Dear Alice,

I have been having a really hard time sleeping at night. I do my best to stay on a regular schedule as best as I can and steer clear of caffeine, but nothing seems to be working. I have considered taking sleeping pills, but haven't for fear of becoming dependent on them for sleep at all times. Do you know how addictive they really are or if there are any other methods I could try? Thanks so much.

Dear Reader,

Sleeping pills can help people sleep better; some feel more alert in the morning, others feel groggy; but (as you suspected), they are not for everyone. Sleeping pills are a temporary, short-term solution to sleep problems. When taken for more than a couple of weeks, they lose their effectiveness and can create dependency. Although research suggests that people with insomnia don't usually become sleeping pill "addicts," the use of sleeping pills over long periods of time, or in higher doses than recommended, can cause "rebound insomnia" — insomnia that returns when you stop taking the meds. As a result, it takes additional medication for people to sleep, and they tend to up their dose. For this reason, and because drugs have potential side effects, experts recommend behavioral approaches, including the ones outlined below, as a first step in treating insomnia.

Any time you're considering a new medication, it's a good idea to consult with your health care provider. In this case, your primary care provider may decide you should see a sleep specialist who can prescribe sleeping pills in a way that will help avoid dependence. If you're a student at Columbia, start by making an appointment with your primary care provider through Open Communicator or by calling x4-2284.

Insomnia (difficulty falling and/or staying asleep, or waking up too early) is usually the symptom of an underlying issue, rather than the problem itself. Some possible causes of insomnia include:

  • stress, anxiety, or depression
  • underlying disease or chronic pain
  • medications, including antihistamines, decongestants, antihypertensives, beta blockers, hormones (similar to those used in birth control pills or to treat thyroid disease), and some asthma or pain medicines
  • drugs, including caffeine, nicotine, and alcohol
  • fluctuations in hormone levels — women report insomnia during pregnancy and menopause, and before and during menstruation
  • sleep disorders, such as sleep apnea (where people have many periods of interrupted breathing as they sleep)

If you think your insomnia could be caused by a physical or mental health problem, or medications, then it's time to involve a medical professional to see if you and s/he can identify some solutions or alternative treatments.

Insomnia can also be caused by poor sleeping habits (a.k.a. sleep hygiene). For many people, bed has become a multi-purpose recreation area. People read horror novels, do homework, gorge on ice cream or take-out food, have heated political debates or hot pillow talk, all while snuggled deep beneath the covers. It's no wonder then that, for some folks, going to bed makes their bodies think slumber PARTY rather than slumber.

Remember, it's a BED-room. If you limit your in-bed activities to sleep and sex, your brain will get the message (and the lack of cookie crumbs between the sheets might improve your sex life, to boot). To re-train your body to think that going to bed means going to sleep, you can try some of the following suggestions:

Wait 'til you're yawning
Don't get into bed until you feel tired. Give yourself fifteen minutes to start snoozing. If you haven't fallen asleep by then, get up and do some other relaxing activity — read a book, have a cup of herbal tea (chamomile, catnip, lemon balm, valerian root, and lavender are good for rest and relaxation). Drinking warm or hot milk 15 minutes before snuggling under the covers may work nicely. Then, when you feel as though you're starting to nod off, go back to bed.
Nix the naps
An afternoon siesta can make it harder to get a full forty winks at night. If you just can't keep your eyes open during the day, limit yourself to a quick nap (less than an hour) before mid-afternoon.

Avoid over-stimulation
Avoid caffeine, nicotine, alcohol, lively conversation, and/or the internet and TV in the hour(s) before bedtime. Large or spicy meals before pre-slumber can also keep you up all night counting anchovy pizzas jumping over fences.

For additional tips, resources, and tools to help you get better sleep, visit Columbia University's A!sleep site. If you feel like you're making an effort at good sleep hygiene, but still not able to sleep, it may be time to consider making an appointment with your health care provider. Best of luck getting your Zzzzzs,


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