Causes, and best sleep aids and therapy for short term insomnia
Episodic or short-term insomnia (i.e., trouble falling asleep, staying asleep or feeling tired during the day), is fairly common, reportedly occurring in one third of the adult population. Chronic insomnia (i.e., longer than 3 weeks) should be treated by a professional. Chronic insomnia is associated with numerous negative outcomes involving memory, task performance, judgement, obesity, heart problems and diabetes.
There appear to be three things you can do about insomnia: identify the root cause and fix it, use a sleep aid like chamomile tea before bed or utilize a sleep therapy such as relaxation therapy. And you can use any combination of fixes, aids, and therapies as needed.
- Caffeine is a powerful stimulant and is present in many foods. Heavy consumption (> 500 mg per day or roughly 4 cups of coffee) can make you feel jittery, anxious and nervous. Even a small amount can keep you up at night, depending on the person and how close to bedtime it is consumed. For the caffeine content of different foods see this, for example. Note the caffeine in the pain relievers/ fever reducers Excedrin® and Anacin®.
- Alcohol consumption helps you fall asleep because it’s a sedative, but may cause you to wake up frequently to urinate (it’s a diuretic) and cause headaches (duh, it’s a neurotoxin) that may keep you from getting back to sleep, so avoid drinking alcohol four to six hours prior to bed time.
- Smoking (nicotine is a stimulant). Note that it has been found that abruptly discontinuing tobacco use while continuing the regular consumption of caffeine doubles the amount of caffeine in the blood stream for some time.
- Overeating (a high calorie diet) can disrupt your internal clock, causing you to be awake when you would otherwise be asleep. The inverse is true as well (sleep deprivation may cause overeating), so there’s a possibility of a positive feedback loop developing.
- Lack of exercise (warning: pdf), except shortly before bedtime when it should be avoided.
- Excessive fluid intake near bedtime may wake you up prematurely to urinate.
- Not having regular bedtime and waking up times, shift work or jet lag.
- Stress, depression or worrying.
- Spicy foods (containing capsaicin) in the evening meal were found to markedly disturb sleep, possible due to elevated body temperature during the first sleep cycle.
- Aspirin and ibuprofen disrupted sleep in comparison to placebo by increasing the number of awakenings and percentage of time spent in the awake stage, and by decreasing sleep efficiency. Acetaminophen did not differ significantly from placebo on any measure of polygraphically recorded sleep.
- Withdrawal from illicit recreational drugs: cocaine, ecstasy and marijuana.
- Restricted breathing (allergies, cold, flu).
- Intermittent noise, which is more disturbing to sleep than continuous noise. The effect increases with the maximum level of the noise events and the ratio of this level to background noise level. White noise generators (aka white noise machines) can help mask intermittent noise by increasing the background noise level.
- Excessive cold or temperature swings during sleep.
- Physical conditions that cause discomfort (pain, itching, hot flashes, etc).
- Miscellaneous medical conditions (thyroid, bipolar, and anxiety disorders, irritable bowel syndrome, sleep apnea, restless leg syndrome, etc).
- Television viewing at bed time is associated with sleep disturbance for K through 4th grade children. I have not found a study for adults, but higher television viewing time is associated with obesity in adults, which in turn is associated with sleep disturbance.
- Habitual snoring is significantly associated with daytime sleepiness, restless sleep, and hyperactivity for children.
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Sleep aids help you feel sleepy or reduce anxiety
Eat a small amount of carbohydrates prior to bedtime such as bowl of cereal, crackers or rice. Cherries contain carbohydrates, and are especially rich in melatonin, which helps regulate sleep, and may be useful as a sleep aid.
Tryptophan rich foods may help as a sleep aid, but the research results are mixed. Common high-tryptophan foods include: milk, nuts and seeds, bananas, honey, eggs. See wikipedia for lists of tryptophan containing foods.
Antihistamines containing diphenhydramine hydrochloride such as Benadryl ®, and Dimenhydrinate, marketed as Dramamine ® in the States, which is used to prevent motion sickness and nausea, both cause drowsiness and can be used as sleep inducers. You obviously want to limit the use of these substances due to possible side effects, and the fact that they become less effective as sleep aids with continuous use.
Chamomile is an effective therapy for anxiety. Chamomile is available as a capsule supplement and as a tea. But don’t use chamomile if you are taking aspirin or another NSAID due to potential interactions because of chamomile’s antiplatelet activity.
Numerous internet sites recommend mint tea as a bedtime drink to help one relax and that it helps the immune system and the digestive system, etc, but studies have found negative effects on the liver and kidneys.
Exposure to bright light (warning: pdf) in the evening may help you sleep longer if you are waking up too early. However, note that later wake-up times are associated with lower average grades for college freshmen, so you may want to avoid bright lights in the evening in order to wake up earlier.
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The following therapies have all been shown to be effective by properly designed experiments of adequate power. There are insufficient studies to tell which therapy is the most effective. Besides, most studies include two or more therapies at the same time.
Stimulus Control Therapy (also called the Bootzin technique)
1. Lie down intending to go to sleep only when you are sleepy. The goal is to become more sensitive to internal cues of sleepiness so you will be more likely to fall asleep quickly.
2. Use the bed only for sleeping; do not read, worry, watch TV, think about your day, or eat in bed. Sex, however, is entirely okay. You want your mind to associate being awake with other areas, not your bed.
3. If you’re unable to go to sleep, get up and move to another room. Stay there until you are really sleepy, and then return to bed. If sleep still doesn’t come quickly (about 10 minutes), get out of bed again. The goal is to associate the bed with falling asleep easily and quickly, and not with being unable to sleep.
4. Repeat step 3 as many times as needed.
5. Set your alarm and get up at the same time every morning, irrespective of how much you sleep you got during the night. This will help your body to acquire a consistent sleep-wake rhythm and keep you from making up for poor sleep by sleeping late.
6. Do not nap during the day unless you do it every day. You want to be somewhat sleep-deprived after a night of insomnia to make it more likely that you will fall asleep quickly the next night.
Relaxation training involves methods aimed at reducing tension or intrusive thoughts at bedtime. This typically involves concentrating on relaxing specific body parts until you are completely relaxed. Compact discs are available from Amazon.com, for example, featuring soothing voices which can talk you through the process every evening prior to bedtime. Search for “relaxation audio cd”.
Sleep Restriction Therapy
This involves curtailing the amount of time in bed to the actual amount of time spent asleep, creating a mild sleep deprivation, and then progressively lengthening sleep time as sleep efficiency improves.
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