Dr Jay Seitz

General considerations

Excessive anxiety, being upset and tense, and having difficulty relaxing, as well as apprehensiveness about the future all interfere with restful sleep.

Rx: What are some of the treatments for insomnia?  Relaxation and stress-reduction are very effective but part of the solution depends on whether you are having trouble initiating sleep or staying asleep.

Of the former, limit caffeine and alcohol consumption in the evenings.  Eat regular and healthy meals and take a multivitamin supplement once-a-day.  Set your alarm and put the clock underneath your bed to avoid nervousness caused by clock-watching.

Use soothing music to fall asleep to, if that is helpful (e.g., quiet piano solos).  A hot bath before sleep is also very effective (particularly, when followed by a loving massage).  So are regular and satisfying sexual unions.

For the latter, use a contoured pillow to avoid stress on neck and turn over your mattress to get even wear (or consider getting a more comfortable mattress).  Set room temperature to 75 degrees F or below and keep humidity down; higher temperatures tend to disturb sleep, particularly, REM sleep and stages 3 and 4 (see below).

Keep noise down during sleep: Women are more sensitive to noise and noise sensitivity increases with age.  Only use sleeping pills for emergencies as they depend to depress REM and thus interfere with the quality of sleep.  They also cause rebound insomnia.  In general, psychoactive drugs are not effective in the treatment of insomnia, at least, not on a long-term basis.

A specific plan

Get up at the same time every morning and get regular exercise 3x-a-week in the morning, preferably.  One approach, if you have trouble initiating sleep, is to begin by going to bed four hours before you plan to get up.  And increase that by one half-hour a night for every five days of sleep in which you slept for at least 90% of the evening, an index of your “sleep efficiency” or the percentage of time you actually slept.  Continue this procedure until you are getting a full night’s sleep.  Generally, this is 8 – 8 1/2 hours but some people need less and some more.

Biology of sleep and dreaming

There are five stages of sleep that have been revealed through the use of electroencephalograms (EEG), eye movement recordings, and recordings of muscle activity.  Neurons (nerve cells) in the brain generate electrochemical signals that routinely spread across the cortex or outer layers the brain and produce an electrical field that can be measured and that manifest regular rhythms or “brain waves.”  They are measured by EEG.  Here are the five stages of sleep:

These stages cycle through 90” periods.  The first four stages are called non-REM sleep (NREM).  Disorders such as sleeptalking or sleepwalking occur in stages three and four (i.e., not when you are dreaming).  Night terrors, which may occur in children 3 – 8 years of age and during the first two hours of sleep, turn up in stage four.  They are believed to be due to faulty maturation of brain stem and also due to psychosocial stress.  Nighmares occur in REM sleep when dreaming occurs.  Surprisingly, when sleeping we do monitor the outside environment.  For example, mothers are particularly responsive to their infant’s nighttime cries.  Insomniacs appear to be completely unable to shutout outside stimuli and may be partly the cause of their sleep problems.  In any event, sleep problems are very common.  In the US, about 50% of adults report problems in initiating or staying asleep.  You are not alone.

Some suggesting reading:

Hauri, P., & Linde, S. (1990). No more sleepless nights. NY: Wiley.

Meditation is a very effective technique for relieving psychosocial stress and has significant scientific support. Herbert Benson, M.D., at Harvard Medical School, has been promoting meditation for stress reduction since the early 1970s in his well-known book, The Relaxation Response. Here are some essential components of Dr. Benson’s relaxation response:

A quiet environment.

A comfortable position: You should start by closing your eyes and relaxing your muscles progressing from the feet to the head.  You should breathe slowly and naturally and use one of the mental devices below as you exhale.

A mental device: A sound, word, phrase or prayer repeatedly silently or aloud or with a fixed gaze on an object.

A passive attitude: Please do not worry about how well you are performing the technique and put aside distracting thoughts.

Practice the technique once or twice daily before breakfast and before dinner for 10-15 minutes.

You may also elicit the relaxation response while exercising.

Remember, there are two basic kinds of meditation. Either of these two are equally effective.

The path of concentration  (e.g., yoga, transcendental meditation, Sufism).  The mind focuses on specific external object.  For example, a mantra, a prayer, a picture, a candle flame, a spot in the lower abdomen, a bodily sensation, or a mandala.

The path of mindfulness (e.g., Krishamurti, Gurdjieff).  The mind observes itself.  For example, internal sensations, mental states, workings of the mind, breathing, position of the limbs, bodily states, or mood.

Hatha yoga as well as other forms of yoga are also effective for stress-reduction as is physical exercise and therapeutic massage. Hatha yoga involves, among other things, physical postures or asanas that are intended to promote physical well-being; improved flexibility, strength, and stamina; as well as encourage mental relaxation.  Hook-up with a yoga instructor in your neighborhood or purchase a yoga DVD.

Physical exercise: Vigorous physical activity has many important benefits.  Proper training (conditioning and technique), equipment, clothing, and footwear can reduce sports injuries.  Consider joining a health club or purchasing weights and equipment for home use.  A fitness instructor may be a good idea, initially, too.

Therapeutic massage: Therapeutic massage involves the manipulation of soft tissues of the body including skin, muscles, tendons, ligaments, and joints.  It reduces pain and psychosocial stress and may induce the relaxation response as well as reduce anxiety and depression.  It may also aid sleep and may have cardiovascular benefits.  Find a practitioner in your area.

Some suggested reading:

Benson, H. (1975).  The relaxation response. NY: HarperCollins.

Clinical neuropsychology evaluates and assesses higher cognitive abilities that may have been compromised by disease or trauma to the brain such as multiple sclerosis, stroke, epilepsy, dementia, traumatic brain injury due to a traumatic external event to the brain (e.g., slipping on pavement and hitting one’s head) and other internal and external events that affect brain function.

The rehabilitation and remediation of brain function may occur through surgery, the use of various drugs (such as cholinesterase inhibitors in Alzheimer’s disease), as well as through the use of neurocognitive rehabilitation.  Neurocognitive rehabilitation or training involves the use cognitive training programs, often computer-based, to rehabilitate cognitive functions like attention, memory, and similar intellective abilities in individuals who have compromised higher-order cognitive abilities.