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The question:
I am exhausted and have trouble falling asleep. What can I do about insomnia?

As many as a quarter of all Americans report trouble sleeping. The immediate consequences of insomnia may result in daytime sleepiness, general fatigue, mood swings, headaches and problems paying attention to various tasks. Long-term sleep deprivation can result in depression, weight gain, lowered immunity, infections or an increased risk of illnesses including high blood pressure, heart attack or stroke.

Determining the cause of insomnia and finding an appropriate solution or treatment requires a systematic approach that takes into account various potential contributing factors. Some sleep disturbances can interfere with falling asleep, while others may affect staying asleep. These include:

 

Stress – emotional and physical, like pain due to injury or illness.
Physical conditions – mattress, pillows, sleeping partner
Environmental factors – noise, temperature, darkness
Food and medication side effects – caffeine, nicotine, diet, alcohol, cold and allergy remedies, blood pressure pills, hormones
Changes in sleep schedule — jet lag or overnight shift-work.

Start the process by taking an inventory of what seems to be interfering with your sleep. Do you drink three cups of coffee daily? Do you eat dinner after 8 p.m.? Is it noisy or too hot in your room? Are you taking a decongestant for a cold, making your heart race? Do you or your significant other snore? Are you under stress at work?

Attempts to modify circumstances within your control may yield immediate results. Prepare for sleep by adapting rituals that will allow you to unwind from your day so that you can clear your head. As hard as it may sound, try to go to sleep and wake up at the same time every day. Get regular exercise. Resist taking naps if you have insomnia (if you don't, they're OK). Take a warm bath or shower, drink some herbal tea or warm milk, and read a few chapters of a book.

You can also adapt your environment to make condition for sleeping optimal. Try a few different kinds of pillows and linens until you find ones you like. Keep the room cool, dark and quiet. Get all electronics out of the bedroom so that you are not tempted to wake up and “check on things,” or watch programs you’ve DVR’d in the middle of the night. Take an over-the-counter analgesic like acetaminophen (like Tylenol) or ibuprofen (like Advil) to relieve any musculoskeletal pain or a headache, and avoid stimulants like nicotine, caffeine and alcohol late in the day. All of these things influence sleep quality and are likely within your immediate control.

If after doing your best to optimize your chances for a good night of sleep, you are still staring at the ceiling in the middle of the night, it may be time to consult a physician. Over-the-counter sleeping pills generally make use of the “drowsy” side effects of antihistamines, and may make you hung over the next day, or exacerbate underlying conditions contributing to your insomnia. Your doctor can better assess the risks and benefits of various prescription sleep aids; any contribution to insomnia by underlying medical conditions like hypertension, diabetes, thyroid disease, or sleep apnea; as well as recommend mental health counseling if applicable to any stressful circumstances beyond your immediate control.

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