Do not force yourself to sleep.. Your guide to treating insomnia behaviorally, away from the trap of tranquilizers Lifestyle

We have ready-made advice for those who suffer from insomnia, such as staying in bed and insisting on relaxation, or sharing the names of “tried” sleeping medications. However, recent research indicates that these prescriptions – even if they provide temporary relief – prolong the suffering of insomnia instead of treating it radically, while the view of science today is turning to insomnia as a stand-alone disorder with effective treatment programs that can be applied in the clinic and even at home.

Do you really have insomnia?

Insomnia is one of the most common sleep disorders globally, and it affects women more than men, and of all age groups, with a remarkable prevalence among the elderly. An international review conducted in 2015, based on United Nations population studies and data, estimated that about 852 million adults around the world suffer from insomnia.

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In the Arab world, a recent Saudi study on the general population reported the prevalence of insomnia at 37.6%, with a higher percentage among females, divorced or widowed people, students, the unemployed, those who live with friends or family, those who are under intense work pressure, and those who use mobile devices before sleeping.

In Alexandria, Egypt, a community-based study of older adults found that 33.4% of them suffered from insomnia, the majority of whom were female, while a pilot study in Beirut reported that insomnia symptoms and disorders are widespread and associated with women and people of low socioeconomic status.

To determine whether you suffer from insomnia or whether your environment is disrupting your sleep, sleep specialists recommend using a sleep diary for several weeks, in which you write down:

• Difficulty initiating sleep.
• Difficulty staying asleep.
• Waking up very early.
• Feeling uncomfortable despite sleeping hours.
• This affected professional or academic performance during the day.

The diagnosis of insomnia requires that these symptoms appear at least 3 nights a week, for 3 consecutive months, despite the availability of sufficient opportunity to sleep.

Why are sleeping pills no longer the first line of defense?

For a long time, insomnia was treated medically as a secondary symptom of other disorders such as depression, chronic pain, or organic diseases, and not an independent disorder, so treatment methods focused on the “cause,” and later resorted to sedative-hypnotics or low doses of antidepressants and others to relieve symptoms in the short term, without a clear goal of achieving complete recovery from insomnia.

This perception was reflected in practical reality in the form of long-term dependence on sleeping pills, which recent research has raised concern about, as the results of 24 studies warned of a number of risks that include:

• Impaired cognition and movement the next morning.
• Digestive system problems.
• Appearance or increase in symptoms of depression.
• The development of psychological dependence or addiction to the pills, with withdrawal symptoms upon stopping.
• Memory problems in the elderly.
• Insomnia returns and worsens when the medication is stopped.

The turning point came in 2016, when systematic reports issued by the Substance Abuse and Mental Health Services Administration (SAMHSA) of the US Department of Health and Human Services considered insomnia to be an independent disorder, which may precede, coincide with, or continue after other diseases, and not just a shadow of another disease.

Cognitive-behavioral therapy…from palliation to recovery

This conceptual shift has been reflected in research and clinical practice, as a study entitled “Insomnia Disorder: The Current State of Science and Future Challenges” published in 2022 in the journal Sleep Research indicates that cognitive-behavioral therapy for insomnia (CBT-I) has become the first line of defense against insomnia, having proven its effectiveness in clinical trials and continuing its positive effects in the long term, because it adopts a structured program that targets sleep-related behaviors and thoughts to enhance natural sleepiness and reduce inappropriate alertness.

Clinical Arab studies soon addressed this type of treatment, and an Egyptian systematic review published in 2023 of seven studies from Egypt, Lebanon, and Saudi Arabia showed that cognitive behavioral therapy for insomnia in the Arab world achieves positive long-term results, with a clear improvement in sleep quality and reduced dependence on medications.

How does insomnia transform from transient attacks into chronic suffering?

In a study published in 2022 in the Journal of Clinical and Specialized Psychology, entitled “Cognitive-Behavioral Therapy for Insomnia,” a team of clinical psychology and behavioral sleep medicine researchers from the Universities of Arkansas and Pennsylvania provided a practical guide that can be used even outside the clinic.

Researchers explain the development of insomnia into a chronic condition through three sets of factors:

1. A person’s susceptibility to insomnia: Such as genetic predisposition or anxious personality type.
2. Triggers: Such as psychological stress, life crises, pain, or a change in work style.
3. Behaviors and thoughts that perpetuate insomnia: Such as spending long hours in bed without sleep, taking long naps during the day, or over-watching the clock and worrying about “sleep failure.”

Based on these groups, the team formulated a simplified program that could serve as a self-care guide for those suffering from insomnia, emphasizing the importance of medical follow-up in severe cases or accompanied by other diseases.

Your practical guide.. What to do if you don’t sleep at night?

1. Set sleep schedules. Do not let bed be a “place of anxiety.”

Treatment begins by setting the sleep window rather than extending the time in bed. Researchers point out that you need to increase your body’s “motivation” to sleep by:

• Set a fixed time for going to bed and a fixed time for waking up, approximately equal to the average of your actual hours of sleep that you recorded in your sleep diary.
• Commitment to waking up every day, regardless of how many hours you slept the night before.

With the schedule adjusted weekly:

• Advance bedtime by 15 minutes if your sleep efficiency improves.
• Delay it by 15 minutes if you notice a decrease or increase in night waking.

2. Bed is for sleeping only. Get up immediately if you become drowsy

Place is linked to what we do there, so the guide emphasizes a simple rule: “If you don’t sleep, get out of bed.”

• Get out of bed if about 20 minutes have passed without falling asleep.
• Don’t go back to bed until you feel sleepy again.
• Avoid reading, watching TV, or scrolling on your phone in bed.
• Try to reduce daytime naps as much as possible, to increase the body’s need for sleep at night.

3. Take control of your surroundings and lifestyle

Sleep environment part of treatment:

• Gradually reduce the amount of caffeine, and set an hour after which you do not consume any stimulants.
• Make sure your bedroom is quiet, dark, and at a comfortable temperature as much as possible.
• Do light physical activity regularly, avoiding vigorous exercise immediately before bed.

4. Control your thoughts instead of the clock

When you get out of bed at night:

• Avoid news, screens and blue light.
• Open a journal and write down the thoughts before you wake up, the thoughts about your sleep and tomorrow, and your emotional responses to them.
• Try to evaluate these thoughts: Are they realistic or exaggerate anxiety?
• Replace phrases like: “I won’t sleep tonight, and I won’t be able to work tomorrow,” with more balanced phrases like: “I might sleep later, and I’ll do my best to work even if I’m a little tired.”
• If you have thoughts like: “I’m going to wake up tired, how am I going to drive to work?”, think about realistic alternatives: “I can use public transportation or share the road.”

5. Enhance your benefits with small steps

To strengthen the impact of the treatment plan, researchers recommend several supportive measures:

• Set an alarm clock away from bed to force yourself to get up on time and not go back to sleep.
• Maintain moderate physical and mental activity during the day, avoiding prolonged inactivity before bedtime.
• Stick to a sleep schedule, even on the weekend.

Also do relaxation exercises before bed, such as:

• Slow breathing: Inhale for four seconds, hold the breath for a second, then exhale slowly for eight seconds.
• Progressive muscle relaxation: Focus on each muscle group and tighten and then gradually relax them, from the forehead muscles to the toes.

In the end, experts remind that trying to sleep persistently may be part of the problem, as the longer we spend in bed while we are awake and worried about not sleeping, the more the brain associates bed with alertness and tension instead of rest and sleepiness.

Therefore, the solution may not be to “cling” to bed and pills, but rather to change our relationship with sleep itself, through a behavioral and cognitive program that can bring us back calmer nights without sedatives.