Suggestions For Managing Insomnia

Daytime

• Avoid caffeinated beverages or restrict them to mornings only.
• Consider if alcohol or medications you take may disturb sleep.
• Consider if illnesses may disturb sleep. Stress, anxiety, depression, and pain are common causes of insomnia.
• Avoid daytime naps (if necessary then only keep them short at 20 minutes)
• Exercise daily, but not in the evening.
• Set aside 30 minutes to actively worry. Write down thoughts and solutions

One hour before bedtime

• Take time to relax one hour before bedtime (yoga, music, meditation, imagery, hot bath, progressive relaxation, count sheep, say ‘the’ continually to block other thoughts).
• Avoid mental stimulation; work, TV, computers.

Bedtime

• Don't go to the bedroom until you are sleepy.
• Choose a regular bedtime; keep it the same on weekends and weekdays.
• Choose a bedtime when you will be sleepy.
• The room should be dark, quiet, comfortable, and secure.
• If you like to read, choose a dull book.
• Consider if you would sleep better on a later or earlier sleep schedule.

During the night

• Sleeping partners and pets should not disturb you.
• If you remain awake for more than 20 minutes, arise and leave the bedroom. Read something dull. Return to bed when you are tired and fighting sleep.
• Consider what may be keeping you from sleeping; snoring, heartburn, pain, restless legs, arm or leg twitching/jerking, sleepwalking.
• Don't watch the clock.
• Don’t arise to eat.

Morning

• Arise at the same time each morning, both on weekends and weekdays.
• If you haven't had a good sleep, try your best not to be too discouraged. Nothing bad will happen to you and you will likely sleep better the next night. Although a bad night may be upsetting, worrying about sleep unfortunately just makes it worse.
• Try to be patient. Any changes to your sleep habits may take 3 weeks to show benefit.
• Try to have reasonable expectations. Some people are never going to be good sleepers, but, on the other hand, increasing sleep by only 30 minutes a night may help you feel better.
  

Sleep restriction

• Makes it easier to fall asleep and stay asleep
• Estimate how long you were in bed overnight, and how long you slept. If they don=t match, then reduce the amount of time you spend in bed so it approximates the amount of time you slept.
• This will compress your sleep to the point that it becomes continuous. Once this happens, then gradually increase the time in bed by 15 minutes at a time until you are only awakening occasionally.
• Example: if you slept only 6 hours in total, then spend no more than 6 hours in bed. Go to bed at midnight and arise at 6 a.m. for the next 2-to-3 weeks. If you are now able to fall asleep within 20 minutes and awaken only a couple to times each night, try to lengthen the time in bed by 15 minutes every 2 weeks until insomnia starts to worsen again. even if the total amount of sleep doesn’t increase, people feel better if it is consolidated and not broken up.
  

SLEEPING PILLS

• Makes it easier to fall asleep and stay asleep
• Recommended for short periods of time.
• Occasional use considered safe, less than 3 times per week.
• Adverse effects include night-time falls in elderly, and morning hangover
• One medication may leave a metallic taste in your mouth.

For more information and assitance
Sleep-Wake Disorders Canada (phone 1-800-387-9253)
www.swdca.org

Sleepnet
www.sleepnet.com

The Sleep Well
www.stanford.edu/−dement

American Sleep Apnea Association
www.sleepapnea.org

National Sleep Foundation
www.sleepfoundation.org

American Association of Sleep Medicine
www.aasmnet.org

Your local library or bookstore:

1. Sleep by Paul Caldwell Canadian Medical Association. Key Porter Publication.ISBN 1-55263-391-8
2. No More Sleepless Nights by Peter Hauri 
3. The Sleep of Your Dreams by Charles Morin 
4. Sleep Thieves by Stanley Coren 
5. Desperately seeking snoozing by John Weidman

R Dales, MD, Respirologist and Diplomat, American Board of Sleep Medicine