What to do when you can't sleep
By Carrie Angus, M.D.
3 a.m. You're scheduled to give a big presentation at eleven,
only eight hours away. You desperately need to sleep so you will
be rested and alert when your big moment comes, but here you are
staring wide eyed at the bedroom ceiling. Your mind is agitated
and your body won't relax. The harder you work at getting to sleep,
the wider awake you are. You've already tried counting sheep,
watching the late show, and making yourself a snack-all to no
avail. In desperation you reach for a sleeping pill.
This is a common scenario in the United States, where approximately
one third of all adults suffer from some type of sleep disorder.
Insomnia, the most common type by far, is clinically defined as
the inability to fall asleep after lying in bed for thirty minutes
or the inability to sustain sleep for more than a few hours without
waking. Practically speaking, however, insomnia can be defined
as unrestful sleep.
We've all experienced some form of insomnia at particularly stressful
times in our lives. It's normal to have trouble sleeping at these
times, and it usually passes after a night or two. Insomnia is
a problem only when it becomes chronic. Although it is associated
with certain physical illnesses-arthritis, heart failure, and
chronic lung disease, for example-most experts agree that insomnia
is a symptom, not an illness in itself. So what is it a symptom
of? There are two answers-the ancient and the modern. At first
glance they seem completely different, but a closer look reveals
some remarkable similarities.
An Ancient Angle on a Modern Malady
Ayurveda, the healing science associated with yoga, tells us that
all disease is caused by indigestion. That is, at some level-either
physical, mental, or emotional-we haven't completed extracting
what is helpful and eliminating what is indigestible. This is
one of the keys to understanding insomnia.
On the physical level, indigestion is caused either by bad food
or by weak digestion and leads to conditions like heartburn (a
contributor to insomnia), flatulence, and diarrhea. Mental indigestion
is the inability to let go of a certain incident or thought-usually
an unpleasant experience. This can be a distant tragedy like the
earthquake in Kobe, Japan, criticism from someone whose opinion
we value, or a work-related problem we're trying to solve. Emotional
indigestion is the recurrence of a feeling, often sadness or anger,
long after the precipitating event. The emotion has not been sufficiently
digested and remains just under the surface, springing up for
no apparent reason. Mental and emotional indigestion are the most
common causes of insomnia. Some of us even grind our teeth while
we sleep in an attempt to chew and digest recurring thoughts and
The Contemporary Angle
Modern explanations for insomnia range from overstimulation and
stress to mucking up our waking-sleeping cycle. Stimulants include
caffeine (coffee, tea, chocolate, and some sodas), and sugar,
as well as activities such as aerobic exercise, arguing, and watching
violent TV shows (or the evening news, for that matter). All these
taken (or experienced) too close to bedtime can rev us up so much
that it is difficult to fall asleep. This is only another way
of saying we are still attempting to digest these substances or
events at the same time we are courting sleep.
Stress is another form of indigestion. Most of my patients who
suffer from insomnia tell me, "My worries keep me awake," or "My
mind won't stop. I don't know how to turn it off." Anxiety, worry,
depression, unpleasant memories, and fears are the most common
cause of sleeplessness. They seem to take on a life of their own
and are determined to stay awake, even though it's way past bedtime.
The third common cause of insomnia, one which has become prevalent
only in modern times, is tampering with the normal cycle of sleeping
and waking. This is a mechanical problem of sorts. Human beings
have a normal sleep rhythm; in general, we are designed to be
awake in daylight and asleep at night. People who work the night
shift, or travelers who have recently crossed several time zones,
may experience insomnia simply because they are trying to sleep
when their internal clock is telling their body to be awake.
Our bodies are designed for sleep to come effortlessly. When it
doesn't, when we're holding on to the day's stresses and reaching
out for tomorrow's too, there are a number of ways of inducing
the body and mind to let go and slip gently into a restful sleep.
Create an Environment that Will Help
Your bedroom should be tranquil and inviting. Make it comfortable
and conducive to sleep. Eliminate ambient light and any noise
that could disturb your sleep. If possible, reserve the bedroom
for sleep and sex. Conduct other activities-reading work-related
material, watching TV, paying bills, and disciplining your children-in
another room. In time, this will create the expectation in your
body that the bedroom is where it goes to relax and rest.
End the Day with a Calming Routine
Go to bed about the same time every night. Create a routine that
prepares you for sleep. You may already have some kind of program
you follow before you go to bed-locking the house, brushing your
teeth, maybe reading a little. A pre-bed routine is a way of telling
your unconscious that it's time to sleep.
Make sure that this routine is relaxing, not stimulating-winding
down before bedtime increases the likelihood that your mind will
let you rest. If you find the news disturbing, skip the late broadcast.
If you live in a safe neighborhood, take a leisurely stroll. Read
something pleasant and soothing-save the suspense novel for earlier
in the day. Take a hot bath. Sit for a period of meditation. The
trick is to calm your mind and quiet your nerves before you get
And speaking of routines, getting up at the same time every morning
will make it easier to fall asleep at night. Attempting to compensate
for a night of disturbed sleep by staying in bed longer in the
morning will simply further disrupt your sleep cycle. Get up on
time, even if you don't feel like you've had enough rest-you'll
have a much better chance of falling asleep easily when bedtime
rolls around again.
Do a Relaxation Exercise
Taking a few minutes to do a short relaxation exercise just before
getting into bed is an excellent way of letting go. This doesn't
have to be elaborate. Great benefits can be gained by simply lying
on your back in the corpse pose (hands at your sides, palms upward,
feet slightly apart). Close your eyes, and systematically address
every part of your body. Start at your scalp and move toward your
toes. Begin by softening your forehead, eyes, face, and jaw. Tensing
and then releasing each muscle group help tight muscles loosen,
especially those in the neck and shoulders. Continue giving attention
to each area of your body-the arms, the trunk, and the legs-until
you reach your toes. Surrender to gravity.
Stay in this relaxed state for a few minutes, letting the floor
support you. Focus on your breathing, releasing all other concerns.
Let your breath come from deep in your abdomen, and let it flow
smoothly, slowly, and evenly. This simple exercise is a way of
telling your mind and body that it is OK to stop thinking, working,
Pay Attention to What You Ingest
It's best to eat a light meal in the evening, especially if you
are dining late. You will sleep more deeply if you have finished
digesting your food before you go to bed. A rich, heavy meal close
to bedtime will interfere with your rest and leave you feeling
sluggish in the morning.
Avoid caffeine, especially after midday. This includes coffee,
tea, chocolate, and many sodas. Coffee has a half-life of four
to six hours. That means it takes that long for half of the coffee
to be digested, and another four to six hours for the next quarter
of it to be eliminated from your body. In other words, it takes
twelve to fourteen hours for 7/8 of the coffee you have ingested
to be eliminated. No wonder you still feel wide awake at eleven
when you had your last cup after dinner.
Sugar can also cause problems. Consider avoiding refined sugar
in the evening because it is absorbed immediately into the bloodstream.
That's why it gives you a burst of energy and sometimes makes
you feel a little high. Eating sugar near bedtime can make you
restless and jittery and can keep you from falling asleep. If
you need a treat at bedtime, a glass of warm milk is your best
Alcohol and tobacco taken near bedtime can also interfere with
deep sleep. It's true that a nightcap will make you sleepy, but
the sleep it induces is light, restless, and shot through with
periods of wakefulness. Likewise, you may associate tobacco with
relaxation, but it actually increases tension. Tobacco is a stimulant
that makes the heart race and blood pressure rise. It's best avoided
altogether, but if you choose to smoke, avoiding it in the hour
or two before bedtime will make your sleep more restful.
Get Some Exercise
If we polled farmers or anyone else who does manual labor eight
to ten hours a day, very few would report a problem with insomnia.
But for most of us, hard work is reserved for the mental sphere,
so we need to exercise our bodies if we're going to sleep well.
Studies of athletes have shown that they do not require more (or
less) sleep than sedentary folks, but their ratio of deep to light
sleep is higher. Doing some form of aerobic exercise at least
three times a week also increases this ratio. Just be sure to
avoid strenuous exercise within several hours of bedtime-it can
be stimulating. But if you exercise at any other time, you'll
It's OK to do long, slow stretches near bedtime, however, for
they will release muscular tension and prepare you for sleep.
Focus on asanas that you find relaxing. Avoid intense backward
bends, such as the wheel, as they may prove to be too invigorating
at the end of the day.
Don't Drug Yourself to Sleep
According to a recent article in the Archives of Internal Medicine,
approximately 20 million prescriptions are written each year for
sleeping aids, a number dwarfed by the quantity of over-the-counter
sleep medications sold annually. Although most of these drugs
do induce sleep within ten to twenty minutes, they interfere with
the deeper stages of sleep. And all of them impair functioning
the next day in one way or another. They can be helpful for short-term
insomnia resulting from a sudden stressful event, but even the
mainstream medi-cal community agrees that sleep medications/sedatives
are not helpful in resolving chronic sleep problems.
Experiment with Natural Remedies
Homeopathic remedies and herbs can help with insomnia. Homeopathic
medicines are extremely dilute extracts from natural substances,
so they don't have the rebound effects drugs do. They are considered
to be non-toxic by the FDA, and many lowpotency remedies are sold
over the counter. One of the best treatments for insomnia is homeopathic
coffee, coffea cruda. Although coffee causes irritability and
sleeplessness in physiologic doses, in homeopathic doses it can
cure these states.
Valerian root, passionflower, and hops, taken before bedtime in
either tablet or tea form, are other alternatives. These gentle,
relaxing substances help your body rest, but they don't affect
your central nervous system the way prescription sleep medicines
do. Both homeopathic remedies and herbal preparations can be purchased
at most healthfood stores or through a holistic physician.
Insomnia is a huge problem in this fast-paced, sugar and caffeine
addicted country. But if we can first identify the habits we have
that contribute to our sleeplessness and slowly change them, and
at the same time add more relaxation and deep breathing to our
pre-sleep routine, we will sleep better.
Above all, don't panic. Insomnia is not life-threatening, although
many people respond to it with agitation or fear. The more anxious
you make yourself about not sleeping, the more sleep will elude
you. So turn the clock to the wall and drop the internal dialogue
about what a horrible day you will have tomorrow if you don't
get to sleep immediately. The key to sound sleep lies in surrendering,
not in trying harder. Once you're in bed, focus on your breath
and empty your mind. If you have a mantra, let your mind rest
in it. Be kind to yourself. Remember, sleep cannot be forced,
but it can be coaxed. It is waiting for you. Allow yourself to
come to it, enter it, and let the world spin without you for a
Lilias Folan has designed a six-week program on audiotape for
people who have trouble getting a good night's sleep. If you can't
find it in your local bookstore, Rest, Relax and Sleep is available
directly from Rudra Press. Call 1-800-876-7798 for more information,
or order directly by sending $29.95 + $5.00 shipping to Rudra
Press, P.O. Box 13390, Portland, Oregon 97213.
Carrie Angus, M.D., is a yoga student practicing holistic
medicine at the Himalayan Institute's Center for Health and Healing
in Honesdale, Pennsylvania.
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