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Your sleep problems fixed


How to Talk to Your Doctor: Sleep Issues
1. The Night Waker
Her challenge: After a stressful breakup two years ago, Meredith Crowell, 40, a single real estate property manager and yoga instructor from Boulder, Colo., would wake up in the middle of the night filled with sadness and anxiety. But even after she felt better emotionally, the sleep troubles continued.

Although she typically falls asleep easily around 10:30 p.m., she is wide awake three or four hours later. She falls back into a fitful sleep, then gets up around 6 a.m. to begin her day. "I never wake feeling well rested, because it feels like I don't get more than about four hours of truly deep sleep," she says.

To no avail, Meredith has tried myriad remedies―warm baths, hot milk, a glass of wine before bed, no food before bed, relaxation techniques, and prescription and homeopathic medicines. She took a prescription medication, but that didn't give her more than four hours of sleep. She even tried taking the medication when she woke in the middle of the night, but that left her too groggy in the morning.

Expert advice: "The good news is that Meredith's insomnia seems to have a clear precipitant―the breakup," says sleep-medicine specialist Dr. David Neubauer, a sleep-medicine specialist and an associate director of the Johns Hopkins Sleep Disorders Center, in Baltimore. Neubauer calls her situation "conditioned arousal," which, he says, is common.

"Her sleep problems may have been initially caused by an external trigger, but over time the sleep problems become self-propagating. Eventually she became conditioned to become anxious about her sleep." Some things that might help: Cognitive behavioral therapy, acupuncture, avoiding wine and accepting some awakenings.
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2. The Early Bird
Her challenge: Brooke Brown, 38, is a married pre-kindergarten teacher with three children from Wellesley, Mass. Given her round-the-clock proximity to small children (her own are ages 4, 7, and 9), Brooke is understandably exhausted by the end of the day. So much so that she often falls sound asleep as early as 7 p.m. But she is routinely awakened around 2 a.m.―by a child, her husband snoring, or a need to use the bathroom―and never manages to fall back asleep. She lies in bed with her brain in high gear, eventually giving up on sleep and getting out of bed at 5 a.m. to get a jump on her day.

Expert advice: “She is spending too much time in bed,” says sleep-disorders specialist Susie Esther. Brooke should establish a standard waking time (and stick to it seven days a week), then work backward to figure out what her bedtime should be. So if she wants to get up at 5 a.m., she should plan to be asleep by about 10 p.m.― not 7 p.m. “She should gradually adjust her bedtime so that she is able to stay awake later, and that will help her body adapt to the new schedule,” says Esther.

To quell Brooke’s middle-of-the-night worrying, Esther suggests that, instead of lying in bed, she get up and do something relaxing, like having a cup of decaffeinated herbal tea. “Staying in bed and trying to sleep will just wake you up more,” says Esther. “Sleep isn’t something you can ‘try’ to do.”

3. The Chronic Insomniac
Her challenge: Kristy Lewis, 29, a married homemaker and photographer from Hampton, Va., can't remember a time when she didn't have trouble sleeping.

"I thought it was normal to take an hour or longer to fall asleep, but in 2004 my doctor diagnosed me with insomnia," she says. She also wakes several times during the night and remains awake for anywhere from a few minutes to an hour.

She also suffers from restless legs syndrome and frequently talks in her sleep. Sleep medications help to some degree but leave her feeling drowsy the next day. She has also tried practicing yoga, doing vigorous exercise earlier in the day, avoiding caffeine, and reading or writing in a journal before bed.

Expert advice: "I would first want to investigate her restless legs problem," says Neubauer. Restless legs syndrome, which has recently been taken more seriously by doctors, can sometimes be caused by anemia. If blood tests show that Kristy has anemia, iron supplementation could help. If anemia is not the cause, she could ask her doctor about medications like Mirapex and Requip, which are often prescribed for restless legs syndrome.
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