America is increasingly sleepless.
It's no surprise. Politics alone can certainly cause many sleepless nights. But insomnia can also be caused by sleep apnea and shift work; hypothyroidism and hyperthyroidism; depression and anxiety; alcohol and marijuana; chronic lung disease; and congestive heart failure.
Just as there are hundreds of causes of insomnia, most people who suffer from sleeplessness do so due to multiple causes. The COPD patient is put on drugs that aid breathing, but these stimulate the heart and arousal. The heart failure patient is given medications like beta-blockers that decrease the amount of work the heart does, but these commonly wake people up. The shift worker has a fall that adds shoulder and back pain to the biological clock-related causes already keeping her awake. Worse, virtually anyone who can’t sleep can develop psychophysiologic insomnia—a fear of sleeplessness that can induce insomnia all by itself.
Recently, cognitive behavior therapy of insomnia (CBT-i) has been endorsed by national clinical groups and experienced a boom in online therapies. Some meta-analyses declare the online treatments as good as face-to-face therapy; others find the opposite is true. But there are things you can do when faced with sleeplessness. Here are 5 ways to get to sleep, even when your insomnia is caused by numerous factors:
1. Get up at the same time every day.
Many people tell me that's impossible. Shift workers can't do it if they want to keep their jobs. Kids’ school schedules conflict with adults getting to work. Other people tell me that waking up to an alarm violates their freedom. Tell it to your biological clock. Time rules life—pretty much all life on this planet.
Over hundreds of millions of years, we have evolved to internally respond to the changes in the sun and moon, stars and seasons. When people get up at the same time every day, they anchor their biological clock in a place that makes them function properly.
Do you want your car engine to work without a timer? There’s plenty of evidence that disrupting your inner clock can lead to multiple diseases, weight gain, increased risk of infection, and early death. Don’t you want to listen to your body when it tells you it’s time to sleep? Well, it can’t tell you to go to sleep if it doesn’t know the time. To make everything work better, you should also try to go to bed at a standard hour. That really keeps your biological clock healthy.
There will be plenty of obstacles. But shift workers can try to keep to a schedule on the days they’re off work. Parents can discuss this with athletic coaches who want their kids practicing in the early morning hours (when injuries are more likely). College students can tell school administrators they don’t want study or social sessions that begin at midnight.
You've got to start somewhere. Clocks control when you sleep: They’re innate. Let them help you; please don't fight them.
2. Get light.
One of the most abundant drugs on the planet, light can work better than Prozac to treat depression. Light increases alertness, literally enlightening us. Exercising in light may create bigger muscles. Light quickly turns on different parts of the immune system.
Light is the biggest zeitgeber, or “time giver” in our biological clock system. People who get morning light sleep better. They have better moods. They wake up faster—and many of us can take one or two hours to fully wake up.
3. Make a list of all the drugs you take and check whether they induce sleeplessness.
Preferably you’ll do this with your doctor, although you can find some useful information online. And I mean all drugs. Not just prescription drugs, but anything that might change your sleep. That includes everything over the counter, including supplements that promise youth, beauty, better skin, and thinner thighs. Don’t forget the alcohol served at dinner, the chocolate in the dessert éclair, the smoothie laced with caffeine-like alkaloids, and the cigarettes and marijuana you like to smoke.
The great French gastronomist Brillat-Savarin said, “Tell you me what you eat and I’ll tell you what you are.” Replace “eat” with “ingest” and he wasn’t that far wrong.
Your body is built to walk, saunter, roam, and climb. If your legs don’t move, use your arms. If you can’t afford an athletic machine or gym membership, put a book (preferably not one of mine, though they work fine) in front of your TV set. Use it as a stair-stepper while you watch your favorite programs. If you're tied to a desk at work, briskly walk to the bathroom or around your building. If you're stuck inside, use the stairs for short bouts of interval training. The fitter you are, the better you’ll sleep. Many possible forms of exercise are part of everyday life. Use them whenever you can.
Train your brain to think in terms of solutions, not just problems. Cognitive behavioral treatment works for many things, in addition to insomnia. It can aid the treatment of anxiety. It’s probably the best therapy for depression (and a third of Americans will end up depressed).
But cognitive behavioral therapy can also become part of a worldview that will help you get through lots of stuff every day. If the world looks scary to you right now, that is another reason to think about ways to solve the problems we face. Writing down problems—and their plans for resolution—can do a lot more than aid sleep. We can train our brain to see what can be done to fix things, including intractable problems like insomnia. And by writing for a few minutes every day, we can find new ways to help ourselves and the people around us.
Helping yourself get more sleep does more than help your body feel rested and alert. It can make you see and deal with the world in a different, better way—which provides hope. Sleeplessness can shatter hope. It’s time to return hope to the night.
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