Dear aVoid:

“The hardest part is going to sleep. I’m up until the am” – from Wikipedia, paraphrased-  Insomnia: Trouble falling and/or staying asleep. Insomnia can occur as a result of (1) certain medical conditions such as hyperthyroidism (the thyroid hormone is produces in access and speeds up various body systems, producing symptoms similar to an overdose of adrenaline), chronic physical pain, sleep apnea and heartburn, (2)  certain medications and drugs, such as caffeine, nicotine and alcohol,  (3) psychological stress, (4) the brain-body being in the habit of staying up at night because of a lifestyle where one is awake at nights (examples: working the night shift, playing computer games at night).

Treatment for insomnia include (1) making life style changes and practicing sleep hygiene: it is recommended to avoid doing the following too late in the day/ too close to bedtime: physical exercise, mental exercise (planning for the next day, trying to solve problems, worrying, thinking about frustrating topics),  big meals/ overeating (or going to bed hungry), and chemical stimulants such as caffeine (including coffee, energy drinks, soft drinks, tea, chocolate, and some pain relievers).

* Regarding alcohol, it helps a person fall asleep because it is a depressant, but the process of metabolizing the alcohol disrupts sleep, so the person doesn’t stay asleep for long.

It is recommended to do the following: daily exercise, keep day time naps short or avoid altogether,  establish and keep a sleep routine/ schedule, relax before bedtime in dim lights, have a comfortable mattress and pillow,  and a peaceful, dark sleep-environment.

* a sleep machine can be helpful (it produces an ongoing sound of ocean waves or rain.. or a train), and perhaps a weighted blanket  (a heavy blanket that is used to aid sleep and reduce anxiety).

(2) Cognitive behavioral therapy for insomnia (CBT-I)-the first step in treating insomnia with CBT-I is to identify the underlying causes of the insomnia by keeping a sleep diary/ journal for a couple of week listing thoughts, behaviors, and stressors that could be contributing to the insomnia.

The steps to follow are to practice sleep hygiene (see above), sleep restriction (instead of staying in bed for too long, frustrated about one’s inability to fall asleep, which creates an association between one’s bed and insomnia- get out of bed and return to bed when tired), relaxation training (hypnosis, guided imagery, meditation), and cognitive therapy: the crucial messages that the therapist tries to communicate to the patient are: * to not TRY to sleep- trying harder will only keep you more awake, * to have realistic expectations about your sleep duration and energy the next day, *to avoid catastrophic thoughts, ex.,  imagining that you are about to die after an insomniac night. Instead, think of insomnia as unpleasant, but not detrimental to your health (on the short term),  * to not think too much about the insomnia, to not have your life revolve around it, and * to control worry and rumination using a thought record: a log where you write down your concerns, and later discuss them with your therapist, one concern at a time, to determine if each is realistic or not.

* Paradoxical Intention involves the therapist telling the patient to do the exact opposite of what he/ she has been doing in bed: to stay awake and avoid falling asleep.

Insomnia is common and therefore, there are books and workbooks on the topic, a few are: Say Goodnight to Insomnia: the six week, drug free program developed at Harvard Medical School,     Sleep Through Insomnia,     The Sleep Solution,      quiet your mind and get to sleep,   The Sleep Workbook   and    The Insomnia Workbook .

I would add that the concept of Radical Acceptance can help with insomnia as in so many other problems in life: to completely accept a situation which we cannot change (any time soon, if at all): to accept it without disliking it, without resisting it, without fighting it in any way; to relax into it instead.

anita