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Top 10 Sleep Problems
By Cleveland Clinic Wellness Editors 
Published 7/6/2011 
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Two-thirds of American adults have difficulty sleeping. So we asked Michelle Drerup, PsyD, a psychologist and sleep specialist at the Cleveland Clinic’s Sleep Disorders Center, to help solve some common sleep problems.

PROBLEM: I can’t stop napping
My sleep at night is terrible, so I find myself falling asleep most afternoons, which I’ll bet just makes my nights worse. But I can’t seem to break the cycle.

SOLUTION: Sounds like a chicken-and-egg problem: Did the naps cause the nighttime insomnia, or did the nighttime insomnia cause the daytime napping? Either way, I can understand why it’s difficult to cut out those naps. When you’re tired during the day and worried that the evening will bring on insomnia, you want to get some sleep when you know you can. And for you, it’s during the day. But you’re right that those naps are just hurting your chances of sleeping at night. Instead of going cold turkey on naps, try shortening them by 15 minutes each day until you get down to zero. See how that affects your ability to sleep at night. If you’re napping in places other than your bed, avoiding daytime naps will also help strengthen the important association between bed and sleep. Taking a nap on the couch in the living room, for example, weakens this connection and likely makes it more difficult to fall asleep in bed that night.

PROBLEM: My thoughts keep my awake
I’ve been pretty stressed lately. At night, when I go to bed, all I can think about is what I didn’t get done that day and how busy the next day will be. Eventually I fall asleep, but it takes a long time, and I don’t feel like my sleep is restful.

SOLUTION: You may not be surprised to learn that stress, anxiety and depression are thought to be present in at least 50 percent of all cases of insomnia. But that doesn’t mean you have to grimace and bear it. On the contrary, if you want to improve your sleep, you’re going to have to learn how to manage your stress. Managing stress is all about taking charge — of your thoughts, your emotions, your environment and the way you deal with problems. To do so, try a few of these strategies:
• Know your limits and stick to them. Say no to added responsibilities when you don’t feel you have enough time or resources.
• Prioritize your to-do list. Separate the “shoulds” from the “musts” and drop tasks that aren’t truly necessary to the bottom of the list.
• Set reasonable standards for yourself. Perfectionism is a big source of avoidable stress.

PROBLEM: Will more drugs help me sleep?
I’m so sleepy during the day, I don’t know what to do. I’ve been taking melatonin before bed for a while now, and I’ve recently added valerian root. But, still, I need more sleep! Is Lunesta the answer?
SOLUTION: Medications for sleep have the advantage of providing same-night effects for treating insomnia. But there are disadvantages too. Melatonin is more likely to be helpful for milder problems with falling sleep. And valerian root, an herb with sedative qualities, has yet to be proven as an effective sleep aid.

I’m not a big fan of sleep medications in general, especially over-the-counter (OTC) ones, which often lead to daytime drowsiness, blurred vision, muddled thinking and dry mouth. Lunesta, which is part of a class of drugs known as benzodiazepine receptor agonists (BZRAs), is a better option, but it’s not a great solution. Because it can lose its effectiveness after several weeks, most patients should use it only for the short term. Plus, many patients taking BZRAs complain that their sleep isn’t deep.

Rather than rely on drugs, you may want to try CBT-I (cognitive behavioral therapy for insomnia), which helps you change the thoughts and behaviors that interfere with your ability to get restful sleep.

PROBLEM: Does lack of sleep affect weight loss?
I notice that when I don’t sleep, I don’t lose weight. Is it that the lack of sleep leads to exhaustion, which means I work out less hard at the gym? Or is there another connection between weight loss and sleep?

SOLUTION: You’re very perceptive! While it may be true that your feelings of exhaustion impact your workout, another part of the story is that there is a direct link between lack of sleep and appetite. Scientists have found that sleep deprivation impacts hormones that are involved in appetite regulation. The effects on these hormones may lead to overeating and weight gain.

University of Chicago researchers found that sleep restriction leads to a dramatic increase in appetite. And not any food will do, apparently. Study participants who were deprived of sleep reported increased cravings for more calorie-dense, carbohydrate-rich foods, such as cake, ice cream, pasta and bread.

PROBLEM: Why don’t sleep aids make me feel rested?
Whenever I take a sleep aid, whether it’s Tylenol PM or Benadryl, it helps me sleep, but I don’t feel well rested the next day. Why doesn’t it feel the same as getting a good night’s sleep naturally?

SOLUTION: The medications you’re relying on to help you sleep contain antihistamines, which make you feel drowsy the next day. Besides daytime sleepiness, you may also experience blurred vision, muddled thinking and dry mouth. Another problem is that they often lose their effectiveness after a few days.

If your sleep problems persist, I recommend you try CBT-I (cognitive behavioral therapy for insomnia). This type of therapy helps you change the thoughts and behaviors that interfere with your ability to get restful sleep. Numerous research studies have found that CBT-I improves sleep in 75 to 80 percent of insomnia patients — and that the results can last a long time.

PROBLEM: Why do I seem to need so much sleep?
How is it that some people can get just three to five hours of sleep per night and still manage to perform well at work? I don’t function well on less than seven hours!

SOLUTION: How much sleep each of us needs varies. Your personal sleep needs are most likely genetically determined. People who sleep six hours or less and function optimally are known as “short sleepers”; people who need nine hours or more are known as “long sleepers.” But short and long sleepers are a minority. And, despite how they may act or what they may say, most people sleeping less than six hours are likely sleep-deprived. Despite everything in our modern society that tends to keep us away from our beds, sleep is important. During sleep, a variety of processes take place that restore our bodies and minds. When you don’t sleep enough — according to your personal sleep needs — your body doesn’t get a chance to recharge, both physically and mentally.

PROBLEM: How can I fall back asleep?
Every night I wake up once to use the bathroom, but after I get back into bed, I can’t go back to sleep. I usually wake up between 3 and 4 a.m., and then I lie there, not sleeping, for hours sometimes. What can I do?

SOLUTION: For starters, try staying away from fluids one to two hours before bedtime, which should lesson your need to wake up to use the bathroom. Secondly, my guess is that because this has turned into a pattern for you, you now expect to stay awake after your middle-of-the-night bathroom trip. No doubt that’s making you feel pretty stressed, which just makes sleep harder to achieve. I recommend two things: 1) Get out of bed when you can’t sleep. Long periods of time in bed not sleeping tend to lead to tossing and turning, along with feelings of worry and frustration about not sleeping. If after about 15 or 20 minutes you’re still awake, get out of bed and go to another room and engage in a relaxing activity. Then return to bed. Repeat until you do fall asleep; 2) Don’t watch the clock. When people have difficulty falling asleep, they tend to watch the clock anxiously, which just makes things worse. Try this: Set your alarm and then put the clock somewhere in the bedroom where it can be heard but not seen.

PROBLEM: Why can’t I sleep for more than four hours?
I sleep about four hours a night, then sit wide awake in bed. I’ve tried listening to music, watching TV and going online, but nothing helps make me tired again. What can I do?

SOLUTION: Have you tried getting out of bed when you can’t sleep? Staying in bed not sleeping — especially if you’re sitting up and reading or watching TV — tends to make people associate their bed with being awake, which is the opposite of what you want. If you’re awake for 15 or 20 minutes just lying there in bed, it’s time to go to another room. Engage in a relaxing activity, such as reading or doing some deep breathing, until you feel drowsy. Skip anything stimulating, such as cleaning or watching a late-night horror flick on TV. Then return to bed. Repeat as often as necessary until you do fall asleep.

PROBLEM: I’m pregnant and I can’t sleep!
I’ve been dealing with insomnia ever since my son was born. I think it started because I felt anxious about him during the night. But the insomnia won’t go away. Now that I’m pregnant again, it has gotten worse. I feel so exhausted, it makes me want to cry.

SOLUTION: I’m sorry you’re having such a difficult time. Unfortunately, many women continue to wake up easily and have trouble falling back to sleep well after their child sleeps consistently through the night. Plus, with so many physical and emotional changes happening throughout pregnancy, it’s no big shock that eight out of 10 women have insomnia and other sleep problems during pregnancy. Many pregnant women say it’s hard to sleep because they are uncomfortable, need to use the bathroom, have leg cramps, and are excited or anxious about their baby’s arrival. Besides consulting with your medical practitioner or ob/gyn, you may also want to seek out a cognitive behavioral therapist who can help you with your anxiety. Cognitive behavioral therapy for insomnia (CBT-I) helps people to think differently and challenge their worrisome thoughts, thereby reducing anxiety. Remember, too, that although insomnia may be frustrating, it is also very common during pregnancy.

PROBLEM: Why does Sunday night always equal so little sleep for me?
I always have the most trouble falling asleep on Sunday nights after the weekend, and then it really messes up the beginning of my work week. Is there anything I can do to avoid this problem?

SOLUTION: By the brief description of your sleep difficulty, I would venture to guess that the weekend is your time off and escape from the pressures of the work week. What may be happening is that on Sunday night you’re starting to psychologically prepare yourself for the long work week, and what you feel is some anticipation and dread. One helpful strategy is to write out your to-do list for the upcoming week in the early afternoon and then set it aside until Monday morning. Also, try to avoid any work-related activities at least a few hours before bedtime on Sundays. Ideally, you should try to do something relaxing in the evening, such as reading a book, taking the dog for a leisurely stroll or enjoying a family dinner.   

In addition, many people stay up later and sleep in on weekends. If you tend to sleep in on Sunday mornings, you may not be tired at your usual weekday sleep time. The best advice is to keep a consistent bedtime and wake-up time, even on the weekends.

If you need help sleeping, try GO! to Sleep, the online program developed by Dr. Drerup and her colleagues at Cleveland Clinic.

Go! to Sleep Program
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