Sleepless in America
By William C. Sherrill Jr., MD, Novant Health Sleep Health 

Two-thirds of American women report experiencing symptoms of insomnia, or the chronic inability to sleep, on a regular basis according to the National Sleep Foundation’s 2007 Sleep in America poll. With so many women in the country experiencing sleepless nights, it is important to understand what causes insomnia and, more importantly, what you can do to break the cycle.

Oftentimes, people who struggle with insomnia are more sensitive to the various behavioral and physical factors that impact sleep, causing their sleep to be more “fragile” than others. As a result, more attention may need to be given on a regular basis to developing good sleep habits.

The first step to experiencing more restful nights is to understand the factors that can disrupt your sleep. The most common causes of chronic sleep loss fall into two categories: behaviors that keep you awake and behaviors that bring disorder to your sleep.

What is keeping you awake?
Behaviors that may keep you awake at night include:

• Engaging in physically or mentally stimulating activities close to bedtime.
• Discussing emotionally charged issues such as family or financial matters prior to sleep.
• Cognitive hyperarousal or the inability to shut off your brain at night.
• Intake of alcohol, caffeine or nicotine in the late afternoon and evening.

What disrupts your quality of sleep?
Certain behaviors also can reduce the quality of your sleep. These include irregular sleep-wake cycles, spending increased time in bed and napping during the day, especially late in the afternoon or early evening.

Two common mistakes people with sleep difficulties make are increasing the amount of time spent in bed and trying to force yourself to fall asleep when you are having difficulty entering early sleep stages. The more time you spend in bed, the more fragmented and less deep your sleep becomes. Lying in bed trying to force yourself to fall asleep often only results in more frustration and subsequent alertness.

Developing better sleep practices
While there are a number of factors that can cause you to lose sleep at night, fortunately many of these are controllable through the practice of sleep “rehabilitation,” a routine to optimize your chances of getting a good night’s sleep. By creating a relaxing bedroom environment and limiting behaviors that can trigger insomnia, sleep “rehabilitation” encourages the development of habits that can interrupt the pattern of sleeplessness.

Developing better sleep practices checklist:

Bedroom environment

• Invest in a comfortable pillow and bed.
• Turn off any distracting lights and quiet sources of noise.
• Turn the thermostat down a degree or two. Cooler temperatures often provide a more comfortable sleeping environment.
• Avoid sleeping with children or pets if possible.
• Move the clock away from your line of vision. If you are having difficulty falling asleep, periodically glancing at the clock will only make you feel more stressed.
• Make your bedroom feel as safe and private as possible.

Emotional habits

• Avoid serious or emotionally charged discussions right before bed. Develop the mental habit of “calling it a day.”
• Take time early in the evening to write down what is on your mind if you have difficulty shutting your brain off at night.

Physical habits

• Avoid alcohol and nicotine in the evening.
• Be sure to avoid caffeine after 3 p.m.
• Minimize fluid intake after 8 p.m.
• Avoid exercise within four hours of bedtime.
• Avoid meals within three hours of bedtime.
• Establish a regular sleep-wake cycle. Set a regular wake-up time and get out of bed at that time regardless of how you slept the night before.
• Do not dramatically change sleep habits on weekends.
• Do not get in bed to rest. Use your bed only to sleep.
• Avoid napping. If you have to take a nap, do so early in the day and only for a short period of time.
• Exercise. The more active you are during the day, the better you will tend to sleep. Inactivity during the day can lead to lighter sleep at night.

A new treatment option for insomnia
Cognitive behavioral therapy (CBT) is a new approach to ending sleeplessness. CBT has been shown to be superior to drug therapy over time. CBT is a multifaceted approach that incorporates stimulus control, sleep restriction, cognitive therapy and relaxation.

Insomnia is not a condition that should be left untreated as it often evolves over time and can trigger other medical problems. It is important to consult your physician to identify potential underlying conditions that affect your ability to sleep and have them treated accordingly.

If you’re still having trouble sleeping after trying the tips above, consider making an appointment at one of our Novant Health Sleep Health locations.