Trouble Falling Asleep? Remedying Sleep-Onset Insomnia

You might remember my previous blog post about nonrestorative sleep that addressed waking in the middle of the night and not being able to fall back asleep. We looked at the roles stress and blood sugar dysregulation play in causing a nighttime cortisol spike that produces a hyperarousal state, making it difficult to fall back asleep. This marks one type of disrupted sleep rhythm that culminates in nonrestorative sleep.

The other common deterrent to peaceful slumber is the inability to fall asleep, otherwise known as sleep-onset insomnia. This is a multifactorial problem, chock full of nuance, so realize there may be one or more causes that need to be addressed if you suffer from this type of insomnia.

Cultivating Circadian Rhythm

First on that list is perhaps the most overlooked aspect to remedying sleep onset-insomnia—rhythm. The human species thrives on rhythm and suffers under chaotic conditions, thus efforts in sleep hygiene are strategies best implemented when the body-mind is winding down. Like Pavlov’s dogs salivating at the ringing of a bell, we can leverage classic conditioning by maintaining a consistent bedtime and ritualized routine. 

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There is a popular phrase circulating among self-improvement circles that, “To win the day, win the morning.” It suggests that always getting up at the same time primes the body for a successful day by front-loading self-care before other factors (kids, work, etc.) exert their influence. Strict adherents of this philosophy refrain from turning on their cellphone until an exercise routine or meditation practice is complete. It’s a no-distraction policy to set the pace for the day.

Although that is a wise practice for the top performers among us, the adage should read, “To win the morning, win the evening before.” In other words, the ability to rise rested is predicated upon getting sufficient sleep, and that means getting to bed at a consistent time to clock in one’s ideal seven to eight hours of sleep.

Leveraging Sleep Hygiene

Sleep hygiene includes anything that helps the wind-down process while avoiding that which causes arousal. Hot baths and reading a novel around bedtime are good ideas; doom scrolling on a brightly lit cellphone screen or watching the nightly “if it bleeds, it leads” newscast are bad ideas.

So, too, must caffeine and alcohol be avoided. Caffeine is a stimulant and should not be consumed after noon, and while alcohol is a depressant, it disrupts sleep quality. Many people claim these substances don’t affect their sleep only to find out that strict avoidance corrects sleep-onset insomnia.

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Other elements of sleep hygiene include a dark bedroom to optimize melatonin secretion from the pineal gland, a light-sensitive gland in the brain that helps regulate circadian rhythm. Bright screens replete with light in the blue spectrum suppress melatonin, to say nothing about the content on those screens that may trigger emotional responses and lead to increased arousal. Best practices include turning off all devices two hours before bed. Consider blackout curtains to eliminate outside light, or use an eye mask, an essential item when traveling.

Room temperature is also consideration. Some require a cool room to fall asleep, while others need to be toasty to settle down. Program your thermostat to keep your bedroom cool, and keep sleep partners who like it warmer comfortable with sufficient bedding.

If outside noise hampers falling asleep, a fan, white noise machine, or air purifier are indispensable. An air purifier doubles as a safeguard against particulate mold spores or pollen that can inhibit proper breathing. Airway restrictions of any type make falling asleep difficult. 

The Paradox of Sleep Medications

Making adjustments based on your circadian rhythm and good sleep hygiene may seem like a lot of work but is far superior to taking commonly prescribed sleep medications. These sedative pharmaceuticals are notorious for altering healthy sleep architecture, producing the proverbial “robbing Peter to pay Paul” scenario.

Hypnotic drugs modestly increase sleep duration at the expense of sleep quality and, ultimately, optimal health. The most commonly prescribed hypnotic drugs are associated with a threefold increase in death, particularly from cancer, even when taken at a frequency as low as 18 pills a year.

Benzodiazepines are problematic because they increase stage 2 non-REM sleep while decreasing stage 3 and 4 non-REM deep sleep, resulting in a total reduction in time spent in REM sleep. This shift in sleep microstructure can lead to deficits in concentration and working memory while contributing to weight gain. These drugs also cause dependency and have high potential for abuse.

Taming the Mind

Even with the best-laid plans to wind down in the ideal sleep setting, the day’s stresses can hinder falling asleep. Methods to counteract a busy brain are variable. You might find benefit in journaling about the events of the day, while others have success with a few minutes of meditation or deep breathing. Sleep researchers encourage counting down from 100 by three or trying to keep one’s eyes open (blinking allowed) to trick the mind into slowing down. Whatever method you choose, stick with it and have it reinforce your bedtime routine. 

With time and perseverance, you can win the evening, the following morning, and many days ahead.

September 10, 2022

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