Q: Doc, I'm not sleeping. What do I do? A: When I see someone for insomnia, the first thing I ask him or her to do is eliminate six common...

Share story

Q: Doc, I’m not sleeping. What do I do?

A: When I see someone for insomnia, the first thing I ask him or her to do is eliminate six common triggers:

1. Alcohol. It disrupts the quality and length of sleep, especially during the second half of the night.

2. Caffeine. Even one cup of coffee in the morning can affect sensitive people.

3. Smoking. Ideally, no tobacco is best, but at the very least, don’t smoke at night.

4. Reading or watching TV in bed. Bed is best used for only sleep and sex.

5. Lying in bed awake for more than 20 minutes. If you are having trouble falling asleep, get up and do something relaxing until you feel tired again. Don’t do things that may be stimulating, like watching TV or paying bills.

6. Avoid naps, and get up at the same time every day, regardless of how much sleep you got the night before. Keeping a regular sleep schedule helps bring your sleep cycle back into balance.

Sleep strategies

The next step is to talk to your doctor about any health problems affecting your sleep. Sleeping will be a challenge, for example, if you haven’t addressed your nocturnal hot flashes or back pain.

The herb valerian may also help with insomnia — but only when used consistently. In one German trial, valerian improved sleep quality for people who took it every night before bed for two weeks. It didn’t work for people who took it only once.

In my opinion, mind-body techniques — like progressive relaxation, biofeedback, guided imagery and cognitive behavioral therapy — are underutilized, powerful remedies for insomnia.

For instance, a large peer-reviewed report summarized the results of 59 smaller studies that found that mind-body therapies helped people get to sleep faster, and sleep longer than prescription medications, after about six months. Given the fact that most people suffer with insomnia for years, and that prescription medications can lose efficacy over time, mind-body techniques may be the best long-term option for insomnia.

You can also join a meditation class, or go to a counselor who is trained in cognitive behavioral therapy.

I usually keep prescription sedatives as a last resort, because they can cause daytime sleepiness and memory problems. However, in certain situations, they may be the best option. For further information, check out the American Insomnia Association at www.americaninsomniaassociation.org.

Dr. Pujari is a Seattle M.D. with an additional degree as a medical herbalist; she practices at the Pujari Center and teaches as part of the residency programs at Virginia Mason and Swedish Providence hospitals. Her column is a weekly feature in Sunday Northwest Life. Send questions to apujari@seattletimes.com for possible use in future columns.