What to do on the nights you are struggling with insomnia, according to experts

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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’s 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 — 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’t coming — 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’t mean that the condition doesn’t deserve treatment or will just go away when the grief, stress or illness does, Paruthi said.

“Insomnia is a real disorder,” she said. “You have to treat both in order to get that person back to their full mental health.”

It’s 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’s sleep, she said.

Many people go undiagnosed because they don’t have the words to describe what is happening to them, and it can be a missed because it isn’t 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’t 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.

“The worst thing somebody with insomnia could do is stay in bed and not sleep,” 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 — don’t look at the clock, just estimate, Salas said.

If you haven’t fallen asleep by that time, use a flashlight that isn’t 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’t drowsy at the bedtime you have set for yourself, you shouldn’t get into bed at that time? Salas said no.

“Most people are quick to be like, ‘Well, I’m not sleeping. I’m just going to stay awake, and I’ll go to bed when I’m tired,’” she said. “But now you’re 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’re going to bed at different times and waking up at different times, you can actually function like a sleep-deprived person.”

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’t 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’s all about teaching your brain that it’s 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.

“That’s the worst thing because we know sleep is definitely important not only for memory, cognition, but for immunities, all sorts of other things,” she said. “I would say that if you notice that you feel like you’re getting enough sleep but you’re still tired and dragging and having problems during the day, it’s time to talk to your doctor.”

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