Cognitive Therapy for Chronic Insomnia

DEAR ASK THE DOCTOR: I am 30 years old, I have been having sleep problems all my life. I exercise as much as I can and do not drink any coffee or alcohol.  My doctor has prescribed me a sleeping pill. I heard this can be addictive. Is there anything else I can use for sleep?

DEAR DEBORAH: You indicate that you have been having sleeping problems for some time so for the purpose of this answer, I am going to assume you suffer from chronic insomnia.  Chronic insomnia is a condition of difficulty with initiating or maintaining sleep that lasts for at least one month and causes significant daytime impairment such as fatigue, mood disturbances, and problems related to employment or relationships.  In my practice, it is a common problem that I see and sometimes medications are necessary.  However, there are other things you can also try.

Firstly, it is important to have good sleep “hygiene”. This includes: avoiding caffeine and nicotine, avoiding exercise 4 hours before bedtime, avoiding larger meals at supper, avoiding day time naps, sleeping and waking at the same time every day, making the bedroom as dark and as comfortable as possible, avoiding other activities like reading, eating or watching television in the bedroom.

Okay, so you have done all that and still do not want to take medication. There is one more proven option - Cognitive behavior therapy (CBT). CBT is effective if there are no underlying medical causes of your sleep problems and this should be excluded by your physician.

The goal of CBT is to break the cycle of insomnia, mental distress, negative and irrational thoughts, and further sleep disturbances.  It consists of identifying a patient's thoughts about sleep, challenging their validity, and replacing them with more adaptive substitutes. Few physicians’s are trained or experienced in CBT and you may have to contact local sleep experts to see who offers this service.

Lastly, I do not want to understate the importance of sleep for the mind and body. If you have tried all of the above and are still experiencing non restorative sleep, I would consider the option of medications.