Insomnia: What to do When Pills Don't Work

“I can't get enough sleep,” James told me. “I had some medication, but it doesn't seem to work anymore.”

It's a common problem. About 30% of the U.S. population reports having trouble sleeping in a given year. About 12% of those turn to pills, and fill about 60 million prescriptions annually. And for many people, they seem to work...for awhile.

* The problem with pills

But there are difficulties. First, side effects are numerous. They include memory problems, morning drowsiness, changes in appetite, headaches, heartburn, shaking, stomach upset, and changes in testosterone and the menstrual cycle. In some cases, sleeping pills have actually start to interfere with sleep.

Second, sleeping pills can stop working as your body develops a tolerance for the medication. This means that you have to use more to get the same effect.

Third, many people who try to stop using them have a “rebound effect.” This happens when you cut down or stop (which should always be done with the advice of your physician), and your insomnia comes back worse than ever.

So if you have insomnia, and you want an alternative to pills, how do you get a good night's sleep?

* Emergency support

When you run into unexpected obstacles in life, it's often helpful to find something to help you cope. My son recently took a fall from about ten feet in the air (don't even ask how he got there...), and broke his wrist. He needed a cast and a pin to support the bone while it healed. He was glad to have the support, and also glad when he could take it off.

Other types of support are more costly. When your car doesn't work, you might use a rental car...but the fees add up quickly. It's nice to have the option if you need it, but you want to consider alternatives like public transportation or riding your bike, and turn in the car as soon as you can.

Sleeping pills can help insomnia temporarily, but the costs are high, and you don't get much more sleep for your efforts. In several FDA studies, subjects who took sleeping pills fell asleep an about 15 minutes faster than a control group, and slept about 30 minutes longer. It makes sense to look at other options.

* It's not about stress

Insomnia can be a mild annoyance or make it impossible to function. It can gradually build up over time, or come on strong after an emotional event. For James, the insomnia started after the death of his father. Other causes of insomnia include anxiety, illness, and hormone imbalance. In a difficult moment, for some people, sleeping pills can help.

However, pills don't address the real problem. The real problem is about how you respond to stress. People who have the tools and abilities to manage their response to stress feel better, perform better, and sleep better.

Sleeping pills don't reduce your anxiety, alleviate your depression, or process an emotionally difficult event. They don't motivate you to respond differently stress. They don't encourage the kinds of inner and outer change that can help with sleep.

In a way, sleeping pills distract you from what you really need.

* Creating balance

The Mayo Clinic, which outlines the risks and side effects of sleeping pills, recommends lifestyle change as the best solution for insomnia. Lifestyle is part of the answer, and many people need to make lifestyle changes . It's helpful to have balance between challenge and relaxation, focus and rest. This is not something that just “happens” to lucky people, but rather something you create.

But for most people it's not your lifestyle choice or the amount of stress you face that determines how good you feel or how well you sleep. Stress, if you know how to manage it, can motivate, energize, and build resilience. Short bursts of stress can even be physically and emotionally healing.

The secret to managing stress is in how you interpret it, what you focus on, and whether you have the understanding and skill to go through it in a healthy way.

* The right kind of support

Where do you find the knowledge, routines, and persistence that you need to help you get a good night's sleep, change your stress response, and improve your quality of life?

You can turn to books such as, “No More Sleepless Nights” and the “No More Sleepless Nights Workbook,” by Peter Hauri and Shirley Linde. This cognitive-behavioral (CBT) workbook can help you understand sleep problems and develop good “sleep habits.”

Audio recordings are another resource. Sound Health Products has a downloadable recording that encourages sleep, which I often recommend to clients*.

Some people, like James, need more help. We used a combination of cognitive-behavioral therapy to address his sleep problems directly, and counseling and neurofeedback to help him process the difficult feelings around his father's death.

James started counseling in response to a crisis. In retrospect, he told me that he thought it was a blessing that the sleeping pills stopped working. That nudged him toward something valuable: learning to rely on his inner resources.

* Your best options

When James finished counseling, he had a better understanding of himself, and a greater ease in negotiating difficult events. As James' sleep improved, so did his mood, work performance, and quality of life.

There will probably be times when life feels stressful and you need emergency support. Like my son, or the stranded driver, you might need some structure to help you heal. Instead using a pill, however, consider working with your response to stress.

Simple practices like CBT, good sleep habits, and neurofeedback can build your response repertoire and help you through. Ultimately it's not how much stress shows up in your life that makes the difference. It's how you approach the stress that helps you get a good night's sleep.