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4 ways to get better sleep

People with insomnia struggle to get a good night's rest. They may be plagued by trouble falling asleep, unwelcome awakenings during the night, or fitful sleep — alone or in combination. They may feel drowsy during the day and yet be unable to nap. Insomnia can leave a person feeling anxious and irritable or forgetful and unable to concentrate.

Finding an effective solution requires uncovering the cause. Nearly half of insomnia cases stem from psychological or emotional issues. Stressful events, mild depression, or an anxiety disorder can make falling asleep and staying asleep difficult. Ideally, once the underlying cause is treated, the insomnia improves.

First-line treatment: Behavioral changes

If you are having trouble sleeping or sleeping well, the following four techniques may help.

Sleep restriction. Fight the tendency to spend a lot of time in bed with the hope of falling asleep. In reality, less time in bed promotes more restful sleep and helps make the bedroom a welcome sight instead of a torture chamber.

Reconditioning. A few simple steps can help people with insomnia to associate the bedroom with sleep instead of sleeplessness and frustration. For example, use the bed only for sleeping or sex and go to bed only when you're sleepy. If you're unable to sleep, move to another room and do something relaxing. Stay up until you are sleepy, and then return to bed. If sleep does not follow quickly, repeat.

Relaxation techniques. A racing or worried mind is the enemy of sleep. Sometimes physical tension is to blame. Techniques to quiet a racing mind — such as meditation, breathing exercises, progressive muscle relaxation, and biofeedback — can help.

Cognitive behavioral therapy (CBT). CBT for insomnia aims to change the negative thoughts and beliefs about sleep into positive ones. People with insomnia tend to become preoccupied with sleep and apprehensive about the consequences of poor sleep. This worry makes relaxing and falling asleep nearly impossible. The basic tenets of this therapy include setting realistic goals and learning to let go of inaccurate thoughts that can interfere with sleep.

Chronic pain and insomnia are an unhealthy combination. According to the National Sleep Foundation, chronic pain disturbs the slumber of one in five Americans at least a few nights a week. Whether it's from a bad back, arthritis, or headaches, chronic pain puts you in double jeopardy: the pain robs you of restful sleep and makes you more fatigued, and thus more sensitive to pain.

But you can start to break this vicious cycle.

"For chronic pain conditions, what you need is good sleeping habits from the beginning — things that will last," says Dr. Padma Gulur, a pain medicine specialist at Harvard-affiliated Massachusetts General Hospital. That means relying on the brain's natural sleep drive as much as possible.

Try "relaxing distraction"

Dr. Gulur recommends "relaxing distraction" to her patients. Some relaxation techniques use basic rhythmic breathing meditation; others focus on guided imagery, in which you imagine being in a calm, peaceful location. Find something that appeals to you and helps you fall asleep. You might look for these exercises on CD, or consider group or individual trainings or sleep education sessions.

Getting back to sleep

For some people, chronic pain not only makes it harder to fall asleep, but can also interrupt sleep. Simply shifting position in bed can trigger pain from a back condition or arthritic knee.

One approach is to take your pain medication right before bed. Check with your doctor to be sure that fits into your treatment plan. If pain does wake you in the middle of the night, first try meditation, visualization, or whatever relaxing distraction you favor. But if it doesn't work, getting up to read a book in a quiet room with low light can help you to get back to sleep. Avoid loud sounds and bright light (that means TVs, smartphones, tablets, and computers).

Staying on a regular sleep schedule is also important. Go to bed at the same time every night and, no matter how the night goes, rise the next day at the same time and remain awake until your planned sleep time. This helps to set your internal sleep clock and enhances the natural sleep drive.

To learn more ways to ensure that you get a good night's sleep, buy Improving Sleep, a Special Health Report from Harvard Medical School.