Insomnia has major effects on mood as well as alertness. It is also a classic symptom of depression.

Short-acting sleeping pills may improve sleep and next-day alertness. But the best way to handle a bout of insomnia is to do nothing; the body's sleep mechanism tends to right itself, if given the chance.

The most effective treatments for chronic insomnia are behavioral techniques that eliminate sleep anxiety and allow the body's own sleep cycle to kick in.

Millions of people resort to sleep medications to cope with the growing problem of insomnia due to increased states of hyper-arousal and poor sleep scheduling, according to Gregg Jacobs, Ph.D.with the University of Massachusetts Medical School. Being able to recognize how much control we have to self-regulate our sleep can restore our body, mind, and relationships. When we are hyper-aroused and have a poor sleep schedule, we are unable to experience the type of deep restorative sleep that can lead to greater levels of health and well-being.

My colleague Linda Cammarata, a registered nurse and a registered yoga teacher with over 25 years of experience in the fields of integrative medicine and sleep health, has formulated a program using eight keys to natural sleep recovery. Used in conjunction with a health care provider who can assess significant biomedical factors that contribute to poor sleep, the eight keys can be used to effectively self-regulate insomnia and better ensure a good night's sleep.

First Key—Recognize: Rhythms and cycles are essential to all life on our planet. Our modern lifestyle has pulled many of us away from natural rhythms resulting in feeling out of sync with our circadian rhythms. Recognize that what you do during sleep and awake cycles influence how well you sleep at night. (Tip—Enjoy 20 minutes of both morning and afternoon sunlight.)

Second Key—Examine: Examine your behavioral patterns and beliefs associated with sleep in an honest and open manner. (Tip—Practice stimulus control by using the bedroom primarily for sleep.  If you find yourself lying in bed for more than a half hour and "trying" to fall asleep, leave the bedroom and engage in a relaxing activity in another room.)

Third Key—Explore: Explore your relationship with sleep. Invite your relationship with sleep to become more loving, patient, appreciative, and compassionate. Learn how to practice letting go of reactive negative habits such as worry, frustration, impatience, and anger. (Tip—Treat any distressing thought as a dear friend or small baby that you can just be with in an accepting, compassionate, and non-judgmental way.)

Fourth Key—Track: Track your sleep patterns with an intention of curiosity and interest. Invite an observing and curious mind into your everyday life. Tracking your habits support healthier, deeper, and more restful sleeping and dreaming. (Tip—Become aware of how your positive thoughts associated with sleep can decrease hyper-arousal and allow you to be in greater resonance with sleep rhythms and cycles. Observe any negative thoughts with a non-judgemental and compassionate attitude.)

Fifth Key—Allow: The attitude of “allowing” provides a receptive way of learning from both our internal and external experiences. Allow and trust experiences that support self-regulation. (Tip—Engage in a deeply restorative daily practice of taking a few minutes to walk outside innature.  Notice the temperature, the textures, the colors, and the overallbeauty of nature.)

Sixth Key—Knowledge: Empowerment comes with knowledge. Become your best advocate for better sleep by learning integrative health care skills, techniques, and practices. There are many ways to reclaim your natural sleep rhythms. Do not give up! Remember to open your mind and explore new possibilities. (Tip—Subscribe to online blogging sites like Psychology Today or WebMD to keep informed of the latest news about optimal sleep health and other natural health care practices.)

Seventh Key—Believe: Believing is a very powerful healing attitude. Research supports that when we truly believe in the efficacy of our health care practices, we have the potential to heal faster. The innateintelligence of your body and mind can lead you back to natural sleep ryhthms. (Tip—Believe in your ability to heal based on your intrinsic and extrinsic resources.)  

Eigth Key—Remember: Remember that we can learn how to reclaim deep sleep and dreaming. Know that there may be a number of issues keeping you awake and remember there are many integrative health care modalities to explore in addressing these personal sleep issues.(Tip—Rest in the confidence that you have the natural ability to become more and more attuned to circadian rhythms.)

The message to overcoming poor sleep is remembering that you have your own natural sleep rhythm. You will find that by applying and mastering these eight keys to natural sleep recovery in your own time, way, and pace, you can experience opitmal health in mind, body, and relationships.

“But doc”, Jason insisted, “I know for a FACT that I slept only two or three hours last night! I was awake most of the night! I was thinking about how to improve sales at the restaurant, and I know I had some good ideas. I just wish I could remember them more clearly…”

Jason, a young and ambitious man in his early thirties, is typical of the patients I’ve seen who have a particular type of insomnia. These patients often report getting very little sleep and yet seem to function reasonably well. For example, a patient may report averaging only three hours of sleep per night, and yet be able to do reasonably well on the job without experiencing daytime drowsiness. Indeed the complaint is usually of being unable to nap even when given the opportunity.

What is going on here? Usually getting only a few hours of sleep will result in sleep deprivation. This results in memory difficulty, difficulty focusing, deep fatigue, sleepiness and automatic behaviors. Automatic behaviors occur when the person engages in activities but has no memory of them. We have all probably experienced some sleep debt and the automatic behaviors that can go with it, such as realizing that we have poured a cup of coffee but don’t clearly remember doing it. It is as if the person is on automatic pilot. The potential of falling asleep at the wheel or while operating machinery or mission critical software is also a significant danger with seep deprivation.

This doesn’t happen with people like Jason. He and those like him experience such intense insomnia that they believe that they are getting almost no sleep at all despite spending a significant amount of time in bed. As it turns out, sleep studies have revealed that people sometimes have great difficulty accurately estimating how long it takes them to fall asleep and just how long they are awake during the night. People who misperceive the sleep state they are in just aren’t good at making these estimates. This is most likely due to high levels of arousal that keep thebrain more active even during sleep and make judgments of wakefulness versus sleep difficult.

When using cognitive behavioral treatment methods for insomnia we often rely on subjectively completed sleep journals, as these are useful even for people like Jason who are greatly misperceiving the amount of sleep they are getting. Using the technique of bed restriction, nightly time spent in bed is reduced to slightly more than the average estimated nightly sleep time that the person reported having over the previous week or two. For Jason, who reported averaging four hours of sleep per night despite spending seven hours in bed, this meant decreasing time in bed to just five hours per night. This technique results in deeper sleep for a number of reasons. Because people are up longer during the day the drive to sleep is increased resulting in deeper sleep. Frustrating time awake in bed is decreased, resulting in less arousal that worsens insomnia. Poor quality sleep that is easily misperceived as wakefulness is reduced as sleep is deepened. As sleep is deepened, it is more restorative. If people have indeed been sleeping more than they think they have because of sleep state misperception and use sleep restriction they will notice that the reduced amount of sleep is likely to be deeper and more restorative. Jason was pleasantly surprised at how much better he felt after spending less, not more, time in bed! So what is his diagnosis, and in addition to bed restriction, what can be done to help?

People who greatly misperceive the amount of time they are asleep during the night and suffer from non-restorative, poor quality sleep and daytime fatigue are diagnosed with paradoxical insomnia. A major focus of cognitive restructuring in this case is to help the patient recognize that in fact they are indeed getting more sleep than they thought.

Paradoxical insomnia is sleep state misperception, “insomnia without objective findings”. The level of daytime impairment is not equal to that which one expects from the lack of sleep reported. Often patients will report that their spouse has claimed they were asleep, when they were fairly certain that they were actually awake. Sleep studies typically confirm that objectively measured sleep is of greater quantity than that subjectively reported. Patients are not malingering and are often surprised that they slept as much as the study indicates that they did. Like Jason, they may initially have a hard time believing that they actually slept as much as the sleep study indicates. This type of insomnia results from over-arousal affecting sleep such that the person spends more time in lighter stages of sleep and has more ongoing cognitive activity in these lighter stages. Is it often the case that patients with paradoxical insomnia will report excessive thinking during the night but have relatively little recall of its content.

A complicating factor is that many people with insomnia will actually sleep better in the laboratory, despite the novelty and discomfort of being observed while trying to sleep in an unfamiliar bed with many electrodes attached to the head and body. These patients have conditioned arousal to being in their own bed and bedroom and actually sleep much better in a novel, even less comfortable, setting. They are used to not sleeping well in their own bed; not sleeping well at home has become a conditioned response. For these patients, being in the lab at sleep time is a break from this pattern and so they sleep better.

For Jason and others with paradoxical insomnia, however, the sleep lab experience is one of taking longer to get to sleep and of being awake more during the night than the sleep study demonstrates. They do not feel that they slept better in the laboratory.

Paradoxical insomnia is found in only about 5 percent of patients who present for treatment of insomnia. Young and middle aged adults tend to have a greater prevalence of paradoxical insomnia, and it often starts in young adulthood and middle age. It is relatively uncommon among children. Several factors increase the risk of paradoxical insomnia. These include depressive traits, excessive central nervous system activation during sleep and excessive mentation before and during sleep.

While paradoxical sleep can often be treated effectively with cognitive behavioral strategies such as sleep restriction and cognitive restructuring, it can persist for months or years if left untreated. Of even greater concern is that sleep may continue to deteriorate over time and develop into more severe forms of insomnia while increasing the risk ofdepression, anxiety and dependency on sleeping medication.

If you or someone you know is suffering from insomnia it is a good idea to get it evaluated and treated as soon as possible, otherwise there is a risk of the conditioning worsening and notably decreasing enjoyment of life. The good news is, relief from insomnia is available to you. Whether you, like Jason, are one of the 5 perecent who have paradoxical insomnia, or whether your insomnia is of the more typical sort, cognitive and behavioral techniques can indeed successfully alleviate your symptoms- and help you once again enjoy restorative, refreshing, sleep. ZZZzzzzzzz…