Insomnia: When Sleep Hygiene Isn’t Enough

If you experience insomnia, you’ve probably heard of sleep hygiene. This refers to a set of behaviors that tend to promote good sleep. If you’re an average sleeper, sleep hygiene is a great tool! Small tweaks in behavior can promote incredible results and result in deep and restful sleep. This isn’t necessarily the case if you are 1 of 3 Americans who experience insomnia or insufficient sleep.

What is Sleep Hygiene?

I wrote a blog post about it a while ago that outlines the basics. The CDC describes sleep hygiene as “good sleep habits” and are about optimizing your routine to get good sleep. It’s about keeping your bedtime and wake time consistent, your bedroom cool and dark, winding down at bedtime and helping your body relax. These behaviors are fantastic and do tend to generally help with sleep. In simple cases, a small change in sleep hygiene can sometimes resolve insomnia.

When Sleep Hygiene Becomes Stressful

I remember when I was living with insomnia, bedtime had become a source of great stress. Like many of my patients, I had a rock solid bedtime routine. I turned my phone off at 8pm, wore blue blocking glasses, drank my chamomile tea, took a hot bath before bed, then slid into a cold bedroom equipped with blackout curtains and a sleep mask. Yet I would lie awake not sleeping, wondering what the point of all the effort my bedtime routine was for!

Once I actually treated my insomnia, I was able to relax the sleep hygiene and no longer required 90% of the extensive bedtime routine. Instead of a 2-3 hour ordeal, I do my best to stop working in the early evening so I have time to relax, I’m mindful of minimizing caffeine and alcohol since those disrupt my sleep, and I like to wear a sleep mask. That’s it. I don’t worry about screens, baths, temperature, curtains, or tea.

If your sleep requires a three hour ten-step routine, it might be time to dig deeper and see if there’s something wrong in your sleep that needs to be improved.

When sleep hygiene isn’t enough, it’s important to explore other causes and solutions for sleep. Avoid going in circles with sleep hygiene that isn’t working, and instead work with a professional to get to the root cause.

Option one: Cognitive Behavioral Therapy for Insomnia

Cognitive Behavioral Therapy (or CBT) is considered the gold-standard for treating insomnia. This is a type of therapy that can be performed by many practitioners including psychiatrists, psychologists, naturopathic doctors, and more if they have completed additional training in this area.

CBT can be helpful to resolve stressful thoughts about bedtime, change behavior and routines, and effectively resolve insomnia over time.

Option Two: Explore Circadian Rhythm Disorders

Circadian rhythm disorders refer to problems with sleep and wake time. These are very treatable disorders, however, sleep hygiene isn’t enough to treat them. The most common circadian rhythm disorders include:

  • A delayed sleep phase disorder means the body doesn’t get tired until late into the night, and you often prefer to sleep later in the morning as well. It’s the quintessential “night owl” often preferring to go to bed after 2am, which unfortunately doesn’t always line up with conventional work and life schedules.
  • An advanced sleep phase refers to falling asleep early in the evening (prior to 9pm) and often waking up early in the day between 2-5am.
  • Shift work disorder can result from work schedules that cause to either keep an irregular sleep schedule, or work during the night when you would normally be sleeping.

Option Three: Explore Mental Health Conditions

One of the most common underlying causes of insomnia is a mental health disorder such as generalized anxiety disorder, major depressive disorder, bipolar disorder, ADHD, and more. If mental health hasn’t been adequately addressed, sleep will often continue to be an issue.

Other possible causes of insomnia when sleep hygiene isn’t enough

Many, many things can lead to difficulty sleeping in addition to sleep hygiene, circadian rhythm, or mental health. In holistic and integrative medicine, we explore the whole person–not just sleep. Other areas to explore include:

  • GI Health
  • Blood sugar issues
  • Thyroid health
  • Adrenal health
  • Pain
  • Vitamin and mineral deficiencies
  • Medications that may be driving insomnia
  • Caffeine, nicotine, or alcohol use
  • Lung disorders
  • Hormone issues

When to see a doctor

If you have tried sleep hygiene and it didn’t work for you, don’t assume you’re doomed to poor sleep. If your doctor has only offered medication without further assessment or any behavioral change, find a provider who will look deeper! There are times medication is helpful and necessary, but when used alone, the underlying cause of insomnia is never addressed.

Book a call for a virtual consultation or explore providers in your area to find solutions for sleep.

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