For the everyday variety of chronic sleeplessness there does seem to be a genetic predisposition. Who knows, the distant ancestors of today’s poor sleepers may have been the “easily rousable” survivors that alerted the others when danger was near. In our hyper-stimulated world, however, being “easily rousable” can become an unhealthy aggravation. Stressful lifestyles, stimulants such as caffeine, artificial lighting, computers, televisions, and odd work schedules are just some of the contributors to disruption of the normal hormones involved with sleep. On top of it all, it seems to worsen as we age.

The nature of sleep is very complex, and sleep is different for many animals on earth. Cycles of sleep are obviously tied to cycles of night and day, but are also intimately involved with how a certain animal evolved. Dolphins, horses, rabbits, and tigers all have very different sleep cycles from those of humans. In most all animals, episodes of deep sleep are necessary to allow the resources of the body to be focused totally on healing.

In humans there are four different stages of sleep as defined by brain wave patterns and another type of sleep defined by rapid eye movements that we call “REM” sleep. Stages one and two are lighter stages of sleep. Healing occurs most intensely when a person is in stages three and four sleep, at which point they are very hard to arouse. We tend to spend less and less time in stages three and four as we age. In terms analogous to a computer, REM sleep is the time when we put all of our files back in order for the next day. You can think of dreams as your screen saver.

Humans typically go in and out of the different cycles of sleep throughout the night, spending only three to four hours in stage 3 and 4 sleep during an eight hour rest period. In our world today this would seem to be quite inefficient. Certainly diving directly into three or four hours of intense deep sleep and being done with it would be practical, but this is not how we evolved. In distant times, becoming almost comatose for three or four hours at a time would have been an almost certain invitation to be eaten by something large; so for survival purposes we learned to catch short intervals of deep sleep here and there. This seemingly inefficient sleep pattern is the one that we must live with today.

The main calming neurotransmitter of the brain is called gamma amino butyric acid, GABA for short.  There are different GABA receptors in the brain, some that keep us calm, but awake during the day and others that maintain sleep at night.  The exact mechanism for how all this happens is still yet to be determined, but in very simple terms, stress, anxiety, worry and even other stress factors such as pain, “use up” GABA and leave the brain in an exciting state.  Individuals with chronic insomnia have been shown to have GABA levels up to 30% lower than average in the day and night. Good sleep depends on GABA. Health practices and medicinal therapy should promote conservation of GABA, during the daytime as well as the night.

Sleep is initiated by a hormone called melatonin.  Darkness, the absence of light, causes secretion of melatonin.  Melatonin initiates changes that shift the brain toward a cycle of sleep.  After the sleep cycle begins, melatonin levels gradually decrease and other neurotransmitters, with GABA being the most important, take over to maintain sleep.  Altered light and dark cycles, almost ubiquitously associated with modern life, are a significant factor contributing to insomnia.

The other major player in insomnia is the adrenal hormone cortisol. Cortisol is responsible for managing the maintenance functions of the body. Chronic stress of any sort (including dysfunction of other hormone systems) disrupts the normal circadian rhythm (day and night cycle) of cortisol secretion. Because cortisol keeps the mind alert, out of phase surges of cortisol are commonly associated with insomnia in the middle of the sleep cycle (1am to 5am). 

Most prescription sleep medications and some nutraceuticals work by acting at the GABA receptor site. In essence, these substances replace GABA and in the process irreversibly alter the GABA receptor such that GABA can no longer have the same effect on the receptor—only the drug works. Tolerance gradually develops to the medication as the liver revs up the ability to remove the drug from the system.   With normal GABA left ineffective and the drug being removed progressively more rapidly, the brain is left in a state of perpetual excitation—with severe rebound insomnia as only one of the consequences. The process can take as little as two months or as long as two years, but tolerance, dependence and worsening of insomnia is an inevitable result of using these medications chronically. Even after discontinuation of the drug, sleep will not return to normal until the body has time to recycle the receptors—this may take months. 

• General screening for chronic disease is indicated. Chronic disease processes, especially those that cause pain, and medications used to treat them can often be contributing factors to insomnia.

• Abnormal adrenal, thyroid and reproductive hormone function can be the root cause of sleep problems. Appropriate treatment of menopause and thyroid disorders can often alleviate insomnia.       

• Food sensitivities and chronic allergies can sometimes irritate the nervous system and contribute to insomnia. Testing is sometimes indicated.

Ambien, Ambien CR, Lunesta, Sonata:  replace the normal calming neurotransmitters involved with sleep and alter the receptor. These medications are very effective, but because they are metabolized by the liver, have a high propensity for development of tolerance.Tolerance develops within two months to two years. Sonata is very short acting and not very useful as a sleep medication. Ambien lasts about 4 hours. Longer acting Ambien CR and Lunesta last about 8 hours. Tolerance is slower to develop with long acting versions. Rebound insomnia, even after short term use, is a common problem. Withdrawal symptoms that are sometimes severe commonly occur after prolonged use. (Often chronic insomnia is more a reaction to long-term sleep medication use than anything else.) These medications should be used only on a very limited basis.

Benzodiazepines: Valium, Xanax and Klonipin effect anxiety more than sleep, but are often used for insomnia. Halcion, Restoril and Dalmane were designed primarily to treat insomnia. There are many other similar drugs on the market. All are very effective at maintaining sleep, but sleep is of poor quality. These drugs are extremely habit forming and subject to tolerance, severe withdrawal symptoms, and severe rebound insomnia. Should be avoided completely for treatment of insomnia.

Gabapentin (Neurontin): anti-seizure drug that can be effective for treatment of insomnia. Increases GABA production, but is not felt to corrupt the GABA receptor. This drug is generally safe and does promote deep stages of sleep, but tolerance develops quickly in some individuals and rebound insomnia does occur.

Rozerem:  is a melatonin agonist (acts like a long acting version of melatonin). It does not cause tolerance. Nightmares are the most common side effect. The drug is effective for some people, but it is also very expensive. Sublingual melatonin is just as effective, better tolerated, and costs only a fraction as much.

Diphenhydramine (Benadryl): ingredient found in most over-the-counter (OTC) sleep medications and is often combined with non-prescription analgesics. It is very effective for mild transient insomnia, but tends to suppress stage 3 and 4 sleep and cause next day sedation. Tolerance generally occurs rather quickly with regular use, limiting its practicality for treating chronic insomnia. Diphenhydramine should be used only on a very limited basis.

Doxylamine (Unisom): antihistamine commonly used in OTC sleep medications with a similar profile to diphenhydramine.

Remeron: an antidepressant with sedative properties. One of the safer prescription medications for use in relieving insomnia. Common side effects include daytime sedation and constipation. Tolerance can occur.

Tri-cyclic Antidepresants: Predominantly used for depression, but have a sedative effect that can be useful for insomnia. Side effects are common and include daytime sedation, constipation and dry mouth. Common names include amitriptyline and nortrityline.

Clonidine: blocks the effects of adrenaline. Most commonly used to treat high blood pressure, but also can be effective for mild insomnia.

Trazadone: antidepressant widely used for treatment of insomnia. High incidence of side effects. Tolerance and dependence are common and many individuals experience severe withdrawal effects when coming off the medication. Though the mechanism of action for this drug is reported as unknown, very likely it does corrupt GABA receptors.

Seroquel: anti-psychotic medication being used in low dosages to treat insomnia. Average doses for treatment of insomnia are 25-100mg. Mechanism of sleep induction is unknown. One possible advantage of Seroquel over other sleep medications is that benzodiazepine receptors do not seem to be effected. The drug has not yet been widely used for insomnia and the potential for tolerance, dependence and withdrawal is relatively unknown. Flat affect is a common side effect. This is a very potent drug and should be used with caution.

Melatonin:  Natural production of melatonin is induced by darkness. Melatonin is effective for initiating sleep, but not maintaining sleep. It is also beneficial for “resetting your clock” during jet lag.When administered as a supplement, sublingual dosing (under the tongue, not oral), is more effective than oral dosing. The starting dose is a half of a 1 mg sublingual tablet. Limit to a maximum dose of 5 mg over a 24 hour period. Extended release versions of melatonin are generally not as effective as sublingual melatonin and can be associated with nightmares and poor sleep. Melatonin carries no risk of tolerance. Patients with significant depression should avoid melatonin.

L-theanine: a natural amino acid found small amounts in green tea and certain mushrooms. As a supplement, it crosses into the brain and completes against exciting neurotransmitters. It may also promote the formation of GABA, but is not felt to affect the GABA receptor. L-theanine has a wonderful calming effect with little potential for side effects. Use of theanine results in decreased adrenaline production. It does not cause sedation during the day, but use during the day will improve natural sleep at night. Because l-theanine is metabolized by the same pathways as other amino acids in the body, there appears to be little risk of tolerance or dependence. A dose of 200mg can be taken up to three times spread throughout the day. L-theaninie is often taken with 500mg of l-glutamine, and a small dose of vitamin B6 to promote the formation of calming neurotransmitters in the brain. This supplement is valuable for anxiety, depression, insomnia, and any other stress induced disorder.

Ashwagandha: derived from a plant belonging to the pepper family, found in India and Africa. Steroid chemicals known as withanolides, present in the roots of the plant, are felt to provide for its medicinal properties. Being similar to cortisol, withanolides probably provide feedback to the brain, thus moderating cortisol secretion by the adrenal glands. These chemicals also have anti-inflammatory effects and direct calming effects on the brain. Ashwagandha also contains potent anti-oxidants. The net effect is increased tolerance to stress, thus ashwagandha is often referred to as an “adaptogen”. Ashwagandha does not cause sedation during the day, but does improve sleep at night. Ashwagandha has been consumed by humans for thousands of years in India and Africa and is well tolerated with little potential for side effects. There are no known adverse consequences with using ashwagandha long term.

Relora: a patented blend of extract from the plants Magnolia officinalis and Phellodendron amurense, both long used in traditional Chinese medicine for management of stress related disorders and anxiety. Plant extracts normalize cortisol secretion and other stress related hormones. Extracts also have a direct calming effect on the brain, but very importantly, there is no evidence that they bind to benzodiazepine receptors. Relora does not cause sedation during the day, but does improve sleep at night. Clinical studies in humans show positive clinical benefit and few reported side effects. Though there are no long term studies available, these two plant extracts have been used for hundreds and possibly thousands of years in traditional Chinese medicine. (Magnolia officinalis may have a mild effect on GABA receptors, but is not felt to alter the receptor)

Magnesium: 400-600mg before bedtime provides a general calming effect. Potential side effects include loose bowel movements in some individuals. Slow release forms of magnesium are ideal.

L-glycine: simplest of all amino acids. L-glycine acts as an inhibitory or calming neurotransmitter. The effects are predominantly found in the brainstem where l-glycine acts to inhibit or calm nerve impulses to muscles. L-glycine also has some inhibitory effects in the central nervous system, but it is not as important as GABA. L-glycine does, however, cross the blood-brain barrier, allowing it to be useful as a supplement. Doses of l-glycine in the range of 3000mg per day have a mild sedating effect in some individuals. L-glycine may be beneficial for restless legs syndrome. L-glycine supplements may increase growth hormone secretion. Side effects are rare.

5-Hydroxy-tryptophan (5-HTP): precursor for both serotonin and melatonin in the brain. During the day it has a mood stabilizing effect and during the night it can promote improved sleep. The recommended dose is 100mg up to three times spread throughout the day or 100-300 mg at bedtime. 5-HTP is also metabolized as a normal substance in the body and therefore there is no risk of dependence and tolerance. Side effects are not common, but some patients report night mares or muscle aches when using it regularly.

Tryptophan: essential amino precursor to serotonin and melatonin. Some individuals report better results with tryptophan than 5-HTP, especially when combined with vitamin B6. Contaminant-free, 100% pure tryptophan is now available from reliable sources in the U.S. Tryptophan and 5-HTP have a very mild link to a rare, but life threatening autoimmune condition called eosinophilia myalgia syndrome. In 1989 an outbreak of cases occurred, all commonly associated with supplementation with the amino acid tryptophan. The supplement was traced to a specific manufacturer in Japan. Whether the cause was tryptophan itself or an unknown contaminant (referred to as “peak X”) has not been determined. Tryptophan was banned for a number of years, but is now back on the market. The risk associated with pure forms of tryptophan and 5-HTP appears to be extremely low, but some caution is advised.

SAMe: anti-inflammatory properties effective for reduction of arthritis symptoms. SAMe is also a mood elevator and a mild sedative, making it useful management of insomnia. The incidence of side effects is low. SAMe should be avoided if taking other anti-depressant medications. The average dose to achieve benefit for insomnia is 400mg taken before bedtime. Results are usually not apparent for 1-2 weeks.

Hawthorn:  normally classified as a "heart tonic," hawthorn is also known to also have calming properties.  It is a very safe herb for everyday use and can be taken on a daily basis to help maintain calm during the day and encourage better sleep at night.  Generally it is taken in the morning and then again in the evening before bedtime.

Passion flower: well-known seditive herb with a favorable safety profile.  Passion flower "turns off the flow of words." When used as a standardized extract it can be very effective for insomnia therapy.  (When found in combination products it is usually underdosed.) 

Motherwort: relaxing herb that is particularly beneficial for "3 am insomnia."  Also known to reduce symptoms of menopause and heart palpitations. 

Skullcap: sedating herb that is particularly suited for reducing muscle spasm, nervous tics and tight, painful muscles.  Skullcap is often used as an adjunct for treating restless legs syndrome.

Chamomile:  herb with mild sedating properties.  Most effective when combined with fresh minced ginger in a tea with honey to reduce gastrointestinal discomfort that may contribute to insomnia. 

Seditol: a patented blend of Magnolia officalis and Ziziphus spinosa found in clinical studies to consistently induce natural sleep in individuals suffering from insomnia. These herbal substances have been used in Asian medicine for thousands of years. Scientific research reveals that these substances affect several different receptors involved with sleep, including the GABA receptor. It is not known whether the GABA receptor is corrupted, but present information suggests a low potential for dependence. These substances can be quite effective for treatment of insomnia, but short-term use is recommended.

GABA: mildly effective for relieving anxiety and insomnia. Effectiveness is limited by the fact GABA taken as a supplement does not readily cross the blood-brain barrier. Also, GABA supplements may suppress already low GABA secretion even further, causing rebound insomnia or anxiety with continuous use. GABA is most beneficial when used on a limited basis. Because the effect is mild, it can be combined with other supplements for a synergistic effect. The sublingual form (under the tongue) is more effective than the oral form.

Chamomile, passion flower, and hops are the most common ingredients found in relaxing teas and supplements. Their effect is mild at best, but they have little potential for harm. The active chemicals are known to affect GABA receptors, but may not alter the receptor. Tolerance does develop with time, but withdrawal syndromes have not been documented.

Valerian root:  has been used for sedation for hundreds of years. The tea has the unappealing smell of “dirty sweat socks”, but encapsulated extracts are available. Valerian works well long term for some individuals, but takes several weeks to start working. About 10% of individuals find valerian to be stimulating with worsening insomnia. Valerian does affect and may corrupt GABA receptors, so tolerance and habituation could be a concern—seems to have less potential than benzodiazepines. Recent studies have found valerian to have a link to liver damage. Liver function should be monitored with long-term use.

Kava kava:  commonly used as an intoxicating beverage in the South Pacific.  Very sedating.  Very likely adversely affects GABA receptors and is known to have addictive potential.  May cause significant and irreversible liver damage, especially in individuals of European decent.  Liver function should be monitored with regular use.

Acupuncture: for most people, acupuncture is very effective for treating insomnia. It is simple and there are no side effects.

Hypnosis: effective adjunct for treatment of insomnia and helpful for learning spontaneous relaxation techniques.

“The Delta Sleep System” by Dr. Jeffrey Thompson: a music CD for initiating and maintaining sleep. Play through the night on a CD player that allows a continuous loop or download onto an MP3 player that allows continuous play. This is an excellent resource for better sleep through the night.  The delta waves embedded in the music encourage deep sleep.  Can be used with "pillow speakers" placed under the pillow at night. 

“The Stress Reduction and Relaxation Workbook”:  catalog of common methods of spontaneous relaxation. An excellent resource for finding the method that works best for you. 

“Meditation for Beginners with Maritza”: a DVD by Gaiam offering an excellent introduction to both yoga and spontaneous relaxation.

“A Stress Management Program”, by Annette Tersigni RN: audio CD providing guidance through a variety of breathing and spontaneous relaxation techniques (includes a 20 minute deep relaxation segment). This is an excellent beginners program.

“Open Focus”: designed by Les Fehmi, a 30 year veteran in neuro-biofeedback, provides a truly effortless avenue for experiencing spontaneous relaxation. www.openfocus.com.

• One of the most important and difficult parts of allowing sleep chemistry to return to normal is avoiding excessive stimulation during the day. This means decreasing daily stress and stimulation as much as possible. Practice the 6 exercises found in the Anxiety/Stress Health Brief for reducing tension during the day. Regular practice of meditation and relaxation techniques several times daily is vital for relaxing an over-stimulated nervous system. A brief “power nap” midday calms the mind and body, allowing for better sleep at night.

• Absolutely avoid caffeine and other stimulants completely (caffeine really does have to go until sleep cycles return to normal). Most beverages are available in caffeine-free versions. Look for hidden stimulants in supplements and foods. Be aware that many if not most medications disrupt stage 3 and 4 sleep. Avoid alcoholic beverages in the evening. Alcohol initially is a sedative, but the metabolites are stimulants. Expect to be wide-eyed and awake about 3 to 4 hours later if you alcohol to treat insomnia.

• Improved dietary habits are important for overcoming insomnia. Avoid refined sugar, refined starches and refined oils completely. Diet should be predominantly composed of fresh vegetables and fruit. Whole grains are preferred over processed and meat consumption should be minimal.

• Food sensitivities and gastrointestinal dysfunction can contribute to insomnia. An elimination diet can be helpful for identifying food sensitivities.  (See Step 2 for a standard detoxification/elimination diet.)

• Be very particular about your bedtime routine. Try to set a pattern of going to bed and getting up at the same time each day. Respect normal day and night cycles as much as possible. If you work an odd shift, use darkening shades to completely darken the room where you sleep.

• Be aware that your bed partner may be keeping you awake. Movement and snoring from a person in the room may be contributing to insomnia. Consider sleeping in an isolated location until insomnia is under better control.

• Avoid excessive light stimulation in the evening. Use low lights and turn off televisions and especially computer screens after 8 pm. This will help stimulate natural melatonin levels. Try reading before bedtime or practicing relaxation techniques.

• Avoid television and computers after 8 pm. Excessive stimulation and exposure to penetrating light adversely affect sleep. Consider reading a book or magazine with a non-stimulating topic or calming plot. Stay away from murder mysteries and horror stories.

• Turn off the News. Worry about things that have direct bearing on your personal wellbeing and ignore everything else.

• Sleep on a comfortable mattress. “Memory foam” mattresses are especially conducive to a good night’s sleep and allow sleeping on the side. Sleeping on the back is one factor that encourages sleep apnea.

• Always sleep in a very dark room. Use heavy shades if necessary.

• Limit noise pollution such as bed-partners snoring or pets moving about as much as possible. Consider obtaining an electronic device that produces “white noise” to drown out surrounding sounds.

• Vigorous exercise during the day is excellent therapy for insomnia, but should be avoided after 8 pm except for relaxing type yoga routines.

• Adjust the thermostat. Being overly hot or overly cool can adversely affect sleep.

• Address chronic pain syndromes and menopausal symptoms.

• Consider acupuncture and hypnosis as adjuncts for insomnia therapy.

• Address chronic disease and pain. There are many non-drug alternatives and less toxic drug therapies to manage symptoms associated with chronic disease.

• Some chronic microbial diseases, such as Lyme disease, are associated with release of “biotoxins” by the microbe. Biotoxins can be a factor in insomnia. Biotoxins can be reduced with specific detoxification protocols.

• Get a sleep test. If excessive snoring or the possibility of sleep-apnea exists, visit a sleep clinic for an overnight stay.

• Combinations of supplements are not as potent as pharmaceuticals, but can be safely used on a continual basis.  For a starting point, many individuals are able to control mild to moderate insomnia with L-theanine combined with ashwagandha/Relora (Cortisol Control).  This combination of supplements is especially effective restoring hormonal balance and normalizing over-stimulated brain chemistry—this allows natural sleep to occur at night.  Theanine 200 can be taken 1-2 times over the course of the day to control adrenaline or once in the afternoon and once before bedtime. Cortisol Control is best taken once during the daytime and then 2 before bedtime. (For a similar approach using different products, take one capsule of Sensoril (ashwagandha) in the morning and then Theanine Serene during the day and/or evening. Theanine Serene is slightly more sedating.  Sensoril can also be repeated in the early evening.

• At bedtime, use of ½ to 1 mg of sublingual melatonin is often effective for initiating sleep. This low dose of melatonin can be repeated several times during the night (up to 5 mg total) upon waking in the middle of the night.  Headaches, nightmares and depression that occur with higher doses of melatonin are unusual with lower subligual doses, but the small doses also seem to be more effective. 

• Passion flower can provide additional sedation if needed—it has a reputation for stopping the continuous chatter that keeps your brain from going to sleep.  Motherwort is beneficial if menopause is an issue, or 3 am insomnia is a problem.  Add skullcap if muscle tension or restless legs are a problem.  These three can be safely taken together and also taken with the supplements above.

• As sleep returns to normal, all of the supplements can be gradually reduced and then discontinued.  Melatonin, at low doses, can be continued indefinitely.  SAMe, 5-HTP (or tryptophan), magnesium and hawthorn are supplements with mild sedating properties that can be used as everyday supplements for promoting optimal health.  They can be used with the above supplements and then continued long-term to maintain normal sleep cycles. SAMe should be considered if pain from arthritis is an issue. Tryptophan/5-HTP and SAMe take several weeks before noticeable benefit occurs. Hawthorn is especially beneficial if daytime anxiety with palpitations are an issue.  Magnesium supplements should always be taken in the evening before bedtime. L-glycine, 3000mg before bedtime (powder or capsule), is a beneficial adjunct for treatment of insomnia in some individuals.  

• Seditol is similar to Relora, but more sedating.  Some individuals find they can use Seditol alone to control mild to moderate insomnia. 

• Valerian works well for some people, but carries the lingering concern of liver toxicity. If you decide to use valerian, consult your healthcare provider and have liver function checked regularly.

• Prescription sleep medications are sometimes temporarily necessary for severe insomnia. Follow the supplement advice for the protocol above. If insomnia is refractory, consult a healthcare provider for further evaluation and therapy. Ask your provider to start with a non-benzodiazepine sleep medication first. Remeron is usually a good first choice. A quarter or even eighth dose is often satisfactory. Remeron can be used with any of the above options and discontinued when sleep improves. (Remeron must be administered by a qualified healthcare provider.)

• Prescription sleeping pills that affect the GABA receptor directly would seem to be the simplest solution to insomnia, but life is never so simple. The absolute best way to prevent your body from returning to a natural rhythm of sleep is by chronically taking one of these medications. If you use sleeping pills chronically, but be prepared to “pay the piper”, as all sleep inducing medications disrupt normal brain chemistry. Habituation often develops quickly and easily and once it occurs, restoration of normal function may take months or even years after discontinuing the medication. Use of these medications greatly reduces the possibility that natural remedies will be effective.

• If you are already taking a sleep medication and want to discontinue it, the prerequisites for doing so include improved general health habits and improved sleep habits. Nutraceuticals are often beneficial. The natural therapies above can be started and then use of the medication reduced very gradually over a period of several months under the guidance of a qualified healthcare practitioner.  Never stop a prescription sleep medication suddenly!

• Many drugs and supplements outside of sleep medications can disrupt sleep. Review the side effects of any regular medications and supplements to be sure they are not contributing to poor quality sleep.  Drugs that commonly disrupt sleep include serotonin-reuptake inhibitors (commonly used for depression and anxiety), blood pressure medications including beta-blockers and calcium-channel blockers, inhalers used for asthma, "non-drowsy" cold medications, steriods and thyroid hormone.

The brain can be trained to give up verbal thought with methods of spontaneous relaxation. A calm day is the best recipe for a calm night. Regular practice of relaxation techniques throughout the day makes for an easier transition into sleep during the night. Once night arrives, these and similar techniques can be beneficial for initiating sleep. 

Establish a routine for falling asleep, whether for going to sleep for the first time of the evening or going back to sleep after becoming awake. Take ten minutes to progressively relax the muscles of the body. Sometimes a warm bath can help. If the body is especially tense and agitated, use a muscle tensioning technique to initiate a deeper relaxation. With muscle relaxation, breathing should also become slow and regular. At this point, ask yourself how intensely the stream of verbal thought is pouring into your brain and from how many directions. It must be squelched before sleep can occur.

There are many techniques for calming the brain. Traditionally, one of the most well known is counting sheep. Many individuals, however, find that continuous counting is not very effective, as it is too easy for verbal thought to slip back in. Sequential counting of breaths works better. Each breath is counted up to a count of ten, and then the sequence starts over. Enough attention must be devoted to keeping up with the count that the brain has to concentrate on only one thought. 

Simple counting is most effective for mild thought congestion only. More elaborate and effective techniques require props.   Tools for sleep training include a simple CD player or MP3 player and relaxation recordings. There are almost an unlimited number of different types of recordings or you can make your own. Most of them deal with breathing and muscle relaxation. Which ones work for you is highly dependent on individual taste. Often the voices are a little bit too “sing-song” or overly enthusiastic and the music is a little bit too “sweet”. Find one that works for you, learn progressive muscle relaxation and breathing techniques, and then put these recordings away or pass them on to someone else. Once learned, use them as part of your regular nightly sleep routine.

There are many guided imagery recordings available, but your own imagination is equally effective. A familiar place from the past that contains pleasant memories provides a perfect vehicle for shifting the brain away from verbal thought. Other suggestions for imagery include memories of a favorite vacation spot or a road trip. Imagine a country road with farms, big overgrown trees, and familiar landmarks along the way. Imagery can even be more abstract. Thoughts of changing shapes or colors, almost like a screen saver, can sometimes be enough to suppress verbal thought.

Imagery and deeper sleep in general can be enhanced by music. Certain types of music, usually specifically written for the purpose, promote the formation of delta waves, the deeper brain waves associated with sleep. One step further, specially recorded music with delta waves imposed within the recording are effective for inducing and maintaining sleep. The best known of this type of sleep music is “The Delta System”, by Dr. Jeffery Thompson. Several variations of delta sleep music can be easily obtained with an internet search. 

“Letting go” is a very important part of going to sleep. All of the concerns that hound you during the day must be put to rest before you can rest. Rarely can problems be solved during the time that you devote to sleeping and always problems can be handled better after a good night’s sleep. Consider placing a jar with a lid by your bedside. Symbolically, the jar is opened, thoughts are placed inside the jar, and the jar is sealed until the next morning. Whenever thoughts of the day arise, shift your mind to the jar. This practice is surprisingly effective.

Adjuncts for encouraging and maintaining sleep include a warm bath and a low sugar snack such as whole grain cereal or a glass of warm milk just before going to bed. A little bit of melatonin under the tongue is often effective for initiating sleep. Side effects with melatonin are generally dose dependent. Start with only ½ of a one milligram sublingual tablet. This small dose can be repeated several times. Other supplements and/or medications can used as directed above. 

Many sleep experts recommend that upon waking in the middle of the night, you should get up, turn on the light, and read or do some other type of activity until you become sleepy. While getting out of bed works for some, this is a perfect opportunity to stay in bed and practice spontaneous relaxation exercises. Have your CD player ready by the bedside, do not turn on the lights if possible (light suppresses melatonin secretion), and start practicing before the stream of verbal thoughts starts pouring in. Not only will you have made good use of valuable practice time, you will probably be asleep again before you know it!

Easily slipping into a state of non-verbal calmness does not happen overnight. It must be regularly practiced during waking hours… practice, practice, practice.