Lawrence Epstein's Advice On Treating Insomnia And Staying Asleep

Lawrence Epstein, MD, is the regional medical director for the Harvard-affiliated Sleep HealthCenters, an instructor at Harvard Medical School, and past president of the American Academy of Sleep Medicine. He is coauthor of The Harvard Medical School Guide to a Good Night's Sleep.

Q: When I have trouble sleeping, I depend on coffee to get through my morning. Will that make it harder to fall asleep the next night, too?

A: Coffee can make insomnia worse. You've got to remember that the effect of caffeine can be long-lasting. The half-life of caffeine is four to seven hours, so it will be in your system for longer than you think, affecting your behavior, your alertness, and your ability to fall asleep. Some people drink caffeine in the afternoon when they feel tired, but it becomes hard to fall asleep at night, which perpetuates the problem. I recommend avoiding all caffeine after noon.

More from Health.com

• The 11 Kinds of Insomnia
• Staying Calm and Getting Back to Sleep
• Insomnia and Pain: How to Treat the Vicious Cycle
• Insomnia's Emotional Toll

Q: Some nights it takes me an hour or two of tossing and turning to fall asleep. When--and how--should I seek medical help?

A: Almost everyone will have an occasional problem sleeping, but you can usually directly relate that to a cause, like a fight with your significant other, work trouble, jet lag from multiple-time-zone travel, etc. These problems can often resolve themselves in a few days.

But if you have trouble sleeping for more than a month even after those issues have been resolved, you may want to see a doctor. Additionally, if you're having symptoms suggestive of a sleep disorder--such as gasping or snoring, frequent kicking or movement at night, disruptive sensations in the legs or arms, or difficulty getting to sleep when you used to be a good sleeper--make an appointment with a physician. Your primary care doctor may refer you to a specialist trained in sleep medicine.

Q: Recently, I've been waking every night to use the bathroom between 2 a.m. and 4 a.m. Why could this be?

A: First, you should try to figure out if you're waking up because you have to go to the bathroom, or if you're waking up for another reason and then deciding to go while you're up. If you're waking up with the urge to urinate, look at your fluid intake and cut down on the amount you drink in the evening. If that doesn't help, see a doctor to rule out a bladder or prostate problem; it may not even be a sleep problem.

If you aren't being awakened by the urge, aging could be the culprit. Your sleep need doesn't change over the course of your lifetime, but your sleep habits do. You wake more as you get older, and your sleep becomes less continuous, so you may need more time in bed to get the same amount of sleep. Most people start to notice a change in their 40s and 50s or during menopause. Waking once or twice at night as you get older is very common and doesn't indicate a problem.

Comments

[roseau]

02:39 PM on 07/20/2010

Wow, this is great info for a middle aged man who has never had sleep issues and is...an idiot.

[ddanimal]

12:32 PM on 07/20/2010

What a USELESS article.

[Conk]

10:21 AM on 07/20/2010

Where is the useful advice?

[Jackandcoke]

11:59 PM on 07/17/2010

Can't argue with the suggestion of exercise. It's necesary for restful sleep. Can be as simple as a walk around the block, to 4 minutes of deep breathing exercise 30 min before bed. Shouldn't complicate matters by putting toxins in to assist. May not wake up one day becasue of it.

[Jonathan Robert]

06:53 PM on 07/17/2010

There are herbal treatments. Valerian and Passion Flower. In addition Calcium.

One must also have adequate exercise.

http://green-cures.blogspot.com/

[dartagnan]

09:36 PM on 07/17/2010

I love natural remedies. There's only one thing wrong with them: They don't work.

I have tried melatonin, valerian, passionflower, every kind of herb and "natural sleep aid" known. I still wake up after three or four hours' sleep and can't get back to sleep again.

One thing that does work: Ambien.

[Jackandcoke]

11:54 PM on 07/17/2010

The reason it works is because it's poison.

[Jonathan Robert]

11:08 AM on 07/20/2010

Any sort of RX is going to be more effective short term. But they have side effects and do not address the underlying problem. Of course not everyone is likely to have the same success with Valerian, chamomile or any other. But they, as well as exercise and proper sleep adjustment scheduling should be attempted before any Rx as the downside of prescription meds goes far beyond the simple addictive quality and extends into overall immune health.
Of course, if you simply cannot sleep, and there are some who cannot but in micro bursts, then in that instance, the downsides do not outweigh. But in most I would suggest attempting all and every holistic attempt.

[Benjo333]

03:15 PM on 07/17/2010

This really is a poor excuse for an article on this topic...there is no real information of value here.

[dartagnan]

09:37 PM on 07/17/2010

Ditto.

[Benjo333]

03:14 PM on 07/17/2010

I love that...waking in your 40s and 50 it is normal an isnt a problem. "You may need more time in bed". Shall I tell that to my boss in the am? Seriously.

What percent of people do you know are using over the counter and prescription sleep meds at this point? I suspect more of us are managing rest than we'd care to know.