Diane, on the other hand, was a wreck when she started waking up in the middle of the night five years ago. Dog-tired by day, "I was up almost every night, anxious and worried, my mind racing," says the 52-year-old who works at a charitable foundation. She would get upset simply because she was awake, which only perpetuated the insomnia. One night, looking for something productive to do, she turned on National Public Radio. "I forgot what I was worrying about, and eventually it lulled me back to sleep." Diane never considered getting medical help because she was concerned about becoming dependent on sleep medication. "I figured," she says, "that it was better to be addicted to NPR." She now refers to herself as a once-in-a-blue-moon insomniac.

Without intending to, she taught herself to relax at the sound of NPR. "I listen to the station all day," she says, "but if I turn it on in the middle of the night, I fall right back to sleep."

Joan, a clinical psychologist who just hit 50, also stumbled on a remedy. Between work and family, she often gets only six hours in bed; if a barking dog or a wobbly hormone jolts her out of a dream, she's in danger of serious sleep deprivation. She used to read literary novels during her bouts of insomnia, but they required too much effort, "so i just moved down the food chain," she says, until she got hooked on romance novels. She still doesn't get the optimal amount of rest, but she stopped feeling so frantic about it—and sometimes the books help her get back to sleep more quickly. Between that and the occasional sleep-in on a weekend morning, she's no longer exhausted the way she was when all she did at night was worry.

For the many insomniacs who need more than NPR or a good bodice ripper, the classic approach is behavioral modification. Experts prescribe an arsenal of lifestyle adjustments that help patients practice what's known as good sleep hygiene. One strategy is taking time during the day to write down everything that needs to get done, in order to prevent panicked list-making in the middle of the night. Another is to avoid stimulating conversation, books or television shows before bedtime. Bains also tells patients not to turn on the light or to look at the clock when insomnia strikes (light can trigger the brain's wake-up chemicals, and the time on the clock fosters anxiety as the patient calculates just how little sleep she's had).

If gentle modifications don't work, Bains and other sleep experts practice various forms of tough love. in the neurology department of New York City's New York-Presbyterian Hospital, Anne Remmes, MD, deprives a patient of sleep until she's so tired that her sleep drive overcomes her tendency to wake up. If a woman says she goes to bed at midnight and wakes up at 7 a.m. but gets only five hours of sleep because she's lying awake for two hours, Remmes has her stay up until 2 a.m. for three or four nights while keeping the alarm set for 7. The goal is to get the same five hours of sleep—without interruption. Once the woman can do that, Remmes lets her go to bed 15 minutes earlier. Three more nights of good sleep and Remmes gives her another 15 minutes, until the patient can sleep for seven hours straight, or until she feels rested the next day.


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