With an early meeting in the morning, I had done everything I could think to do to get through my latest bout of insomnia and go to sleep.
I had exercised, eaten an early dinner, given myself time to wind down, read a few chapters until I felt drowsy, and softly closed my eyes.
When I woke up in the middle of the night, it was as if someone opened a web browser I had forgotten that I minimized, and all the tabs started reloading. What if it rains when I get married next year? Did I annoy my friend when I asked for pet-sitting help? I should really do a better job of keeping in touch with extended family. Am I taking too much time off? Not enough?
Before I knew it, I was buzzing. I did get some sleep, eventually, but it was constantly interrupted by my tossing and turning. Once the first rays of sunlight came through my bedroom window, I had given up.
I am one of the 1 in 10 people who have chronic insomnia, said Dr. Shalini Paruthi, codirector of the Sleep Medicine and Research Center at St. Luke鈥檚 Hospital in Chesterfield, Missouri, and American Academy of Sleep Medicine spokesperson.
Chronic insomnia is when a person takes more than 30 minutes to fall asleep or fall back asleep up to three times a week for more than three months 鈥� which, as a result, impacts their day with symptoms such as concentration problems or changes in mood, said Dr. Rachel Salas, professor of neurology at the Johns Hopkins University School of Medicine in Baltimore.
There are several useful methods to treat the condition, including fixing your sleep hygiene and engaging in cognitive behavioral therapy specifically for insomnia. But those take weeks to take effect.
What do you do on those nights where you just know sleep isn鈥檛 coming 鈥� or, at least, not without a fight?
Why do you have insomnia?
The first step is to identify where the insomnia is coming from, said Paruthi, who is also an adjunct professor at Saint Louis University School of Medicine.
Sometimes insomnia can come on with big life changes, such as grieving a loved one or a experiencing a medical event, she added. Often, insomnia can go hand in hand with stress, anxiety and depression.
But that doesn鈥檛 mean that the condition doesn鈥檛 deserve treatment or will just go away when the grief, stress or illness does, Paruthi said.
鈥淚nsomnia is a real disorder,鈥� she said. 鈥淵ou have to treat both in order to get that person back to their full mental health.鈥�
It鈥檚 also possible for insomnia to be caused by restless leg syndrome. The condition affects a lot of people, but is often underestimated as a cause of insomnia, Paruthi said.
A feeling of restlessness and an urge to move in your arms, legs or torso is a state of hyperarousal and can keep you from a good night鈥檚 sleep, she said.
Many people go undiagnosed because they don鈥檛 have the words to describe what is happening to them, and it can be a missed because it isn鈥檛 always just the legs that are affected, she add.
If that is the case, she recommends getting up, walking around the house and doing some stretches to ease the restless feeling before trying again to get to sleep.
Do you stay in bed?
Don鈥檛 let bed become a place associated with long stretches of stressing to get to sleep, said Salas, who is also a sleep neurologist at the Johns Hopkins Center for Sleep and Wellness.
鈥淭he worst thing somebody with insomnia could do is stay in bed and not sleep,鈥� she said.
If you worry, check your phone or watch TV in bed, the brain gets conflicting messages about what your bed is for, Salas said.
Instead, try to do your normal pre-bedtime routine, and then get into bed at your bedtime and give yourself roughly 15 to 20 minutes to fall asleep 鈥� don鈥檛 look at the clock, just estimate, Salas said.
If you haven鈥檛 fallen asleep by that time, use a flashlight that isn鈥檛 your phone to go into another room and try another activity until you start to feel drowsy and try again, she added.
Does that mean if you aren鈥檛 drowsy at the bedtime you have set for yourself, you shouldn鈥檛 get into bed at that time? Salas said no.
鈥淢ost people are quick to be like, 鈥榃ell, I鈥檓 not sleeping. I鈥檓 just going to stay awake, and I鈥檒l go to bed when I鈥檓 tired,鈥欌�� she said. 鈥淏ut now you鈥檙e dealing with the variability of a bedtime and awakening time. And we know from studies that people that even if they got 10 hours of sleep, if they鈥檙e going to bed at different times and waking up at different times, you can actually function like a sleep-deprived person.鈥�
Sleep-friendly activities
Whatever you do in those times when you get out of bed needs to be relaxing and follow good sleep hygiene, Paruthi said.
Salas recommends that her patients listen to classical music or nature sounds to help their brain make the association with sleep. Or you can read a book that isn鈥檛 terribly interesting or magazines with short articles by flashlight, she added.
That is not the time to do that load of laundry or start checking work emails, Salas said. Remember, it鈥檚 all about teaching your brain that it鈥檚 time to wind down.
If you are trying all the recommended practices but still having a hard time, there are effective over-the-counter or prescription medications that you can talk to your doctor about to get you through particularly difficult nights, Paruthi said.
If you find yourself getting seven to nine hours of sleep and still feeling tired during the day, there could be an underlying sleep disorder you need to treat, Salas said.
鈥淭hat鈥檚 the worst thing because we know sleep is definitely important not only for memory, cognition, but for immunities, all sorts of other things,鈥� she said. 鈥淚 would say that if you notice that you feel like you鈥檙e getting enough sleep but you鈥檙e still tired and dragging and having problems during the day, it鈥檚 time to talk to your doctor.鈥�
