How to Solve 9 Sleep Problems

Expert advice for anyone who tosses and turns at night.

The Night Waker

Her challenge: After a stressful breakup two years ago, Meredith Crowell, 40, a single real estate property manager and yoga instructor from Boulder, Colorado, would wake up in the middle of the night filled with sadness and anxiety. But even after she felt better emotionally, the sleep troubles continued. Although she typically falls asleep easily around 10:30 p.m., she is wide awake three or four hours later. She falls back into a fitful sleep, then gets up around 6 a.m. to begin her day. "I never wake feeling well rested, because it feels like I don't get more than about four hours of truly deep sleep," she says. To no avail, Meredith has tried myriad remedies―warm baths, hot milk, a glass of wine before bed, no food before bed, relaxation techniques, and prescription and homeopathic medicines. She took a prescription medication, but that didn't give her more than four hours of sleep. She even tried taking the medication when she woke in the middle of the night, but that left her too groggy in the morning.

Expert advice: "The good news is that Meredith's insomnia seems to have a clear precipitant―the breakup," says sleep-medicine specialist David Neubauer, M.D., a sleep-medicine specialist and an associate director of the Johns Hopkins Sleep Disorders Center, in Baltimore. Neubauer calls her situation "conditioned arousal," which, he says, is common. "Her sleep problems may have been initially caused by an external trigger, but over time the sleep problems become self-propagating. Eventually she became conditioned to become anxious about her sleep." Some things that might help:

• Cognitive behavioral therapy (CBT) is often used in cases like this, and the experts agree that it could help Meredith. "CBT aims to stop the behaviors that are perpetuating the insomnia," says Susie Esthera, M.D., a specialist in sleep-disorder medicine at Charlotte Eye, Ear, Nose, and Throat Associates, in Charlotte, North Carolina, and the president-elect of the American Academy of Sleep Medicine. Typically, a therapist will work with a patient for four to eight weeks―in sessions that last from 30 minutes to two hours―to assess, diagnose, and treat the underlying problem, such as relationship worries. The therapist will teach the patient things like progressive-relaxation techniques and point out actions that are getting in the way of deep sleep, such as rehashing conversations that occurred earlier in the day. (To find a therapist, go to the website of the National Association of Cognitive Behavioral Therapists, at nacbt.org.)
   
• Acupuncture. "Acupuncture may help reduce her anxiety and induce deeper sleep," says Rubin Naiman, Ph.D., the director of sleep programs at the Miraval Resort, in Tucson.
   
• Avoiding wine. "There is a notion that alcohol will help you sleep," says Neubauer. "And while it often does help you fall asleep quicker, your sleep will be more disrupted."
   
• Accepting some awakenings. The experts stress that nighttime awakenings are perfectly normal―much more normal, in fact, than the elusive solid eight hours people think they should be getting. Most people will roll over and go back to sleep, but those with insomnia become conditioned to feel anxious when they awake during the night. "You need to accept that you will arouse some, so reassure yourself in the middle of the night that nothing catastrophic will happen if you are awake for a while," says Esther. To that end, she suggests keeping the glaring electric clock off the bedside table. "Clock watching will only increase your anxiety about being awake," Esther says.