How to Treat Insomnia: 10 Medication-Free Tips

Difficulty with sleep is one of the most common patient complaints that presents in a primary care doctor's office. 

Chances are, you will suffer troubles with sleep at some point in your lifetime. It can be distressing and cause difficulty with functioning during your wake hours. That's why I'm dedicating my next two episodes to the topic of insomnia treatment.  Today, we will discuss 10 medication-free tips to help you catch your Z's, and next week we'll review the prescription and over-the-counter medication alternatives.

The first thing you may want to do is run to the doctor for a prescription medication to help you sleep. However, you don’t always need to rely on medications. In fact, insomnia can often be managed on your own by simply changing your lifestyle and routines. Resist the temptation to head for the medicine cabinet right away, and instead take steps to treat your insomnia naturally.  Let's find out how in today's episode.

Sponsor: This episode is brought to you by the audiobook edition of Total Recovery by Dr. Gary Kaplan. In this informative program, one of the country’s top integrative doctors radically rethinks chronic pain. Listen to an excerpt at www.macmillanaudio.com/TotalRecoveryAudio.

What Is Insomnia?

Defining what exactly contitutes a good night’s rest is really subjective and it varies from person to person. 

However, patients with insomnia say that they either have difficulty falling asleep, staying asleep, or awaken too early and are unable to return to sleep.  It’s only considered a significant medical condition when patients have a difficult time functioning throughout their day as a result of poor sleep. When insomnia diminishes quality of life, that's a real problem.

What Causes Insomnia?

If you suffer from insomnia, you really need to ask yourself this one question:  Why can’t I sleep? 

The first step is to examine your lifestyle, environmental stressors, and mental well-being carefully.  Although insomnia can occur in patients without any other underlying health conditions, it is often accompanied or exacerbated by other medical factors.  It’s very important to consider other untreated health conditions that can interfere with sleep, because once you manage the underlying culprit, the insomnia improves or even resolves entirely. 

I’ve discussed many of these at length in prior episodes. So if you haven't heard or read them, please be sure to take a few minutes to check each one out before you move on. 

Here are 8 potential medical issues that can interfere with a good night’s sleep:

1.     Restless Legs Syndrome:  This is characterized by an urge to move or a “creepy-crawly” sensation in the legs that stimulates movement and interferes with sleep.

2.     Sleep Apnea:  Moments of oxygen deprivation to the brain during sleep. Apnea affects those who snore.

3.     Illicit drugs:  Drugs that are activating, such as methamphetamines, can cause insomnia.

4.     Medications:  Certain over-the-counter drugs (such as decongestants) and prescription drugs (such as some antidepressants and weight-loss drugs) can cause sleep problems.

5.     Pain:  Hand pain or numbness keeping you up at night?  Heel pain after a long day at work? Back pain from picking up the heavy kiddos? Uncontrolled pain can be the source of your insomnia. 

6.      Mental health conditions: Anxiety disorders, depression, bipolar disorder, all can interfere with sleep.  In general, those with anxiety tend to have trouble falling asleep, and those with depression tend to have more early morning awakenings.  Treat the underlying mental health condition and the insomnia typically resolves or improves.

7.     Bladder issues:  Prostate enlargements, uncontrolled diabetes, and overactive bladders are some of the potential causes of increased frequency of urination at night time.  And if you are waking up to urinate at night, it can take a toll on your sleep.

8.     Stress:  Life stressors are often mind-consuming and, not surprisingly are often barriers to getting a good night’s sleep.  Even positive life changes, such as moving or getting married, can be stressful.  If you’ve tried planning a wedding, you know what I mean.

Addressing these health issues may be all that you really need sleep well again.  However, if you’re still not able feel refreshed in the mornings, it may be time to consider active treatment for insomnia.

Treating Insomnia:  Lifestyle and Behavioral Therapy

Next week, I’ll discuss some of the most common over-the-counter and prescription medications used to treat insomnia.  But before you consider medication, I really try to encourage my patients to work on some rather simple lifestyle and behavioral changes that can often aid in managing insomnia. 

For many patients, adopting a good “sleep hygiene” using the following 10 tips is really all they need in order to re-catch their Z’s:

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1. Adopt a routine schedule: Try to maintain a regular sleep/wake schedule. That is, sleep at the same time every night and awaken at the same time each morning no matter how sleepy you are. This may be a challenge during the first few nights, but eventually your body will get used to maintaining the same schedule. Do not vary your weekend schedule by more than one hour from your weekday schedule.

2. Avoid daytime naps: People who nap have more difficulty falling asleep at nighttime. If you can skip your nap, you will find that you will be able to not only fall asleep faster, but will be able to better maintain your sleep during the nighttime.

3. Avoid caffeine and alcohol: Caffeine is a brain stimulant that interferes with good sleep. Do not drink caffeine past noon, and limit the intake to no more than 1-2 cups a day.  Alcohol may seem to initially help you fall asleep more rapidly, however it causes early morning awakenings and difficulty returning to sleep. Additionally, both caffeine and alcohol are diuretics that may cause an urge to urinate in the middle of the night. 

4. Use the bedroom only for bedroom activities: Don’t get into the habit of watching TV, surfing the internet, eating, or performing any other non-bedroom activities in your bed. You want to train your brain into thinking that once you are in bed, it's time to go to sleep. If you routinely engage in other activities in bed, your brain will have more difficulty shutting down at bedtime. Do not use your bed for anything other than sleep and sexual intimacy. 

5. Avoid bedtime high carb snacking: Avoid sugar or carbohydrates within two hours of sleep. If you are hungry, eat small portions of foods that promote sleep such as a glass of warm milk, turkey, or nuts.

6. Avoid nighttime fluids: Drinking fluids 3 hours prior to sleep causes an urge to urinate in the middle of the night. Try to drink more fluids in the first half of the day and less at nighttime.

7. Get regular exercise: Routine exercise releases endorphins that decrease stress; this in turn increases deep sleep. Get at least 30 minutes of cardiovascular exercise daily, such as walking, running, or biking. Try to avoid doing this in the evenings, however, as the endorphins can cause brain stimulation if performed within 3 hours of sleep. 

8. Getting to sleep: If you are unable to fall asleep within 30 minutes of laying down, get up and do something relaxing, such as light reading or taking a warm bath. Then go back to bed once you feel sleepy.

9. Learn to manage the stress:  Find a hobby, join a dance class, distract your mind.  Learn a few relaxation techniques and do them at bedtime.  Consider counseling or therapy, or seek help from your religious congregation.  We all experience life stressors, they will never disappear completely.  But if you can change how you respond to the stress, you can dramatically improve your sleep.

10. Put it on paper:  If you're a typical Type A personality, then you likely ruminate over everything you need to accomplish in the upcoming day or days at bedtime.  If you're Type A, you know who you are: overly driven, high achieving, impatient, rigidly organized, super responsible.  My Type A patients tend to have more difficulties with falling asleep.  They often say they lay awake at nights thinking of “all the things they have to do.”  My advice is to stop keeping yourself awake by thinking of all those to-do lists and instead, get up, put it on paper, and then get back into bed.  Sometimes just writing it down helps to shake it all off.

If taking the above steps doesn’t significantly treat your insomnia, then it may be time to discuss the issue with your physician.  Getting a good night’s sleep is so important to your overall health. If you are unable to obtain adequate sleep, it can manifest itself physically and emotionally and interfere with your functioning and quality of life.

Although implementing these 10 steps requires some effort, it’s a worthwhile process. It may not happen overnight (no pun intended), however, a good night’s sleep is well worth the effort to change your habits.

Share your ideas and learn more quick and dirty tips with us on the House Call Doctor’s Facebook and Twitter pages!  You can even find me on Pinterest!

Please note that all content here is strictly for informational purposes only.  This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider.  Please always seek a licensed physician in your area regarding all health related questions and issues.