7 steps to stop insomnia

Sleep is precious, and yet we give it so little consideration. To many Americans with insomnia, however, sleep is extremely precious. About 10% of men and 20% of women have chronic insomnia, meaning it occurs at least 3 times per week for at least 3 months. Meanwhile, 30% of US adults struggle with occasional or short-term bouts of insomnia. It’s a very prevalent problem.

But insomnia may be even more prevalent among physicians, many of whom are already sleep-deprived. Those with higher levels of burnout were more likely to have symptoms of insomnia and poor quality of sleep, researchers found. 

Fortunately, insomnia is treatable, although not everyone responds well to the same approaches. The following seven steps can help sufferers conquer their insomnia, or at least diminish its hold on them. The steps go in order from the most basic to the most advanced, but it’s not exactly a stepwise approach. Some individuals may require only a few of these techniques, others may need to try them all. 

1. Dispel the disruptors

First things first: Eliminate or reduce the things that may impair sleep. Avoid caffeine and nicotine in the hours before bedtime. Limit drinking alcohol—one drink may relax you, but excessive drinking can disrupt your sleep. Don’t watch intense TV shows. And put away the phone and the laptop, which emit blue light and contribute to sleeplessness. 

Regular exercise is good for body, mind, and soul. But, if you’re having trouble snoozing, do it in the daylight hours. Exercise in the evening can be disruptive to sleep. Also, avoid foods that may disrupt sleep, like spicy or fatty foods. 

2. Downshift before bedtime

At least 30 minutes (or better yet, an hour) before bedtime, start calming things down. Do activities or routines that help you decompress. Lower the lights and turn down the sounds. Read a book, take a warm bath, do some relaxing stretches, or listen to soothing music. Have a warm decaffeinated beverage, like herbal tea or warm milk. 

Once it’s time for sleep, make the bedroom quiet and dark. (Investing in a good mattress beforehand wouldn’t hurt either.)

3. Practice relaxing

Relaxation should be the simplest thing in the world, yet sometimes it just doesn’t come easy. You may have to put a little effort into relaxing—without stressing yourself out, of course. 

“Spend five to 10 minutes doing a calming routine—such as deep breathing, guided imagery, or progressive muscle relaxation—before you turn in,” the National Sleep Foundation advises. “These decompression techniques can help you feel less stressed and reduce your blood pressure and heart rate.” 

You can learn to do these techniques on your own, or there are apps to guide you through them. 

4. Put your brain into ‘off’ mode

Try to turn off your brain before you turn in for the night. But, how do you do this when daytime stresses threaten to carry on into nighttime? To quell these worries, try one of these techniques:

• Journaling. Jot down your concerns before getting ready for bed, close the book, and put it aside for another day. Oftentimes, just writing down a worry is enough to take the steam out of it. 

• Practice mindfulness meditation. Close your eyes and focus on your breathing. Doing this helps take your mind off your thoughts—it’s the grown-up version of counting sheep. “When thoughts do come to mind, simply notice them as if they were clouds floating across the sky and return your attention to your breathing,” the National Sleep Foundation says. “Having a clear, calm mind puts you in a sleep-friendly state.”

5. Restrict your sleep time

Lying in bed wide awake wondering when you’ll finally fall asleep often just perpetuates insomnia, even after the initial cause of the insomnia has been eliminated. As a result, the act of lying in bed itself can become associated with sleeplessness. To break this unhealthy cycle, sleep scientists suggest restricting the time spent in bed just to sleep and only sleep. How? 

• Get up when you’re awake. If you lay awake for 20 minutes or more while trying to fall asleep, resolve to get out of bed and go to another quiet place in the home to “reboot” with a different restful activity before going back to bed to try again. 

• Restrict the time you spend in bed. Set a time limit during which you can sleep. To determine this limit, use your nightly total sleep time averaged over the last week or two. For example, let’s say you’ve been going to bed from 11:00 p.m. to 7:00 a.m. but averaging only about 6 hours of sleep per night. So, for this technique, you’d start by restricting your time in bed to only 6 hours (eg, 12:00 a.m. to 6:00 a.m.). “This sounds harsh but after a week or so there will be a marked decrease in time spent awake in the middle of the night,” according to experts at the Stanford Sleep Disorders Clinic, Stanford, CA. Next, gradually add 15- to 30-minute increments in bed, as long as waking in the middle of the night remains low.

6. See a therapist

“For many people who have been unable to find an answer to their sleep problem, cognitive behavioral therapy [CBT] may be the solution they need, and it is recognized by the American College of Physicians as a first line of treatment,” said Donna Arand, PhD, president of the Society of Behavioral Sleep Medicine. 

CBT combines behavioral techniques (eg, sleep restriction) with cognitive therapy (eg, replacing anxiety with positive thoughts). Therapy may require six to eight sessions, but even a single session of CBT has been shown to reduce insomnia severity.

7. Consider medication

If CBT doesn’t reduce insomnia, then medication can be considered. Pharmacologic therapy specifically indicated for treating insomnia includes hypnotics, benzodiazepines, certain antidepressants, as well as first-in-class drugs like suvorexant and ramelteon. Other medical treatments may include the off-label use of antidepressants and antipsychotics. 

Choosing the correct prescription medication depends on whether the insomnia problem involves “falling asleep” or “staying asleep.” At least one drug—suvorexant—was shown to address both problems.

What about over-the-counter drugs and supplements? The American Academy of Sleep Medicine (AASM) advises against the use of the antihistamine diphenhydramine, the hormone melatonin, or the herb valerian to treat insomnia. For the most part, these over-the-counter products were really no better than placebo for treating insomnia, the AASM reported in its clinical practice guidelines. 

“Sleep should be the most pleasant, relaxing, and restorative experience of the day, but sleep disorders are notorious for robbing us of that nightly pleasure,” says Patti Van Landingham, director of the American Alliance for Healthy Sleep. “People who have chronic insomnia need to seek help so that they can experience the joy of sleep again.”