Rational Approaches for Managing Insomnia

Sleep simply does not come naturally to some people. We’re all wired differently and our circadian rhythms are environmentally influenced. Those who travel frequently or do shift work often report difficulties with the sandman.

The use of sleep agents is quite common and is a boon to the pharmaceutical industry. And if taken responsibly, they are safe and effective. They are also not the first line of defense when it comes to managing insomnia.

I couldn’t begin to count the number of patients I’ve worked with who have alluded to sleep problems at some point in our sessions together. This got me thinking about what people are doing that could be making it more difficult for them to attain a good night’s rest.

The important first step to managing sleeplessness – particularly if it has become chronic – is to honestly confront yourself about why you may be having difficulty sleeping. Think medical first. Are you having trouble breathing? Are you in pain? How about sleep apnea or restless legs? These medical influences should be investigated before considering sleep aids. What about alcohol use just prior to bedtime? Are you taking decongestants within an hour of bedtime? Are worrisome thoughts causing you undue stress?
It’s interesting to me how we routinely prepare for the start of our day but not for its conclusion. Sleep induction is a process. At least 30 minutes before bedtime all unnecessary stimulation should cease. If your regularly scheduled bedtime is 11pm, then no later than 10:30 pm, off goes the TV, TiVo, cell phone, iPod and iPad. All medications should be taken at least one hour before bedtime to reduce the incidence of bathroom visits. The sleeping room should be as dark as possible. The thermostat should be set at a comfortable temperature. Are you reading something soothing, praying or meditating to help you relax? This is what it takes for appropriate sleep preparation. What’s your track record for doing these things? What I’ve listed here are common sense approaches often eschewed in favor of a sleeping pill.

If however, after providing due diligence to these recommendations, you’re still struggling and decide to try medication, think about what you want it do for you and for how long. The “how long” part is important because insomnia is often temporary. Consider taking sleep aids for 2-3 days at first and assess the results. An over-the-counter preparation such as melatonin or a low-dose


-type product can be a good place to start. You may find that after a brief medication trial, you’re then able to sleep again on your own. Chronic insomnia on the other hand, should be discussed with your doctor, with the two of you developing a comprehensive management plan that may need to consider what’s going on between the ears – if you get my drift.

Science has yet to crack the code as to why we need sleep, so it’s best to just accept that we do. When thought of as merely an option, medications can be a part of the insomnia solution; when used without a goal in mind or without a sense of purpose, they’ll eventually make matters worse.


Joe Wegmann is a licensed clinical social worker and a clinical pharmacist with over 30 years of experience in counseling and medication treatment of depression and anxiety. Joe’s new book, www.pesi.com. To learn more about Joe’s programs or to contribute a question for Joe to answer in a future article, visit his website at www.thepharmatherapist.com, or e-mail him at joe@thepharmatherapist.com.