Insomnia's costs extend beyond the bedroom. Compared with normal sleepers, people with insomnia are less productive at work and have twice as many auto accidents. They also report generally poorer health, because sleep is critical to immune function.
"Insomnia is so common that it's accepted-mistakenly-as a normal part of getting older," says William Dement, M.D., Ph.D., director of the Stanford University Sleep Disorders Clinic and chairperson of the National Commission on Sleep Disorders Research.
But there's hope. Sleep specialists typically help about 80 percent of even chronic insomniacs fairly quickly with a program that combines home remedies, mainstream medicine, and alternative therapies.
Eliminate caffeine. "Caffeine causes more sleep problems than most people realize;' says Katherine Albert, M.D., Ph.D., director of the sleep laboratory at New York Presbyterian Hospital/Cornell Medical Center in New York City. But don't eliminate caffeine cold turkey, or you'll experience withdrawal symptoms-notably, a headache that can last for several days. Instead, taper off over a few weeks by decreasing proportions of regular with increasing proportions of decaf. In addition, sip less regular tea and more herbal teas, and drink fewer caffeinated soft drinks and more that are caffeine-free.
Confirm that it's decaf. If a restaurant server makes a mistake and gives you regular coffee instead of decaf, you could be up all night. When you're served what you think is decaf, make sure. Ask, "This is decaf, isn't it?"
Say no to nightcaps. "Doctors used to tell insomniacs to have a cocktail or glass of wine before bedtime;" says Peter Hauri, Ph.D., director of the insomnia program and codirector of the Sleep Disorders Center at the Mayo Clinic in Rochester, Minnesota. "But many people find that drinking late in the evening produces troubled, fragmented sleep." A glass of wine with dinner won't hurt, but don't drink alcohol within a few hours of retiring.
Watch what you eat. The healthier you are, the better you sleep. The healthiest diet is low-fat and near-vegetarian, based on whole grains, beans, fruits, and vegetables. Go easy on fatty, hard-to-digest foods: meats, deep-fried foods, fast foods, and greasy snacks.
Watch when you eat. Bedtime snacks are fine, as long as they're small and light. Don't eat a big dinner or anything heavy within an hour or two of bedtime, Dr. Hauri advises. Digestive processes can disturb sleep.
Eat sleep-inducing foods. An amino acid, tryptophan is a component of serotonin, a chemical messenger in the brain that helps induce sleep. In 1996, the Food and Drug Administration made tryptophan a prescription-only item. Ask your doctor for a prescription if you like-or get the amino acids from food sources such as tuna, cottage cheese, rice, oatmeal, eggs, peanut butter, and milk.
Sweat, then sleep. Regular exercise is one of the best things you can do to sleep soundly, Dr. Hauri says. Any activity helps, but he especially recommends walkingideally, one brisk half-hour walk every day.
"Exercising in the late afternoon releases the day's stress and decreases your appetite for dinner, which helps you stick to the light supper that sleep experts recommend," Dr. Albert says. "Just don't exercise too close to bedtime. That's stimulating and can keep you up."
Breathe your way to Zzzs. Deep breathing is a fundamental relaxation technique. Five to 20 minutes of sitting quietly and breathing deeply before going to bed might help you fall asleep, Dr. Hauri says.
Focus on a mantra. A panel of experts appointed by the National Institutes of Health (NIH) investigated nondrug approaches to treating insomnia. They concluded that meditation produces "significant improvement in sleep."
Soak before snoozing. Bathing is a traditional relaxing bedtime ritual. Researchers at the University of California, Santa Barbara, put it to the test. Not surprisingly, their study showed that compared with nonbathers, people who took a tolerably hot bath an hour or so before bedtime fell asleep faster.
Boost sleep with the Bootzin Technique. This behavior therapy program was developed in the 1970s by Richard Bootzin, Ph.D., then at Northwestern University in Chicago. It's often quite helpful in inducing sleep. Here's what to do.
Go to bed only when you feel sleepy. Ignore the clock. Thne in to how you feel.
Use your bed only for sleeping and sex. No eating, reading, watching TV, talking on the phone, or anything else.
If you go to bed but can't fall asleep, get up and leave the bedroom. Read, watch TV, listen to music-do something until you feel sleepy again. Then return to bed.
Repeat step 3 as often as you need to throughout the night.
No matter when you go to sleep, set an alarm for the same time every morning.
Don't nap during the day.
The first night or two of using the Bootzin Technique, you may repeat step 3 several times. But over a few nights, the repetitions typically diminish and often disappear. If your insomnia recurs after a period of sleeping well, simply return to the six steps.
See yourself in dreamland. "Visualization therapy can be a powerful tool for inducing sleep," says Martin L. Rossman, M.D. The Academy for Guided Imagery in Mill Valley, California, offers a visualization audiocassette called A Restful Sleep: An Imagery Experience with Getting a Good Night's Sleep. For ordering information, write to the Academy for Guided Imagery at P. O. Box 2070, Mill Valley, CA 94942-2070.
Slip into slumber with biofeedback. The NIH panel also gave high marks to biofeedback relaxation training as a sleep aid. It's similar to meditation.
Entice the Sandman with the scent of lavender. Lavender is an aromatherapy favorite for relaxation and insomnia. You can buy lavender essential oil in many health food stores and through mail-order catalogs. To use it, place a few chips of rock salt in a small, capped vial, then add a few drops of the oil. The salt absorbs the oil, so it doesn't splash out when you open the vial. Uncap the vial and inhale the scent as needed.
Try sex. Lovemaking has a well-deserved reputation for improving sleep. But not all sex works. "It depends on how the sex makes you feel," Dr. Hauri explains. "If you feel loved and cared for, sex can help you sleep. But if it's unsatisfying or takes place in a problematic relationship, it might be the prelude to a very poor night's sleep."
Keep a sleep diary. A sleep diary can be quite helpful in overcoming sleep problems, Dr. Albert says. It can reveal sleep-disrupting behavior patterns that might otherwise remain hidden. For 2 weeks, simply jot down what and when you eat, drink, and do everything else during the day. Also note your emotional stressors, any drugs you take, and how long and how well you sleep. Look for connections between nights when you sleep poorly and what's going on in the rest of your life.
Ditch the double bed. If you and your spouce sleep in a double bed, switch to a queen- or king0size bed, Dr.Hauri advises. "Larger beds become especially important as you age". sleep less soundly and are more likely to be disturbed by a restless bedmate."
Create comfort. Test different types of mattresses. Splurge on sleepwear that feels just right for you. If you have arthritis or a bad back, try extra pillows or specially shaped therapeutic pillows.
Preserve peace. You can probably sleep through steady noise-for example, the hum of a nearby freeway, Dr. Rauri explains. But you're likely to get rudely awakened by sudden, intermittent noises-cats fighting in a neighbor's yard or a motorcycle roaring up the street. To preserve nighttime quiet, try wearing foam earplugs.
Create a dark environment. For a darker bedroom, Dian Buchman, Ph.D., author of The Complete Guide to Natural Sleep, suggests investing in blackout drapes, blinds, or shades. Or wear a sleep mask.
Banish your bedroom clock. "Many insomniacs have big, illuminated digital clocks staring at them all night and making them anxious;" Dr. Rauri says. If you use an alarm clock, place it so that you can't see the time while you're in bed.
Sleep separately. What if one of you likes a hard foam mattress but the other prefers a waterbed? Many couples with very different sleep styles feel obligated to share the same bed. Consider twin beds or different bedrooms. "You'll both sleep better and probably feel more loving toward one another, which can lead to better sex," says Louanne Cole-Weston, Ph.D., a sex and marital therapist in Sacramento, California.
Distract Yourself. Sleep is like love: It arrives only when you don't try to force it. Think about something else. Years ago, the traditional advice was to count sheep. But a Gallup survey showed that one-third of American adults read themselves to sleep.
Avoid oversleeping. Many people with insomnia stay in bed too long. If you need 7 hours of sleep but are in bed for 9, you'll toss and turn for two. Maybe you just need to go to bed later.
Establish a schedule. Every sleep expert agrees: Go to bed and wake up at the same time every day, even on weekends. "Many people need regular sleep/wake cycles and have trouble sleeping if they don't stick with them;" Dr. Hauri says.
Getting regular is particularly important if you suffer from "Sunday night insomnia;" the inability to fall asleep on Sunday night. "Maintain your weekday schedule on the weekend, and you may get relief come Sunday," Dr. Rauri says.
Adopt bedtime rituals. Before turning in, most people lock up their homes, change into their pajamas, brush their teeth, and turn out the lights. If you have trouble sleeping, you might add a few more rituals. Drink a cup of herbal tea, chat with your spouse, do some light reading, or take a tolerably hot bath. If you lie awake worrying that you might forget what you have to do the next day, make a "to do" list of everything you need to remember before you retire. Then let go of your list until morning.
Quit smoking. As if you need another reason to quit: Where there's smoking, there's often insomnia. Nicotine is a powerful stimulant, and insomnia is a frequent complaint among smokers.
Savor a sedative side effect. Over-thecounter antihistamines are notorious for causing drowsiness. This side effect can be a problem if you need to drive a long distance, but it comes in handy if you have insomnia. Over-the-counter sleep aids-including Alka-Seltzer PM, Compoz, Excedrin PM, Nytol, Sominex, and Unisom-contain the antihistamine diphenhydramine. Follow the directions on the package.