How to Solve 9 Sleep Problems by Sally Wadyka

Expert advice for anyone who tosses and turns at night.

The Night Waker

Her challenge: After a stressful breakup two years ago, Meredith Crowell, 40, a single real estate property manager and yoga instructor from Boulder, Colorado, would wake up in the middle of the night filled with sadness and anxiety. But even after she felt better emotionally, the sleep troubles continued. Although she typically falls asleep easily around 10:30 p.m., she is wide awake three or four hours later. She falls back into a fitful sleep, then gets up around 6 a.m. to begin her day. "I never wake feeling well rested, because it feels like I don't get more than about four hours of truly deep sleep," she says. To no avail, Meredith has tried myriad remedies―warm baths, hot milk, a glass of wine before bed, no food before bed, relaxation techniques, and prescription and homeopathic medicines. She took a prescription medication, but that didn't give her more than four hours of sleep. She even tried taking the medication when she woke in the middle of the night, but that left her too groggy in the morning.

Expert advice: "The good news is that Meredith's insomnia seems to have a clear precipitant―the breakup," says sleep-medicine specialist David Neubauer, M.D., a sleep-medicine specialist and an associate director of the Johns Hopkins Sleep Disorders Center, in Baltimore. Neubauer calls her situation "conditioned arousal," which, he says, is common. "Her sleep problems may have been initially caused by an external trigger, but over time the sleep problems become self-propagating. Eventually she became conditioned to become anxious about her sleep." Some things that might help:

• Cognitive behavioral therapy (CBT) is often used in cases like this, and the experts agree that it could help Meredith. "CBT aims to stop the behaviors that are perpetuating the insomnia," says Susie Esthera, M.D., a specialist in sleep-disorder medicine at Charlotte Eye, Ear, Nose, and Throat Associates, in Charlotte, North Carolina, and the president-elect of the American Academy of Sleep Medicine. Typically, a therapist will work with a patient for four to eight weeks―in sessions that last from 30 minutes to two hours―to assess, diagnose, and treat the underlying problem, such as relationship worries. The therapist will teach the patient things like progressive-relaxation techniques and point out actions that are getting in the way of deep sleep, such as rehashing conversations that occurred earlier in the day. (To find a therapist, go to the website of the National Association of Cognitive Behavioral Therapists, at nacbt.org.)
   
• Acupuncture. "Acupuncture may help reduce her anxiety and induce deeper sleep," says Rubin Naiman, Ph.D., the director of sleep programs at the Miraval Resort, in Tucson.
   
• Avoiding wine. "There is a notion that alcohol will help you sleep," says Neubauer. "And while it often does help you fall asleep quicker, your sleep will be more disrupted."
   
• Accepting some awakenings. The experts stress that nighttime awakenings are perfectly normal―much more normal, in fact, than the elusive solid eight hours people think they should be getting. Most people will roll over and go back to sleep, but those with insomnia become conditioned to feel anxious when they awake during the night. "You need to accept that you will arouse some, so reassure yourself in the middle of the night that nothing catastrophic will happen if you are awake for a while," says Esther. To that end, she suggests keeping the glaring electric clock off the bedside table. "Clock watching will only increase your anxiety about being awake," Esther says.

  The Early Bird

  Her challenge: Brooke Brown, 38, is a married prekindergarten teacher with three children from Wellesley, Massachusetts. Given her round-the-clock proximity to small children (her own are ages four, seven, and nine), Brooke is understandably exhausted by the end of the day. So much so that she often falls sound asleep as early as 7 p.m. But she is routinely awakened around 2 a.m.―by a child, her husband snoring, or a need to use the bathroom―and never manages to fall back asleep. She lies in bed with her brain in high gear, eventually giving up on sleep and getting out of bed at 5 a.m. to get a jump on her day.
  
  Expert advice: “She is spending too much time in bed,” says sleep-disorders specialist Susie Esther. Brooke should establish a standard waking time (and stick to it seven days a week), then work backward to figure out what her bedtime should be. So if she wants to get up at 5 a.m., she should plan to be asleep by about 10 p.m.―not 7 p.m. “She should gradually adjust her bedtime so that she is able to stay awake later, and that will help her body adapt to the new schedule,” says Esther. To quell Brooke’s middle-of-the-night worrying, Esther suggests that, instead of lying in bed, she get up and do something relaxing, like having a cup of decaffeinated herbal tea. “Staying in bed and trying to sleep will just wake you up more,” says Esther. “Sleep isn’t something you can ‘try’ to do.”

  The Chronic Insomniac

  Her challenge: Kristy Lewis, 29, a married homemaker and photographer from Hampton, Virginia, can't remember a time when she didn't have trouble sleeping. "I thought it was normal to take an hour or longer to fall asleep, but in 2004 my doctor diagnosed me with insomnia," she says. She also wakes several times during the night and remains awake for anywhere from a few minutes to an hour. She also suffers from restless legs syndrome and frequently talks in her sleep. Sleep medications help to some degree but leave her feeling drowsy the next day. She has also tried practicing yoga, doing vigorous exercise earlier in the day, avoiding caffeine, and reading or writing in a journal before bed.
  
  Expert advice: "I would first want to investigate her restless legs problem," says sleep-medicine specialist David Neubauer. Restless legs syndrome, which has recently been taken more seriously by doctors, can sometimes be caused by anemia. If blood tests show that Kristy has anemia, iron supplementation could help. If anemia is not the cause, she could ask her doctor about medications like Mirapex and Requip, which are often prescribed for restless legs syndrome. Otherwise, Kristy might consider:
  

  • Pay even more attention to her evening routine and her sleep environment. "Good sleep habits don't necessarily solve sleep problems, but they do create a foundation for improved sleep," says Neubauer. Good habits include things such as keeping the bedroom cool and dark, using a fan or a white-noise machine to create a blanket of sound, and using the bed exclusively as a place for sleeping―and not for watching television, for example.
     
  • Making an appointment at a sleep clinic, which can be a smart step for people with a long history of sleep issues. Most often this involves office visits (which will not necessarily be overnight observations), during which the patient will undergo a physical examination and work with a doctor to assess and diagnose the cause of the sleep problems. (For more information or to locate a sleep specialist near you, go to the website of the American Academy of Sleep Medicine, at aasmnet.org.)

    The Hormone Sufferer

    Her challenge: Patty Magovern, 53, a married human-resources director from Wall, New Jersey, never had trouble sleeping―that is, until menopause hit last year. “My whole life, I would fall asleep as soon as my head hit the pillow and sleep through the night,” she says, “but those days are long gone.” Now, no matter what time she goes to bed, she has difficulty falling asleep and, like clockwork, awakens at 1 a.m. For the rest of the night, she tosses and turns before finally getting up at 6:30 a.m. Taking over-the-counter or prescription medications helps but leaves her feeling logy in the morning rather than refreshed. She doesn’t want to take hormone-replacement therapy to treat her menopause symptoms, including the hot flashes that sometimes disrupt her sleep, because she worries about the risks.
    
    Expert advice: There is some evidence that hormonal changes can have an effect on sleep. If hot flashes are a big issue, sleep-medicine specialist David Neubauer, points to recent studies that have shown that sleeping in a cooler-than-normal room can help prevent them. More advice:
  • Use caution regarding over-the-counter sleep medications, since they contain some type of antihistamine, which can stay in the body for a long time. “It takes about 18 hours for your body to clear out 50 percent of the active drug. For most of your waking hours, it will still be in your system, making you drowsy,” says psychologist Rubin Naiman.
     
  • Patty might also benefit from taking 0.3 milligram of an over-the-counter melatonin supplement about 20 minutes before bedtime since the production of melatonin (a naturally produced hormone that helps regulate circadian rhythms) drops off as we age.
     
  • Go for a checkup. “Around the time a woman reaches menopause, other risk factors may emerge, such as sleep apnea,” Neubauer says. Patty should consider that new medications she may be on could also be disrupting her sleep.