The first medication approved specifically for sleep was Dalmane (flurazepam) in 1970. Twelve years later, Halcion (triazolam) was developed and became the world’s best selling sleep aid. Today, Ambien (zolpidem) and Lunesta (eszopiclone) are some of the most popular medications around.
Considering that approximately one in three Americans suffer from insomnia, these medications bring in millions of dollars for pharmaceutical companies year after year.
In some cases, medication is a good choice. For the sleep deprived individual who has been running on fumes for weeks, the occasional “chemical cure” can be just what the doctor ordered.
But using medication to sleep over the long term can make things worse. Specifically, sleep architecture can be severely disrupted, leading to continued sleep difficulties. Also, if taken for an extended period of time—and depending on the type of sleep aid used—a person can become psychologically or physically dependent on the medication.
As a prescribing psychologist, I appreciate the positive impact medications can have on an insomniac’s life. But as a clinical psychologist, I am well aware of the myriad behavioral strategies available to help people rest better.
However, it has been my experience that mental health professionals often neglect this aspect of treatment with patients. In part, I think it’s because we assume their presenting (or identified) issues are more severe than insomnia (depression, anxiety, substance abuse) and warrant priority treatment. But in fact, insomnia is often a driver of other psychological problems, or at a minimum, makes other conditions worse.
Below are some basic, and often neglected, strategies to teach your patients in order to help them sleep better. Indeed, the most effective way to get a person’s sleep back on track is through simple behavioral changes that have been shown to work.
1. Avoid caffeine and alcohol. Caffeine is a stimulant. Set a 4 p.m. cutoff for cola, coffee, tea, and energy drinks. Alcohol is a depressant—and while it may seem logical that something that makes a person drowsy will help them sleep, in the long run alcohol disrupts a person’s sleep patterns, causing restless sleep. Furthermore, when caffeine and alcohol leave the system, they cause people to enter different stages of sleep, potentially leading to awakenings.
2. Structure your environment. The body and mind need quiet, darkness, and a comfortable temperature to sleep. Turn off the television, close the blinds, and adjust the thermostat before bedding down. Establishing a bedtime routine is also critical. Structure the last hour before you go to bed and follow that routine every night.
3. Stop watching the clock. Watching the minutes tick by leads to frustration, which leads to insomnia. Turn the clock so you can’t see the time. If not, you will train your brain to wake up throughout the night for the sole purpose of seeing what time it is.
4. Set a specific sleep/wake schedule. The more a person’s wake-and-rise schedule is fixed, the better their body and mind will respond when they want to fall asleep and when they want to get up. The same goes for weekends, as well. Just like with diets, if you count calories during the week and throw calorie caution to the wind on the weekends, you’ll never lose weight.
5. Don’t nap too late. If you have to nap during the day, do it early in the day. Catching late-day winks reduces the need to sleep at night. And the later in the day a person naps, the worse it gets.
6. Rely on the sun. Light is great for regulating the sleep/wake cycle. Let the natural rays shine through in the morning and get a few beams in the afternoon.
7. Eat smart. It’s always a good idea to eat healthy, but that’s not what I’m talking about here. Avoid eating large, salty, or spicy meals right before bed. Your digestive system will thank you.
8. Exercise early. Vigorous exercise releases cortisol, a stress hormone that will interrupt sleep. If possible, exercise in the morning or early afternoon.
9. Stop thinking in bed. Very few problems get solved between the time a person gets into bed and falls asleep. All that’s occurring is delaying sleep. Worry about things earlier in the evening…or not at all.
10. Use the bed only for sleep. Watching TV, playing video games, or cramming on homework in bed are the worst things a person can do if they’re trying to sleep better. In essence, they’re associating the bed with everything but sleep. One exception to this rule is sex.