Insomnia is my schoolyard bully.

If sleep is my recess from a busy shift at work, insomnia is the playground mafioso, sauntering over to my place of business, demanding precious hours of sleep like it is some chump-change that I can spare. But for the sake of my well-being and for the safety of my patients, I cannot give in to this nocturnal oppression any further.

Neither should you.

The clinical condition of sleeplessness, better known as insomnia (in — lacking / somnia — sleep), occurs when all three of the following criteria are met:

  • Difficulty initiating or maintaining sleep and/or experiencing non-restorative sleep
  • Impaired sleep in the setting of adequate sleep opportunity
  • Daytime functioning is impaired due to sleeplessness

Sounds about right? You’re not alone.

A clinical study published in Sleep some years ago found that 69 percent of participating adult primary care patients reported either intermittent or chronic insomnia.

This high prevalence of insomnia increases with age, worsens with major life turmoil such as divorce and unemployment, and is linked to one’s family history (thanks, Mom).

To sum things up, insomnia affects many if not most of us at some point in our lives.

That being said, I’ll save you few precious readers from any further self-pitying complaints regarding my personal experience with insomnia and instead offer you an arsenal of tried-and-true behavioral therapies to employ against this bothersome foe.

Sleep Hygiene 101

Sleep hygiene is a practice that involves various pro-active measures that function to promote high-quality sleep and reduce the incidence of insomnia.

In Edward Stepanski and James Wyatt’s excellent review of sleep hygiene, they summarize a myriad of tools that are incorporated into this behavioral sleep concept.

Although many of the ideas listed in their article have been shown to reduce sleeplessness in affected individuals, not all are completely practical. Let’s run through a few of these suggestions together and identify those that can most easily be implemented into our daily lives.

Plan #1: Decrease adverse stimuli in your bedroom (turn off radio/television, reduce infiltrating light).

Comment: This is not only pragmatic, but also relatively easy to accomplish. Cover those annoying flashing electronic lights. Move your bedroom TV into another room. Use earplugs and/or a sleeping mask. Get your snoring lover to sleep on his or her side. Be sure to ask nicely as to avoid sleep-adverse arguments.
Plan #2: Try not to force yourself to sleep.

Comment: This is easier said than done, but it works. Instead of counting sheep or adding numbers (I’ve used both strategies to no avail), get out of bed and read a novel on the couch until your lids get heavy. The goal in removing yourself from the bedroom is to prevent your mind from developing lasting negative associations between your bed and the experience of insomnia.
Plan #3: Maintain a regular sleep schedule, reduce naps and sleep as long as necessary to feel rested.

Comment: If you have any combination of a job, family, friends, pet, or hobby, this is nearly impossible to accomplish. Nevertheless, daytime naps have been shown to decrease the quality of subsequent stretches of sleep and should be avoided as much as possible, especially when adequate time to sleep at night is readily available.
Plan #4: Reduce alcohol intake, particularly in the late afternoon or evening.

Comment: Contrary to common belief, there is strong evidence demonstrating that a few innocent nightcaps at the end of a long workday can not only fragment insomniacs’ subsequent night of sleep, but also reduce the most restorative phases of their natural sleep patterns. Although not as strongly evidenced, similar negative changes in sleep patterns have been associated with cigarette and heavy caffeine use. Reducing these habits is exceedingly difficult to accomplish, but can provide lasting positive health effects including, but not limited to, improved sleep hygiene.
Plan #5: Resolve worries before bedtime.

Comment: As a type-A-moderately-anxious-borderline-neurotic-stage-5-worrier, this bit of advice is as useless as telling me that I should sleep with my eyes open. Yet entering the bedroom at night with a clear mind has been suggested to decrease sleep issues and increase the quality of an insomniac’s sleep. Stress-reducing activities such as daily exercise, meditation, and regularly scheduled visits to the therapist may prove to be as effective in combating insomnia as any pharmacologic sleep-aid.
Take-Home Point:

Similar to a prepubescent ruffian’s insatiable need for milk money, insomnia will always be around to intimidate innocent victims into giving up their precious hours of sleep.

And as a secret change pocket or swirly-conducive new haircut will hinder schoolyard bullies from doing their worst, practicing sensible sleep hygiene will prevent insomnia from taking over one’s night.

Brian Secemsky, M.D.

Medical writing for patients, students
and practitioners.

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