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The Prescott Daily Courier | Prescott, Arizona

home : features : features November 24, 2015

1/19/2013 9:58:00 PM
Insomniacs must replace negative thoughts with positive ones
Courier Columnist

Dear Dr. Rosenberg,

My husband has been having a hard time getting to sleep for several months. Now he is convinced that he is going to have a heart attack or, based upon what he read, get cancer because of his inability to sleep. He is so worried about this that I believe it is making his insomnia worse. Would you have any ideas?

A: I would suggest a method of CBT (cognitive behavioral therapy) called cognitive restructuring. Your husband has developed what we classify as dysfunctional beliefs about sleep. Examples of such beliefs are: "If I don't get to sleep I'll be miserable," "I cannot function when I don't get enough sleep and I will be fired," "I know I'm going to get sick from this." In actuality most of us can function relatively well with 5 1/2 hours of sleep called core sleep. Another problem is that most people with insomnia tend to underestimate their actual time asleep. Negative thoughts make the insomnia worse by causing anxiety; this can lead to a heightened stress response, making good sleep almost impossible.

In cognitive restructuring, we ask the patient to identify these negative thoughts and write them down. We then ask them to replace those thoughts with more realistic and positive ones, such as: "I've been through this before and I have functioned all right," "I'm physically fit and in good shape," "I'm probably sleeping longer than I think I am." We ask the individual to rehearse them in their minds for a short period of time daily. In the majority of patients the negative thoughts are replaced by more positive ones, resulting in better sleep.

Dear Dr. Rosenberg,

My mom takes an over-the-counter sleep aid called Tylenol PM. She has been complaining of some unsteadiness on her feet and trouble urinating since she started. I'm worried that the sleep aide could be the cause. Is that possible? Her doctor does not know she takes this. She does not mention it because it is a nonprescription medication.

A: What you mention are some of the side effects associated with the older antihistamines that are contained in these over-the-counter sleep aids. They have what are referred to as anticholinergic side effects, resulting in dizziness, dry mouth, urinary retention, residual sleepiness and confusion. I would therefore urge your mother to stop the medication. These symptoms will most likely go away.

Dear Dr. Rosenberg,

My husband refuses to be treated for sleep apnea. He drives 40 miles to work every day and I know he has almost fallen asleep several times while driving. Is there anything you could suggest that I tell him to change his mind? I'm really concerned.

A: A study published in the June 2011 issue of the Journal Sleep addressed just this issue. The article informs us that people with sleep apnea who wear their CPAP have a 50 percent decreased incidence of death due to motor vehicle accidents. The people in this particular study were observed over a 10-year period.

Dear Dr. Rosenberg,

When I can't sleep I stay in bed and try to fall back asleep. Sometimes this goes on for hours. Recently a friend told me she had the same problem. She was told that staying in bed when this happens is not good. What do you think?

A: Your friend is correct. Staying in bed to try to make you fall back asleep is counterproductive. Your brain will associate the bed with being awake and anxious instead of it being a calm and relaxing place. If you find that you are unable to fall asleep after 20 minutes or more, get out of bed and go into another room. Once in the other room do something relaxing, such as reading, sewing or a crossword puzzle. When you are sleepy once again, you may return to the bedroom. Believe me, this technique is much more effective

than what you are doing now.

Dr. Robert Rosenberg, board-certified sleep medicine specialist, will answer readers' questions by incorporating them in future columns. Contact him through the form at or via mail at the Sleep Disorders Center of Prescott Valley, 3259 N. Windsong Drive, Prescott Valley, AZ 86314.

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