Sleep

Introduction

Health Implications

Adequate, uninterrupted sleep is vital for health. Both animal and human studies have shown that circadian disruption — disruption of our 24-hour internal clock — is associated with diseases such as metabolic syndrome, type 2 diabetes, obesity, cardiovascular disease, cancer, and mood disorders. And many researchers hypothesize that disturbed sleep may be the earliest manifestation of neurodegenerative diseases such as Alzheimer’s and Parkinson’s disease. Inadequate sleep is also associated with concentration and memory impairment, social withdrawal, impaired occupational or academic performance, irritability, headaches, and heart palpitations. Detecting and treating disturbed sleep as early as possible may slow the disease process, or even prevent it altogether.

80 Official Sleep Disorders

The American Academy of Sleep Medicine (AASM) publication The International Classification of Sleep Disorders, Third Edition (ICSD-3) identifies more than 80 official sleep disorders. Most are uncommon but a handful are fairly common: insomnia, sleep apnea, narcolepsy, and restless leg syndrome — with insomnia being the most prevalent. Approximately 10% of our adult population is affected by insomnia and 30-35% is affected by transient insomnia. Seniors are more often diagnosed with chronic insomnia than other age groups. This is likely due to medical conditions, medications, and/or age-related decline in deep sleep and an increase in nighttime awakenings.

Insomnia

Insomnia is defined generally as difficulty with initiation, duration, or quality of sleep. It is commonly applied when three conditions are satisfied: ample time and opportunity for sleep, persistent sleep difficulty, and daytime dysfunction associated with inadequate sleep. If daytime functioning and affect are unaffected, by definition, a patient does not have an insomnia disorder.

Restless Leg Syndrome

The Restless Leg Syndrome Foundation estimates that 2-3% of the US adult population has restless leg syndrome (RLS), also known as Willis-Ekbom Disease (WED). It is a neurological sensory-motor disorder that creates unpleasant sensations in the legs and feet and less commonly in the arms. The sensations are described as aching, crawling, creeping, electric, itching, or throbbing — typically accompanied by the urge to move the legs. Symptoms often occur in the evening and can interfere with falling asleep or can disrupt sleep. It is common for symptoms to fluctuate from day-to-day. People with RLS typically are intolerant of caffeine and alcohol and should avoid both.

Some people have a genetic predisposition for RLS. Researchers have discovered gene variants that contribute to the risk for RLS and it often runs in families. However, it may appear as a result of a more serious condition such as peripheral neuropathy, kidney failure, or spinal cord conditions. Or it may simply be due to an iron deficiency and can be cured with iron supplementation.

The FDA has approved a mechanical device for treatment of RLS called Relaxis. The manufacturers claim that over 90% of patients experience relief with Relaxis. If you think you may have RLS, ask Dr. Harlin to run your RLS genetic panel and check your labs for iron.

Early Diagnosis is Key

Short sleepers are more likely to develop chronic diseases, and they are more likely to die at a younger age than those that have a fully restorative sleep on a regular basis. Fortunately, many complications associated with sleep disorders are preventable, but early diagnosis and treatment are key.

Sleep Hygiene: The first line of treatment

Treatment options include sleep hygiene (lifestyle and behavioral changes), pharmacologic interventions, surgical interventions, and other options. Here we address sleep hygiene only, as it is the first line of treatment.

Background Education

The Suprachiasmatic Nucleus, Our Master Clock

Biological clocks that manage our circadian rhythms are located throughout the body. We have hundreds of “clock genes” but only one master clock. This central regulator is located in the suprachiasmatic nucleus (SCN), in an area of the brain called the hypothalamus. The SCN takes its cues principally from the retina which detects the day-night cycles of the sun. Exposure to light stimulates a nerve pathway from the retina in the eye to the hypothalamus. The SCN initiates signals to other parts of the brain that modulate our physical activity and food consumption, hormone secretion, body temperature, heart rate, and muscle tone — all of which play a role in making us feel sleepy or wide awake.

The Sleep-Wake Cycle

The sleep-wake cycle is thought to be regulated by the interplay of two major processes, one that promotes sleep and one that maintains wakefulness. The interplay of genetic pathways is complex and our scientific understanding of the sleep-wake cycle is incomplete. However, melatonin, a hormone, and adenosine, a neurotransmitter, are known to play key roles. Melatonin helps to synchronize our biological clocks and adenosine decreases neuronal excitability and helps maintain deep sleep.

Melatonin Production

When the sun goes down and darkness occurs, the pineal gland is “turned on” by the SCN and begins to actively produce the hormone melatonin, which is released into the blood. The brain makes this neurohormone from the amino acid tryptophan. In a body with typical sleep patterns, the melatonin levels start to rise 14 to 16 hours after awakening and peak in the middle of the night. In the evening, melatonin production naturally increases to help you go to sleep. In the early morning hours, before you’re ready to wake up, melatonin production tapers off to allow you to be awake and alert for the day.

Adenosine — another key player

Scientists have found that adenosine triphosphate (ATP) levels, the energy currency of our cells, show a surge during the initial hours of sleep in certain regions of the rat brain (and likely the human brain). Researchers have also found that the levels of phosphorylated AMP-activated protein kinase (P-AMPK), well known for its role in cellular energy sensing and regulation, goes down as ATP levels surge during the initial hours of sleep. This suggests that the sleep-induced surge in ATP and the decrease in P-AMPK levels set the stage for the restorative processes occurring during sleep. Sleep likely plays an essential role in the replenishment of high-energy compounds.

Adenosine, Exercise, and Deep Sleep

After high-intensity exercise, studies show an accumulation of adenosine in rat brains. Adenosine is known to decrease neuronal excitability and to help maintain deep sleep. Adenosine accumulation in the brain after exercise is likely the link between intense exercise and restorative sleep.

Clearing Waste Products in the Brain

Common sense suggests that sleep is an important restorative process for the brain and the body, and research is increasingly backing this up. According to a small, 2018 study by researchers at the National Institutes of Health (NIH), losing just one night of sleep led to an immediate increase in beta-amyloid, a protein in the brain associated with Alzheimer’s disease. Beta-amyloid is a metabolic waste product present in the fluid between brain cells. In Alzheimer’s disease, beta-amyloid clumps together to form amyloid plaques, negatively impacting communication between neurons. During sleep, the brain clears waste products that accumulate during the day as a result of normal metabolism. Amyloid-β gets “mopped up” during sleep, but inadequate slow wave sleep (deep sleep) increases amyloid-β levels.

Sleep Cycles and Sleep Stages

Healthy adults have 4 or 5 sleep cycles per night. Each cycle lasts approximately 90 minutes. Each sleep cycle consists of five stages: Stages 1, 2, 3, and 4, which are followed by rapid eye movement (REM) sleep. The stages are divided into two general categories: non-REM sleep and REM sleep.

Each of the four stages of non-REM sleep has its own electrophysiologic characteristics. Stage 1 is the transitional stage from wakefulness to sleep. If a person is awakened from this stage, he or she may claim not to have been asleep. Stages 2, 3, and 4 are marked by slow-wave (low frequency) sleep and increasing high amplitude brain activity. As one progresses from stage 2 to 4, sleep deepens with each successive stage and arousal becomes increasingly difficult. Stages 3 and 4 provide us with restorative sleep, known as deep sleep.

During REM sleep, EEG activity is dominated by low amplitude, high-frequency activity resembling wakefulness. REM sleep is the stage in which we are most likely to dream. The first sleep cycles each night have relatively short REM sleep stages and long periods of deep sleep. Stages 3 and 4 occur mainly during the first third of the night while the length of stage 2 sleep lengthens with each successive cycle. Later in the night, as deep sleep time decreases, REM periods lengthen.

Sleep Patterns Change As We Age

As we age, our sleep patterns change. Older patients commonly complain of disturbed and unrefreshed sleep. The amount of slow-wave, restorative sleep begins to decline in early adulthood and declines significantly as we age — at approximately 2% per decade. Most elderly adults have relatively short periods of slow-wave sleep and fewer of them. Studies show that age-related changes in non-REM sleep are the primary determinants of an otherwise healthy older adult’s sleep quality. The decrease in deep sleep, experienced by most seniors, results in easier and more frequent awakenings from non-REM sleep. In addition, sleep disorders tend to increase with age.

Changes in Food Response

Inadequate sleep also affects the brain’s response to food — particularly high calorie “junk” food. Our brains sense a negative energy balance and tell us that we are in a food-deprived state when we actually are not. This causes us to overeat without intending to and often without even realizing it. And this can lead to weight gain, which can further impair sleep. Research studies overwhelmingly show that adults who sleep six or fewer hours per night tend to gain more weight over time than those who sleep seven to nine hours per night.

Changing Our Habits Requires Discipline

Sleep hygiene is the habits you put in place each day that affect sleep. If you have insufficient sleep, developing good sleep hygiene can take a concerted effort, but one that is well worth it. Changing our habits requires discipline. To improve your sleep, develop your day’s schedule oriented around good sleep hygiene. We recommend that you implement most, if not all of the suggested recommendations listed below. If your sleep difficulties don’t improve through good sleep hygiene, talk to Dr. Harlin or consult with a sleep specialist.

Sleep Hygiene Recommendations

Exercise

If you get at least 20 minutes per day and 150 minutes per week of moderate to vigorous exercise, you will likely sleep significantly better. The more exercise, the better. For walking to qualify as “moderate” exercise, you would need a pace of 100 steps per minute.

Exercise is particularly helpful at improving sleep in those suffering from depression. Researchers found that when depressed insomnia sufferers exercised, insomnia rates dropped. After exercising, participants also fell asleep faster, had a more restorative deep sleep, and woke fewer times during the night. However, it is best to get this exercise during daylight hours and at least two to three hours before going to bed.

30-60 Minutes of Daylight

Daylight has a hugely positive influence on our body clocks. The longer you can expose yourself to daylight the more healthy your sleep cycle will become. You want to get at least 30 minutes of daylight exposure on a sunny day. Double this if it’s cloudy. For best results, try to avoid wearing sunglasses during this time.

Light Therapy Lamp

If you find it difficult to get enough exposure to natural light you should try a light therapy lamp. If you want to use one, make sure it emits 10,000 luxes of white light and use it for 30 minutes every day.  As a potential side benefit, research studies show that optogenetic stimulation of the prefrontal cortex results in increased synaptic strength and exerts an antidepressant effect in animal models. (Hines)

Take Time to Relax and Unwind

A healthy bedtime routine allows your body and mind time to slow down before you turn the lights out. Take at least half an hour to play quiet music, take a bath, or read a book with a positive and calming message — or better yet, take 20-30 minutes for loving-kindness meditation. Make your evening hours a time to relax, away from work or other daytime obligations. If you can, turn off your phone at 9:00 pm or earlier. It’s best to avoid the news, bill paying, and sources of potential conflict during the hours before bed.

Commit to a Bedtime Schedule and Bedtime Routine

Our bodies adapt and get used to going to sleep at a specific time but only if these times are fixed. Going to bed and waking up at the same time every day will help condition your mind and body to fall asleep more quickly. If your sleep is not as robust as you’d like it to be, commit to a schedule for going to bed and getting out of bed.

Meditate Daily

Learn to meditate. It can be an excellent means to calm ourselves, control our thinking, and ease our anxieties — especially before bedtime. Meditation and relaxation techniques get easier the more we practice them. Persevere and don’t give up. Meditation and putting yourself into a relaxed and positive state comes easier with practice.

Transcendental, Mindfulness, and Loving-Kindness Meditation

The EEG signatures or brain wave patterns associated with each meditation practice are different. Research conducted by the Institute of HeartMath shows that people can develop their ability to control their emotional state, as well as some underlying physiological processes, by sustaining sincere, heart-focused states such as appreciation and love, in other words, practicing loving-kindness meditation. Practicing transcendental meditation, or clearing the mind, can be very helpful to get back to sleep after a nighttime awakening. We recommend that you find a form of meditation that works for you.

Creative Visualization

Imagine yourself sleeping easily and soundly, like a baby. Make sure you see this very clearly.  Once you’ve got the picture in your head, think of it often, not only when you are relaxing or meditating, but throughout the day as well. Lastly, BELIEVE that sleep is yours or will be yours. Any disbelief is negative energy and will counteract what you’re trying to achieve.

No Pressure

Never label yourself as an insomniac and don’t pressure yourself to fall asleep. The brain can’t fall asleep when you are challenging it with a task, even if that task is falling asleep. Sleep comes naturally if you relax and allow it to come.

Waking in the Middle of the Night

If it takes you time to fall asleep, or you wake up in the middle of the night, don’t stress; as we age, our sleep is less efficient than when we were younger. This is a good time to practice transcendental meditation — to clear your mind of all thought.

No Clocks

Remove all clocks from your bedroom. If an alarm clock is absolutely necessary, turn it around so it doesn’t face you. This will help remove pressure on yourself to fall asleep within a certain amount of time.

If you want to monitor your sleep, there are a number of sleep tracking gadgets that you wear or smartphone apps that monitor your sleep cycles.

Create Your To-Dos List

It’s important that your brain is calm and clear before you go to bed.  Jot down your ‘to-do’ list before bedtime. Transfer everything that’s in your head down on paper. This simple ritual will help your mind relax when you lie down and help prevent mental chatter.

Create Your Solutions List

Stress and anxiety may cause sleeping problems or make existing problems worse. But a lack of sleep can also cause an anxiety disorder. When we go to bed, our minds may revert to unresolved issues. Spend 15 minutes each day thinking about the thoughts that cause you to feel anxious. Write them down. Jot down actions you can take to resolve your anxiety around these issues. This will free you up from having to do this when you lie down for bed. Recognize that some issues are out of your hands and train yourself not to worry about what you can’t fix. Trust that you will be ok no matter the outcome.

Avoid the Blue Light in Electronic Devices

Blue light from the sun is highest at midday. It signals to your brain that it’s daytime — time to be awake. Blue light controls melatonin secretion, so melatonin levels at night are exquisitely light sensitive. Artificial blue light, such as that emitted by lightbulbs, computers, tablets, televisions, and cell phones, suppresses melatonin levels at the time of night when it should be increasing. Your body’s thirty-seven trillion cells don’t get the message that it’s nighttime until you turn out the lights— several hours after the sun goes down.

Avoid electronic screens during your relax and unwind time. Or use an app to shift the color spectrum of light in your computer screen after sunset into an amber hue. But best to avoid electronic devices during your relax and unwind time.

Make Your Bedroom a Sleep Haven

Reserve your bedroom for sleep, intimacy, and restful activities such as meditation and reading for pleasure. Keep it cool, dark, and quiet. Light exposure at night can undermine the pineal gland’s release of melatonin. Block out the light with blackout curtains or sleep with an eye mask and unplug light-emitting devices. Get rid of night-lights and other sources of nighttime light in the bedroom, ensuring that it’s completely dark while you sleep. But make sure the path from the bed to the bathroom is a clear path with nothing to trip on in the dark. Better to keep a flashlight on your nightstand than to keep a nightlight on all night. Sound insulate your bedroom if you are a light sleeper or use a white noise generator to mask noise.

Melatonin Supplementation

Melatonin is a hormone produced naturally by the pineal gland in your brain. It plays a key role in signaling to your body that it’s time to sleep. Our melatonin production tends to drop significantly as we age.

Melatonin supplements offer levels of the hormone that can affect serum melatonin levels and influence sleep patterns. Because the rate at which melatonin production drops as we age differs from person to person, the exact dose can differ from person to person. Melatonin has been shown to improve sleep in people with diabetes, schizophrenia, Alzheimer’s disease, Parkinson’s disease, irritable bowel syndrome, and those who are hospitalized. Low-dose melatonin (1 – 3 mg) appears relatively benign when taken 30-45 minutes before going to sleep. Some people require more and some people will find no effect from melatonin. However, too much melatonin, or when taken long term, may have adverse effects.

Melatonin can potentially affect blood pressure as well as estrogen and testosterone levels. Melatonin can also interact with certain foods and medications. Headaches and daytime sleepiness are also more common in people taking melatonin. And long-term use is associated with an increased risk of bone fracture. (It is hypothesized that melatonin is one of the hormones that modulate bone formation and resorption.) It is likely best to use melatonin on an as-needed basis rather than on a regular basis.

Note: supplements are not subject to manufacturing purity regulations the way drugs are.  Filler materials in supplements may vary considerably. Also, the dosages are not consistent from one brand to another, sometimes even from the same seller. Best to purchase only a trusted brand. We recommend you reference Consumer Labs’ research on brands.

Napping

If you need a nap, it is best to get up from your nap by 1:00 pm. If you sleep past 1:00 pm, you’ll likely not be able to keep your bedtime schedule. If you can’t stay awake in the afternoon, take only a 15- to 20-minute nap — that’s usually long enough to improve alertness but not so long that you feel groggy afterward. Don’t nap at all in the evening before you go to bed.

If your schedule permits it, and a bi-phase sleep schedule suits you, it can be a very healthy means to adequate sleep. Attempt to keep your total sleep time to 8 hours per day.

Healthy Eating Promotes Healthy Sleeping

For your best night’s sleep, strive to eat a diversified whole-food, plant-based diet — fresh fruits, vegetables, whole grains, and legumes. Although results from studies assessing the relation between absolute nutrient intake and sleep duration are inconsistent, current evidence suggests a trend toward higher absolute intake of fat and sugar and reduced intake of fiber in short sleep duration. A diet low in fiber and high in saturated fats could take a toll on your sleep by decreasing the amount of deep, slow-wave sleep. Meanwhile, eating too much sugar could result in more midnight wake-ups. On the other hand, a healthy balanced diet that’s high in fiber and low in fat, sugar and refined carbohydrates could help you to fall asleep faster, and help you sleep more soundly.

Don’t Eat Sweets Before Bed

Don’t eat sweets before bed, particularly if you have symptoms of hypoglycemia. Sweets before bed can make blood sugar plummet during the night. Even if it plummets into “normal” range, this can kick the adrenals into action and give you a restless sleep or a 3 A.M. wake-up with anxiety — which are signs of reactive hypoglycemia with adrenal fatigue.

Fructose is Associated with Melatonin Impairment

Studies show that both fructose consumption and high blood glucose are detrimental to pineal melatonin synthesis in rats. Human studies indicate that hyperglycemia is detrimental to melatonin production also in humans. Although further studies are needed to fully clarify the mechanisms, the study results provide evidence that high circulating glucose levels interfere with pineal melatonin production. (Human metabolism and rat metabolism are strikingly similar. Human studies typically follow rat studies.) Therefore, keep blood glucose levels within a healthy range.

Don’t Skip Meals

People who experience rapid changes in blood sugar levels throughout the day can experience a drop in blood sugar around 3 A.M. This leads to the body producing adrenalin — a stimulant that wakes us up. Keep your blood sugar levels relatively stable throughout the day by not skipping meals and eating healthy foods. A diet high in minimally processed, high-fiber, plant-based foods such as low glycemic index vegetables and fruits, whole grains, legumes, and nuts will markedly blunt the post-meal increase in glucose (and triglycerides). Eat six small meals instead of three meals a day, if this helps stabilize your blood sugar.

Processed foods, meat, and dairy trigger postprandial glucose spikes and elevated lipids in the blood. This generates free radicals and the oxidative stress triggers a biological cascade damaging proteins in our body, inducing inflammation, and causes a fight or flight nerve response. This lasts for over 4 hours after the meal. These foods should be avoided at all times, to both improve sleep and lower inflammation.

Foods that Promote Sleep

There are a few nutrients that have been found to aid in promoting sleep: tryptophan, magnesium, calcium, and B vitamins. Some of these nutrients help the body produce melatonin, the hormone that is responsible for regulating your sleep/wake patterns.

(It’s best not to take vitamin B supplements before bedtime as they can act as stimulants. Also, use of a multivitamin or multiple single vitamins is associated with poorer sleep maintenance compared to individuals who do not take vitamin supplements. At least one study found a tendency for vitamin users to have a greater number of awakenings during the night, more total wake time during the night, greater use of sleep medications, and a higher rate of insomnia than non-users.)

Chia seeds come from a flowering plant in the mint family. They’re full of soluble fiber and ALA, a form of omega-3s. They also contain protein and minerals including iron, calcium, magnesium, and zinc. More importantly, they could be a good natural sleep aid. Chia seeds contain twice the levels of the amino acid tryptophan as turkey. Tryptophan raises melatonin and serotonin levels and helps promote sleep.

Our pineal gland is not the only thing that produces melatonin; it is found in some plant foods too, with goji berries at the top of the list, followed by raspberries, almonds, tart cherries, and tomatoes — in that order. However, the levels naturally occurring in foods are not high enough to change our melatonin levels just by eating these foods. Best to eat a diet that can help you sleep better by assisting melatonin production in the body.

Antioxidants are anti-inflammatory and because inflammation causes pain, antioxidants and an anti-inflammatory diet might also promote a good night of sleep.

Maintain Appropriate BMI

Poor sleep results in daytime lethargy, lower energy levels, and drowsiness, which leads to less exercise. Both cross-sectional and epidemiologic studies have demonstrated that those who sleep less are more likely to consume energy-rich foods (such as fats or refined carbohydrates), to consume fewer portions of vegetables, and to have more irregular meal patterns.

Like most things involving sleep, the interactions are complex and the causal relationship between sleep and BMI runs both ways. Too little sleep slows down our metabolism, lowers our energy, and in turn, the extra weight makes it harder to sleep.

Eating well is the first step to losing weight. And that can pay dividends when it comes to your sleep. A reduction in body fat, especially around your midsection, makes you less likely to struggle with sleep problems like sleep apnea, restlessness, or insomnia, and less likely to feel drowsy during the day.

Eliminate Foods that Harm Sleep

Try to eliminate (or significantly reduce) your intake of the following foods:

Aged cheese
Alcohol
Artificial sweeteners
Bacon and other smoked or processed meats
Caffeine
Chocolate
Monosodium glutamate (MSG)
Refined carbohydrates and sugar
Spicy foods
Sweets

Gastroesophageal Reflux (GERD), aka Heartburn

People with nighttime heartburn are more likely to have sleep problems and disorders like insomnia, sleep apnea, restless legs syndrome, and daytime sleepiness. Luckily, the right diet can make a difference. Steer clear of fried or high-fat meals, spicy foods, alcohol, and soda—especially close to bedtime.  Studies show that elevating the bed head (6-8 inches) is an effective therapy in relieving the symptoms of reflux for people that get reflux when they lie down.

Avoid Eating at Least 4 Hours Before Sleep

Finish dinner several hours before bedtime. If you need a snack in the evening, eat something small and low fat so your food will get through the stomach before you go to bed.

Limit Fluids Before Bedtime

To minimize nighttime trips to the bathroom, don’t drink anything during the four hours before bedtime. Get your hydration earlier in the day. Take small sips if thirsty during the evening.

Massage and Aroma Therapy

There are limited studies on massage and sleep; however, massage has been shown to have beneficial effects on numerous health conditions. Studies show that patients who receive regular massage achieve lower blood pressures as well as improvements in depression and decreased urinary and salivary cortisol. Another study documented increased parasympathetic activity following a single short session (10 min) of head massage. The head massage also reduced heart rate. Adding an aroma oil to massage has additive effects and the aroma oils themselves have been noted to alter brainwaves in the direction of relaxation and reduced heart rate. Several studies have shown that the use of lavender decreases the time before falling asleep, having deeper and more restorative sleep, less early morning awakenings, and being more rested on morning arising.

Probiotics to Help with Sleep

The probiotic Lactobacillus Reuteri is one of the most studied strains of probiotic bacteria, boasting a variety of proven health benefits from increasing circulating Vitamin D to reducing inflammation and improving sleep. Animal studies have even shown that L. Reuteri helps prevent weight gain from obesity-causing diets. Take L. Reuteri before bedtime, but don’t take L. Reuteri with a hot beverage as the bacteria may not survive the higher temperatures.

Sleeping Alone

More studies are coming out that prove sleeping alone improves your sleep. Research shows that couples who share a bed have 50% more disturbed sleep compared to those who sleep alone.

One study in 1969 found that couples who slept alone got far more of the deepest, restorative levels of sleep. It’s also known that we toss and turn during the night far more when we are sharing a bed. Sleeping apart doesn’t need to mean your relationship is in trouble; it just means you want to get a better night’s sleep.

Medications

Medications such as anti-hypertensives, anti-depressants, statins, beta-blockers, and even cholinesterase inhibitors (e.g. Aricept) can disrupt sleep. Over-the-counter and prescription drugs that may have caffeine in them include pain relievers, weight loss pills, diuretics, and cold medicines. These and other medications may have as much or even more caffeine than a cup of coffee.  Speak to Dr. Harlin about the possibility of your medications disrupting your sleep.

Cognitive Behavioral Therapy for Insomnia (CBT-I)

Cognitive behavioral therapy for insomnia (CBT-I) is a structured program that helps you identify and replace thoughts and behaviors that cause or worsen sleep problems with habits that promote sound sleep. These thoughts and behaviors are learned. So, they can be unlearned. CBT-I is aimed at changing sleep habits and scheduling factors, as well as misconceptions about sleep and insomnia, that perpetuate sleep difficulties.

Unlike sleeping pills, CBT-I helps you overcome the underlying causes of your sleep problems. Cognitive behavioral therapy is the only insomnia treatment that has been proven (time and again) to be safe and effective. CBT-I is the most effective form of treatment for chronic insomnia.

CBT-I improves sleep in the vast majority of insomnia sufferers, has no side effects and improvements are long-term, has been found to be more effective than sleeping pills, and has been shown to be effective in reducing or stopping sleeping pill use.

Cognitive behavioral therapy for insomnia includes regular, often weekly, visits to a clinician, who will give you a series of sleep assessments, ask you to complete a sleep diary and work with you in sessions to help you change the way you sleep. Online CBT-I is also available, such as http://www.insomnialand.com


Hines DJ, Schmitt LI, Hines RM, Moss SJ, Haydon PG. Antidepressant effects of sleep deprivation require astrocyte-dependent adenosine mediated signaling 2013 Jan 15;3:e212. doi: 10.1038/tp.2012.136. PMID:23321809