NOTICE: Difficulty falling asleep the first time is called sleep onset insomnia. Difficulty staying asleep is sleep maintenance insomnia. These are two very different symptoms. This page deals with sleep onset insomnia.
Sleep is necessary for life, just like breathing. Everyone knows if we do not breathe we die. The same is true for sleep. This makes the human sleep drive incredibly strong. The proper way to treat insomnia is to: 1) address unrealistic expectations and beliefs regarding sleep 2) remove bad sleep habits and then 3) optimize sleep drive.
Common Sleep Misbeliefs
The first step is to acknowledge that you can sleep. The fact that you are reading this means you are sleeping. You may not be sleeping like you want, but that is different than not sleeping at all. You can sleep or you would be dead.
The second misbelief you must address, is the belief that you need eight hours of sleep every night. You could argue that anyone that uses an alarm to wake up is sleep deprived. Everyone will encounter a bad night's sleep now and then. It is part of life. If you have a bad night's sleep you need to make sure you take steps to promote a better night's sleep the next night.
The third misconception most people have is the amount of time they are actually sleeping. This is called sleep state misperception. The worst person to judge how much you are sleeping is you. This is because you are going in and out of consciousness. Anyone who spent 8 hours in bed but woke up 5 times for 5 minutes each, would describe their night as poor despite spending over 7 hours asleep.
Key Sleep Habits for Insomnia:
- Keep the same sleep/wake schedule 7 days a week
- Develop a relaxing bedtime routine
- Avoid exposure to direct light sources (TVs, computers, phones) within 2 hours of bed
- Avoid all caffeine
- Avoid all alcohol
- Avoid all nicotine
- Avoid stimulant medication such as amphetamines and methylphenidate
- Remove all sources of light from your room.
- Either keep your room quiet, or have a white noise to drown out other noises.
- Do not have a clock visible from your bed.
- Remove all electronics from your room including cell phones, computers, TVs, etc.
- NEVER take a nap during the day
- Use your bed for sleep and sleep only. Do not do awake activities in your bed like watching TV, using a computer/phone, or reading.
- If you get into bed and realize you are struggling to sleep, get out of bed and do something that helps you relax that does not include direct light sources or stimulation. Don't get back into bed until you feel sleepy. Even if you are up for a large portion of the night, keep your regular wake time.
Optimizing Sleep Drive
There are 3 main things that control sleep drive. Sleep drive is the likelihood you will fall asleep and stay asleep given the opportunity. The three things that control sleep drive are: 1) the time of day 2) the amount of time since we last slept and 3) the amount of physical activity we do in the preceding wake period.
Humans are supposed to be awake when it is light and asleep when it's dark. It's the way our brain is designed. While we do not control the sun and the moon, we do control our exposures to direct light sources - cell phones, computers, and TVs. Direct light sources delay sleep onset. This has been proven with research studies. Teenagers are the most susceptible to direct light sources. To increase sleep drive avoid all direct light sources within 2 hours of bed.
The longer we are awake, the higher our sleep drive becomes. Another way of saying you need 8 hours of sleep a night is saying you need 16 hours of wake time a day. If you want to increase sleep drive, extend your wake time to 17 hours. Still not sleeping? Extend your wake time to 18 hours.
The more physical activity you do during the day, the more likely you are to sleep at night. 30 minutes of exercise a day is recommended for heart health. This means activity that is getting your heart rate up to 50 to 70% of age predicted maximum. It is best to exercise early in the day and do not exercise within 2 hours of your bed time.
What if I Still Cannot Sleep?
If you are truly doing everything described above and still cannot sleep, it is time to talk to an expert. Click here to get a sleep medicine consult.