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Help: I wake up multiple times a night Add to ...

The question

I am a healthy, active 30-year-old woman. I have not slept through the night in over a year - I always wake up two or three times a night, restless and annoyed and unable to get back to sleep. Do you have tips/mental strategies for falling back to sleep easily? And what can I do to treat this? (I'd prefer not to take sleeping pills).

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The answer

Chronic sleep problems are very common and impact up to one-third of the population at any point in time. A much higher percentage of people will experience more short-term/transient sleep problems (often tied to particular events that are happening in their life, that resolve when those stressors resolve). The good news is there are very effective cognitive and behavioural strategies that can dramatically improve sleep length and quality.

"Insomnia" is a broad term and can include trouble falling asleep, trouble staying asleep and/or early-morning awakening.

There are a number of "usual suspects" that reliably and predictably impact our sleep:

  • Stressors (e.g., related to intimate relationships, finances, work, family, friends) - and the associated worries that come along with them
  • Untreated physical health problems (e.g., anaemia and thyroid dysfunction are two common culprits), sleep disorders (e.g., sleep apnea) or medications that disrupt the sleep cycle
  • Poor diet/health behaviours (e.g., high levels of caffeine, excessive alcohol consumption, smoking)
  • Behaviours that are not conducive to sleep (e.g., not exercising at all; exercising or eating too close to bedtime; sporadic sleep and wake times; doing activities that require you to be alert in bed, such as working, watching TV, reading)

You indicate you are healthy and active, which is great (as regular exercise will help improve the quality of sleep). But if you have not had a physical over the last year, I would encourage you to see your family doctor to ensure there is no other medical contribution (anaemia is a very common cause of sleep disruption for women in their menstruating years).

If you are taking any prescription medications you may also inquire about whether they have any impact on sleep cycle/quality.

Assuming there are no physical causes to your sleep problems, I would do an inventory of current stressors in your life. Worries and anxieties are a huge cause of sleep disruption.

Identifying the stressors and taking an active, problem-solving approach to target those stressors would be important. It sounds counter-intuitive, but setting some dedicated "worry time" an hour or more before sleep can be helpful. Set aside 15-20 minutes to sit somewhere quiet (not your bedroom) and spend time thinking about and writing down all the worries that are on your mind that day.

Ask yourself "what can I do about this right now"; if there is action to take, take it…usually though there is no immediate action that can be taken, and scheduling a time to deal with the problem can help get it out of your mind temporarily.

Engaging in good sleep hygiene behaviours is important (sleep hygiene - like dental hygiene - refers to behaviours that promote good sleep and prevent later sleep problems).

Finally, I am glad to hear you say that you are reluctant to take sleeping medications - although they can help with sleep for the short-term, sleep medications are habit-forming, they do not address the core issues that are contributing to sleep problems, and prescribing guidelines only recommend their usage for short, time-limited periods (usually 7-10 days only).

The Canadian Sleep Society has some excellent, publically available brochures on sleep. You can also find information on a range of sleep disorders and stages of sleep at www.sleepdex.org.

Send psychologist Joti Samra your questions at psychologist@globeandmail.com. She will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail web site. Your name will not be published if your question is chosen.

Read more Q&As from Dr. Samra.

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The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.

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