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Sleep Education Reduces Sleepless Nights
Excerpt By Janice Billingsley, HealthScoutNews

If your energy is sapped because you can never sleep through the night, take comfort in the fact that you can break your exhausting habit.

That's what Duke University researchers found in a study of longtime insomniacs. Sleep education, combined with behavioral therapy, increased nightly slumber by as much as a half hour for many sleep-deprived sufferers.

That was a big step forward for some whose sleep troubles had plagued them for an average of 13 years.

"This was a big improvement. They reduced their wake-up times by more than half, so that their sleep time increased by 20 to 30 minutes a night," says study author Jack D. Edinger.

Insomnia, which affects between 28 million and 33 million Americans, is characterized by sleeplessness that hinders daytime activities, causing exhaustion, lack of concentration and increased health risks. It's often missed and rarely treated, Edinger says.

"Insomniacs are not spring-loaded to come in for treatment. It's not like an injury; you're not outwardly bleeding, and you feel annoyance at first. People think they should be able to handle it," he says. "Unfortunately, the things that occur to people to do naturally, like taking a nap, going to bed earlier, sleeping in on weekends, are most often worsening their problem."

In his study, which appeared in the Journal of the American Medical Association, Edinger looked at 75 people with sleep problems. There were 40 men and 35 women, and about 55 had suffered insomnia for an average of 13.6 years.

Of those, 25 received a combination of sleep education and behavioral therapy, 25 were trained in muscle-relaxation techniques and 25 were placed in a placebo group. All had reported problems with staying asleep during the night. This is a type of insomnia associated with older people, Edinger says, while younger people more often have trouble falling asleep.

The first group listened to an audio tape of basic facts about sleep, including sleep requirements, the mechanics of sound slumber, the effects of sleep deprivation and the effects of aging on sleep. They then were asked to change their sleep habits by not napping during the day, using the bed for sleep alone and, if they found themselves awake for more than 20 minutes, to get out of bed. They were also, based on their histories, given a recommended amount of time to stay in bed, Edinger says. Often insomniacs will stay in bed too long, hoping to get more sleep. They were then asked to keep a daily sleep log, noting their sleep patterns for the previous night.

The second group was given muscle tensing/relaxation exercises to do each night before bedtime, and the third placebo group was given simple relaxation exercises with no proven effect. These groups were also asked to keep daily sleep logs.

After six weeks, testing by the scientists and a review of the sleep logs found those in the first group had a 54 percent reduction in the time they were awake during the night, compared to only 16 percent and 12 percent reductions in the other two groups.

"We were really pleased with the results. They confirmed our treatments," Edinger says.

"This was a good study," says psychologist Peter Hauri, a consultant at the Mayo Clinic's Sleep Disorder Center. "We use cognitive behavioral therapy daily."

While the therapy is beneficial for those with entrenched sleep problems, Hauri uses other techniques as well with the approximately 6,000 people who come to the sleep center annually. Called "sleep hygiene rules," they include limiting the amount of time a person spends in bed. Also recommended is 20 minutes of intense aerobic exercise about five to six hours before bed.

"Insomnia is characterized by hyper-arousal -- high metabolism, high body temperature, brain waves going fast," he says, either from physical causes such as caffeine or emotional causes such as worry, stress or even boredom. If you exercise about six hours before you go to sleep, you set your body up for a "rebound effect," fatigue that coincides with your bedtime, easing the way towards sleep.

You should also get your clock out of sight: "Set the alarm and hide it in the top dresser drawer, otherwise it will make you compute your sleep time, which is arousing and uncomfortable," he says.

It's fine to help sleep along by reading or watching a movie on the VCR in bed, as long as you don't know what time it is, Hauri says. Don't watch a television show, for instance, because that will tell you the time.

"Some people say to only use the bed for sleeping, but I suggest finding whatever works for you," he says. "Read as long as you can. When you can't read any longer, drop the book on the floor and go to sleep."

"In the majority of cases you can make things better. You might not become a champion Olympic sleeper, but you can improve your sleep habits," Hauri says.

What To Do: The Sleep Foundation has helpful information about how to combat insomnia. For an explanation of what the brain does during sleep, go to The National Institute of Neurological Disorders and Stroke.

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