We ask the experts to settle common questions we've all wondered about.
Question: If you are having problems sleeping, and don't want to rely on medication, is there a sure-fire way to nod off. It's often suggested you should try to count sheep or imagine a relaxing scene. Is there any evidence that these methods work?
Answer: In order to help understand and properly diagnose any sleep issue, there are some important questions that need to be answered, such as: What kind of sleep problem are you having? Are you having difficulty falling asleep, difficulty maintaining your sleep or early morning awakening? Is this a recent problem (i.e. in the past month) or a chronic problem, lasting six months or more? Furthermore, it is very important to be mindful of any medical problems and medication currently being taken because these factors could both play roles in sleep disruption.
Due to a multitude of variables, each individual case is examined independently. For example, if a patient is suffering from depressive or anxiety symptoms, they need to be given special attention. It is also important to exclude other sleep-related pathology such as sleep apnea (pauses in breathing during sleep), restless legs and leg kicking during the night.
If it is determined that insomnia is in fact the primary concern and sleep medication is not the preferred treatment, then there are other non-pharmacological options. Cognitive behavioural therapy has the best evidence as a treatment modality. This form of therapy involves breathing and relaxation exercises that utilize imagery (such as envisioning a relaxing scene) while controlling breathing and monitoring muscles. This helps in improving treatment outcomes in two ways: by decreasing the amount of time required to fall asleep and by reducing the number of times sleep is interrupted.
This therapy essentially helps take your mind off those thoughts that are keeping it active and preventing you from falling asleep. Being able to address any stress that may be contributing to the worries and thoughts during the night is an important aspect of a successful treatment.
You can try counting sheep. But, in terms of evidence-based medicine, there is no such data that support this approach. In fact, there is evidence that counting sheep may be counterproductive and results in more difficulty falling asleep. Some people end up placing too much cognitive attention on the act of counting sheep (some even concerned about the imagined sheep's size, colour and so on), which prevents them from relaxing (the original purpose of counting sheep). This, in turn, creates a heightened emotional response that stimulates the individual and increases their challenge of falling asleep.
Dr. Raed Hawa is a physician certified in psychiatry and sleep medicine at the Toronto Western Hospital.
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