Dream On

I sleep like a baby—waking every two hours crying and screaming. I know, it’s an old joke, but loss of sleep or insomnia is now a major public health problem. One researcher estimates that the total health care bill dealing with direct and indirect costs of treating insomnia related illness is over $42 billion dollars per year. When we experience insomnia symptoms for most nights for a prolonged period our risk of heart attack, heart failure, obesity and diabetes rises dramatically. We’re now beginning to understand that when insomnia exists with these chronic health conditions then we must treat both. Women are at greater risk than men for having insomnia, as are older adults, workers with rotating shifts and travelers going across multiple time zones. A clear majority of us know why we have trouble sleeping (stress, anxiety, significant loss). Worrying about loss of sleep only seems to make the problem worse. We go to bed anxious about whether this will be another night of tossing and turning. We’re frustrated if sleep doesn’t happen quickly. Our mind races and it seems we can’t turn it off. So when we sleep and perchance to dream what do we do when counting sheep is not effective? Do we simply toss back another pill? Previous readers know we push for pill-less remedies.

We know an alcoholic nightcap doesn’t help. Sure it makes us sleepy and for a short while we’re out like a light. In a few hours, however, our liver breaks down the booze and the waste products trigger our brains to wake up. There are several sleep hygiene therapies that make sense for us to do: limit caffeine intake, exercise daily, keep the bedroom quiet, dark and cool. A much more intriguing and useful program developed by Dr. Richard Bootzin, a professor of psychology at the University of Arizona in Tucson, stresses the concept of stimulus control. Basically it breaks the cycle of arousal from sleep and strengthens using the bed and bedroom as stimuli for sleep. The rules are seemingly easy. Go to sleep only when sleepy (not when your only fatigued but your mind is still racing). If you can’t sleep or wake during the night get out of bed (and engage in quiet activities such as reading) and return only when sleepy. Get up at the same time everyday, regardless of how much sleep you had the night before (this helps reset your internal clock). Avoid naps longer than 15 to 20 minutes during the day. It is not an overnight cure, but with practice may offer a pill-less solution. Something to consider.

At least sleep on it.

About Steve P. Sanders

A general internist writing and sharing ideas and art.

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