How to Conquer Chronic Insomnia

It’s possible to address sleep deprivation with self-help techniques and clinical interventions.

We’ve all had the occasional night of tossing and turning, but for some, this problem persists. This is a case of chronic insomnia, a condition in which someone loses sleep at least three times a week over the course of one to six months, and has trouble carrying out normal activities during the day.

Insomnia Today

Today’s adults, particularly Americans, have grown accustomed to brushing aside the cues that signal the need for more sleep, says Carol Ash, DO, medical director of Sleep for Life in Hillsborough, N.J. The effects can be hard to spot, she says, even when insomnia is impairing performance at work.

“You’re skilled at your job, so you’re really quite capable of managing on a day-to-day basis. But decision-making can be impaired; the consequence of sleep debt can be delayed and subtle,” she says.

Some signs of insomnia include:
  • Difficulty falling asleep or waking up too early
  • Waking up during the night or having trouble falling back asleep after waking up
  • Sleep that leaves you feeling worn out or irritable
  • Drowsiness during the day
    • Self-help is the first step in treating chronic insomnia. Eating or exercising around bedtime is likely to keep you agitated and sleepless at night. “We need about an hour to wind down,” Dr. Ash says “There’s no quick ‘sleep switch.’” In particular, avoid caffeine during the day.

      Make the bedroom a restful refuge dedicated to sleeping and sexual activity only — banish distractions such as television and electronics.

      The body’s internal thermostat associates sleep with a drop in temperature, so it’s important to keep the sleeping area cool. “That’s why a bath at night helps some people sleep,” Ash explains. “When you’re done, there’s a transition to a cooler temperature.” If necessary, put up block-out shades to keep the room dark.

      Diagnosing Insomnia

      The primary tools for diagnosing insomnia include a detailed sleep history, as well as a physical exam and an evaluation of your medical, substance, and psychiatric history. It’s important to identify any other medical or psychological conditions that could be causing your sleep deprivation.

      Two other tools are available, but less frequently used: Polysomnography involves recording a person’s sleep pattern, breathing, heart activity, and movements during sleep; daytime multiple sleep latency testing (MLST) is a daytime nap test that measures drowsiness by the speed at which you fall asleep.

      The primary goal of any chronic insomnia treatment is to improve the quality and quantity of sleep and clear up any problems insomnia causes during the waking hours. It is not uncommon for a clinician to suggest treating an underlying condition or to use a combination of behavioral therapies and medication.

      Sleep medication usually is used as a final option, when other treatment options have not produced consistent, restful sleep. Specifically, the medication that’s most appropriate depends on several factors:

      • Symptoms (i.e., difficulty falling asleep, staying asleep)
      • The goal of treatment
      • The result of previous treatments
      • Patient preferences and cost
      • Other treatment possibilities
      • Other medical or psychiatric conditions
      • Contraindications to the medication
      • Interactions with other existing medication
      • Side effects

      Insomnia has a high relapse rate, so a clinician will likely want to review a patient’s status every six months after the condition is resolved.

      If you have insomnia, it might be some comfort to know that you’re not alone. “We’re living in a time of unprecedented wakefulness,” says Ash.

      By Elizabeth Connor – Medically reviewed by Christine Wilmsen Craig, MD