Management of sleep problems.

Non pharmacological treatment of insomnia

1) Maintain regular hours for going to bed and waking up. Try to wake up at a fixed time every day, even if you find it difficult to fall asleep at a fixed time. Even though you feel sleepy, do not sleep again. Within a few days the time of sleep onset advances to an earlier time.
2) Avoid heavy meals closer to bed time. Early dinner is better, especially if it is heavy.
3) Avoid day time naps.
4) Engage in some physical exercises. Avoid doing it or any other vigorous physical activity during late evenings.
5) Avoid tea, coffee and tobacco at least 6 hours prior to bed time.
6) Avoid bright light before sleep time. It is better for the bedroom to be dimly lit and slightly cool to promote sleep.
7) Clean up your mind before going to sleep. Avoid pondering over issues while lying on the bed. If you suddenly remember something urgent or important, jot it on a piece of paper to look into it next morning.
8) Avoid gazing at the clock repeatedly if you are lying in the bed awake. It is better to sit up and do something that is dull, boring and non stimulating.
9) If you find it difficult to get sleep even after 15 to 20 minutes in bed, get up and sit down. Get something that is not very stimulating or interesting to read. Read it sitting on a chair beside the bed using a reading lamp or in dim light. If you feel sleepy after sometime again try to sleep. Repeat this till you sleep.
10) If you feel tensed up while in bed, engage in deep, slow, abdominal (diaphragmatic) breathing. Take slow deep breaths ensuring that your abdomen lifts up with each breath. Avoid laboring with your chest. When the breath is fully in and your abdomen is protuberant, start slow exhalation by slowing tucking in the abdomen. Repeating this for a few minutes will make you feel relaxed. Thinking some positive thoughts or soothing imagery during this deep breathing may be helpful to some.
11) Use the bed exclusively for sex and sleeping. Avoid reading on the bed even during daytime.
12) Keep away from the tendency to use alcohol as a hypnotic.
These measures can be tried by any one who has difficulty to get sleep. There is no risk involved with any of this.
Insomnia can be transient or continuous.
Transient insomnia is due to mental tension or some minor problems. Continuous insomnia may be due to medical or psychiatric disorders.
Depression, anxiety, psychosis, substance abuse etc are the psychiatric illnesses leading to insomnia.

Using drugs for the treatment of insomnia is not always advocated. First of all the medical and psychiatric disorders have to be ruled out. Next an agent with minimum chances of abuse has to be selected which does not cause daytime sleepiness. Unfortunately, not many drugs are available which satisfies the above criteria. Hence it is better to consult a doctor for choosing a drug and for appropriate instructions.