Beating insomnia

What to do when counting sheep leaves you wide awake night after weary night.

If you have a hard time falling asleep, remaining asleep or wake up too early, then you may suffer from insomnia. Typically, people complain of poor quality of sleep and not enough sleep, which have a huge impact on daytime activities. Work performance may suffer, and daytime sleepiness and irritability may occur.

Insomnia occurs in approximately 30 per cent of the adult population, more commonly in the elderly and in women. Older people usually experience early morning awakenings and difficulty getting back to sleep while younger people usually have difficulty falling asleep.

Transient insomnia occurs in response to a stressor, such as jet lag or worry over an upcoming meeting. Typically, once the stressor has gone away, your sleep pattern will return to normal.

Short-term insomnia due to ongoing personal stress can last as long as a couple of weeks. Triggers include divorce, a death in the family or financial problems.

Chronic insomnia lasts longer and can be associated with other medical conditions, such as depression, anxiety and mood disorders, diseases such as arthritis and cancer that cause pain, and conditions such as asthma and sleep apnea that affect your breathing.

Certain medications can also cause insomnia. These may include alcohol, caffeine, nicotine, over-the-counter cough and cold products containing decongestants, thyroid medications, some blood pressure regulators and antidepressants such as fluoxetine and paroxetine. The list of drugs that can bring on insomnia is huge, so talk to your pharmacist or doctor.

Regardless of the type of insomnia you have, good sleep hygiene is the key to overcoming it. Try not to nap during the day. Regular exercise contributes to good quality sleep, but avoid vigorous activity within three hours of bedtime. Maintain a good sleep-wake schedule seven days a week by rising at the same time daily. Go to bed only when drowsy and get out of bed if you are unable to sleep. Avoid caffeine, smoking, drinking and eating large meals just before you go to bed. Too much fluid before you turn in may lead to washroom breaks during the night. Minimize noise, light and extreme temperatures in the bedroom and use your bedroom only for sleep and sexual activity.

Develop your own relaxation routine just before bed. For example, take a warm bath, listen to music or drink a cup of warm milk. Behavioural therapy may be added if good sleep hygiene has not worked. Talk to your doctor about relaxation therapy, biofeedback and cognitive therapy.

Non-prescription medications are good for mild insomnia, provided they are reserved for occasional use only. If you can predict you will have difficulty sleeping on the night before an important meeting, for instance, you may want to try over-the-counter sleeping aids such as Nytol, Sleep-Eze D and Simply Sleep, all of which contain the antihistamine diphenhydramine. As you can build tolerance to the sleep-inducing effects of diphenhydramine, try it for only two or three nights in a row. (If you need help more regularly, talk to your doctor about possibly being put on medication that improves your sleep pattern, which diphenhydramine does not do.) Diphenhydramine simply makes you drowsy, making it easier for you to fall asleep. Start by taking a dose of 25 milligrams 30 to 60 minutes before bedtime. Morning drowsiness and grogginess is a common side effect. If you have certain medical conditions such as glaucoma or a prostate problem, talk with your pharmacist or physician first as this drug may not be the right option for you.