Why Can’t I Sleep?

Posted by Michael Kimmel in Columns 29 Apr 2015

perfect hunk fitnessSo many of my clients (and friends) complain about poor sleep or lack of sleep.  Why do so many of us not sleep long, well and deeply?  What’s going on here?  The National Sleep Foundation (which receives financial support from pharmaceutical companies) estimates that 20 percent of Americans, up from 13 percent eight years ago, sleep fewer than six hours a night. The lucky few who sleep a full eight hours or more dropped to 28 percent, from 38 percent, the foundation said.

Sleep is a $23.9 billion industry — if you count things as diverse as mattresses, white noise machines and prescription pills — and it has more than doubled in the last decade, according to Marketdata Enterprises, a research firm in Tampa, Florida.  The market for insomnia alone is expected to grow 78 percent, to nearly $3.9 billion, as drug makers scramble to bring more pills to market to compete with name brands like Lunesta, Sonata and Ambien CR.  There is even a new event, the National Sleep Foundation’s Big Sleep Show, to promote sleep-inducing products and services to the tired masses. It occurs several times a year.

Being chronically sleep-deprived is more than just tiring. It can lead to depression, high blood pressure and lower productivity, both on and off the job. If your problem is insomnia (and not medically-related), here are some cost-effective ways to get the sleep you need, and a few things you should avoid altogether.

· If you have been tossing and turning, do not drink caffeine after 2PM.  Yes, 2PM! (that’s what the experts recommend).
· Avoid downing more than a glass of wine (or the equivalent amount of other alcohol) in the evening.
· Save stressful activities, like arguments with your partner or a review of your finances, for early in the day (doesn’t that sound like fun?).
· Get into bed a half-hour before you plan to turn out the lights, and read a calming book. No TV, BlackBerry or electronic diversion of any kind an hour or so before bed, because they tend to be stimulating, not relaxing.
· Exercise regularly.
· According to the American Academy of Sleep Medicine: don’t waste your money on herbs like Valerian or fancy mattresses. There is no proof that herbs or special bedding help.
· Over-the-counter medications that contain sleep-inducing antihistamines are fine for a night or two, but that is all. They typically do not work over the long term, and they bring unpleasant side effects like dry mouth and grogginess.

If you still cannot sleep and you’ve tried all of the above, find a doctor who is a Board-certified sleep specialist.  Doctors with that certification have passed a rigorous exam and have a thorough knowledge of sleep medicine. Go to the American Board of Sleep Medicine’s sleep center site (www.sleepcenters.org). All accredited sleep centers are required to have one certified sleep doctor on staff.

A sleep doctor will first try to rule out an underlying medical condition that would require treatment by a different type of specialist. If you have primary insomnia, a medical condition in its own right, your doctor will probably begin treating you right away.

In addition to medications, please consider a non-drug option.  If you have insomnia that has been going on for months, consider cognitive behavioral therapy (aka “C.B.T.”)  It helps you change your behaviors and thoughts that get in the way of a good night’s sleep.  The cognitive part of the process teaches you to change anxiety-producing thoughts that interfere with your ability to sleep.  The behavioral part aims at actions that impair your ability to sleep, like spending too much time in bed or not exercising at all during the day.

“C.B.T. should be the first-line therapy for people with chronic insomnia,” says Dr. John Winkelman, medical director of the Sleep Health Center at Brighan and Women’s Hospital in Boston, and a consultant to several pharmaceutical companies. “It’s fabulous…in the short run, medication is helpful, but in the long run, people need to change their actual sleep habits — that’s what C.B.T. helps them do.”

Whatever you chose to do about your sleep problems, TAKE ACTION.  The most wasteful thing is not doing anything.  The cost of living with insomnia can be far more than the cost of treating it.