Insomnia—difficulty in falling asleep or staying asleep—affects some 30 per cent of the population. It is usually a problem if it occurs on most nights and causes distress or daytime effects such as fatigue, poor concentration, poor memory, and irritability. These symptoms may predispose you to accidents, to depression and anxiety, and to medical disorders such as infections, high blood pressure, obesity, and diabetes.
Insomnia can be caused or aggravated by poor sleep habits, depression, anxiety, stress, physical problems such as pain or shortness of breath, certain medications, and alcohol or drug use. Short-term insomnia specifically is often caused by a stressful life event, a poor sleep environment, or an irregular routine.
1. Have a strict routine involving regular and adequate sleeping times (most adults need about seven or eight hours of sleep every night). Allocate a time for sleeping, for example, 11pm to 7am, and do not use this for any other activities. Avoid daytime naps, or make them short and regular. If you have a bad night, avoid ‘sleeping in’ because this makes it more difficult to fall asleep the following night.
2. Have a relaxing bedtime routine that enables you to relax and ‘wind down’ before bedtime. This may involve doing breathing exercises or meditation or simply reading a book, listening to music, or watching TV.
3. Many people find it helpful to have a hot drink: if this is the case for you, prefer a herbal or malted or chocolaty drink to stimulant drinks such as tea or coffee.
4. Sleep in a familiar, dark and quiet room that is adequately ventilated and neither too hot nor too cold. Try to use this room for sleeping only, so that you come to associate with sleep.
5. If you can’t sleep, don’t become anxious and try to force yourself to sleep. The more anxious you become, the less likely you are to fall asleep, and this is only likely to make you more anxious! Instead, get up and do something relaxing and enjoyable for about half an hour, and then try again.
6. Take regular exercise during the daytime, but do not exercise in the evening or just before bedtime because the short-term alerting effects of exercise may make it more difficult for you to fall asleep.
7. Try to reduce your overall levels of stress by implementing some simple lifestyle changes.
8. Eat an adequate evening meal containing a good balance of complex carbohydrates and protein. Eating too much can make it difficult to fall asleep; eating too little can disturb your sleep and decrease its quality.
9. Avoid caffeine, alcohol, and tobacco, particularly in the evening. Also avoid stimulant drugs such as cocaine, amphetamines, and ecstasy. Alcohol may make you fall asleep more easily, but it decreases the quality of your sleep.
10. If insomnia persists despite these measures, seek advice from your doctor. In some cases, insomnia may have a clear and definite cause that needs to be addressed in itself—for example, a physical problem or a side-effect of medication.
Behavioral interventions such as sleep restriction therapy or cognitive-behavioral therapy can be helpful in some cases and are preferable to sleeping tablets in the long-term.
Sleeping tablets can be effective in the short-term, but are best avoided in the longer term because of their side-effects and their high potential for tolerance (meaning that you need progressively higher doses to achieve the same effect) and dependence.
Sleeping remedies that are available without a prescription often contain an antihistamine that can leave you feeling drowsy the following morning. If you decide to use such remedies, it is important that you do not drive or operate heavy machinery the next day.
Herbal alternatives are usually based on the herb valerian, a hardy perennial flowering plant with heads of sweetly scented pink or white flowers. If you are thinking about using a herbal remedy, speak to your doctor first, particularly if you have a medical condition or allergy, if you are already on medication, or if you are pregnant or breast-feeding.