Reality Health
By Dr. Sara Levine
Dear Dr. Levine,
I’ve been having trouble sleeping. I’ve even
taken to trying a “nightcap,” but, alas, I’m still
tossing and turning. What do you recommend?
First, I must let you know that you are not alone. 1 in 3 people
suffer from insomnia -- inadequate or poor sleep quality. Insomnia
means different things to different people. Some may have trouble
falling asleep; others have trouble sleeping through the night. Some
with insomnia are functional and symptom–free the next day;
others suffer from daytime sleepiness and irritability. Daytime sleepiness
can be quite dangerous behind the wheel of a car. So if you suffer
from this symptom, you must work aggressively at finding the right
treatment for your insomnia.
Let us discuss the most common causes of poor sleep quality.
1. Alcohol: Your nightcap disrupts the duration and quality of your
sleep, especially during the second half of your evening.
2. Nicotine, caffeine, diet pills, energy drinks and other psychostimulants:
Caffeine stays in your blood for a long time, and sensitive people
might have insomnia related to a single cup of java in the morning.
Hopefully, insomnia will motivate you to quit smoking. If that’s
not possible, don’t smoke at night. Have your physician review
your entire medication list to evaluate your medications for insomnia
as a side effect.
3. Reading, watching TV, finishing up paperwork in bed: Your bed
should only be for sleep and sex.
4. Daytime napping and irregular sleep schedules: Regardless of
how little sleep you have had, waking up at the same time each morning
and avoiding daytime naps help rebalance your sleep cycle.
5. Lying awake in bed for more than 20 minutes : If you can’t
sleep, get up and do something. Pick a soothing, relaxing, or boring
activity (nothing stimulating like an action video game or an uncompleted
project from work) to keep you from fretting over your insomnia. When
you begin to feel sleepy, it’s time to head back to bed.
Let’s talk about therapies: medication based and behavioral.
Behavioral therapies are most effective when more than one treatment
is used. Behavioral therapies include: stimulus-control, sleep-restriction,
progressive muscle relaxation, biofeedback, cognitive therapy, and
sleep-hygiene education. Sounds complicated. Why not just take a pill?
If we are only speaking about a short term problem with insomnia,
you might have a good argument. Both cognitive-behavioral therapy
and treatment with medications are effective in the short term. Over
the long term, patients receiving nonpharmacologic therapies enjoy
long lasting relief from symptoms, while many of those treated with
medication have returned to their baseline level of insomnia.
Make sure to talk to doctor about any health problems that might
affect your sleep, such as heartburn or chronic back pain. I recommend
making prescription and herbal medications your last resort. Instead,
approach your doctor with a completed sleep diary where you have recorded
bedtime, total sleep time, time until you fall asleep, number of nighttime
awakenings, use of sleep medication, time you rise in the morning,
and a rating of each night’s sleep. With only a few sessions,
your primary doctor, trained in behavioral therapy, or sleep specialist
can help you make significant improvements in your sleep and your
life. Rest assured. ©2007 by Sara Levine
Sincerely,
Sara Levine, M.D., F.A.A.P.
Dr. Sara Levine is board certified by both the American Board
of Internal Medicine and the American Board of Pediatrics and has
been practicing medicine for more than nine years. She graduated summa
cum laude from Case Western Reserve University and was elected to
Phi Beta Kappa. She received her M.D. from Case Western Reserve University
School of Medicine. She has completed Advanced Clinical Education
in Child and Adolescent Obesity from the University of California,
San Francisco. Dr. Levine is in private practice in Boca Raton
Please email all questions to drsaralevine@bellsouth.net
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