Insomnia - Ditch the Phone for Better Sleep p.2
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7 Ways to Improve Your Sleep Hygiene p.11
Home Remedies Expert Q&A Prescriptions for Sleep
Insomnia
Ditch the
Phone for
Better Sleep p.2
Scan for
More Info
NEW & NOW By Avery Hurt ASK THE EXPERT: JAMES MCGUIRK, M.D.
By Stacey Colino
WELCOME to HealthCentral’s guide to Insomnia. Within these pages, you’ll learn about current research,
how to make the most of every doctor visit, the latest treatments, and more.
For additional tips and info, go to HealthCentral.com/InsomniaGuide.
A FAMILY
AFFAIR
A recent survey by the Sleep
Foundation found that 42%
of people with insomnia I used to have trouble falling
share a home with some- asleep. Now I have trouble
one who also has insomnia. with waking up and not
What gives? being able to get back to
Wendy Troxel, Ph.D., a sleep. Why the change?
clinical psychologist at the Insomnia can take several differ-
RAND Corporation, a global TUNE OUT, ent forms, and there’s a multitude
research organization, says
the situation is likely due to SLEEP of things that can lead to nocturnal
awakenings. The most common thing I You don’t want to work out too close be psychological, especially if you’re
a combination of factors.
Some risk factors for insom-
BETTER? see is the development of sleep apnea
[a breathing disorder]. Other medical
to bedtime, though how close is too
close depends on the individual. But
prone to rumination: If you’re wor-
ried about something and you think
nia, such as depression or Worries about money, family, problems—such as bladder conditions, definitely don’t exercise within an about it over and over, that can inter-
NEXTLEVEL
anxiety, tend to run in fami
fami- or work can keep you awake joint pain, and movement disorders hour of bedtime to prevent it from fere with sleep. Cognitive behavioral
lies, she says. But the biggest at night. Now, you can add like restless legs syndrome—can cause interfering with sleep. therapy for insomnia (CBT-I)—which
culprit is probably habit. the state of the world to you to wake up from sleep during the helps people change sleep-related
ACUPUNCTURE
“Families share habits and that list. A national survey night. Or, there could be environmen- ◾ How can I prevent my occasional thoughts and behaviors, using guided
behaviors that can be linked of 2,040 U.S. adults by the tal factors, such as if you’ve moved to bouts of insomnia from turning into imagery and relaxation techniques—
with insomnia, including Ohio State University Wexner a new home. a chronic problem? can help with rumination. It’s a way
sleep routines,” says Troxel. Medical Center in Columbus When they have trouble sleeping, to distract your brain from those
IF YOUR INSOMNIA is related to depression, the results Parents can set an exam- found that the pandemic, ◾ I know that napping isn’t recom- people start to worry about it, and thoughts, so you can improve the
of a recent clinical trial suggest that you might benefit ple of good sleep behaviors political divisions, and other mended if you have insomnia. What that worry propagates the insomnia. quality of your sleep.
from electroacupuncture (EA), a modern take on an and make those a part of the global crises are among the can I do to stay alert and productive? So part of it is to try not to worry
ancient Chinese therapy. With EA, tiny electrodes are family’s wind-down routine concerns keeping people up. The best thing to do is make sure you about it, which admittedly is easier ◾ What else do you wish people
attached to acupuncture needles, delivering a small instead, she says, like not The 2022 survey also stay busy and occupied. Take breaks said than done. One of the most asked you about insomnia?
buzz of electricity as the needle is inserted into the skin. bringing phones into bed- found that nearly half of from what you’re doing, get up and important things to do is maintain People don’t really ask me about what
28
The trial included 247 patients, 18 to 70 years old, who rooms before bedtime. Americans scroll through walk around outside and expose really good sleep habits, such as kind of sleep routine to have. I wish
had both depression and insomnia. Those patients—who their phones right before yourself to natural sunlight—it’s good having a consistent bedtime and people realized how impactful it is to
were advised to continue taking their antidepressants bed, and 37% fall asleep with for waking us up. If you can’t do that, awakening time, day after day. But make changes to their sleep routine
and other medications—were divided into three groups. the television on. Not only is sitting in front of an artificial sunlamp if you can’t sleep, don’t lie in bed and be consistent. Keep in mind,
One group received EA three times per week, along with this a recipe for poor sleep, that has a brightness measurement for more than 20 minutes without insomnia isn’t something that hap-
standard care, such as advice about healthy living and it also offers a big clue about of 5,000 to 10,000 lux can help wake sleeping: Get up and do something pened overnight, so it’s not something
FROM TOP: GETTY IMAGES; VANDERBILT UNIVERSITY MEDICAL CENTER
managing stress. The other two groups served as con- how to improve it. Turning off you up. The bright light signals to calming until you’re ready to try that’s going to get fixed overnight. It
trols, with one receiving sham acupuncture (where the the world and its problems— your brain that it’s daytime and stim- again. Before you go to bed, avoid can take weeks or months. ◾
needle touches the skin but isn’t activated) plus standard at least temporarily—by ulates your brain to stay awake. screens for at least an hour: The light
care, and the other receiving just standard care. Percentage shutting down your devices from them will keep you awake even
JAMES MCGUIRK,
By the end of the eight-week study, sleep improved
of adults before bedtime is a great ◾ Can exercise help with insomnia, if you don’t want to be.
GETTY IMAGES (2). COVER: GETTY IMAGES
M.D., is an assistant
for those in the EA treatment group, based on their habit to help you get better or does it sometimes worsen it? professor of
scores on a common measurement of sleep quality. They
also got, on average, almost 30 minutes more sleep time
using a sleep, says Aneesa Das, M.D.,
professor of internal medi-
Yes and yes. Exercise absolutely can
help with insomnia. I recommend
◾ Why do I sometimes have insomnia
when I’m really stressed out?
neurology in the
sleep division at
than the control groups. What’s more, they found that smartphone cine at the Wexner Medical exercising as intensely as you feel It could be physiological: If you’re Vanderbilt University
Medical Center in
their sleep was still improved 24 weeks after the EA
treatments had ended. The study was published online
to track Center. comfortable with, though more vig-
orous exercise is going to be more
really stressed out, you could have
increased cortisol levels, which can
Nashville, Tennessee.
in JAMA Network Open. their sleep tiring and that can help you sleep. make you feel revved up. Or, it could
2 HealthCentral Guide HealthCentral Guide 3
OVERVIEW
Rowley, M.D., professor of pulmonary,
critical care and sleep medicine at
Wayne State University School of
Medicine in Detroit. The reasons
for not getting those crucial seven
hours might differ—one person may
struggle to fall asleep, another may
have trouble staying asleep, and still
Oh, to
others might wake up too early—
but the outcome is the same: sleep
deprivation.
During normal sleep, you cycle
through what’s known as rapid eye
movement (REM) sleep and non-REM
Sleep!
sleep. It’s during REM sleep that most
dreaming takes place—the eyes dart
back and forth, but the rest of the
body is still. A stretch of REM sleep
can last from 10 to 60 minutes, with
each successive REM period getting
I
longer. On average, adults go through
f even just reading this headline five cycles of non-REM and REM sleep
makes you yawn, you may be one in any given night of normal sleep.
of the estimated 35% of American That doesn’t happen with insomnia.
adults who, according to the American You may hear the terms “acute”
Academy of Sleep Medicine, don’t and “chronic” insomnia; the first lasts
For some of us, a get enough sleep because of insom- less than three months, the second
good night’s sleep is nia. Keep reading to learn what
insomnia is and what it means for
persists longer. But if you’re getting
insufficient sleep for any length of
an impossible dream. your health. time, it’s worth taking seriously, says
Dr. Rowley.
Why is it so hard to What Exactly Is It?
What Causes Insomnia?
get enough zzz’s? Insomnia doesn’t mean you never
sleep, even if it feels that way. (One Often, sleep troubles beget more
By Patty Onderko study found that more than a quarter sleep troubles. If you’re nervous
of people with insomnia get much about falling asleep tonight because
more sleep than they realize.) The you couldn’t fall asleep last night,
sleep disorder’s definition is much says Dzierzewski, the anxiety around
more subtle—and often subjective. going to bed can make it that much
Simply put, insomnia is “dis- harder to relax and get adequate
satisfaction with sleep quantity or zzz’s. That stress can continue to
quality,” says Joseph M. Dzierzewski, mount, transforming what might
Ph.D., vice president of research have been just a few bad nights into
and scientific affairs at the National insomnia.
Sleep Foundation (thensf.org), who But falling and staying asleep is
is based in Washington, D.C. “It is not always a mental game. Many
waking up feeling unrefreshed.” cases of insomnia are caused by
And for most humans, feeling other sleep disorders, such as
refreshed requires a minimum of obstructive sleep apnea (a breath-
seven hours of sleep a night. “Healthy ing abnormality) and restless legs
sleep generally means falling asleep syndrome (an uncontrollable urge
within about 15 to 20 minutes of to move the legs). Or, the cause may
going to bed and sleeping for at be an underlying medical condition:
GETTY IMAGES
least seven hours, with few awaken- Alzheimer’s disease, anxiety disor-
ings each night,” explains James A. ders, asthma, chronic autoimmune
(Continued on page 7)
4 HealthCentral Guide
OVERVIEW
(Continued from page 4)
or pain disorders, chronic obstructive
pulmonary disease, depression, heart
disease, or Parkinson’s disease, to
name a few. Sometimes, the medi-
cations for these conditions can
interrupt sleep, says Dzierzewski. Deep Sleep
Moderate Sleep 20–40 minutes
Insomnia caused by another 10–25 minutes
health disorder used to be called
“secondary insomnia,” while insom-
nia caused by stress was known as
“primary.” But that distinction is no
longer considered relevant. “Rigorous
research has shown that when insom-
nia is the direct result of another
disorder, it is still deserving of
Light Sleep REM Sleep
focused attention and treatment and 1–7 minutes 10–60 minutes
responds well to insomnia treatment,”
says Dzierzewski. Plus, the relation-
ship between another health condition
and insomnia can go both ways, with
insomnia sometimes causing or wors-
ening the health issue.
SLEEP CYCLE STAGES
Finally, lifestyle habits can play a
role. Excessive consumption of caf- conditions, get less exercise, and that the disorder is also associated
feine, alcohol, or drugs doesn’t do have less exposure to daylight, says with hypertension, coronary artery
sleep any favors, says Dzierzewski. Dzierzewski. Our sleep undergoes a disease, and heart failure. Plus, grow-
Neither does “misusing the bed and physiological overhaul, too. As we ing evidence shows that short sleep
bedroom,” he says, referring to using age, what’s called our “sleep archi- durations might be at least partially
them for anything other than sleep tecture” shifts: We spend less time in behind this country’s obesity and
and sex. “Think of the bed as a tool the deepest stage of sleep, leading to diabetes epidemics. In men, lack
designed for sleep, not for working, more frequent overnight wake-ups. of sleep has been linked to erectile
watching TV, or snacking,” he says. dysfunction and impaired fertility.
Going to bed at different times every The Effect on Health And research has found that women
night can also wreak sleep havoc. Sure, there may be nights—or even who had poor-quality sleep showed
weeks—when, because of circum- increased signs of skin aging, includ-
Who Is Most at Risk? stances (a newborn in the house, for ing fine lines, uneven pigmentation,
The risk factors already discussed example, or a tough work deadline), and slackening of skin and reduced
aside, some people are more likely you don’t get the full, restorative elasticity, compared with women
to develop insomnia than others. seven hours. But those nights should who had healthy sleep. Beauty sleep,
Females are at the top of the list, be the outliers, says Dzierzewski. Get- indeed!
with a lifetime risk that’s 40% higher ting less sleep consistently over time
than that for males. Why? Women will take a big toll on your health, he The Good News
may experience insomnia at higher says. Along with diet and exercise, You don’t have to live with less-
rates because of a combination sleep is the foundation for optimal than-dreamy sleep. Insomnia can be
of socioeconomic factors, physi- function of every part of your body, successfully treated and cured, says
ological factors like pregnancy and from your brain to the ligaments in Dr. Rowley. Talk with your doctor
menopause (when hormones are your toes. “People with insomnia about what the causes of your
fluctuating), and social contributors recover more slowly from injury, insomnia might be and how you can
like the uneven distribution of child- experience more pain, are more sus- get back to feeling refreshed when
care responsibilities, says Dzierzewski. ceptible to mood disturbances, and you wake up. ◼
If you’re a woman over age 65, experience faster rates of cognitive
the news is even more dishearten- decline than people who get healthy Scan for more
ing. Older adults are more likely to sleep,” says Dzierzewski. info, or go to
GETTY IMAGES
experience insomnia because they Need more motivation to take your HealthCentral.com/
are prone to having underlying health insomnia seriously? Research shows InsomniaGuide.
HealthCentral Guide 7
OFFICE VISIT
DID YOU KNOW? Over the long term, sleep deprivation important to figuring out what’s going
can weaken your immune system and lead to persistent low- on with your sleep, Ebben says, so
level inflammation throughout the body, which underlies many don’t be reluctant to share them.
chronic medical conditions.
Will I Need a Sleep Study?
backgrounds, including neurology, you take each medication. Certain Maybe, but it’s more likely that you
pulmonology, internal medicine medications taken too close to bed- won’t, says Ebben. Sleep studies,
and psychiatry. These doctors then time may keep you awake longer called polysomnograms, “are gener-
become board-certified in sleep med- than you want. A sleep specialist can ally used to determine if a person’s
icine through a yearlong specialized help create a medication schedule sleep disturbances are caused by a
fellowship. designed for optimal sleep. sleep-related breathing disorder,” he
There are also certain psycholo- In addition to making a list of says, the most common of which is
gists and other health professionals meds, write down all the strategies obstructive sleep apnea (OSA).
who provide what’s known as cogni- you’ve tried so far to resolve your In OSA, the muscles around the
tive behavioral therapy for insomnia insomnia, says Dr. Rowley, from sleep airway relax and collapse in on the
(CBT-I). This treatment is one of the aids to relaxation videos. And on narrow upper respiratory tract, caus-
most effective to emerge from the the day of your appointment, wear ing labored breathing—or even briefly
field in the last 20 years. comfy clothes that are easy to take stopping it. During a polysomnogram,
If you have trouble finding a sleep off and put back on, as your doctor you sleep overnight at a hospital or
specialist, look for an accredited will not just talk with you, but also do sleep center while your breathing and
The Doctor Is In
sleep center, which should have a a physical exam. blood oxygen levels are continuously
well-rounded team of healthcare Besides taking these steps, the monitored to see if your air intake is
providers. Locate one near you at main thing you need to do is “prepare being interrupted during the night.
sleepeducation.org/sleep-center. to be completely honest,” says Ebben. (There are sleep testing devices for
“We can’t help patients if we don’t home, too, but polysomnograms “are
Before Your Appointment know the whole picture.” Your sleep the gold standard for diagnosing
S
Since some drugs have side effects specialist will want to know about any apnea,” says Ebben.) In a 2019 study,
o you’ve been struggling disturb sleep, such as diabetes and that disrupt sleep, write down a list of substance use (recreational drugs, over 35% of people with OSA were
to get a good night’s sleep thyroid disorders. Your PCP can then all the medications and supplements alcohol) as well as your daily diet and also found to have insomnia.
for a while now and you’re refer you to a sleep specialist if needed. you’re taking, says Dr. Rowley. It’s easy exercise habits. Do you have a mid- If your doctor doesn’t suspect OSA,
increasingly fatigued during the day. If you’ve already been diagnosed to forget things (the over-the-counter night snack before you go to bed? Do you won’t need a polysomnogram.
If you’re not sleeping, Is it really worth a trip to the doctor? with diabetes or another chronic allergy medicine you don’t think twice you enjoy an after-dinner espresso? Instead, you’ll likely be asked to log
After all, doesn’t everyone have dif- condition, such as multiple sclerosis, about, for example) when you’re with How much wine do you have with your sleep and daily habits in a sleep
it’s time to get some ficulty sleeping sometimes? Sure, arthritis, liver disease, heart disease, the doctor. Note, too, the time of day dinner? Details like these can be diary for two weeks, says Ebben. ◼
help. Here’s how says Matthew Ebben, Ph.D., a sleep
specialist and associate professor of
psoriasis, or Parkinson’s, and you
develop insomnia, see your disease
to prepare yourself psychology in clinical neurology at specialist first to make sure your con-
Weill Cornell Medicine in New York dition is being treated as effectively DEAR SLEEP DIARY: WHY AM I AWAKE?
for your medical City, but that doesn’t mean your lack as possible. A SLEEP DIARY is a log that tracks fell asleep, how many times you woke
appointment. of shut-eye is any less detrimental to
your health and well-being.
If you have no underlying condi-
tions and have been suffering through
your shut-eye over time. If you want to
be a gold-star patient, you can com-
up during the night, and when you got
up in the morning, many sleep diaries
By Patty Onderko “If you’re having trouble sleeping sleepless nights of tossing, turning, plete a sleep diary (download one at have fields in which you can input:
on a regular basis, it’s important to and despondent clock-staring for sleepeducation.org/resources/sleep-
see a doctor about the issue,” says more than three months, though, diary) before your first appointment to ■ Whether you’ve used your bed for
give your doctor a sense of how much— anything other than sex or sleep
Ebben. Mounting anxiety around “it’s not unreasonable to go straight
or how little—slumber you’re getting. ■ When you take medicine
bedtime and whether or not you’ll fall to a sleep specialist,” says James A. But it’s not necessary, says Ebben. In ■ When you drink alcohol or caffeine
asleep is another good indicator that Rowley, M.D., professor of pulmonary, fact, many sleep physicians will have ■ When you nap
it’s time to seek professional help. critical care and sleep medicine at their own sleep log that they’ll want you ■ Your exercise routine
Wayne State University School of to use for two weeks after your first visit
Who to See Medicine in Detroit. as a diagnostic tool. Keeping a sleep A sleep diary can offer convincing,
Your primary care provider (PCP) is diary can help you and your doctor spot concrete evidence that you sleep much
behaviors or habits that might be con- better on days you exercise, for exam-
a great place to start, says Ebben. What Is a Sleep Specialist? tributing to poor sleep. In addition to ple, says Ebben, which may motivate
“Your PCP can do a physical exam and Sleep medicine is a multidisciplinary
GETTY IMAGES
GETTY IMAGES
giving you space for logging when you you to exercise more.
run blood work,” he says, to rule out field, says Ebben, which means that
common medical issues that can specialists come from all different
8 HealthCentral Guide HealthCentral Guide 9
TREATMENTS
same tools can help settle you back reset their internal clocks (circadian
into slumber. Progressive muscle rhythms) when they’re suffering
relaxation, starting at the feet and from jet lag. But the AASM doesn’t
working your way up, is one helpful recommend it for either sleep-onset
technique. Or you might try deep insomnia (difficulty falling asleep) or
breathing or counting your breaths. sleep-maintenance insomnia (prob-
Some relaxation techniques lems with staying asleep) because
practiced during the day can also there’s little evidence that it works for
help you sleep at night. Dr. Romaker these purposes. Melatonin may also
recommends gentle yoga, pointing interact with other medicines, so if
out that it has been shown to be you’re thinking of giving it a try, be
effective regardless of the cause of sure to check with your doctor first PILLOW TALK
the insomnia. Also, yoga can be used and ask about the safest dose to take.
SLEEP HYGIENE DOESN’T mean taking
in conjunction with other therapies,
a bath before bed and wearing clean
such as CBT-I, and the benefits of Off the Shelf
Hello, Sandman
pajamas (although those strategies
yoga are immediate. Lots of people reach for over-the- might help). It’s the term sleep doctors
counter (OTC) sleep aids when they use for simple habits that can help you
It’s All in the Timing can’t get enough shut-eye, but that’s sleep better. Some of these are taught
Spending less time in bed—at least probably not a good idea. Most OTC in CBT-I programs. Here are a few tips
at first—might help you get more sleep medications rely on antihista- that you can start using right away:
sleep in the long run. This technique mines to make you drowsy. They do
O
■ Go to bed at the same time each
is called sleep restriction. Rather than work for some people—about 10% to night, and get up at the same time
nce your doctor has ruled through thoughts and behaviors that turning in early, you actually stay up 25%, according to Dr. Romaker—but each morning, including on weekends.
out or begun treating other might be interfering with your sleep. later at night, but still get up at the they stop being effective if you take Doing so can help regulate your inter-
issues that may be con- Over the course of several coaching same time in the morning. The idea them for more than a week or so. nal clock.
tributing to your insomnia, it’s time sessions, typically from four to eight, is that, even though you spend less Another reason not to take antihis- ■ Limit your exposure to bright light
to zero in on treating the insomnia you’ll learn how to recognize when time overall in bed, more of that time tamine sleep meds regularly is that in the last hour or so before bedtime.
itself. Your doctor will work with you you’re dwelling on negative or trou- is spent sleeping. Once you’re asleep they can affect your balance. The
to find out what’s keeping you awake bling thoughts, as well as how to deal at least 85% of the time, you can AASM does not recommend these ■ Keep your bedroom free of elec-
Getting a good and the best way to address the with those thoughts in a more produc- start increasing your time in bed in types of sleep aids because there’s tronics: no computers, phones, or TVs
allowed. Use your bedroom for only
problem. Fortunately, there are many tive way—one that doesn’t keep you 15-minute increments. Sleep restric- not a lot of evidence that they’re
night’s sleep may tools available. Be confident that if awake. You can meet with a therapist tion also means forgoing naps and effective, and there are some ques-
the three S’s: sex, sickness, and sleep.
Turn off all your electronic devices at
take a little trial and one approach doesn’t work, there are
other options to try. Plus, there’s a lot
in person, by telehealth, or via an app.
CBT-I doesn’t focus only on man-
not sleeping late in the morning. That
way, you’re more likely to be drowsy
tions about their safety. least 30 minutes before turning in.
error, but you and you can do on your own. aging your thoughts. You’ll also learn at bedtime. Note that this technique Prescription for Sleep ■ Keep your bedroom quiet, dark, and
cool—around 65 degrees is ideal.
No one approach works for every- some good sleep hygiene tips that is not for people in high-risk jobs. You and your doctor may decide
your doctor have lots body, and successful treatment for will help you make sure your body that in addition to other techniques ■ Avoid alcohol for four hours before
of tools to choose insomnia usually requires a multi-
pronged plan. These are some of the
and environment are primed for sleep
when you crawl under the covers.
Melatonin
Melatonin is a hormone produced
and therapies you may be using, you
need prescription medication for your
bedtime. Even moderate amounts of
alcohol can interfere with sleep.
from to help you options you’ll likely discuss with your While CBT-I has many advantages, naturally by the body. Some people insomnia. The most common medica-
■ Stay away from caffeine for a
doctor. it doesn’t work for everyone. You find that melatonin supplements help tions used to treat insomnia are in a
sleep the whole
40
minimum of eight hours before bed-
have to be committed to the pro- class of drugs called hypnotics. These time—or risk being kept awake.
night through. Don’t Overthink It
If worry or intrusive thoughts are
gram. Ann Romaker, M.D., director
of the Sleep Medicine Center at the
drugs bind to specific receptors in
the brain to induce sleep. Zolpidem ■ Be active. Exercising during the day
By Avery Hurt keeping you awake, cognitive behav- University of Cincinnati College of (Ambien), eszopiclone (Lunesta), and can help you sleep better at night. The
Sleep Foundation recommends that
ioral therapy for insomnia (CBT-I) Medicine in Ohio, points out that you zaleplon (Sonata) are the most well-
you stop exercising at least 90 minutes
might be just what you need. The might not begin to see the benefits known of these. before bedtime.
American Academy of Sleep Medicine for 90 days—or sometimes longer. Other drugs help you sleep by
(AASM) recommends CBT-I for both But for those who stay the course, Percentage of targeting receptors in the wake-
insomnia not caused by other health CBT-I can be very effective, she says. people with promoting sections of the brain.
conditions and insomnia associated insomnia who Suvorexant (Belsomra), lemborexant
with other conditions, such as chronic Deep Breaths also have (Dayvigo), and daridorexant (Quviviq) Scan for more
pain or depression. With CBT-I, a Relaxation and meditation once clinical are in this class of drugs. Ramelteon info, or go to
GETTY IMAGES
GETTY IMAGES
professional therapist trained in this you’re in bed can help you fall asleep, depression. (Rozerem) works by stimulating HealthCentral.com/
method will show you how to work and if you awaken in the night, the receptors for melatonin. ◼ InsomniaGuide.
10 HealthCentral Guide HealthCentral Guide 11
MY CHRONIC LIFE
to muster up the energy. It really system relaxation, and crazy horrible again—and that, too, took the power
affected my life and my relationships [medicinal] teas that tasted unbe- away from insomnia,” she says.
and my thoughts. It kind of con- lievably bad,” but to no avail. “I was
sumed me. I was walking around life always in that ‘chasing sleep’ mode,” A Different Perspective
just sort of half alive.” she says. Kendall likens insomnia to a pho-
For Kendall, now 54, sleep issues bia—a fear of not sleeping. It’s a
began in childhood, when her parents A Life Less Lived controversial view, she admits, but
moved her to a different bedroom Feeling controlled and limited by her one held by several sleep experts.
in the family house. “For whatever condition, Kendall says, “I stopped “This way of thinking is that
reason, that just seemed so dramatic living life as fully as I could. I stopped insomnia is a fear or anxiety issue
and traumatic to my 8-year-old brain. committing to trips and outings and versus a sleep problem,” she says.
I felt very alone and separated from anything that would threaten my “If we say over and over that sleep
my family,” she says. “I think my brain sleep even more. My life got smaller Kendall, enjoying a smooch from her is hard, that it’s a problem we need
created a link that being awake at and smaller. boyfriend’s dog, Guinness. to fix, it unintentionally confirms
night was something really unwanted, “It was a very difficult thing to the brain’s fear of not sleeping. It
that it was scary and lonely.” navigate, because you hear all the until 3 or 4 in the morning and then becomes this vicious loop.
She settled into her new bedroom time that this is a prevailing problem sleep till 10 or noon.” “I approach sleep by creating
eventually, but sleep evaded her again in the world, but you really feel like more ease and effortlessness,” she
in her teens. As a ballet student at a you’re in a small club when you’re in An Epiphany says. “Instead of creating struggle
performing arts high school, she lived it,” she says. “You try to explain your Then, in September 2019, a shift and tension and rules and rigid
in a dorm. “I was attuned to the fact experience to people, and they just occurred. During her final year of behaviors, sleep can be easy.” While
that everyone else could sleep just fine, don’t understand.” study for a master’s in holistic health this approach may not work for
but I would have these periods where On top of the effects of sleep at St. Catherine University in St. everyone, it works for Kendall.
I was lying up on the top bunk awake,” deprivation, Kendall says, her sleep Paul, Minnesota, Kendall says she And Kendall has proved the theory
Kendall says. “That’s when I started issues made her feel ashamed. “You experienced a change in the way she to herself, including on nights when it
developing this identity that there was feel like insomnia is your fault. You thought about insomnia, which led to takes time to fall asleep or she wakes
something wrong with my brain, that I blame yourself, and you just feel the resolution of her problem. She is up. “I view that as a sleep disruption,
couldn’t sleep like other people could.” alone in it. Insomnia infiltrated every- now insomnia-free. which is normal,” she says. “That’s
Insomnia didn’t plague her every thing I did. I had this ongoing worry As she learned about the mind- how I knew I was beyond insomnia,
Sleep? No
night, but it flared up unpredictably about the status of my sleep.” body connection, she says, she because disrupted sleep doesn’t
and could last for several days or In her late 20s, Kendall left ballet became fascinated with the concept spiral me into another cycle of sleep-
even weeks. These cycles of sleep- and began working as a flight atten- of neuroplasticity, or the brain’s abil- lessness. I know that my sleep system
lessness persisted during college and dant (her career until 2020), while ity to change. She chose the topic for is dynamic. I don’t even think about
through the next three decades, until still juggling her life around the need her thesis project, focusing on how insomnia anymore.”
Problem
Kendall finally found relief in 2019. to get more sleep. “I slept at oddball the nervous system and the stress Kendall’s own success—after
times or took naps in the daytime,” response affect behavior. decades of sleeplessness—is why she
‘Always Chasing Sleep’ she says. “But my schedule was “I became aware of the sub- is dedicated to helping others with
Kendall first sought help for sleep upside down, where I would stay up conscious mind and how it creates insomnia. She earned a sleep coach
issues in her 20s, while dancing ballet patterns in our lives, and things certification and established her own
professionally. She was medically started to shift,” Kendall says. “I practice (bethkendall.com). In the
F
diagnosed with sleep-onset insomnia, had that click, an ‘aha,’ that my fall of 2022, she launched her own
or most of her life, Beth Kendall or trouble falling asleep. brain wasn’t broken, that this was a program, Mind Body Sleep, which
Changing her felt insomnia looming. A con-
stant companion, it was there
“I saw just about every sleep med-
icine specialist,” she says. “I did two
mental program I had been running
on replay. That was the beginning
she characterizes as a “mentorship
for insomnia.” Kendall offers a free
thinking about at night as she lay in bed, not sleep- sleep studies, where I went to a facil- of my starting to respond to sleep course via email and, for those want-
ing, and as she struggled through the ity and had all these wires coming differently. Over time, my brain let ing more support, a three-month paid
insomnia helped this day, exhausted at work or worrying out of my head, but no one had an go of the hyperarousal. I now under- video curriculum, one-on-one phone
woman find relief about whether she could commit to
plans with friends or boyfriends or
answer for me. I really did spin my
wheels for decades.”
stand that focusing on making sleep
happen kept me from sleeping.”
sessions, and access to a private
community of others with insomnia.
from a lifelong issue. enjoy a vacation. Kendall took prescribed medi- The change in her waking life has “I want to give people the infor-
“Insomnia just follows you around cations for more than 20 years, but been remarkable. “I started making mation I wish I’d had,” Kendall says. “I
By Suzanne McElfresh
like a ghost,” she says. “It’s hard to either they didn’t work or caused side plans that I wouldn’t previously make want to provide hope, because that’s
SCOTT HOLMES (3)
live your life fully because your gas effects. She also tried supplements without considering the impact on what I needed when I was going
tank is always running on empty. and other treatments, such as “med- Kendall at work as a sleep coach, my sleep. My focus switched from through it. I want to be an example of
You’re always pushing through, trying itation, sleep hygiene rituals, nervous supervised by her cat Lover Boy. trying to fix my sleep to living my life what’s possible for people.” ◼
12 HealthCentral Guide HealthCentral Guide 13
Doctor Discussion Guide
Insomnia
Lack of sleep and poor-quality sleep can be detrimental to your health, so it is important to resolve your insomnia. But to do that,
you must first figure out what’s causing your sleep troubles. Work stress, family worries, erratic schedules, and using electronics
before bedtime are some of the things that can contribute to not getting the restorative sleep you need. So that you can track and
then address the possible causes of your insomnia, experts recommend keeping a sleep journal to record your sleep patterns and
habits. Then, bring your sleep journal and the filled-out discussion guide below to your next appointment with your healthcare
professional to provide them with details needed to determine the best treatment plan for you.
DESCRIBE YOUR INSOMNIA AND SLEEP HABITS:
BEFORE GOING TO SLEEP
How long have you had difficulty sleeping?
In the hours before going
to bed, how often do
you drink any of the
Which do you have trouble with? following beverages?
Falling asleep Staying asleep Both Caffeinated drinks
(coffee, tea, soft drinks)
How often are you waking up each night? Never
1–3 times per week
Do you have a consistent sleep schedule? 4–5 times per week
Yes No Every night
Alcoholic beverages
Which sleep remedies have you already tried? (Check all that apply.) Never
1–3 times per week
Relaxation Caffeine Over-the-Counter Prescription
Exercises Avoidance Medicine Medicine Other 4–5 times per week
Every night
Do you relax and unwind
On most days, how do you feel when you wake up? (Check one.)
before bed?
Extremely Very
Tired
Slightly Very No
Exhausted Tired Rested Rested
Yes
Sometimes
Has your lack of sleep and/or poor-quality sleep negatively How often do you use
affected your productivity during the day? electronic devices shortly
Yes No before going to bed?
Never
1–3 times per week
Do you have any health problems besides your insomnia?
4–5 times per week
Every night
Find more tools and info at: HealthCentral.com/InsomniaGuide
14 HealthCentral Guide
TOOLS & TIPS
Do home remedies for insomnia
work? Their success may vary, but
they’re worth a try. By Lambeth Hochwald
9 Tips for
Self-Care Take time for tea. headphones pumping in says. “Cooling the frontal sour cherry) may improve
Drinking non- sounds all night long. cortex may slow down your sleep, thanks to the
caffeinated tea racing thoughts and help high levels of melatonin it
may help you fall asleep. Use essential oils. you fall asleep faster.” contains, according to one
“Certain types of tea, such Multiple studies study in which 20 indi-
as chamomile, are believed have shown that Keep your feet viduals consumed either a
to be especially relaxing,” the scent from spraying toasty. Wearing placebo or tart cherry juice
says Janet Kennedy, Ph.D., lavender essential oil on socks or keeping concentrate for seven days.
a psychologist and sleep bedsheets, for example, a hot-water bottle near Among those who drank
specialist in New York City. can help with insomnia. your feet might make a the cherry juice, the total
“But it’s the ritual of relaxing noticeable difference melatonin content in their
with a cup of tea that’s most Take a warm bath. throughout the night. urine was significantly
beneficial.” A good soak in elevated.
the tub is an old- Block the light.
Soothe yourself fashioned way to help Wearing an eye Calm your racing
with sounds. promote sleep. Just be sure mask might mind. If all else
Many people you’re soaking in warm (not improve your sleep since fails, open up a
swear that white noise or hot) water. “The rise in body your body responds to light book to help your mind
calming music helps them temperature while you’re in even when your eyes are and body detach from the
fall asleep. “While there’s the tub, followed by cooling closed. “Light also affects stress of the day, Kennedy
no hard data, we do know after the bath, could help melatonin levels, compro- suggests. “Reading gives
that white noise helps to you fall asleep more mising sleep duration and your mind a place to go,
buffer intrusive noise from quickly,” says Kennedy. quality,” says Kennedy. away from stressful
the outside world,” says thoughts,” she explains.
Kennedy. And if blocking Lower your head Consider cherry “Meanwhile the body takes
out the noise is what you’re temp. By putting a juice. Drinking just over and pulls you into
looking to do, Kennedy rec- cold pack on your one glass of tart sleep.” And isn’t that what
ommends using a white forehead before bed, you cherry juice (particularly we’re hoping for when
noise machine over wearing may sleep better, Kennedy Montmorency, a variety of insomnia hits? ◼
MEDICAL EDITOR: Shaheen Lakhan, M.D., Ph.D., FAAN, neurologist and pain specialist, chief medical officer, Click Therapeutics, Inc., New York City.
HEALTHCENTRAL GUIDE MEDICAL EXPERTS: Aneesa Das, M.D., professor of internal medicine, Ohio State University Wexner Medical Center, Columbus; Joseph M. Dzierzewski, Ph.D., vice
president, research and scientific affairs, National Sleep Foundation, Washington, D.C.; Matthew Ebben, Ph.D., sleep specialist and associate professor of psychology in clinical neurology, Weill
Cornell Medicine, New York City; Janet Kennedy, Ph.D., psychologist and sleep specialist, New York City; James McGuirk, M.D., assistant professor of neurology, sleep division, Vanderbilt
University Medical Center, Nashville, TN; Ann Romaker, M.D., director, Sleep Medicine Center, University of Cincinnati College of Medicine, OH; James A. Rowley, M.D., professor of pulmonary,
critical care and sleep medicine, Wayne State University School of Medicine, Detroit; Wendy Troxel, Ph.D., clinical psychologist and senior behavioral and social scientist, RAND Corporation, Santa
Monica, CA.
REMEDY HEALTH MEDIA: Julia Savacool, editorial director, HealthCentral.com; Linda Roman, editor; Hallie Einhorn, copy editor; Bev Lucas, fact-checker; Douglas+Voss, designers.
HealthCentral Guides are free publications distributed in U.S. doctors’ offices. The information herein should not be construed as medical advice or advice on individual health matters, which should
be obtained directly from a healthcare professional. The publisher of HealthCentral Guides is not responsible for advertising claims. HealthCentral Guides are published by Remedy Health Media,
2111 Wilson Blvd., Suite 330, Arlington, VA 22201. remedyhealthmedia.com. Copyright © 2023 Remedy Health Media. All rights reserved. The content in HealthCentral Guides is produced by editorially
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16 HealthCentral Guide
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