Integrative medicine is all about finding and treating the root causes of disease so you can live a longer, healthier life. In my Four Pillars of Health series, I wrote about how poor sleep is associated with a range of negative health outcomes, and suggested some tips on how to improve sleep.
But what if sleep itself is the problem? According to the American Sleep Association, approximately 50 - 70 million people in the U.S. have a sleep disorder, and insomnia is the most common, with as many 30 percent of adults experiencing some form of short-term insomnia each year.
As with many of our country’s chronic health problems, traditional medicine is good at treating the symptoms of insomnia, usually with medication, but is not as good at dealing with insomnia’s root causes.
Prescription drugs such as Ambien and Lunesta have been the traditional norm for treating insomnia and related disorders—but the medical community is fast realizing that those kinds of interventions can themselves disrupt sleep patterns, as well as lead to dependency. What these prescriptions certainly do not do is treat the root causes of insomnia.
So, what is insomnia, and what are its causes?
What is Insomnia?
Insomnia is a sleep disorder that can make it difficult to fall asleep, stay asleep, or cause you to wake up too early and not be able to get back to sleep.
It can include:
Difficulty falling asleep
Waking up in the middle of the night
Waking up too early
Sleep that isn’t restful
If any of these apply to you, you have insomnia. The question is how long it’s been going on. Insomnia can be acute (lasting a few days or weeks), transient (lasting a short time, but not recurring), or chronic (difficulty sleeping at least three days a week for a month).
Of course, many people suffer insomnia for much longer, even years or decades. If this is you, you are not just at higher risk of developing certain chronic diseases—your entire quality of life is impacted.
Causes of Insomnia
The causes of insomnia can be as wide and varied as your life. Sometimes it may be unclear why you are losing sleep, getting poor sleep, or waking up too early or too often. Those cases can be frustrating, and will require experimentation with different approaches, which I will discuss more below.
More often, however, you are usually at least somewhat aware of the reasons you are losing sleep. They can include:
Stress and anxiety. Probably the leading cause. “Anxiety is probably the principal underlying reason for insomnia,” according to Matthew Walker, a neuroscientist and author of the excellent book, Why We Sleep.
Irregular sleep schedules. An irregular sleep schedule is a sure way to get less sleep than your body needs, whether due to shift work, or from extensive travel and jet lag.
Lifestyle and environmental factors. A lot of recommendations for better sleep are tied to improving your environment, so these may feel like familiar warnings: no excessive electronics before bed, don’t drink too much caffeine or alcohol, avoid too much light or noise in the bedroom, or a bedroom that is too warm.
Mental health disorders. Anxiety and depression can cause pervasive negative thoughts, catastrophizing, and rumination, all of which will surely impact the quality, length, and depth of your sleep.
Physical illness or pain. “Almost any condition that causes pain can disrupt sleep,” writes the American Sleep Foundation, not to mention conditions impacting the nervous and respiratory systems.
Medications. Certain medications can themselves cause you to lose sleep, including antidepressants, blood pressure drugs, anti-asthma medications, or those that cause daytime drowsiness.
Once you have an idea of what is causing your insomnia, you have a better idea of how to treat it without medication.
Physical illnesses that can cause insomnia
Insomnia is not an isolated illness. Sometimes it can be caused by multiple factors, including physical illnesses, which in turn may have their own multifactorial roots. It's important to consult with an integrative medicine physician who can help you investigate and develop a holistic approach to treatment.
Insomnia can be caused by physical illnesses such as chronic pain, acid reflux, Parkinson's disease, and thyroid disease. Other medical conditions that can cause insomnia include restless legs syndrome, sleep apnea, and undiagnosed or untreated sleep disorders. Insomnia can also be a symptom of other health problems, such as mental health disorders like anxiety and depression, and neurological problems.
How to treat insomnia without medication
The good news here is that science is on your side. With each year, new studies are showing that the interventions listed below have the same or greater effect in improving sleep than do prescription drugs, and with fewer side effects.
The bad news is that behavior change can be very hard. It’s one thing to know what the causes and solutions are, and another to actually act on that information. “No alcohol before bed” is good advice, but how to actually shift habits is a more difficult challenge. That’s part of what Dignity Integrative can help with: setting realistic goals, providing monthly accountability, assessing progress, identifying roadblocks, and revising the plan if necessary.
What I can do here is provide some advice and describe why this behavior change may help. The following is a summary of current best practices in how to get rid of insomnia without medication:
Keep a worry journal. Putting anxious thoughts, especially your to-dos, down on paper has been shown to reduce the likelihood that you are ruminating on them while you try to fall asleep. Multiple studies have tracked groups of healthy adults who spend a short time (five minutes is sufficient) each night before bed just writing out the things which are on their mind, and found that they fall asleep much faster than the control groups.
Meditation. As Matthew Walker details in his book, meditating before bed helps calm your nervous system, which, if you have insomnia, is likely to be in a fight or flight state of agitation.
Leave the bed. If you haven’t fallen asleep in 15 or 20 minutes after going to bed, don’t keep trying. Your body is an association-generating machine, and staying in bed will create an association in your brain between the bed and lying there awake. You wouldn’t sit and wait at the dinner table, waiting to get hungry, would you? If you are having trouble falling asleep, get up, read a book, meditate, or do something quiet until you are tired.
Set a regular schedule. This may go without saying, but setting the alarm for the same time seven days a week is essential to getting your body into its natural rhythms. Many people think they can deal with less sleep during the week and then catch up on the weekends, but repeated studies have shown you can never fully catch up! Lost sleep one night is lost sleep forever.
No electronics before bed. The blue light from the screens suppresses melatonin, the hormone our body releases as a signal that it’s time to sleep. So, if watching Netflix or scrolling through the news or (worse) your email before bed is a habit, it’s time to find a new habit to replace it with.
Cut the alcohol and caffeine. Numerous studies have shown that alcohol may help get you to sleep faster, but that effect is dramatically outweighed by the second order effect of a less restful night’s sleep in general. If a drink before bed is part of your routine, it’s time to find a replacement routine, such as a warm glass of milk or a hot, non-caffeinated tea.
Warm showers and hot drinks. Speaking of hot tea, drinking something warm or taking a hot shower before bed leads to your body shedding that heat when you step out of the shower. This nudges your body toward lowering its core temperature, which it does naturally when you’re asleep, and thus acts as a signal that it is time to go to bed.
Keep the temperature low. Most recommendations suggest a temperature between 60 and 70 degrees is ideal. So open those windows and let the cold air wash in! Or, set your thermostat to lower the temperature each night, and use bedding appropriate to the season.
Reduce light and noise. The blue light of electronics, or the lights of outside street lamps can have a serious impact on our quality and depth of sleep. Even a small amount of light, for example from a power strip, has been shown to have an impact. Get some heavy curtains, turn off the electronics, get a sleep mask, whatever you have to do to reduce the amount of light in the room.
Natural supplements. If your problem is related to travel or jet lag, melatonin can be helpful to reset your body’s rhythm (though long-term use is not recommended). Meanwhile, naturally occurring supplements like valerian root, ashwagandha, and chamomile have shown some limited effectiveness in helping people fall asleep—and in fact many of the “sleepytime” teas you will find have a combination of these herbs or roots in them.
This is not an exhaustive list, but hopefully it is one that shows you there are many options for getting rid of insomnia without medication. And, like I mentioned above, we recognize that merely having the knowledge to act doesn’t necessarily lead to change.
Can insomnia go away on its own?
In some cases, insomnia can resolve on its own without the need for treatment. Acute insomnia, which is typically caused by a specific event or stressor, usually lasts a few days or weeks and resolves once the underlying cause is addressed or resolved.
However, chronic insomnia, which lasts for a month or longer, is less likely to go away on its own and may require treatment. We here at Dignity Integrative can help.
Chronic insomnia is often related to an underlying medical or psychiatric condition, and addressing the root cause of the insomnia is necessary to manage the symptoms.
It's important to note that even if the insomnia resolves on its own, it's still crucial to practice good sleep hygiene habits to maintain healthy sleep patterns.
What to do when Sleep Hygiene doesn't work
If you've tried implementing good sleep hygiene habits but are still experiencing insomnia, there are other non-medication techniques you can try.
One approach is cognitive-behavioral therapy for insomnia (CBT-I), which is a type of talk therapy that focuses on changing negative thoughts and behaviors related to sleep. CBT-I can help identify and change the thoughts and behaviors that may be interfering with sleep, and can be an effective long-term treatment for insomnia.
Another technique to try is sleep restriction therapy, which involves limiting the amount of time spent in bed to match the amount of actual sleep obtained. This technique aims to increase the sleep drive and help consolidate sleep into one continuous period. As sleep efficiency improves, the amount of time spent in bed can gradually be increased.
It's important to keep in mind that finding the right approach for treating insomnia may require some trial and error. If one technique doesn't work, don't give up. Talk to your healthcare provider about other options and strategies that may be effective for you. In some cases, a combination of approaches may be necessary to successfully treat insomnia.
What if insomnia is left untreated?
Insomnia can have serious negative consequences if left untreated. Chronic insomnia can increase the risk of developing other physical and mental health conditions, including:
Depression and anxiety
High blood pressure and heart disease
Weakened immune system
Impaired cognitive function
Increased risk of accidents and injuries due to fatigue and daytime sleepiness
Lack of sleep can also have a negative impact on your quality of life, causing irritability, difficulty concentrating, and decreased motivation and productivity.
If you need help, we are here for you! Contact us today for a free 15-minute consultation.