The US Army has a number of ‘schools’ that are designed to train soldiers for combat or certain skills. Some of these courses must induce certain levels of stress. The number one, most-effective way of inducing stress is sleep deprivation.

The absence of sleep or insufficiency of sleep causes a number of problems. It has been suggested that Fibromyalgia has its roots in a lack of sleep. In fact, one study was able to induce symptoms of fibromyalgia after disrupting sleep for just 7 days!

Lack of sleep increases stress and fatigue. It increases cortisol levels which disrupts blood sugar control and increases insulin resistance.

Lack of sleep can derail weight loss, increase illness, inhibit muscular growth, and make just about everything worse!

So what do we do about it?

Well, like every other medical problem, we need to determine the CAUSE of the problem. Insomnia is not THE problem, it is a symptom of the REAL problem.

‘SLEEP HYGIENE‘…

1. Regular schedule – this means going to bed at the same time and waking at the same time every day (weekends included!). You may not be able to control what time you actually go to sleep but you CAN control what time you get up. Get up at this time every day.
2. Don’t force sleep – some people start getting stressed out about falling asleep which is totally counter-productive. This ‘stress’ makes it even harder to fall asleep. If you run into this problem get up and out of bed and go do something else until you feel you might be able to fall asleep.
3. Avoid smoking in evening – you should quit smoking all together but try to avoid smoking later in the day. Here is an article discussing the relationship of smoking & sleep disturbances.
4. No caffeine after lunch – caffeine is a stimulant and may provide just enough of a boost to prevent falling asleep
5. No “night caps” – alcohol severely disrupts normal sleep cycles. Here are a couple of articles on the association between alcohol & sleep: Article 1, Article 2 & Article 3.
6. Exercise 20-30 min at least 4-5hrs before bed – Here is a pretty good article on the benefits of exercise on sleep but how exercising too close to sleep can keep us up.
7. Don’t go to bed hungry
8. Adjust environment – pitch black room, completely blacked out. No lights. Avoid external sounds (barking dogs, dripping faucets, etc), you can use a ‘white noise’ machine to drown out those sounds. Make your room slightly cool. Read more about this here.
9. Deal with worries before bed – patients frequently talk about their mind racing keeping them from going to sleep. Here, we need to try to get our mind on other, calmer things. I recommend relaxation exercises to help with these issues: Breathing Exercises, Guided Imagery, Meditation, Progressive Muscle Relaxation, Relaxing Mind & Body
10. Light exposure – try to get bright (and natural if possible) light exposure during the day and avoid artificial light at night. This will help with the appropriate circadian rhythm for melatonin & sleep.
11. No reading, working on the computer, watching TV, etc in bed. The bed is only for sleep & sex. Other activities can cause a ‘pavlovian’ response and inhibit sleep. We want to make sure that the bed is associated with sleep.
12. Sleep journal – can help determine what is causing the insomnia. I recommend recording foods and events in regard to their frequency and times. A good journal can provide a lot of information that will often determine the cause of the sleep problems.

Here is a pretty good article on sleep and what you can do about it.

Insomnia & sleep disturbance is treatable! Long-term, the best solution is addressing the steps above to treat the problems that are causing the insomnia. However, some patients are having such difficulty that they need some immediate intervention.

MEDICATIONS:

Natural Sleep Aids: the two with the best evidence supporting them are Melatonin & Valerian. Both of these are safe and can be very effective. Valerian seems to be effective for up to 4-6 weeks and then you may need a break from it. Melatonin is produced by the pineal gland within our brain and helps with our circadian rhythm. It can help ‘reset the clock’ so to speak to improve sleep.

Medications: there are several classes of medications that can be used (primarily short-term use) to help get started with sleep improvement.

1. Non-benzodiazepine sedative/hypnotics – includes Ambien, Lunesta, & Sonata. These medications work by attaching to the GABA receptors in the brain in the same location as the benzodiazepines. They typically work quickly and have a short half-life.
2. Benzodiazepines – includes valium, restoril, halcion, etc. These medications do work to put you to sleep but they do not provide a restful sleep and I do not recommend them except in rare cases and only for short term. They are habit forming and are controlled substances.
3. Rozerem – a melatonin receptor agonist. It works well for some people