We've all pulled all-nighters - you know how crappy you feel after cramming for that final exam. But imagine how you'd feel if your entire life consisted of one all-nighter after another . . . forever. If you feel like a rock instead of sleep like one, you may be among the 40-50% of tired Americans who complain of occasional bouts with insomnia. In fact, every year as many as 10 million Americans consult a physician for help with their sleep disorders (don't worry . . . they don't all go to the same physician). True, Leonardo da Vinci, Winston Churchill and Florence Nightingale only slept four hours a night, but they were obviously freaks of nature. While the required amount of sleep varies from person to person, most of us mere mortals need between 7 and 9 hours a night.

Insomnia can have serious repercussions, including:

  • Making us feel crappy and listless
  • Making us moody
  • Lowering our thinking speed and productivity
  • Weakening the immune system, making us more susceptible to viruses
  • Being a major factor in 200,000 auto accidents every year
  • Costing the economy billions for work place absenteeism
  • Playing a role in industrial disasters such as Exxon Valdez and the Three Mile Island nuclear plant accident

Since no one likes nuclear meltdown, it is important to take steps to prevent insomnia. Fortunately, some very simple lifestyle changes can help you get better zzzz's. And believe us, unless you are a shepherd, you won't miss counting those sheep.

1. CLASSIFY YOUR PROBLEM

OK, so let's get the definition out of the way: "insomnia" describes any episode of unrefreshing sleep, difficulty falling asleep, frequent awakenings, or waking up too early in the morning. Women and the elderly are the most frequent victims.

So to overcome your insomnia, your first move is to classify the type you are battling, because each type presents unique challenges and calls for different treatment. The three basic kinds are:

Transient insomnia
Short-term insomnia
Chronic insomnia

Transient insomnia

Transient insomnia is a disturbance in sleeping patterns which lasts for a few nights only. In this case, you are a princess who has a brief run-in with a frustrating pea such as: jet lag, excitement, stress, illness, or a change in sleep schedule.

Here is the good news: those with transient insomnia soon return back to normal, and sleeping pills ease the course of the problem. While not conducive to long-term use, in the short term sleeping pills provide relief without fear of dependence or a gradual loss of their effectiveness.

Short-term insomnia

Short-term insomnia is slightly more serious because it persists for about 2-3 weeks. Contributing factors include a job change, divorce, serious illness, financial problems, or the death of a close friend/relative.

Chronic insomnia

Chronic insomnia is the rarest and most serious type, with episodes lasting longer than a few weeks. In spite of this, 10-15% of the US population suffers from it.

To combat chronic insomnia you must first rule out the possibility that it is a symptom of some other underlying health problem. See a doctor to ensure that such conditions as heart disease, diabetes, epilepsy, pregnancy, menopause, or arthritis are not responsible for the sleep loss. In addition, medications prescribed for certain health conditions such as high blood pressure or asthma may adversely affect sleep.

You should also identify any psychological factors standing in the way of your beauty rest. If you feel sad, worthless, or suicidal, you may be depressed. In fact, one of the premiere symptoms of depression is the inability to go back to sleep after waking up too early. By treating mental conditions, you can often alleviate the sleeping problem that is just a manifestation of a larger issue (ooh . . . how Freudian).

2. CHANGE YOUR DIET AND EXERCISE ROUTINE

While it would be nice to blame insomnia on things we can't control, stress is the leading cause of insomnia. Many cases of insomnia also stem from lifestyle habits:

Caffeine
Alcohol
Eating
Smoking
Exercise

Caffeine

This is the most widely known cause of insomnia; if you are tossing and turning at night, start by tossing out the caffeine. An ingredient in coffee, tea, colas, chocolate, and some medications, caffeine is a stimulant and a nightmare for the sleep-deprived. For the especially sensitive, its effects can last for as long as 20 hours. You know who you are.

Alcohol

Alcohol is tricky. You may argue that liquor acts as a sedative and initially helps to induce sleep. However, alcohol actually lightens and fragments sleep, causing you to wake up as your body metabolizes it. You may think you're out cold, but you're not getting the full-rested sleep that you need. While you're at it, try to limit your intake of any liquids close to bedtime (this time, consider the princess and the pee). The moral of the story: less nightcap, more Happy Hour. Besides, read some alcohol facts. Turns out it's not so great for your brain, either.

Eating

Yes, you tend to feel sleepy after a heavy meal, but the trick's on you: heavy meals actually keep you awake as your digestive system puts in some overtime. Keep track of what you're eating before bed. Also, avoid spicy and fatty foods that cause heartburn, MSG (found most commonly in Chinese food), and foods that cause gas. However, the right kind of eating can improve the quality of sleep as much as undermine it. No matter how much it pains you to admit it, your mother was right about the milk thing. Milk has an amino acid that the body converts to a sleep-enhancing compound in the brain. Calcium is a natural relaxing agent along with several other vitamins such as the B vitamins and magnesium.

If hunger bothers you at night, have a light snack before bedtime. Some foods in particular promote production of melatonin, a hormone associated with the onset of sleep. Among these desirable snacks are cottage cheese, soy nuts, chicken, pumpkinseeds, and turkey. That's why you're such a slug after your Thanksgiving meal. Finally, high-carbohydrate foods such as bread act upon another essential hormone, serotonin, which reduces anxiety and contributes to refreshing sleep.

Smoking

If you won't listen to the American Lung Association, at least pay attention to the bags under your eyes. For the light sleeper, nicotine has to go. It's a stimulant that increases blood pressure, speeds up the heart rate, and stimulates brain activity. Of course, there's also the whole cancer thing. There's plenty of online "quit smoking" support groups, so join one and kick the habit.

Exercise

Regular exercise is a sleep promoter. But if you work out too close to bedtime, the increase in your heart rate and metabolism will make your body too excitable to sleep. So exercise in the late afternoon is ideal, because you then have time in the evening to settle down. In this way, exercise has the same sleep-enhancing effect as a warm bath. Both activities help to raise body temperature, and the body reacts by producing melatonin to take the body temperature back down.

3. IMPROVE YOUR SLEEPING ENVIRONMENT

  • It may seem obvious, but make your bed as comfortable as possible. Experiment with what works best for you, be it a feather bed, waterbed, bed of lettuce, whatever.

  • Choose a position conducive to sleep. This is often the position you find yourself waking up in. If your sleeping partner is the source of your insomnia (as he/she often is), asking him/her sleep in the garage isn't a viable option. Rather, if he/she kicks or snores, think of buying a bigger bed or earplugs. If he/she makes many toilet trips during the night, situate him/her on the side of the bed closer to the bathroom.

  • Get rid of the large, luminous clock staring at you. It not only produces distracting light, it is a stressful reminder that "Hey, you aren't sleeping. Yep, that's right. Not sleeping. Loser." The act of worrying about sleep is, in itself, enough to keep you awake.

  • Control the amount of light in your bedroom. Excessive brightness not only affects your eyes, but it also influences the hormone production that helps to establish a healthy sleep cycle. Wear a sleep mask if necessary.

  • When it comes to noise, many people find repetitive sounds easier to sleep through than intermittent and abrupt ones. Ear plugs or a continuous background sound such as a fan can help mask disturbing noise (the next-door neighbors' fight, a barking dog, etc). Another option to consider is a white noise machine.

  • Control the thermostat. Temperature extremes, whether too hot or too cold, are no fun for the light sleeper.

4. ALTER YOUR SLEEPING SCHEDULE

  • Try to keep your bedtime consistent from night to night. No doubt this is difficult for those with shifting work schedules, but by sticking to the same general bedtime and waking time every day (even weekends), regardless of the amount of sleep you get, you are more likely establish a regular sleeping rhythm.

  • No more napping. Although occasionally refreshing, a power nap cannot substitute for a full night of REM, and it perpetuates the poor sleep cycle.

  • Don't do your taxes, file your nails, direct a play, rescue endangered species, etc. in bed. You should associate your bed with sleeping and sex only (not that they're mutually exclusive . . .). So, head to bed once you feel sleepy, and if Hypnos, the Greek God of sleep, doesn't pay you a visit within 15-30 minutes, get out of bed.

  • If you can't sleep, don't stress and gripe. This just makes you more anxious and less likely to get your rest. This isn't to say that you should participate in extreme sports at 3 a.m. Do a low-key activity (e.g., take a warm bath or read and return to bed as soon as you feel tired again). It really doesn't pay to stress about sleep. Remember that the goal is to sleep like a baby, not to act like one.

  • Once you start using our tips, you should keep a sleep diary for 1-2 weeks. Note which applied techniques work for you.

5. CONSIDER MEDICAL TREATMENTS AND BEHAVIORAL TECHNIQUES

While some of us may prefer the naturalistic suggestions given above, there is a sizeable portion of insomniacs who cry out "Just drug me! Give me some pills and knock me out!" Please don't yell. Here are some interventions that you can use to help bring the onset of sleep:

Sleeping pills
Melatonin
Herbs
Behavioral techniques

Sleeping pills

As we stated before, those with transient insomnia get the greatest benefit from sleeping pills. As a general rule, you should take them for the shortest time and in the lowest doses as possible. You must be EXTREMELY careful with sleeping pills; they only remain effective for 2-3 weeks, at which point you may develop a tolerance for (or addiction to) them.

The most commonly prescribed pills come from the benzodiazephine family; however, they do tend to have side effects, including a "hangover" feeling, motor coordination problems, memory loss, and low levels of alertness. Many Americans, nevertheless, seem to believe that the benefits outweigh the drawbacks - as many as 5-8% of the adult population in Western countries uses sleeping pills more than once a week.

Melatonin

Some regard melatonin as a more attractive alternative to sleeping pills because your pineal gland naturally secretes melatonin in the dark (thank you, evolution). Taking melatonin supplements became popular in the early '90s when doctors found it instrumental to the onset of sleep.

As little as .1 milligrams can enhance sleep, so taking 1-3 milligrams an hour or so before bed will surely do the trick. Supposedly, melatonin supplements will not interfere with sleep quality, memory, or next day performance the way that pills do. Furthermore, it does not lose its effectiveness in the long run. You can pick up some tablets in any health food store, but remember that scientists are still testing the effects of the stuff. Melatonin is a hormone, and any teenager can tell you that hormones can get complicated.

Herbs

The next suggestion is the herb valerian. Quite popular in Europe and available in health stores, valerian improves sleep quality without causing a hangover effect. Just steep about 300-400 mg of the root in hot water for tea 30 minutes before bedtime. Other popular herbs include skullcap, passion flower, California poppy, and lemon balm.

Behavioral Techniques

We're not saying that you're bonkers or anything, but perhaps the problem is purely mental. If that's the case, here are some options:

  • Experiment with relaxation and meditation techniques at bedtime to reduce body tension and relieve the muscles. Talk a partner/spouse into giving you a slow massage as treatment for your insomnia. Who could resist your plea? Also, some people find sex prior to bed relaxing. (Try a new pick up line: "Hey hun, wanna help me cure my insomnia?" Its worth a shot.)

  • Some more drastic/extreme techniques include sleep restriction or light therapy. For sleep restriction, limit yourself to only a few hours of sleep a night and gradually increase the time you allot. Basically, exhaust yourself until you can sleep normally. On the other hand, light therapy works under the premise that your internal clock is out of whack and just needs to be reset to reflect the actual time of day. For example, if you wake up too early, you should expose yourself to bright light in the evening thereby convincing your body to get tired later that night and sleep later the next morning. If you go to sleep too late, light exposure in the morning serves the same purpose.

  • Cognitive therapy is another option. Many people have dysfunctional attitudes about sleep that can lead to a vicious spiral. If you're nervous about sleep, you cannot relax long enough to get it. In this case, a therapist can talk through your concerns with you, bring your harmful attitudes to the surface, and give you a new sense of control.

So off to the Land of Nod with you! With any luck, you will soon be worrying more about what that weird dream meant. Just remember: sometimes a cigar is just a cigar.