Adults Need a Bedtime Too: Diagnosing, Managing, and Treating Insomnia
Created by Brittany Albright MD, MPH
Sleep can be challenging and elusive yet necessary for your best mental health. It is often the first symptom / warning sign of mental health problems and can trigger and/or exacerbate underlying mental health problems. First, you need to characterize your sleep problems and sleep patterns. For example – is it difficult to fall asleep, stay asleep, or are you waking up too early? If you wake up at night, is it difficult to fall back asleep. We recommend keeping a sleep log next to your bed or on an app on your phone.
To best address your issues with sleep, is essential that you and your healthcare provider identify the cause of your sleep problems, which may involve a physical examination, laboratory studies, and additional testing. It is essential to develop and implement behavioral, psychological, and social solutions to improve your sleep. Lastly, you may require interventions such as a Cpap machine and/or medications to improve your sleep quality.
There are many different causes of sleep disturbances, including:
Stress and anxiety: Emotional stress and anxiety can interfere with the ability to fall asleep and stay asleep. Conditions such as post traumatic stress disorder can make it difficult to fall asleep and are characterized by nightmares.
Mood disorders: Mood disorders such as depression can disrupt every aspect of the sleep cycle and can cause you to sleep too much or too little. Early morning awakening is a common symptom of depression. Bipolar disorder manic episodes can also cause people to not be able to fall or stay asleep.
Attention deficit hyperactivity disorder: The majority of individuals with ADHD have sleeping difficulties, especially with falling asleep.
Poor sleep habits: Poor sleep hygiene practices such as irregular sleep schedules, caffeine consumption, and excessive screen time can contribute to sleep disturbances.
Medical conditions: Certain medical conditions, such as sleep apnea, restless leg syndrome, frequent urination at night, narcolepsy, and chronic pain, can interfere with sleep.
Medications: Some medications, such as antidepressants, stimulants, and beta-blockers, can interfere with sleep.
Environmental factors: Factors such as noise, light, pets/animals, and temperature can affect sleep quality.
Hormonal changes: Hormonal changes during pregnancy and menopause can lead to sleep disturbances.
Job: Some jobs that require work at odd hours or long shift can disrupt sleep patterns.
Substance use: Alcohol, caffeine and drug use can interfere with sleep, as can withdrawal from these substances.
Aging: As we age, our sleep patterns can change, and it may become more difficult to stay asleep for a full night.
Once you have identified the underlying causes of your sleep problems, we recommend addressing and treating any underlying medical and mental health conditions. Additionally, there are important sleep hygiene recommendations to implement:
Sleep Hygiene Recommendations:
Stick to a consistent sleep schedule: Try to go to bed and wake up at the same time every day, even on weekends.
Create a relaxing bedtime routine: Incorporate relaxing activities into your bedtime routine, such as taking a warm bath or reading a book.
Avoid caffeine and nicotine: Avoid consuming caffeine and nicotine in the hours leading up to bedtime, as they can interfere with your ability to fall asleep.
Avoid food: Avoid food, especially high sugar food within 3-4 hours of bedtime. If you wake up in the middle of the night, avoid the temptation to eat.
Limit alcohol consumption: Although alcohol may help you fall asleep initially, it can disrupt the quality of your sleep later in the night.
Create a comfortable sleep environment: Make sure your bedroom is cool, dark, and quiet. Consider investing in a comfortable mattress and pillows.
Limit screen time: Avoid using electronic devices such as phones, tablets, and laptops in the hour leading up to bedtime, as the blue light emitted by these devices can interfere with your body's natural sleep cycle.
Exercise regularly: Regular exercise can help you fall asleep faster and enjoy deeper, more restful sleep. However, avoid exercising close to bedtime, as it can be stimulating and interfere with your ability to fall asleep.
Reduce stress: Ensure that you are not having stressful conversations or participating in stressful activities close to bedtime.
Therapies for Insomnia:
Cognitive Behavioral Therapy (CBT): CBT-I is a type of therapy that can help individuals overcome negative thoughts and behaviors that contribute to sleep problems.
BT-I typically involves several elements that work together to improve sleep habits and promote restful sleep. Here are some key elements of CBT-I:
Sleep Education: This involves learning about healthy sleep habits, the causes and consequences of insomnia, and the factors that can interfere with sleep.
Stimulus Control Therapy: This technique involves associating the bed and bedroom only with sleep and sex, and removing all other activities from the bedroom.
Sleep Restriction Therapy: This technique involves limiting the amount of time spent in bed to only the amount of time spent sleeping, with the goal of increasing sleep efficiency.
Relaxation Training: This technique involves learning and practicing relaxation techniques such as deep breathing, progressive muscle relaxation, and visualization.
Cognitive Restructuring: This technique involves identifying and challenging negative thoughts and beliefs about sleep and insomnia, and replacing them with more positive and realistic thoughts.
Sleep Hygiene: This involves implementing good sleep habits, such as maintaining a consistent sleep schedule, creating a comfortable sleep environment, and limiting caffeine and alcohol intake.
Mindfulness: This involves paying attention to the present moment in a non-judgmental way, which can help reduce stress and promote relaxation.
These elements are typically delivered over several sessions, either in person or via teletherapy, and are tailored to the individual's specific needs and sleep patterns. By implementing these techniques, individuals can improve the quality of their sleep and enjoy better overall health and wellbeing.
Mindfulness meditation: This is a practice that involves paying attention to the present moment in a non-judgmental way, which can help reduce stress and anxiety and promote relaxation. Research has shown that mindfulness meditation can be an effective tool for improving sleep quality.
Here are some steps you can take to try mindfulness meditation for sleep:
Find a quiet and comfortable place to sit or lie down.
Close your eyes and take a few deep breaths, focusing on the sensation of your breath as it enters and leaves your body.
Begin to scan your body, starting at your feet and moving up to your head, noticing any areas of tension or discomfort. As you do this, simply observe any sensations you experience without trying to change them.
Focus your attention on your breath, allowing your breath to be the anchor for your thoughts. When your mind starts to wander, gently bring your attention back to your breath.
Continue to focus on your breath and observe any thoughts or sensations that arise, allowing them to pass without judgment or analysis.
If you find that your mind is particularly active or you're struggling to relax, try counting your breaths or repeating a calming phrase to help you focus.
When you feel ready to finish your meditation, take a few deep breaths and slowly open your eyes.
By practicing mindfulness meditation regularly, you may be able to reduce stress and anxiety, which can improve the quality of your sleep. It's important to note that mindfulness meditation is just one technique and may not be sufficient on its own for treating sleep problems.
By implementing these techniques, you can improve the quality of your sleep and enjoy better overall health and wellbeing. If you are still struggling with sleep problems despite treatment of underlying mental health and physical health conditions and using sleep hygiene, you may consider starting an over the counter or prescription medication temporarily for symptom relief.
There are several over-the-counter medications that can help with sleep, including:
Diphenhydramine (Benadryl): This antihistamine medication is commonly used to treat allergies, but it also has sedative effects that can help with sleep.
Doxylamine succinate (Unisom): This medication is also an antihistamine and is used for the short-term treatment of insomnia.
Melatonin: This hormone is naturally produced by the body and helps regulate the sleep-wake cycle. Melatonin supplements are available over the counter and can be helpful for some individuals in promoting sleep.
It's important to note that over-the-counter sleep aids should only be used for short-term relief of sleep problems and should not be used as a long-term solution. Additionally, they may not be appropriate for everyone and can have side effects and risks, so it's important to consult with a healthcare provider before taking any new medication, even over-the-counter ones. It's also important to prioritize good sleep hygiene practices as the first line of defense for improving sleep.
There are several types of prescription medications that can be used to help with sleep, including:
Benzodiazepines: These medications are sedatives that work by increasing the activity of a neurotransmitter called GABA in the brain. Examples include diazepam (Valium), lorazepam (Ativan), and temazepam (Restoril).
Non-benzodiazepine sedatives: These medications are similar in action to benzodiazepines but have a lower risk of dependence and withdrawal. Examples include zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon (Sonata), Quiviviq, Belsomra (suvorexant), Dayvigo (lemborexant)
Antidepressants: Certain antidepressant medications, such as trazodone (Desyrel) and doxepin (Silenor), can be prescribed in lower doses to help with sleep.
Melatonin agonists: These medications work by mimicking the action of the hormone melatonin, which regulates the sleep-wake cycle. Examples include ramelteon (Rozerem) and tasimelteon (Hetlioz).
Antipsychotic medications: These medications are off label for insomnia and should be used with caution and in low doses for insomnia if other medications are ineffective and/or you have a mood disorder. By blocking specific neurotransmitters in the brain such as dopamine, antipsychotic medications can cause sedation and help individuals fall asleep more easily. However, they can also have potential side effects, such as weight gain, metabolic changes, and movement disorders. Sedating medications include quetiapine (Seroquel), ziprasidone (Geodon), and Zyprexa – these medications are currently FDA approved for bipolar disorder.
It's important to note that while these medications can be helpful for some individuals, they all carry potential side effects and risks. They should only be used under the guidance of a healthcare provider and as part of a comprehensive treatment plan for sleep issues. Additionally, medications should never be used as a substitute for good sleep hygiene practices, such as maintaining a consistent sleep schedule and creating a comfortable sleep environment.
If you are struggling with sleep, please give Sweetgrass Psychiatry in Mount Pleasant, SC a call at (843) 800-1303 and we will be happy to get you set up with a new patient consultation.