Natural Sleep Aids
Natural Sleep Aids: Dietary Supplements continued...
It's important to remember that the FDA regulates dietary supplements under a different set of rules than conventional foods and drugs. Manufacturers aren't required to register or get FDA approval of their product before selling it. "People think, 'it's natural, that means it's safe,'" says Shives, who is medical director at North Shore Sleep Medicine in Evanston, Ill. "But strychnine is also natural. 'Natural' doesn't mean you shouldn't use caution."
In the case of melatonin, for example, Shives doesn't advise parents to give it to children, especially boys, since there is evidence that it can affect testosterone levels.
Be sure to consult your physician before you take any dietary supplement. Some supplements can interact with other medications or have unanticipated side effects.
Natural Sleep Aids: Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy, or CBT, describes a variety of therapies that modify thought and behavior patterns. CBT has been used to effectively treat other conditions, including depression, phobias, and eating disorders.
When used to treat insomnia, CBT helps patients alter thoughts and behaviors that disrupt sleep and trigger insomnia. A CBT program typically includes six to eight half-hour sessions with a sleep therapist.
CBT programs for insomnia can include the following techniques:
Sleep hygiene helps patients improve their daily sleep habits by counseling them to go to bed and get up at the same time each day, avoid caffeine in the late afternoon and evening, monitor nighttime eating, and engage in relaxing activities before bed, for example.
Stimulus control helps patients develop calming, sleep-inducing associations with their bed and bedroom. For example, patients are counseled to remove TVs and computers from the bedroom, and to use the bed only for sleep and sex.
Sleep restriction limits the number of hours spent in bed, which helps increase sleep efficiency.
Cognitive therapy helps patients understand and counter negative thoughts and misconceptions that keep them awake.
Relaxation techniques help people relax with guided imagery, meditation, deep breathing, and muscle relaxation.
Biofeedback helps patients identify and learn to control physiological factors that could impede sleep.
CBT has been shown to effectively treat insomnia, even for people with long-term sleep issues, according to sleep expert Miran.
Shives, who routinely refers patients to a psychologist who uses a variety of CBT techniques, agrees. "I'm a big believer in CBT," she says.
For patients with serious insomnia problems, Shives often begins treatment by combining a CBT program and a short course of prescription sleep medication. "Many of my patients have a desperate look in their eyes by the time they come in to see me," she says. "I know if they don't go away with a slip of paper in their hands it will be a dark day indeed."
Sleep experts Miran and Shives agree that there needs to be more research into CBT and how it compares to other treatments for insomnia, but so far the results are promising -- without any side effects.