Insomnia: Prevention

The following are suggestions to help anticipate and modify situations likely to be associated with insomnia. They are not foolproof, nor will they safeguard the patient from the consequences of sleep deprivation once it has occurred.

Insomnia from jet lag

* Behavioral and short-term drug therapy has been used.

* If you can anticipate a trip, begin to shift your bedtime to coincide with the time schedule in your destination.

* Short-acting tranquilizers (benzodiazepines) have been shown to be useful. Melatonin, a hormone secreted by the pineal gland that regulates our sleep-wake cycles, has also been used.

Insomnia from shift changes

* Behavioral therapy has been useful in modifying the insomnia and symptoms of sleep deprivation in shift workers.

* You should shift your schedules forward in a clockwise direction - from days to evening to night shift - and allow sufficient time to adapt (at least one week) between shift changes.

* Bright light is a potent stimulus to circadian rhythm. Bright light is being examined as a rhythm synchronizer.

* Shift workers should stress the importance of good sleep habits with regular bedtime and awakening.

o Supplemental naps may be necessary to ensure work time alertness.

o Discuss the use of naps with a doctor.

o Some people promote using short-acting sedatives in the first few days following a shift change, but not everyone agrees.

Insomnia from acute stresses

* Stress may be positive or negative, and concerns about sleep may vary. Many stressors will go away with support and reassurance.

* Education about the importance of good sleep habits is also helpful.

* Some people may need short-term treatment with medications. A doctor will often work toward the lowest effective dose with a short-acting sedative to achieve proper sleep.

General recommendations include the following:

* Work to improve your sleep habits.

o Learn to relax. Self-hypnosis, biofeedback and relaxation breathing are often helpful.

o Control your environment. Avoid light, noise, and excessive temperatures. Use the bed only to sleep and avoid using it for reading and watching TV. Sexual activity is an exception.

o Establish a bedtime routine. Fix wake time.

* Avoid large meals, excessive fluid intake, and strenuous exercise before bedtime and reduce the use of stimulants including caffeine and nicotine.

* If you do not fall asleep within 20-30 minutes, try a relaxing activity such as listening to soothing music or reading.

* Limit daytime naps to less than 15 minutes unless directed by your doctor.

o It is generally preferable to avoid naps whenever possible to help consolidate your night's sleep.

o There are certain sleep disorders, however, that will benefit from naps. Discuss this issue with your doctor.


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