There is a time for every purpose, even sleep. Make a schedule.
Getting a good night’s sleep is essential to good health, yet despite being one of the most powerful biological drives, people can mess it up — and the result is insomnia.
One of the major errors that can lead to insomnia is having a variable schedule, said Jennifer Martin, PhD, a clinical psychologist and professor of medicine at the David Geffen School of Medicine at the University of California at Los Angeles. “If you shift your schedule around more than an hour from night to night, you are going to create a feeling of perpetual jet lag,” she says. “This is one of the ‘big ones’ among sleep errors.”
Being adherent to a sleep schedule is a key to good sleep, agrees Steven Feinsilver, MD, director of the Center for Sleep Medicine at Lenox Hill Hospital and professor of medicine at Hofstra Northwell School of Medicine in New York City. “The biggest thing you can do if you want to be a decent sleeper is to stick to a really strict time to sleep, especially the wake-up time,” he said.
Another error that can mess up sleep is spending too much time in bed, saysTom Roth, PhD, director of the Sleep Disorders and Research Center at Henry Ford Hospital and professor of psychiatry at Wayne State University, School of Medicine in Detroit. “If you need 6 hours of sleep and you stay in bed for 8 hours, this will lead to bad sleep.”
Don’t let the television lull you to sleep, either, says Dr. Martin, who also serves on the board of directors for the American Academy of Sleep Medicine. “Sleeping with the TV on is a bad idea,” she says. “The constant noise and light changes fragment sleep. The person might not be aware of these awakenings because they can be very brief, but the cumulative effect throughout the night is poor quality sleep.”
That nightcap is also a way to ruin sleep, even though you may think that it helps you get to bed. “Alcohol is also a terrible thing to do,” Dr. Roth says. “If you have a drink or two before bedtime, it will help you go to sleep, but when it wears off after 3 or 4 hours, you will wake up — and then you can’t get back to sleep again.”
Russell Rosenberg, PhD, chief science offer and chief executive officer of NeuroTrials Research of Atlanta, says he agrees that avoiding alcohol, especially around bedtime, is prudent. “If someone is drinking more and having more sleep problems, one thing to consider is cutting back on alcohol, especially three hours before bedtime. A nightcap may help someone get to sleep, but it can fragment sleep, so I don’t think it is a good idea.”
Some people complain about having insomnia because they have a hard time falling to sleep, and that may be because they have an unrealistic approach to sleep, says Dr. Feinsilver. “If patients think they are going to go to bed and instantly fall asleep for eight hours, physicians need to set expectations. Students study all night, turn their lights off, and try to sleep. The brain doesn’t go from ‘thinking hard’ to ‘off.’ People need relaxing time in the evening.
“There are people who work three to 11 and try to go to bed at midnight. That never works,” Dr. Feinsilver says. “The worst thing they can do about sleep is to worry about sleep. It is always self-defeating.”
Compounding the problem occurs when people with insomnia try different methods of self-cure, but reaching for over-the-counter sleep aids, health food store remedies, the advice of friends, and occasionally seeking sleeping pills from providers can lead to dependence on these pills or other concoctions and can still leave the patient with insomnia.
“For the most part, I help people get off of these sleeping pills,” says Dr. Martin. “As a psychologist, I firmly believe that how people think is important, and I think this is an important point: if the patient want to come off a medication, that medically or physiologically these agents are not very addicting for the most part, but the psychological dependence is very powerful. A lot of times, people struggle to get off these medications on their own.”
Many people also confuse a bad night of sleep with clinical insomnia. “A bad night of sleep now and then is not a clinical disorder,” Dr. Martin says. “Chronic insomnia disorder is trouble either falling asleep or staying asleep that goes on for at least three months and happens at least three times a week, and then we also have this criterion that it has to be severe enough to affect how the person feels or functions during the day.”
Feinsilver notes, “There was a poll taken years ago, and when asked, ‘Do you ever have trouble sleeping?’ about 50% of the general population said yes, and if you ask, ‘Are most nights bad?’ about 10% of the population said yes. Those are extraordinary figures, but I really don’t know what it means, because people cannot assess their own sleep and a lot of this has to do with your expectations about sleep.”
“If a person has insomnia, I would hope they would reach out to a sleep specialist, a sleep clinic, or a psychologist who specializes in sleep, or a board-certified sleep specialist physician who can help them get good treatment,” Dr. Martin says. “It is something worth talking about with your health care provider, and if patients are not interested in medication, they should say that and seek alternative options.”
Cognitive behavioral therapy remains the backbone of insomnia treatment, the researchers said, but there are also new pharmaceutical agents that are safer and more effective that traditional medications. “The field of sleep research is a relatively young field in medicine, and I feel there are still a lot of seminal discoveries to be made,” Dr. Martin says. “It is a pretty exciting time now to be in this space, because there are new discoveries every 10 years that change our thinking. There are not many areas in medicine where you have big discoveries.”
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Disclosure: Roth disclosed that he consults for many companies who do work in insomnia, including Merck, Eisai, Novartis. Rosenberg disclosed that he and his research organization consult for all the companies that work on insomnia issues. Martin and Feinsilver disclosed no relevant relationships with industry.
Source: Various telephone interviews.