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James J. De Santis, Ph.D.
138 N. Brand Blvd., Ste. 300, Glendale, CA 91203
112 W. Bennett Ave., Ste. 4, Glendora, CA 91741
(818) 551-1714

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What is Insomnia?

Anyone can lose a night's sleep due to a variety of causes, including illness,
travel, or worry. We usually adjust back to our normal schedule the next
night without help. This isn't usually a problem.

However, we sometimes can fall into a pattern of nightly trouble falling
asleep, staying asleep, or waking up too early. These can begin to interfere
with our ability to function at work, with family, or with daily life.

In such situations, there are many remedies that have been found useful to
get back to regular, restful sleep. If you are having difficulty sleeping, some
of these may be helpful to you in order to get a good night's rest.

Sleep Scheduling

Keep a "sleep log" for a week or two to identify what may be interfering
with sleep. Log observations on paper nightly: the time you go to bed, how
long it takes to fall asleep, how many times you wake during the night and
when you wake, what time you wake in the morning, and what time you get
out of bed. Log your mood, any important events occurring during the day,
and what you eat before bedtime.

Gauge how many hours you should be sleeping by how much sleep you need
to wake refreshed and function without drowsiness during the day. Don't try
to force yourself to sleep; instead, schedule enough time for sleep; eight
hours is average. If you routinely wake up to an alarm clock, you may be
sleep-deprived. Avoid going to bed too early or staying in bed too long.
Excessive time in bed may cause fragmented and shallow sleep. Follow this
new routine consistently, even on weekends, to strengthen your day-night
rhythm that will lead to regular sleep onset.

Avoid napping during the day. You can disrupt your normal day-night cycle
with too much sleep in the day.

Foods & Diet

Hunger can disturb sleep. A healthy snack or a glass of milk before bedtime
may help. Avoid heavy meals just before bedtime. Eat at regular times
during the day.

If overweight, consider a weight-reduction program with the guidance of
your physician. Obesity can be a factor in sleep disorders and breathing
problems during sleep.

Eliminate caffeinated coffee, teas, cola drinks, chocolate (which contains
caffeine), cigarettes, or stimulants in the late afternoon and evening.
Caffeine activates the "alertness center" of the brain, keeping you awake.
While low levels of nicotine have a sedating effect, higher concentrations
produce arousal. Heavy smoking can produce breathing difficulties that can
contribute to poor sleep.

Avoid alcohol at supper and before bedtime. Although alcohol may help
tense people fall asleep more easily, when it wears off, a "rebound" effect
can trigger waking in the middle of the night.

While an occasional sleeping pill may be of some benefit over the short
term, it treats the symptom but not the underlying reason you can't sleep.
Chronic use may be ineffective and also aggravate sleep problems. Consult
your physician.

Sleep-Inducing Activities

Light physical exercise in the evening may be helpful, such as a brisk walk
for about twenty minutes. Avoid heavy exercise at least three hours before
bedtime, so your body has a chance to unwind.

A hot bath can help induce sleep. Body temperature naturally drops as we
fall asleep. A 20-minute soak before bedtime raises core body temperature,
and the subsequent drop in temperature initiates drowsiness.

Develop calming bedtime rituals that are the adult equivalent of lullabies,
such as relaxing with a novel, listening to soft music, meditation, or prayer.
Avoid television.

If you are not asleep within 30 minutes of getting into bed, leave the room,
do some neutral activity to clear your mind, then return to bed.

Sleep Environment

Associate your bedroom with sleep. Use some other part of the house for
activities like office work, phone calls, family discussions, eating, or viewing
television.

Control sound, light, temperature, and humidity in the bedroom. Thick
carpet and drapes can dampen sound. Remove clocks that tick. A "white
noise" machine creates a soft, steady hushing sound that soothes while
masking loud or sudden sounds. Control excessive warmth or dryness during
the night. If the air is dry, consider a humidifier. Air movement is conducive
to good sleep; consider a quiet circulating fan.

If you sleep with a partner, consider sleeping alone temporarily to eliminate
the disturbance when a partner changes sleep position until you
re-establish normal sleep patterns. Avoid having pets on your bed that can
disrupt sleep.

If your mattress is more than five years old, it may be time for replacement.
A firm mattress is better than a soft one for most sleepers. Select a
mattress at least six inches longer than you are tall. If you sleep with a
partner, consider a king-size box spring with two twin mattresses and a
foam bridge to isolate movement.

Adopt a good sleep posture, consisting of sleeping in a modified S-shape on
your side, a small pillow under your head. Some conditions, like back
problems, may dictate using different sleep positions; consult your physician
or chiropractor.

Psychological Approaches

Use a relaxation exercise at bedtime--such as diaphragmatic breathing,
guided imagery, or progressive muscle relaxation. Deep breathing involves
holding your shoulders back, filling your lungs slowly and deeply with air,
holding it for three seconds, and exhaling gently. Repeat three or four
times. Guided imagery involves closing your eyes, visualizing a tranquil
scene, like a forest or beach, and using your imagination to recreate all five
senses. Progressive muscle relaxation involves tensing and relaxing one
group of muscles at a time, working through your entire body from head to
toe.

If your mind is "racing" and the "motor won't turn off" at the end of your
day, because you are preoccupied with problems you need to tackle, write
down a list of your worries. Cross off the items over which you have no
control. Briefly review the remaining items. Jot down possible solutions and
when you can realistically handle each. Then put the list "to bed" by putting
it away in a drawer until tomorrow. Think to yourself, "I'm finished with my
work for now. Everything is taken care of for today."

When to Seek Help

People who are unable to sleep because they are perfectionistic or
distressed about problems with work, family, or other aspects of daily life
should not try "harder" to sleep but should deal with such problems during
the day. If coping with worries on one's own is difficult, consider obtaining
consultation on ways to help manage or resolve such stresses.

Some clinical disorders like narcolepsy, sleep apnea, or restless leg
syndrome which can contribute to poor sleep may require evaluation by a
specialist.
Suggestions for Better Sleep