In an article cleverly titled “Are Doctors Sleepwalking Through Treating Your Insomnia?” Eric Sabo reported that many physician-prescribed sleep remedies are no better at curing your insomnia than are your own made-up fixes, like taking an allergy pill or sipping a glass of wine. In fact, many of the medications doctors prescribe may make the person drowsy enough to fall asleep, because drowsiness is a side effect of the medication, not what the med was developed to treat!

Prescribing sleeping pills requires more monitoring. So physicians began prescribing antidepressants because of the relaxing and drowsiness side effects. In fact, from the mid 80s to the mid 90s, sleeping pill scripts dropped by half while use of antidepressants tripled. Trouble was, antidepressants were created for depression, not chronic sleeplessness. And they carry other side effects, such as lowering blood pressure, or prolonged grogginess (lasting up to two days).

Chronic insomnia, lasting from six months to several years, is of course the most severe. Everyone misses a good night’s sleep occasionally—a thunderstorm sets you to worrying whether the trees in your yard might crash on your house, or you have an early plane to catch and fear missing the alarm. Episodic or acute insomnia can last weeks, but not usually longer than six months. You have a new job and worries about making good keep you awake until you settle in. But ongoing inability to fall asleep and stay asleep long enough to feel rested is what’s usually referred to as insomnia—inability to sleep.

Insomnia affects about 60 million Americans a year, with a third more women than men tossing and turning. Because it is often caused by another problem, seeing a physician is recommended and certainly not an overreaction. The sleeplessness could result from clinical depression or another mental illness, or from a circadian rhythm disturbance. These are not usually difficulties people can correctly identify at home on their own.

Especially since some people suffer with insomnia for years—because of the dangers of becoming addicted to sleeping pills—support of an understanding physician, or a referral to a sleep expert can be “just what the doctor ordered.”

It’s recently been determined there is one approach that has the greatest success with insomnia. It’s called “cognitive behavioral therapy.” It’s usually conducted in a psychotherapist’s office or a pain management clinic.

Other than strictly physical diagnoses, most insomnias are connected to some sort of anxiety that prevents the mind from becoming still. The cognitive behavior therapist asks the “patient” about sleeping, work, family life, etc., all to construct a window into the patient’s life. Often the patient is quite able to identify the wakefulness problem directly. “When I go to bed, I lie awake reviewing everything I did at work today, wondering how I could have managed it better, especially since they never tell me anything till the last minute…”

The details of your case are probably different. In fact, you might fall asleep like a kitten and awake near morning due to a urinary urgency, but after returning to bed, you start thinking about the coming work day.

Our work lives are so much more mental than they were 50 years ago. It’s no wonder we don’t fall asleep from physical exhaustion as soon as the evening meal is complete. We haven’t been out in the field tossing hay bales up to a trailer the whole day. Our predominantly sedentary lifestyles provide many opportunities for performance anxiety, or simply the inability to turn the mind off.

Cognitive Behavioral Therapists help a person recognize thoughts and beliefs that are irrational and replace them with beliefs that are more rational. Since all of the beliefs—both those that don’t serve us well and those that do—come from our own heads, it’s not a difficult matter to incorporate beliefs that help us sleep better.

These new beliefs would not be simple mantras “willing” ourselves to sleep better: “I always get a good night’s sleep.” They’re likely to be much more specific to our particular situation, therefore more credible, and therefore they work quite well.

If you’ve tried everything you know of to relax and get a better night’s sleep, yet you’re still spending a significant amount of your time in bed completely awake, seek out professional help. Once you know what sort of disorder you’re fiddling with, you’re much closer to employing a solution that is optimal for you.

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