“When your clock is robust, you naturally start feeling sleepy more or less at the same time every night. If you vary the wake time, the amplitude of the signal becomes flatter, the signal is weaker. “It creates a very robust biological clock. That steady wake time sends cues to your body, she says. She suggests picking a regular wake time that fits your circadian rhythm. “If you always wake up at the same time,” Manber says, “you are toning your internal biological clock that controls sleep and wakefulness.” But you can control what time you wake up every day. You can’t control when you fall asleep or you wouldn’t have insomnia. But many people can find relief with these at-home measures. When patients undergo CBTI with a sleep specialist, the insomnia typically improves with four to six sessions, Manber says. “As you know, life happens and when we become stressed, we tend to lose sleep over it.” By applying CBTI skills, people can prevent new bouts of chronic insomnia or recover from them. In contrast, CBTI resolves insomnia without drugs and equips patients “with skills that nobody can take away from them so they can use them should insomnia come back,” Manber says. Further, once patients stop taking them, insomnia might return, requiring another course of drugs. They often do, but they can have side effects and drug interactions and aren’t meant for long-term use. More doctors have become aware of CBTI since the American College of Physicians issued a guideline in 2016 calling it the first-line treatment for chronic insomnia in adults, preferred over sleep medications. Her method: cognitive behavioral therapy for insomnia (CBTI), a nondrug treatment that can improve sleep by helping patients change beliefs and behaviors. Instead of trying to sleep, allow sleep to happen, Manber says.įor more than two decades, she has helped patients undo ineffective habits, stop their sleep medications, and drift into slumber on their own. And that very effort to sleep ends up creating arousal and interfering with sleep.” “When you talk to somebody who has trouble sleeping, they will name a long list of things that they’re doing to try to sleep. Sleep is an automatic process,” she says. “When you talk to somebody who sleeps well and you ask them, ‘How do you sleep? How do you do that?’ they will likely look at you with blank eyes. Still others get anxious at bedtime, pondering whether to take sleep medications or wind down with a nightcap.īut trying so hard to fall asleep is counterproductive, says Manber, a professor of psychiatry and behavioral sciences at the Stanford University Medical Center and a behavioral sleep medicine specialist. Others give up evening outings or vacations to avoid messing up their sleep schedules. Patients who are frustrated and fatigued tell her that they toss in bed all night, seeking that elusive comfortable spot. Sleep expert Rachel Manber, PhD, has seen the pervasive miseries of insomnia.
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