Peter G. Hanson M.D.

Insomnia has many misconceptions.  First, not everyone needs to sleep for eight consecutive hours.  Not even if we USED to sleep that long in our younger years.  As we age, the body’s need for sleep often diminishes, sometimes to a fraction of what it was during our teen-aged years.  Winston Churchill let the free world through WWII with less than 4 hours of sleep per 24 hour day.  Even that was not consecutive; he had a rigid 45 minute “cat nap” built into every mid-afternoon’s schedule, and could catch up the rest in a couple of other mid-night bits.  No amount of drugs would have improved his waking energy, and none would have given him a longer sleep, save perhaps a general anesthetic every night!  So in terms of function, Winston was simply the master of his unique sleep needs, and was NOT suffering from insomnia.

Other people may sleep 6-8 hours at night, but do so very inefficiently; these people have lots of time asleep, but get little out of it, and are still pooped the next day. 

So the criterion for insomnia is not hours of sleep, but quality of energy during the waking hours.  

Drugs are often the first option, either taken off the shelf by the patient directly, and often prescribed by doctors as a first gambit.  While this may be fine for a brief period of time, such as for a couple of days to get over jet lag or other sleepless interval, there are considerable side effects.  President Bush 1 illustrated this in Japan in the ’90’s, when he took Ambien on Air Force One as it crossed the Pacific, then played tennis with the Emporer’s son (a skilled player, coached by American pros from Peter Burwash International), then attended a state dinner.  He threw up his meal in the Japanese Prime Minister’s lap.  So much for diplomacy, and so much for the “harmless” nature of Ambien.

So let’s take a look at some of the best ways to fall asleep BEFORE needing to reach for that prescription.

1.  Consider your bedtime “sleep hygiene“.  If your bed is cluttered with work papers, then naturally you will wake up thinking about work.  Same point as trying to sleep on your work desk: wrong task and bad timing.

Action item: keep something dull to read yourself to sleep.  Crossword or sudoku, perhaps short articles in magazines.  Do not keep thriller novels at hand, and do not watch news of horrible disasters on TV just before you turn out the lights.

2.  Consider temperature:  The body lowers its temperature by as much as 5 degrees every night (say to 93 F), as it cuts down circulation to the whole body, save the vital heart/lungs/brain connection.  If you time it right, a warm bath just before bedtime can elevate the temperature by 5 degrees (say to 104 F).  As you get ready for bed, the temperature drops, and can keep on with its downward momentum to shepherd you into a good start to your sleep.

3.  Don’t just lie there!  If you wake up, and cannot get back to sleep, GET UP and DO SOMETHING!  Perhaps finish off some work or household chores, or catch up on some intended reading etc.  But don’t do it in bed!  When you have finished, and have reached the point of fatigue, then reenter the bed and see if you can fall asleep then.  At the very least, you will have accomplished something from your next day’s list of activities, which will make the stress levels better. 

4.  Don’t eat protein just before sleeping.  Remember the nightmares that a late-night pepperoni pizza can bring!  Protein hits the indolamine “wake-up” switch in the brain.  If you must eat late at night, try carbs, such as bread or pasta (whole wheat), and have your proteins at least a few hours earlier in the day. 

5. Exercise, but not just before sleeping.  A big dog kept in a small apartment will naturally need a lot of running; if denied, the dog becomes understandably anxious, high strung, and a poor sleeper.  But you should run or work off your own steam at least a couple of hours before bedtime, otherwise the body will be on an alert footing, and sleep will be difficult.

6. Night time “cocktail”: Hot milk, or melatonin can also help with sleep.

7. Consider a time-management session, if you have trouble putting your day’s agenda to bed.  Unresolved bits of the day’s “to do” list will continue to resurface through the night, and bedevil your sleep patterns.

8.  Try acupuncture, as this can often solve even the worst cases of insomnia.

For more info, visit www.peterhansonmd.com.