When counting sheep does not bring sleep, many women are turning to sleep meds. Results from the National Health and Nutrition Examination Survey from 2005 to 2010 indicated that 4.1 per cent of respondents 20 and older said they had used a prescription sleep aid in the previous 30 days, according to a data brief from the Centers for Disease Control's National Center for Health Statistics.
That report is U.S.-based, but in Canada lack of sleep is also a growing concern. Studies have shown that sleep disorders affect up to 30 per cent of Canadians, and more than half of them are women. As women who have trouble falling asleep, some of us can trace the problem back to the days when we woke up to care for infants and toddlers. Still others are sure that the stress of juggling work and family is responsible for a lack of sleep drive or finding ourselves suddenly awake at 3 a.m.
When calming tea and meditation don't work, many women plead with their doctors for prescription sleep aids. But there is another solution that's worth looking into. It's called cognitive behavioural therapy or CBT and it's all about changing your attitude and sleep behaviour so that you can reset your body clock for natural sleep.
I asked Dr. Colleen Carney, director of the Sleep and Depression Lab at Ryerson University in Toronto and an expert in CBT and sleep disorders, of her view on insomnia and its causes. She strongly believes that insomnia is often a "clock problem." "Many people can't keep a schedule that suits their body or they don't try to keep a schedule at all," she said.
She surprised me when she said that sleep schedules are not just for kids. "We have a clock in our body and that clock needs input from our behaviour to keep setting itself. If we continuously change things around, we get increased fatigue, sleep problems and mood difficulties." Adults experience the same problems as kids when they have variable sleep schedules: We're cranky, lack focus, and can experience jet-lag-type symptoms.
A lot of insomniacs toss and turn the whole night through, but the message that is sending to your mind is that bed equals wakefulness: She calls it "conditioned arousal." To cure yourself of this, if you don't fall asleep after 30 minutes, get out of bed, do something mindless and return to bed only when you are sleepy. This may seem like common sleep-hygiene advice. But it can be very powerful if you stick to it because by getting back in bed only when you are sleepy, you, like Pavlov's dog famously salivating at the sound of a food-promising-bell, will associate bed with sleep. Eventually.
Dr. Carney's view is that an increasing number of people today are tired but wired. Take the time to unwind, she says: Never do wakeful activities in your bed, such as talking on the phone, texting, reading, watching TV or checking your email. (This is classic conditioning, alright. And good advice. But I tried to go cold turkey and found I couldn't. However, on those few nights that I forced myself, I slept easily and well.)
Anyone wanting to sleep better without resorting to pills should probably try CBT, but not a lot of psychologists or counsellors currently offer it because this area of sleep disorders research is relatively new. But in her new book Goodnight Mind, Dr. Carney, along with co-author Rachel Manber, shows desperate non-sleepers a version of CBT that's designed to help turn off a noisy mind.
The book takes work, so it's not as easy as popping a pill. It begins by getting readers to keep a sleep diary in order to determine their how much sleep they really need. Once that need is calculated (say seven hours) you learn how to set up a sleep schedule to match your body clock.
You must maintain that schedule every day, says Dr. Carney. Even if you don't fall asleep until 2 a.m., get up at the time you agreed to rise -- even if that's six. No napping the next day, and as tired as you are, try to stay up until the bedtime you had set for yourself in your schedule. The idea is that your sleep clock will eventually kick in: As crazy as it sounds, sometimes the best cure for not sleeping is insomnia.
Goodnight Mind instructs readers to challenge the idea that being awake at night is a complete catastrophe, and it advises us to counteract any worry by focusing on the present moment. Take sleep loss in stride and begin to think like a good sleeper: Avoid thoughts that create performance anxiety, the I-must-sleep-now-and-what-if-I-can't-fall-asleep panic that sets in.
I like Dr. Carney's version of sleep therapy, and it's worth trying if you're one of the millions of insomniacs who, according to the CDC study, are turning to sleeping pills. "Sleep is like falling in love," she told me. "You can't force it. All you can do is set the stage for it and get out of the way."