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Can’t Sleep?
Ray Andrew, MD

Just as my staff and I were packing up to leave the Springville, Utah, office one night, Carol ran through the door and exclaimed, “Thank heavens you’re still here! Do you have any more of those jellybeans?” For the first time in years, she had been able to sleep without taking two drugs that left her with a hangover the next day. After two weeks of good nights, she didn’t want to go back to either the sleepless nights or the drugged ones.

In busy medical practices throughout America, it has become all too commonplace to shorten office visits by prescribing sedating drugs for insomnia. Desperate patients, having seen a butterfly commercial on TV, come to the office requesting a knockout drug by name. The temptation can be difficult to resist. Who wants to lie in bed all night when a drug can render us unconscious within minutes?

Unfortunately, unconsciousness and rest are not the same thing. These drugs lead to poor sleep quality instead of enabling people to reach the deep stages that are necessary for renewed energy, healthy mood, memory formation, and a strong immune system. Worse yet, back in the days when our office still prescribed such drugs, our own patients recounted some very concerning experiences with them - like finding the kitchen stove on in the morning. Or being picked up by police in one's pajamas while trying to pick up a prescription from a drive-through pharmacy at 2:30 am. Thankfully, there is a better way to get to sleep and stay asleep, without all the risks. But it takes more effort on the part of doctor and patient alike. I often tell patients it would be nice if the human body was like a car that could be pulled into bay #1, hooked up to the computer, and diagnosed in a matter of minutes.

But the body is infinitely more complicated than that. This is why patients with insomnia don’t leave one of our offices in five minutes with a prescription for a drug. Who, when smelling smoke inside a building, would go around spraying air freshener, or turning a fan on to remove the smoke? So why do we routinely take drugs to cover up symptoms that bother us?

The most successful treatments for insomnia require identification and treatment of the underlying causes, of which there can be several even in a given individual. In the case of Carol, she could not fall asleep because her cortisol production stays too high at night. Cortisol, a hormone made by the adrenal glands, is supposed to be at its highest level in the morning and lowest at night. If it's too high at night, it can be difficult if not impossible to fall asleep and stay asleep. By contrast, if production is too low in the morning, it can be hard to wake up and get going for the day. The “jelly beans” enabled Carol to sleep by reducing her nighttime cortisol production.

Your insomnia may not stem from the same cause as Carol’s. In fact, you may have five different contributing factors, requiring time and effort to sort out and treat effectively. Your best bet is to seek out a physician who specializes in functional medicine. However, there are several things anyone can do to get started on the path to healthy sleep, without the aid of a doctor:
• Do not do anything in bed (such as reading, watching TV, listening to music) except sleep.
• Wake up at the same time each day, including weekends.
• Avoid heavy meals near bedtime.
• Avoid melatonin-lowering substances, including caffeine, alcohol, and tobacco.
• Engage in regular exercise in the evening but not within 3 hours of bedtime.
• Eliminate noise, light, excessive heat or cold.
• Move alarm clock away from bed.
• Leave bedroom if can't fall asleep; return when more tired.
• Limit fluid intake near bedtime.
• Take a hot bath before bedtime.


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