Insomnia means having trouble sleeping.

Transcription

1 Insomnia There are many steps you can take to improve your chances of getting a good night s sleep. Insomnia means having trouble sleeping. It can mean having a hard time falling asleep, waking up during the night and not being able to fall back to sleep, or waking up too early in the morning. Almost everyone has trouble sleeping sometimes. This is not usually a problem unless it causes regular fatigue. Chronic Insomnia can lead to serious health conditions and affect your physical, mental and emotional health. Most people need 6 to 8 hours of sleep each night. You may need less or more. It really depends on your age, health, lifestyle, genetics, and natural sleep-wake cycle. How you feel counts more than how many hours of sleep you ve had. If you feel good and rested, chances are you are getting enough sleep. What can cause insomnia? Insomnia can be caused by many things such as: Poor sleeping habits Depression, anxiety, or stress Some medical conditions such as sleep apnea or restless leg syndrome Medications (prescription, over-thecounter, and herbal) Using caffeine, alcohol, or tobacco before bedtime. Can t sleep? What can you do? Improving your sleep habits is the most important step you can take. For the next 3 to 4 weeks, try these steps to change your sleep habits and see if your sleep improves: Try to go to bed and wake up at around the same time each day, even on weekends. If you cannot fall asleep within 15 to 30 minutes of going to bed, get up and do something relaxing until you feel tired. Read a book, listen to music, or enjoy a warm bath. Avoid using your computer or watching TV. Try not to watch the clock. Avoid napping. If you must nap during the day, nap at least four hours before your bedtime and for no longer than 20 minutes. Only use your bedroom for sleep and sex, not for working, watching TV, or other activities. Make sure your bed, bedding, and night clothes are comfortable and your room is quiet and dark. Plan relaxing evenings and avoid stress, especially in the hour before bedtime. Try to deal with family conflict or other problems at another time. Avoid caffeine (especially after 12 noon), alcohol, tobacco, and, if possible, medicines that can keep you awake. Drink most of your fluids in the earlier half of the day and less in the evening to avoid waking up to go to the bathroom during the night. Enjoy regular physical activity for 30 to 60 minutes at least 3 times a week, but do so 4 to 6 hours or more before bedtime. Regular exercise will help you get deep sleep. Try to skip bedtime snacks or have only a light snack one to two hours before bedtime. What about sleep medicines? The first step for treating insomnia is improving your sleep habits. If you have tried the recommendations listed above for 3 to 4 weeks, but you are still having a hard time sleeping, you may want to try a sleep medication. HEALTH EDUCATION

2 Insomnia There are several medications to consider. You should be aware that although these medicines can be helpful when used now and then, they do not cure insomnia. These include: Over-the-counter (OTC) antihistamine medicines such as Benadryl, Tylenol PM, Unisom. If you have glaucoma, constipation, or an enlarged prostate, you should not use these sleep medicines. Prescription medicines such as Desyrel and Restoril. Other prescription medications that are newer on the market include Ambien, Ambien CR, Lunesta, Sonata, and Rozerem. These newer medicines have not been proven more effective than the others used for insomnia. They have similar side effects and some are more expensive. When it comes to sleep medications, keep in mind the following: Using sleep medicines too often can cause some people to become dependent on them. In fact, longterm use of medications may do more harm than good. Common side effects of sleep medications include daytime drowsiness, memory problems, and difficulty driving or doing things for which you need to be alert. What about herbal remedies? Herbal medicines and supplements such as melatonin and valerian are sold over-the-counter. At this time, not enough is known about whether these medicines are safe or actually work for treating insomnia. If you are taking melatonin, valerian, or any other herbal medicine, be sure to discuss this with your doctor or other health care professional. Seniors: How does age affect sleep? The number of sleep hours needed to feel refreshed often decreases with age. If you are a senior, you may need less sleep than you used to. To avoid waking up too early in the morning, it can be helpful to skip naps and limit fluid intake in the evening. Also, keep in mind that prescription sleep medications can increase the risk of falls, which is particularly a concern for older adults. Older people should also avoid nonprescription sleep medicines like Benadryl, Tylenol PM, and Unisom, because they may cause memory problems, blurred vision, dizziness, dry mouth, and other side effects. These side effects are more common and problematic in the elderly. If you continue to have trouble sleeping, talk with your doctor about other options such as behavioral therapies or a low dose of prescription sleep medicine. When should I call Kaiser Permanente? Insomnia can be frustrating and can leave you feeling anxious, depressed and fatigued. Improving your sleep habits takes time. It may take you several weeks before you notice improvement. Be sure to call your doctor if: This information is not intended to diagnose health problems or to take the place of medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. Herbs and supplements are sold over-the-counter. Kaiser Permanente carries only herb categories for which some evidence exists to show that the herbs may be effective to treat certain medical conditions. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only. 2004, The Permanente Medical Group, Inc. All rights reserved. Regional Health Education and Pharmacy Services, California Regions (Revised 3-11) RL 8.5 You think that your insomnia is caused by a medical condition or problem, such as sleep apnea, restless leg syndrome, anxiety, or depression. You ve had insomnia for one month or more and it has not improved. If you have questions about insomnia medicines, please speak with your Kaiser Permanente pharmacist or doctor. Other resources Books Say Good Night to Insomnia, by Greg Jacobs, PhD Relief from Insomnia: Getting the Sleep of your Dreams, by Charles Morin, PhD No More Sleepless Nights, by Peter Huari, PhD, & Shirley Linde, PhD Cultivating Health: Improving Your Sleep Kit. Kaiser Permanente Web sites Connect to our Web site at kp.org to access health and drug encyclopedias, interactive programs, podcasts, health classes, and much more. For an online program designed to help you assess and improve your sleep, visit kphealthylifestyles.org. To use the program, you must register for a password or kp.org/register. National Sleep Foundation sleepfoundation.org Visit your Kaiser Permanente Health Education Center or Department for books, videos, classes, programs, and additional resources. Some health concerns, including insomnia, can be seriously affected by violence or abuse. If you are hit, hurt or threatened by a partner or spouse, there is help. Call the National Domestic Violence Hotline at or connect to ndvh.org.

3 Major birthday coming up? Making a presentation at work? Caught in traffic? These are just some of the everyday events that can cause stress, making you anxious, tense, angry, or afraid. Stress can come from bigger events, too, such as a new job, divorce, or the death of a loved one. In short, you can t avoid stress. But learning how to manage it can improve your emotional well-being and your physical health. Stressed It s not just desserts spelled backward Stress and your body When you re under stress, your body releases chemicals (namely, cortisol and adrenaline) that activate a fight or flight reaction. These chemicals affect every organ in your body and can cause increased heart rate, muscle tension, and insulin secretion, as well as decreased immune response and libido. Once the stress passes, these chemicals return to normal levels. But consistent stress can lead to health problems, including headaches, muscle pain, allergy-like reactions, memory difficulties, and high blood pressure. Taking control These simple steps can help you reduce and manage stress: Exercise and eat a balanced diet. Manage your time. Set realistic goals and expectations. Talk with a loved one or write in a journal. Try relaxation techniques. Take time for yourself. Stay positive. Stressed or depressed? Sometimes, what seems like stress is actually depression. Changes in sleeping or eating patterns; decreased energy, concentration, or enjoyment; or thoughts of death may indicate clinical depression if you experience them consistently for two weeks or more. If you think you re depressed, call your physician or health care professional. Depression isn t a sign of weakness; it s a medical condition that often is successfully treated. To learn more about stress Visit us online at kp.org and search our health encyclopedia.

4 Relaxation Skills There are many ways you can relax. Deep breathing, muscle relaxation, and the relaxation response are simple and good for your health. Relaxation has many benefits. It can help you feel calmer, think more clearly, and relieve stress, headaches, and tight muscles. Whether you want to take a break from a stressful day or manage your stress for the long-term, a regular relaxation practice can really help you get back to a calmer state. There are many ways to relax. Three common methods are: deep breathing, progressive muscle relaxation, and the relaxation response. When learning these skills, it is important to find a quiet place where you won t be disturbed. Try to practice for 10 or 20 minutes once or twice a day. It may take two to three weeks to fully develop these skills, but once you have trained your mind and body to relax, you ll be able to get the same relaxed feelings quickly. Deep breathing When it is done with purpose, deep breathing can help calm you down. It can help you let go of stress and worries and focus quietly on the present moment. How to do deep breathing Place both hands on the lower part of your stomach and inhale so that your belly pushes gently against your hands. Your stomach muscles should be relaxed. Then, gently push with your hands as you exhale slowly. If it helps, imagine a balloon in your stomach that inflates when you inhale and deflates when you exhale. Practice this several times. When you breathe out, try to imagine tension and stress leaving your body; say to yourself, I am feeling relaxed and calm. Here are some important tips for practicing this skill: Wear loose, comfortable clothing and find a quiet, relaxing place to practice. Start practicing for just one to two minutes. Slowly increase your practice time up to five minutes. Practice several times a day. In the beginning, it may help to practice deep breathing while lying down on your bed or on the floor. Lie on your back, bend your knees, and place your feet comfortably apart. If you feel lightheaded, dizzy, or anxious, you may be breathing too deeply or too quickly. If this happens, stop practicing for a moment and breathe normally until the symptoms pass. Try inhaling and exhaling through your nose to prevent hyperventilation. As you progress, practice deep breathing in a variety of settings (e.g., sitting at your desk, waiting in line, or watching television). Be patient and gentle with yourself. Progressive muscle relaxation The body responds to tense thoughts or situations with muscle tension, which can cause pain or discomfort. Progressive muscle relaxation will help you reduce stress and become more relaxed. It involves tensing and releasing each muscle group to create a deeper sense of relaxation. It can also reduce feelings of anxiety. You can use a recording to help you go through all the muscle groups, or you can follow the instructions below. Progressive muscle relaxation often helps with stress-related health problems and can help you fall asleep. Note: If you have fibromyalgia or myofascial pain syndrome, check with your health care professional before practicing progressive muscle relaxation. HEALTH EDUCATION

5 Relaxation Skills How to do progressive muscle relaxation Pick a place where you can stretch out comfortably, such as on a pad or carpeted floor. Tense each muscle group for 4 to10 seconds (hard, but not to the point of cramping). Then release the muscle and give yourself 10 to 20 seconds to relax. Try to relax each muscle group a little more deeply each time you do this exercise. How to tense muscle groups Hands: Make a fist. Wrists and forearms: Extend your arms and bend hands back at the wrist. Biceps and upper arms: Make a fist, bend arms at elbows, and flex biceps. Shoulders: Shrug them. Forehead: Wrinkle it into a deep frown. Around the eyes and bridge of the nose: Close eyes as tightly as possible. (Remove contact lenses before beginning this exercise.) Cheeks and jaws: Grin from ear to ear. Around the mouth: Press lips together tightly. Back of the neck: Press head back against the pad or supporting surface. Front of the neck: Touch your chin to your chest. Chest: Take a deep breath, hold it, then exhale. Back: Arch your back up and away from support surface. Stomach: Suck your stomach into a tight knot. Hips and buttocks: Press your buttock cheeks together tightly. Thighs: Clench hard. Lower legs: Point your toes toward your face, as if trying to bring them up to touch your head. Lower legs: Point your toes away and curl them downward at the same time. Relaxation response The relaxation response slows the heart rate and breathing, lowers blood pressure, and helps relieve muscle tension. It can help you slow down, reduce stressful feelings, and refocus your thoughts. Technique (adapted from Herbert Benson, MD): Sit quietly in a comfortable position with your eyes closed. Become aware of your breathing. Breathe slowly and steadily; breathing from your belly and not from your chest. Each time you exhale, say the word one (or any other word or phrase) silently or aloud. Or, you may choose to fix your gaze on a stationary object. Any mental stimulus will help shift your mind away from distracting thoughts. Continue this for 10 to 20 minutes. As distracting thoughts enter your mind, don t dwell on them. Just allow them to drift away. Sit quietly for several minutes until you are ready to open your eyes. Notice the difference in your breathing and your pulse rate. Don t worry about becoming deeply relaxed. The key to this exercise is to be passive, to let distracting thoughts slip away like waves on the beach. Practice for 10 to 20 minutes once or twice a day, but wait for at least two hours after a meal. When you have set up a routine, the relaxation response should come with little effort. Additional resources Connect to our Web site at kp.org. Visit your facilityʼs Health Education Department for books, videos, classes, and additional resources. Want a customized online stress management plan? Check out our HealthMedia Relax Healthy Lifestyles program at kp.org/healthylifestyles. Try out our Health Coach Stress Less Program at kp.org/mindbody. If you are hit, hurt or threatened by a partner or spouse, this can seriously affect your health, including your ability to manage stress. There is help. Call the National Domestic Violence Hotline at or connect to ndvh.org. This information is not intended to diagnose or to take the place of medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only. 2007, The Permanente Medical Group, Inc. All rights reserved. Regional Health Education (Revised 2-10) RL 6.4