep laboratory at New York Presbyterian Hospital/Cornell Medical Center in New York City. But don't eliminate caffeine cold turkey, or you'll experience withdrawal symptoms-notably, a headache that can last for several days. Instead, taper off over a few weeks by Onlineremediesing decreasing proportions of regular with increasing proportions of decaf. In addition, sip less regular tea and more herbal teas, and drink fewer caffeinated soft drinks and more that are caffeine-free.

Confirm that it's decaf. If a restaurant server makes a mistake and gives you regular coffee instead of decaf, you could be up all night. When you're served what you think is decaf, make sure. Ask, "This is decaf, isn't it?"

Say no to nightcaps. "Doctors used to tell insomniacs to have a cocktail or glass of wine before bedtime;" says Peter Hauri, Ph.D., director of the insomnia program and codirector of the Sleep Disorders Center at the Mayo Clinic in Rochester, Minnesota. "But many people find that drinking late in the evening produces troubled, fragmented sleep." A glass of wine with dinner won't hurt, but don't drink alcohol within a few hours of retiring.

Watch what you eat. The healthier you are, the better you sleep. The healthiest diet is low-fat and near-vegetarian, based on whole grains, beans, fruits, and vegetables. Go easy on fatty, hard-to-digest foods: meats, deep-fried foods, fast foods, and greasy snacks.

Watch when you eat. Bedtime snacks are fine, as long as they're small and light. Don't eat a big dinner or anything heavy within an hour or two of bedtime, Dr. Hauri advises. Digestive processes can disturb sleep.

Eat sleep-inducing foods. An amino acid, tryptophan is a component of serotonin, a chemical messenger in the brain that helps induce sleep. In 1996, the Food and Drug Administration made tryptophan a prescription-only item. Ask your doctor for a prescription if you like-or get the amino acids from food sources such as tuna, cottage cheese, rice, oatmeal, eggs, peanut butter, and milk.

Supplements

Mellow with melatonin. This hormone is involved in regulating sleep. Several studies have demonstrated its sedative effect, but melatonin has been used as a sleep aid for only a few years. Its long-term safety is still unknown.

Melatonin is available over the counter in health food stores and most drugstores. Use it according to the package directions. Melatonin is not appropriate for women who are pregnant or breastfeeding or who are considering pregnancy. Nor should it be taken by anyone who is prone to depression; who is taking an antidepressant; or who has diabetes, epilepsy, migraine, or rheumatoid arthritis. Possible side effects include nausea, headache, giddiness, difficulty concentrating, and daytime sleepiness.

Defy deficiencies with a multi. "Deficiencies in the B vitamins, calcium, copper, iron, magnesium, and zinc can contribute to sleep problems," Dr. Hauri says. By eating a healthy, well-balanced diet, you can cover your nutritional bases. As insurance, clinical nutritionist Shari Lieberman, Ph.D., recommends taking a daily multivitamin/mineral supplement that supplies all of these nutrients.

Exercise

Sweat, then sleep. Regular exercise is one of the best things you can do to sleep soundly, Dr. Hauri says. Any activity helps, but he especially recommends walking­ideally, one brisk half-hour walk every day.

"Exercising in the late afternoon releases the day's stress and decreases your appetite for dinner, which helps you stick to the light supper that sleep experts recommend," Dr. Albert says. "Just don't exercise too close to bedtime. That's stimulating and can keep you up."

Relaxation Therapies

Breathe your way to Zzzs. Deep breathing is a fundamental relaxation technique. Five to 20 minutes of sitting quietly and breathing deeply before going to bed might help you fall asleep, Dr. Hauri says.

Focus on a mantra. A panel of experts appointed by the National Institutes of Health (NIH) investigated nondrug approaches to treating insomnia. They concluded that meditation produces "significant improvement in sleep."

Soak before snoozing. Bathing is a traditional relaxing bedtime ritual. Researchers at the University of California, Santa Barbara, put it to the test. Not surprisingly, their study showed that compared with nonbathers, people who took a tolerably hot bath an hour or so before bedtime fell asleep faster.

Boost sleep with the Bootzin Technique. This behavior therapy program was developed in the 1970s by Richard Bootzin, Ph.D., then at Northwestern University in Chicago. It's often quite helpful in inducing sleep. Here's what to do.

1. Go to bed only when you feel sleepy. Ignore the clock. Thne in to how you feel.
2. Use your bed only for sleeping and sex. No eating, reading, watching TV, talking on the phone, or anything else.
3. If you go to bed but can't fall asleep, get up and leave the bedroom. Read, watch TV, listen to music-do something until you feel sleepy again. Then return to bed.
4. Repeat step 3 as often as you need to throughout the night.
5. No matter when you go to sleep, set an alarm for the same time every morning.
6. Don't nap during the day.

The first night or two of using the Bootzin Technique, you may repeat step 3 several times. But over a few nights, the repetitions typically diminish and often disappear. If your insomnia recurs after a period of sleeping well, simply return to the six steps.

Visualization

See yourself in dreamland. "Visualization therapy can be a powerful tool for inducing sleep," says Martin L. Rossman, M.D. The Academy for Guided Imagery in Mill Valley, California, offers a visualization audio­cassette called A Restful Sleep: An Imagery Experience with Getting a Good Night's Sleep. For ordering information, write to the Academy for Guided Imagery at P. O. Box 2070, Mill Valley, CA 94942-2070.

Biofeedback

Slip into slumber with biofeedback. The NIH panel also gave high marks to biofeedback relaxation training as a sleep aid. It's similar to meditation.

Aromatherapy

Entice the Sandman with the scent of lavender. Lavender is an aromatherapy favorite for relaxation and insomnia. You can buy lavender essential oil in many health food stores and through mail-order catalogs. To use it, place a few chips of rock salt in a small, capped vial, then add a few drops of the oil. The salt absorbs the oil, so it doesn't splash out when you open the vial. Uncap the vial and inhale the scent as needed.

Herbal Medicine

Take tea and sleep. Many medicinal herbs are gentle sedatives. James A. Duke, Ph.D., recommends chamomile, catnip, hops, lavender, lemon balm, passionflower, and valerian. With the exception of valerian, you can enjoy these herbs in teas, either individually or in combination. Add 1 to 2 teaspoons of herb to 1 cup of boiled water, steep for 10 minutes, then strain.

Valerian is very effective, but it has an unpleasant taste. As a tea, the herb is virtually undrinkable. Look for capsules or a tincture in health food stores and drugstores. Use it according to the package directions.

Home Remedies

Try sex. Lovemaking has a well-deserved reputation for improving sleep. But not all sex works. "It depends on how the sex makes you feel," Dr. Hauri explains. "If you feel loved and cared for, sex can help you sleep. But if it's unsatisfying or takes place in a problematic relationship, it might be the prelude to a very poor night's sleep."

Keep a sleep diary. A sleep diary can be quite helpful in overcoming sleep problems, Dr. Albert says. It can reveal sleep-disrupting behavior patterns that might otherwise remain hidden. For 2 weeks, simply jot down what and when you eat, drink, and do everything else during the day. Also note your emotional stressors, any drugs you take, and how long and how well you sleep. Look for connections between nights when you sleep poorly and what's going on in the rest of your life.

Ditch the double bed. If you and your spouce sleep in a double bed, switch to a queen- or king0size bed, Dr.Hauri advises. "Larger beds become especially important as you age". sleep less soundly and are more likely to be disturbed by a restless bedmate."

Create comfort. Test different types of mattresses. Splurge on sleepwear that feels just right for you. If you have arthritis or a bad back, try extra pillows or specially shaped therapeutic pillows.

Preserve peace. You can probably sleep through steady noise-for example, the hum of a nearby freeway, Dr. Rauri explains. But you're likely to get rudely awakened by sudden, intermittent noises-cats fighting in a neighbor's yard or a motorcycle roaring up the street. To preserve nighttime quiet, try wearing foam earplugs.

Create a dark environment. For a darker bedroom, Dian Buchman, Ph.D., author of The Complete Guide to Natural Sleep, suggests investing in blackout drapes, blinds, or shades. Or wear a sleep mask.

Banish your bedroom clock. "Many insomniacs have big, illuminated digital clocks staring at them all night and making them anxious;" Dr. Rauri says. If you use an alarm clock, place it so that you can't see the time while you're in bed.

Sleep separately. What if one of you likes a hard foam mattress but the other prefers a waterbed? Many couples with very different sleep styles feel obligated to share the same bed. Consider twin beds or different bedrooms. "You'll both sleep better and probably feel more loving toward one another, which can lead to better sex," says Louanne Cole-Weston, Ph.D., a sex and marital therapist in Sacramento, California.

Distract Yourself. Sleep is like love: It arrives only when you don't try to force it. Think about something else. Years ago, the traditional advice was to count sheep. But a Gallup survey showed that one-third of American adults read themselves to sleep.

Avoid oversleeping. Many people with insomnia stay in bed too long. If you need 7 hours of sleep but are in bed for 9, you'll toss and turn for two. Maybe you just need to go to bed later.

Establish a schedule. Every sleep expert agrees: Go to bed and wake up at the same time every day, even on weekends. "Many people need regular sleep/wake cycles and have trouble sleeping if they don't stick with them;" Dr. Hauri says.

Getting regular is particularly important if you suffer from "Sunday night insomnia;" the inability to fall asleep on Sunday night. "Maintain your weekday schedule on the weekend, and you may get relief come Sunday," Dr. Rauri says.

Adopt bedtime rituals. Before turning in, most people lock up their homes, change into their pajamas, brush their teeth, and turn out the lights. If you have trouble sleeping, you might add a few more rituals. Drink a cup of herbal tea, chat with your spouse, do some light reading, or take a tolerably hot bath. If you lie awake worrying that you might forget what you have to do the next day, make a "to do" list of everything you need to remember before you retire. Then let go of your list until morning.

Quit smoking. As if you need another reason to quit: Where there's smoking, there's often insomnia. Nicotine is a powerful stimulant, and insomnia is a frequent complaint among smokers.

Other Good Choices

Homeopathy

Buy a homeopathic sleep aid. Depending on your specific insomnia symptoms, a homeopath might prescribe any of a number of medicines. Homeopath Dana Ullman frequently recommends Arsenicum, Coffea, Ignatia, Lycopodium, and Nux vomica.

Many health food stores and some drugstores now carry homeopathic sleep aids. If you try one of these products, take it according to the package directions.

Chinese Medicine

Point the way to sleep. Oriental medicine doctors often use acupuncture to treat insomnia. But you can't very well visit an acupuncturist at 2:00 every morning. Acupressure is an effective do-it-yourself alternative. Apply steady, penetrating finger pressure for 3 minutes to each of the following points.

• Bladder 62, located in the first indentation directly below your outer anklebone
• Kidney 6, located in the slight indentation directly below your inner anklebone
• Governing Vessel 24, located between your eyebrows, where the bridge of your nose meets your forehead
• Heart 7, located on the pinkie side of the wrist crease that's closest to your palm

Restore tranquillity to your Heart. In Chinese medicine, if insomnia is not caused by some other medical problem, it is brought on by a lack of harmony in the Heart organ network, according to Efrem Korngold, O.M.D., L.Ac. To calm the Heart, Dr. Korngold prescribes pacifying herbs such as ziziphus seed, jujube seed, poria fungs, gardenia fruit, and schisandra fruit.

Home Remedies

Catch 40 winks. "Most insomniacs sleep better when they don't nap," Dr. Hauri says. "But this isn't true for everyone. Napping helps some people sleep better. Experiment and see what works best for you."

Check your medications. Caffeine is an ingredient in a surprisingly large number of drugs, including many pain and weight-loss medications. Ask your pharmacist about the possible stimulant effects of every medication you take.

Be aware of the depression connection. The myth is that people who are depressed sleep most of the day. Some do, but others hardly sleep at all. Ironically, Dr. Albert says, depression-related insomnia often responds to a counterintuitive solution­sleeping less. "Reduce your sleep time by 1/2 hour every 2 to 3 weeks until you limit your sleep to 5 hours a night. That often helps. You sleep less, but you sleep fairly deeply. Most people call it an improvement."

Unfortunately, if you have depression-related insomnia, the antidepressants your doctor prescribes might make it worse. The most popular family of antidepressants-fluoxetine (prozac), paroxetine (Paxil), and sertraline (Zoloft)-often disrupts sleep. Ask your doctor about newer drugs that don't have this effect.

Over-The-Counter Drugs

Savor a sedative side effect. Over-the­counter antihistamines are notorious for causing drowsiness. This side effect can be a problem if you need to drive a long distance, but it comes in handy if you have insomnia. Over-the-counter sleep aids-including Alka-Seltzer PM, Compoz, Excedrin PM, Nytol, Sominex, and Unisom-contain the antihistamine diphenhydramine. Follow the directions on the package.

Medical Measures

Sleeping pills may knock you out, Dr. Albert explains, but they prevent good, deep, refreshing sleep. They can be helpful when used in the short term for up to a week if you're dealing with a major trauma-for example, the death of a loved one. But after a week, they begin to lose their effectiveness.

Years ago, when doctors prescribed barbiturate sleeping pills, addiction was a real problem. But current sleep aids carry much less risk of dependence. According to Dr. Dement, today's sleeping pills are rarely abused. "In fact, they're underprescribed," he says. "A recent Gallup survey found that only 10 percent of people with serious insomnia get prescriptions and that few of them use sleeping pills for more than 5 nights."

For his patients with severe insomnia, Dr. Dement prescribes the drug zopidem (Ambien). Because of the small but real risk of abuse, he provides only 10 pills at a time while working to find nondrug solutions to the sleep problem. Refills are rarely necessary.

If your doctor gives you sleeping pills for short-term use and you find yourself needing refills of your prescription, ask your doctor for something else-a referral to an accredited sleep clinic. Few people require more than three visits to a sleep clinic. "Clinical sleep work is very gratifying," Dr. Dement explains. "The vast majority of insomniacs can be diagnosed and treated fairly quickly, and then they feel great."

The American Academy of Sleep Medicine makes referrals to the more than 200 accredited sleep centers in the United States. For a list of these centers, send a stamped, self-addressed envelope to the association at 6391 Bandel Road N.W, Suite 101, Rochester, MN 55901-8758.