What we're about to explore just might make a major difference in the quality of your life if you’re having difficulty sleeping on a regular basis.

While issues of sleep apnea (breathing cessation) due to a host of respiratory and central nervous system causes has been discussed in a prior column, we’re about to focus on insomnia from a rather different perspective.

Rather than dwelling on well-established causes such as medication side effects, exercise, eating/drinking/smoking prior to sleep, noise, jet lag, or extreme temperatures, let's take a closer look at an issue that is far more commonplace.

It's a fact many people in our society simply suffer from insomnia for no apparent cause. This is especially apparent for seniors, yet individuals of all ages experience this as well. While the issue of daytime fatigue associated with disordered sleep is well recognized, many other symptoms remain relatively obscure. Some of these include headaches, muscle tension, irritability, frustration and diminished mental/physical performance. The list is rather extensive when one considers the fact that adequate sleep is necessary for appropriate neurological, endocrine and immune function.

It is not surprising that the most common treatment for insomnia unassociated with sleep apnea (even in the absence of a bona fide cause) is a prescription for sleeping pills. Unfortunately, side effects vary considerably and effectiveness tends to diminish over time. Most people do not even consider another approach.

A recent study published in the Journal of the American Medical Association (JAMA, April 11, 2001) is shedding new light on insomnia from a rather unique treatment perspective. It has nothing to do with the latest pharmaceutical breakthrough, the most commonly touted supplement, or counting sheep.

Researchers at Duke University Medical Center studied 75 men and women (average age 55.3 years) with sleep maintenance insomnia, a condition characterized by more than 30 minutes of awake time in the middle of the night. These people did not experience transient sleep problemsæ subjects on average noted 13.6 years of insomnia. Participants were randomly divided into 3 6-week interventions which included cognitive behavioral therapy including sleep education, stimulus control, and time-in-bed restrictions, relaxation training or placebo therapy.

The investigators used polysomnography (sleep studies) to determine outcomes. The most favorable effects were found in cognitive behavioral group participants who manifested a 54% reduction in wake time after sleep onset even through 6 months of follow-up. Those in the relaxation group and the placebo group averaged 16% and 12% reductions respectively. Sleep efficiency (the amount of time asleep compared to the total time in bed) was 85% for the cognitive behavioral group compared with 78.8% in the relaxation group.

The Duke researchers also identified 2 common misconceptions about sleep. The first belief is that everyone needs 8 hours of sleep a night in order to remain healthy. The second is that the elderly can and should sleep as much as much as they want even if it means remaining in bed in the morning to catch up on a poor night's sleep. Both of these assumptions are clearly erroneous. The bottom line - reestablishing a healthy sleep-wake cycle requires a 3-fold strategy:

• Eliminate excessive naps during the day as well as the triggering causes noted previously.
• Follow a consistent schedule for going to bed and getting out of bed in the morning.
• Develop appropriate expectations for the amount of sleep time your body needs. Healthy sleep time varies considerably - learn to listen to your body.

While these suggestions seem elementary on the surface, they have been scientifically shown to substantially improve sleep. As a physician, I believe it is much more sensible to offer these insights to anyone in need rather than simply prescribing sleeping pills.

On a final note (this is no time for yawning), here’s a personal suggestion I'd like to add. Consider avoiding our planet's greatest recount of violence (the World News) prior to sleep. A healthy dose of laughter instead just might create the stuff pleasant dreams are made of - Mind Over Matter!