LOST in Melbourne

Head Off Chronic Insomnia

When worry drives your life, studies show you’re more likely to develop chronic insomnia. Here’s how to prevent that — and get a good night’s sleep.

Reign in your work life. Give your heart to your work, but be a little more stingy with your time. Decide how many hours a week is reasonable to get your work done, add 10 percent in case you’re wrong, then walk away.

Swim. Or run. Or bike. Or skate. Or skip rope with some kids on the neighborhood playground. You get the idea. Twenty minutes of aerobic exercise reroutes all the adrenaline that worry generates.

Work on stress. Since a study at the Finnish Institute of Occupational Health revealed that stressful events are twice as likely to trigger sleeping problems in those who experience anxiety, keeping a lid on daily stressors is important. Skim over the stress-reducing tips on the previous pages, pick out your favorites, and use them to do just that.

Put worry on a schedule. "In today’s busy world, we don’t have time to do normal worrying until the lights go out," says Mary Susan Esther, M.D., director of the Sleep Center at South Park in Charlotte, North Carolina, and president of the American Academy of Sleep Medicine. "Yet everyone needs a worry time," she adds. The trick is to schedule it on a regular basis, early in the evening — any time before 8:00 P.M. Sit down with a stack of 3 x 5 index cards and ask yourself, "What am I worried about?" Then write down one worry on each card. When you seem to have written down your last worry, go back to the first card, reflect on the worry it describes, and give yourself a reality check.

Does the worry involve a problem that you can do something about? If not, rip up the card. If there is something you can do, write down possible actions and tuck the card into a worry box. You can give it more thought in the morning and decide what to do.

Stay off ebay. In fact, shut off your computer altogether, urges Dr. Esther. A lot of people with worry insomnia are tempted to go online before bed and play computer solitaire or check eBay to see if they’ve won what they were bidding on. "But the computer is interactive, so you can’t just watch, you have to respond," says the sleep specialist. "And that interaction is stimulating enough to keep you up half the night."

For instance, one Florida woman boots up every night around 10:00 P.M. She intends only to check her bids on eBay. Since she feels she has a sleep problem, she intends to be in bed by 11:00 P.M. But without fail, she’s still online at 3:00 A.M. "What can I do?" she asks with a helpless shrug. "I just can’t sleep!"

Head for the bathroom. Once you’ve shut down the computer and had your scheduled worry session, a warm bath before bed will not only relax you, it will also adjust your body’s temperature to a point that signals your brain: "Hey, honey, it’s time for sleep."

Hide the clocks. "Digital clocks blare time at you," says Dr. Esther. "It’s normal to wake throughout the night, but if you look at a clock and see the time, it’s likely to increase your anxiousness about not being asleep." If you need a clock to wake you in the morning, just turn its face to the wall right before bed. You’ll hear it just as well.

Sweet Tension Tamers

Keep milk and cookies within reach. Milk contains sleep-inducing tryptophan, but you need carbs to get it into your brain. Dr. Esther likes cookies (low-fat, of course) as the carb, but you could substitute crackers if you’d prefer. There are tryptophan supplements on the market, but neither she nor the FDA recommends them; their safety is still in question.

Nix nightcaps. "Sometimes sleepless individuals will have a drink or two to help fall asleep," says Dr. Esther. "While it will shorten time falling asleep, alcohol actually causes more arousal as your body metabolizes it. The result is it shortens sleep.

"A glass of wine with dinner is okay," she adds. "But a glass afterward may have an impact on your sleep."

Treat yourself like a child. Create a nurturing postbath, prebed routine that’s intended to help you wind down, says Dr. Esther. A little reading, a little soft music — whatever makes you feel nurtured and relaxed.

"We tend to take care of everyone else before we take care of ourselves," says Dr. Esther. "That has to change."

Stop those thoughts. Once you hit the sheets, worry time is over — especially about sleeping. There’s a therapy trick called "thought-stopping" that works like a charm, says Dr. Esther. "If you find yourself thinking about tomorrow and saying, ‘It’s going to be a bad day because I’m never going to sleep,’ immediately think: ‘STOP. Don’t go there. I know I’ve done this before. If I don’t fall asleep, I’ll get out of bed, flip through a magazine, but I am NOT going to focus on this stuff!’" Sounds simple, but once you try it, you’ll find it works!

Restrict time bed to sleep time. If you’re going to bed at 10:00 P.M., sleeping from 11:30 P.M. until 2:00 A.M., tossing and turning until 4 A.M., then sleeping until 6, you’ve gotten 8 hours in bed but only 4 1/2 hours of sleep. That’s a huge mismatch, which can actually inhibit your sleep drive and cause insomnia all by itself. To prevent it, when you wake at 2, go read a book in the living room. Being up increases your sleep drive — which could make you sleepy enough to fall asleep when you return to bed.

Schedule your sleep time. "Stick with it seven days a week," says Dr. Esther. Opening your eyes at the same time every morning triggers a series of biochemicals that, as the day winds down, tell your body when it’s time to sleep.

Work with a cognitive behavioral therapist. In a study at the Université Laval in Quebec, researchers measured the effects of cognitive behavioral therapy for GAD on insomnia and found that insomnia practically disappeared among study participants.

What’s more, in 21 other studies involving 470 patients with insomnia from a variety of causes, cognitive behavioral therapy worked just as well as sleeping pills at increasing sleep and improving sleep quality — and it was actually better than sleeping pills at helping study participants get to sleep faster.

Despite its intimidating name, cognitive behavioral therapy — or CBT — is simply learning new information about what keeps you from sleeping (the "cognitive" part) and learning how to manipulate your behavior (the "behavioral" part) so that it doesn’t. It generally takes only four or five 30-minute sessions to effect change.

Unfortunately, certified cognitive behavioral therapists are scarce. To find one, visit http://www.academyofct.org/ and click on "Find a Certified Cognitive Therapist." Fill in your Zip code on the pop-up, and a list of therapists in your area will appear. If none do, you can visit http://www.cbtforinsomnia.com/. The Harvard researcher who demonstrated the effectiveness of CBT vs. sleeping pills has taken his study and packaged it into an online program.

Seek a sleep specialist. "If you’ve been struggling with a sleep problem for almost a month, talk to a sleep specialist," suggests Dr. Esther. "You already know what your issues are, but a sleep specialist might be helpful by prescribing an anti-anxiety medication to use for a few weeks as you get control of your worries and establish better sleep habits."

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