Diary of a Insomniac Physician aka What to Do If You Can’t Sleep and You Suffer Insomnia: Part 1
By Dr. Natan Schleider, M.D.
July 16th, 2017
It is 2:08 am on Sunday, July 16th, 2017 and for no particular reason, I cannot sleep. I did not drink any caffeine today. I am practicing good ‘sleep hygiene’ [we will get to that later but that is the fancy doctor jargon meaning all the stuff you are supposed to do when you sleep, for example, go to bed at the same time every night).
This month’s journal of the American Academy of Family Physicians, American Family Physician (Volume 96 Number 1, July 1st, 2017 p.29-35) has an article which I read: ‘Insomnia: Pharmacologic Therapy.’
Given that my 4-year-old daughter, Ellie, keeps kicking me in the head as she tosses and turns at night in my bed (and refuses to use her toddler bed), I thought I would add my personal knowledge and experience with insomnia. Ok, now I realize I am not practicing proper sleep hygiene but kicking your toddler to the curb so you can sleep simply is not in the medical textbooks (and you parents out there can now say ‘I told you so’ and warn me of the dangers of letting children sleep in your bed but Ellie says “Daddy I’m afraid of monsters in the dark and want to sleep in your bed.” Yet I digress.)
So who is more likely to suffer insomnia?
- Women get it twice as often as men, especially if pregnant or post-menopausal
- Older adults
- Patients with chronic medical conditions like heart and lung disease and psychiatric conditions like depression, anxiety, substance abuse, and posttraumatic stress disorder.
- People who are grieving death of a loved one
- People separating or divorcing
- People of lower socioeconomic class
- Patients withdrawing for alcohol and opiates
As a family physician and addiction medicine doctor, I see a lot of patients for insomnia, I mean, it is up there for the primary purpose of the visit with high blood pressure and sore throat.
Having been on call for a medical practice where patients and the hospital can call at all hours of the night, my insomnia has worsened over the years. Maybe I am becoming one of those ‘older adults’ that gets less sleep? Maybe now that I’m a single parent I ‘sleep with one eye open’ which, as most single parents will attest to, means we don’t get much sleep?
Here are Dr. Schleider’s sleep hygiene techniques or ‘behavioral interventions’ as the journal article liked to put it that I use to try to get to sleep. These work most nights:
- I go to bed around 8 pm every night with my daughter, even on Saturday and Sunday (yes, I’m boring but I value my sleep). I wake up around 3 am to 4 am every morning. A regular sleep schedule gets you body used to falling asleep on time.
- Caffeine is a luxury item I cannot afford and I drink coffee or tea or diet coke maybe twice a week and only in the morning.
- The human body likes a cool, quiet, dark place to sleep so keep the lights out and the room chilly. I use a face mask and earplugs and white noise from a fan and an air conditioner in summertime for the double bonus of keeping me cool and the ambient white noise.
- Avoid naps which can mess with my sleep cycle.
- I am not supposed to read or watch TV in bed according to the American Sleep Association but here I am guilty by proxy, that is, Ellie makes me watch My Little Pony with her as her ‘white noise’ is the television which she needs to fall asleep. This is a real problem for me…
- I do not drink alcohol or smoke tobacco or drink any energy drinks as these interfere with sleep.
- I try to exercise before 12 noon. Exercising before going to sleep, while better than no exercise at all, can release neurotransmitters and hormones (IE endorphins and adrenaline) which can keep you awake. The verdict is out in my mind on vigorous sexual activity before bed but my advice is: go for it, enjoy it while it lasts unless it really affects you sleep cycle in which case maybe you and your partner can switch to morning intercourse.
- I try to keep busy until I am so tired, I fall asleep. This is contrary to other advice which suggests mediation and baths and scented candles before bed but that just doesn’t work for me.
Well, that’s pretty much it on ways to get to sleep without medicines or supplements, at least in my personal and professional experience. Please add any comments or suggestions you have as it is almost 3 am here in New York City and I should try to get back to bed!