You’ve been staring at the shadows cast by the ceiling fan for who knows how long. Check the clock. Twenty minutes. Really? Only 20 minutes have passed since your head hit the pillow? You close your eyes, will yourself to sleep. Your mind flits to the meeting tomorrow, then to that weird pinging noise the car’s making, and, oh no, the neighbor’s dog is barking … again. You open your eyes. Count the fan blades. Close your eyes. Breathe in, breathe out, relax, rest, sleep. Or not.
Thirty minutes later, you give up and get out of bed. Might as well read, you think. Actually, that’s what you should have done at the 20-minute mark, sleep experts say. When you’re having a sleepless night or a bout of insomnia—like 30 percent of Americans—the worst thing to do is lie in bed and keep trying to sleep. Get up, read a boring book or listen to soothing music; then go back to bed in an hour. Whatever you do, don’t worry about sleeping.
Anxiety about not sleeping is the leading cause of sleeplessness, says Dr. Raghu Reddy, director of the University of Arkansas for Medical Sciences Sleep Medicine Clinic. But acute or short-term insomnia isn’t something that should make you toss and turn, punch the pillow and swear. It happens to most people at some point in their lives and typically resolves itself, particularly when the cause is obvious—stress, a life-changing event, illness or the neighbor’s barking dog.
When sleeplessness lasts more than three nights, it’s time to seek professional help. Don’t reach for over-the-counter medications. While they help you fall asleep, the quality of induced sleep isn’t the same as natural sleep, Reddy says. “Most over-the-counter drugs don’t allow normal sleep cycling. You may feel like you’ve slept well, but you haven’t. And you develop a tolerance to them over time, so they quit working.”
The most effective and lasting treatment for people with chronic insomnia is cognitive behavioral therapy, say Reddy and Dr. Jason Williams of the Baptist Health Sleep Center in Little Rock. They agree that cognitive behavior therapy (CBT) can be a lifesaver for people with chronic insomnia that’s not directly associated with any other problem, such as depression, medical issues or chronic pain.
CBT involves two steps. The first is cognition, which means recognizing and changing your beliefs about sleep, including associating the bed with only sleeping and sex (no watching Jimmy Fallon or playing games on your iPad in bed). During this step, Williams says, one of the hardest things to do is rid yourself of the fear and anxiety that strikes when you slide under the covers, or even earlier when you begin to merely think about trying to sleep.
The second step in CBT focuses on developing good sleep behaviors, which involves a number of strategies, including adhering to specific times for going to bed and waking up, keeping a sleep diary, and learning biofeedback and relaxation techniques.
How long an insomnia sufferer needs to continue therapy depends upon his commitment and consistency in following a prescribed program, Reddy says, but 90 percent of people who undergo CBT are “cured.” If a person continues to practice his newly learned sleep habits and remembers that everyone has trouble falling asleep occasionally, he’ll be free of the anxiety that used to keep him awake. For a chronic insomniac, that’s a dream come true.