Can’t Sleep? Ask Yourself These Questions

You shut off the TV in your bedroom and close your eyes, hoping to drift off quickly. An hour later, you’re staring at the clock, starting to stress about how you’re going to be able to function at work tomorrow.

And this is the third night in a row this has happened. Why can’t you sleep?

We spoke to Linda Myerholtz, PhD, a clinical psychologist with UNC Family Medicine, about some strategies for getting to sleep and staying asleep without the aid of medication, which can help in the short term but can be habit-forming and cause unpleasant side effects in the long run. Getting better sleep starts with asking yourself some simple questions.

1. What is your sleep environment like?

Is your room cool, dark and quiet at bedtime? Have you done everything possible to transform it into a restful setting? If not, it could be affecting the quality of your sleep.

“As much as possible, someone who is having trouble sleeping should remove anything from their bedroom that is likely to wake them,” Dr. Myerholtz says. “This may include pets in the bed or even, in some cases, a partner. Easier said than done for some people, but this can really help improve sleep quality.”

Do you have a TV in your bedroom, or spend a few minutes before bed scrolling through social media on your phone? This might also be keeping you from getting to sleep as quickly as you might like. The light emitted from these devices tells your brain to stay awake.

2. What else do you use your bedroom for?

It’s also important to be mindful of what you’re using your bedroom for besides sleep. You may not realize it, but your brain is constantly building routines and associations that may help or hinder your ability to sleep.

“I always tell my patients that the bedroom is really for two things: sex and sleeping,” says Dr. Myerholtz. “Don’t watch TV or look at your phone in bed, because the kind of light these devices emit can interfere with the production of the hormone melatonin, which helps your brain regulate your sleep cycles. Reading in bed can be OK as long as you are not using a tablet, which emits the same kind of troublesome light as a TV or a phone.”

3. Do you exercise, smoke, or drink alcohol or coffee close to your bedtime?

Exercise can be great for deep and restful sleep, but not right before bed. Dr. Myerholtz recommends refraining from exercise for at least two hours before turning in.

Other, less healthy habits to avoid before bed: caffeine, nicotine and alcohol.

“Basic sleep hygiene—avoiding these kinds of things that might stimulate you before bed—is mostly straightforward, but that’s often why it doesn’t occur to people,” Dr. Myerholtz says. “Avoiding nicotine and caffeine for four to six hours before bed is important because those substances can stimulate the brain.”

And though the depressive effects of alcohol may make you feel sleepy, it’s not a great choice for someone already experiencing sleep issues.

“While alcohol can help some people fall asleep, it also interferes with the quality of the sleep. This means people wake up not feeling rested,” Dr. Myerholtz says.

4. Do you lie in bed worrying when you can’t fall asleep?

So you’ve made your room quiet and dark, skipped an afternoon cup of coffee and haven’t checked Facebook from your pillow. But even so, instead of drifting off, you stare at the clock, counting the minutes until you have to wake up for work and worrying about how you’ll be able to function if you don’t fall asleep. What now?

Give yourself about 20 minutes in bed (and don’t spend that time staring at the clock). If you haven’t fallen asleep, get out of bed, go to another room and do something boring, such as reading a book or magazine that’s not particularly interesting to you. When you start to feel sleepy, lie down and try to sleep again. If you’re still awake after another 20 minutes, get up and repeat the process.

“We don’t want a person lying awake and worrying, which is one of the prevailing causes of insomnia when things like the sleep environment have been addressed,” says Dr. Myerholtz. She says people who try this approach “are often up and out of bed a lot for the first few days. But the idea is to break the brain’s habit of thinking ‘I’m lying down, it’s time to worry’ and replace it with ‘I’m lying down, it’s time to sleep.’”

5. Are you willing to try a challenging but potentially effective approach?

If stimulus control doesn’t do the trick, Dr. Myerholtz suggests a tactic called sleep restriction, which isn’t easy but can work.

Over five days, track how many hours you sleep a night and find the average. Let’s say the average is five hours and you have to get up at 7 a.m. Counting back five hours from 7 a.m. gives us 2 a.m., which is your new bedtime for the time being—no napping and no going to bed early (sorry). Once again, you’ll need to keep track of how many hours you sleep. If after a week your sleep efficiency has improved, you can go to bed 15 minutes earlier. (Sleep efficiency is how much of the time you spend in bed sleeping; the longer it takes you to fall asleep and the more often you wake up throughout the night, the lower your sleep efficiency.)

“The idea is to get the body tired enough that it will get to a deeper level of sleep and reduce some of the tossing and turning that might be interfering with sleep,” Dr. Myerholtz says. “But sleep restriction is tough. For those who try it, it works really well, but they’re probably going to be exhausted and miserable for at least a week.”

If you’re going to try a sleep restriction regimen, Dr. Myerholtz recommends letting your family and co-workers know ahead of time that your mood and concentration might suffer, and you could be a bit grumpier than usual.

6. Have you brought sleeplessness up with your doctor?

If you have persistent problems sleeping and you’ve addressed the environmental and behavioral factors that might be causing difficulties, it may be time to talk to your doctor about your insomnia.

Chronic insomnia may have a number of underlying causes, including anxiety, depression, asthma and chronic pain. If your insomnia is secondary to another condition, treating that condition may help alleviate your sleep problems.

Your doctor may also prescribe a non-habit-forming sleep aid to help you get back into a healthy sleep routine, or refer you to a sleep specialist.

The most important thing is to find a way to get not just the quantity of sleep you need, but also good quality sleep, Dr. Myerholtz says.

“Some people may never get to a point where they are sleeping eight hours a night, but if we can improve the quality of their sleep that’s a huge win.”

If these tips don’t work for you, talk to your doctor to see if a sleep study is right for you. Learn more about sleep studies at the UNC Sleep Disorders Center in Chapel Hill or at REX Sleep Disorders Centers in Wake County.