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I'm amazed - and worried - that so many of you can't sleep. I was hosting WYFP last weekend when someone came in and talked about their problem with insomnia, asking me if I could help. I promised to write a diary about insomnia this week ... and it was like a teacher asking the class to raise their hands if they want more recess. At least ten more Kossacks were either asking for such a diary or offering their well-tried solutions for their own sleep problems.

All of my Nurse Kelley Sez diaries are interactive, but I particularly need your input on this one. Insomnia is no longer a problem for me. After making lots of major and minor changes in my life I now sleep undisturbed for eight hours almost every night. Some of those major changes included retirement, divorce, and moving to the side of a mountain, none of which I would recommend you try just to get some sleep. I'll tell you what I know as a professional as well as what helped me overcome my own sleep problems, but then I need to know what's worked for you.

Insomnia is defined as the inability to obtain an adequate amount or quality of sleep. While insomnia can be a diagnosis ( primary insomnia ), it is most often a symptom of another clinical disorder ( secondary insomnia ). Some of the triggers of insomnia are anxiety, pain, depression, grief, alcoholism, and drug use, including many prescription drugs.

There are three types of insomnia.  Initial insomnia is difficulty in falling asleep. Intermittent or maintenance insomnia is difficulty in staying asleep because of frequent or prolonged waking. Terminal insomnia is early morning or premature awakening.

Sleep apnea, please note, is considered a separate type of sleep disorder and needs to be assessed by a sleep expert. If you have - or are reported to have - loud snoring, frequent awakenings, excessive daytime sleepiness, insomnia, morning headaches, intellectual deterioration, irritability or other personality changes, and physiologic changes such as hypertension and cardiac arrhythmias, get yourself assessed for sleep apnea as soon as possible. It is nothing to mess around with. Prolonged sleep apnea can cause a sharp rise in your blood pressure and may also lead to cardiac arrest. Over time, apneic episodes can also cause cardiac arrhythmias, pulmonary hypertension, and subsequent left-sided heart failure.

While insomnia is frequently treated (some would say over-treated) with sleeping pills, such medications have their own drawbacks. In fact, while many of them will make you sleep, the quality of your sleep may be less than stellar. You might not want to hear this, but treating insomnia usually requires a lot of work on your part, a good bit of trial and error, and modifications to your lifestyle. Medications can help break the cycle of insomnia, but they are seldom a long-term solution.

Professionals who treat sleep disorders usually begin with a sleep history. I suggest you do your own sleep history and examine it for clues. What is your usual sleeping pattern? Specifically, sleeping and waking times; hours of undisturbed sleep; quality of sleep (e.g., effect on energy level for daily functioning); and time and duration of naps. What bedtime rituals (reading, positioning aids, etc.) help you fall asleep? What medications do you take? What is your current sleep environment? Have you had recent changes in sleep patterns, or difficulties in sleeping?

If your answer to the last question is "yes", keep digging. What do you think might be causing the problem? Do you have a medical condition that could be causing you to have insomnia? Have you recently begun taking medication(s) that might alter your sleeping pattern? Are you experiencing any stressful or upsetting events or conflicts that may be affecting your sleep? Engage in introspection! You are your own expert about what's going on with yourself.

Sleeping Environment

Nurses know secrets about sleeping. We learn the basics in nursing school, but our advanced training comes when we do shift work. We learn to avoid stimulants for up to six hours before we have to sleep. We learn to keep our bedrooms dark: blackout curtains and no lights at all (including all those red and green lights from alarm clocks, computers, security systems, TV's, etc.) We learn to protect our sleep from noise by wearing earplugs and having a buffering sound, like a fan or a humidifier. This is an important tip for those of you who have intermittent insomnia. We learn the best temperature for sleeping, and we find ways to keep our bedrooms at that temperature. Our beds are our nests, feathered with whatever mattress, linens, pillows, and positioning aids best help us sleep. If your partner or children or pets share your bed, and if they interfere with your sleep, you have some decisions to make, don't you?

Sleep Aids

If pain is keeping you awake - or if it wakes you up before it's time - insomnia is your secondary problem. Get the pain treated effectively. If anxiety is keeping you from falling asleep, treat the anxiety. You may benefit from meditation, advanced relaxation techniques, herbal remedies, counseling, or the smallest possible dose of a muscle relaxant taken several hours before bedtime. If you usually sleep just fine but find you can't sleep on those nights you most need to get your rest, you have a form of sleep anxiety and may benefit from herbal remedies, OTC products containing diphenhydramine hydrochloride (the active ingredient in Benadryl) or something prescribed by your MD, NP, or PA.

Lifestyle Hygiene

If you're carrying around an extra fifty pounds or more, particularly in your neck and/or belly, don't be surprised if the quality of your sleep has deteriorated. Lose some weight. If insomnia has you taking a nice, long nap during the day, stop napping until you're back on track. If you drink alcohol every day and you're experiencing some form of insomnia, quit drinking. See if that helps. If you or someone in your household thinks bedtime is a good time to pick a fight, rethink your priorities. Bedtime is a good time to have experienced harmony, relaxation, a light snack and perhaps some nice sex in the preceding hour. Bedtime is NOT the time to engage in a flame war on your favorite blogging site. Shut down your computer and your smart phone at least an hour before bedtime. If you like to read before you sleep, make it something boring. Turn off your phone. Write in a gratitude journal.

If lights out is the time you start obsessing about thinking about your problems, ask yourself this question as you list each one: Is there anything I can do about it right this minute? If the answer is "no" - and it is almost always "no" - hand that problem over to the universe for the night. Learn to disengage, particularly from that chattering nag in your brain, and you'll sleep sooner, better, and longer. If, instead of problems, you lie in the dark and beat yourself up because of your perceived failings as a child/parent/partner/employee/fill-in-the-blank, I encourage you to learn how to love yourself, at least a little. We're all flawed human beings. If you don't believe me, go to any bookstore and count the shelves of self-help books.

If you can't or won't exercise for any other reason, do it to improve your sleep. Nurse Kelley isn't suggesting you train for a marathon; take a walk every day. Not only will your sleep improve, it will do positive things for your health and your mood.

Herbal Remedies

This is not my area of expertise. Fortunately for all of us, our own mayrose knows more about this subject than anyone else I know, and she has kindly agreed to be around when I post this diary. Thank you, my friend!

A Special Note About Grief

Grief has a universal impact on our sleep cycle. Some of us get insomnia; some of us sleep too much; some of us have disturbing dreams. If you are experiencing insomnia because of a loss - a loved one, a pet, a job, your health - please accept my condolences and my hope that you will use this time to take very good care of yourself. Any major loss creates stress that is detrimental to your immune system, with the effects often seen in roughly six months in the form of illness. Whenever you can, force yourself to eat right and take those walks I mentioned. Write about your grief. Talk about your grief. Seek medical attention if you need it.

Now It's Your Turn

As many of you know, some of the best information in my diaries can be found in the comments. Please join me as we discuss our problems getting enough sleep. Talk to Nurse Kelley!

Originally posted to Nurse Kelley's Blog on Fri Dec 18, 2009 at 03:44 PM PST.

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