The right sleep habits can go a long way in helping you get the quality and quantity of sleep that you need to feel rested during the day. But if you’re still struggling with insomnia that interferes with your daily life—despite tweaking your bedtime routine and steering clear of sleep disruptors like caffeine, alcohol, and electronics—then it may be time to talk to a doctor. Insomnia is treatable, but everyone responds differently to different approaches. Ask your physician about some of these common methods.
You don’t need a doctor to try relaxation exercises, like progressive muscle relaxation. Systematically tensing and relaxing muscles in different parts of the body—gradually, from head to toe—may help you calm your body and prepare for sleep. You can also try breathing exercises, meditation, or guided imagery.
Set Strict Sleep Rules
Lying in bed awake can contribute to sleeplessness by creating an unhealthy association between your bedroom and being awake. Commit to getting out of bed whenever you’ve been awake for 20 minutes or more, then going to a different part of your home to “reset” with a different restful activity before trying again. Likewise, consider restricting your sleep hours. For example, go to bed at 10:00pm and wake up at 6:00am, regardless of how much time you spent asleep. The logic: If you go to bed at 10:00pm, toss and turn until midnight, and then sleep until 8:00am, you’ll be likely to repeat the pattern night after night.
See a Therapist
Ongoing sleep struggles can get into your head, feeding unhealthy fears and beliefs about sleep. Put another way: The more you battle insomnia, the more you worry about your insomnia, and that worry breeds more insomnia. Cognitive behavioral therapy involves combining concrete behaviors, such as setting regular bedtimes and wake times, with practicing positive, rational thinking. Though you can do it in person or online, a single weekly online session has been shown to help people with insomnia improve their sleep quality in just six weeks.
Talk to Your Doctor About Medication
When nothing else works, sleep aids or supplements like melatonin, with or without a prescription, can help with insomnia. But it’s always best to talk to a doctor before taking any sleep aid or supplement.
- Finally, a cure for insomnia?
- End Sleepless Nights With These Natural Insomnia Remedies
- Why Insomnia Happens
- Why You Should Steer Clear of Sleep Meds
- Making Time for Exercise
- Using Sunlight to Promote Healthy Melatonin Production
- Taking Steps to Manage Stress
- Eating Pro-Sleep Foods—and Avoiding Sleep Stealers
- Make Sleep-Friendly Lifestyle Changes
- Natural Remedies for Sleep
- Consider Meeting With Your Doctor
- Natural Sleep Aids: Home Remedies to Help You Sleep
- Five tips for better sleep
- What to do When You Can’t Sleep
- What to Do if You Can’t Sleep
- Good sleeping habits
- Cognitive and behavioural treatments
- Sleeping tablets
- Treatments that aren’t recommended
Finally, a cure for insomnia?
Hugh Selsick (right) with Andrew Eaton, a clinical scientist, at the Insomnia Clinic. Photograph: Sarah Lee/The Guardian
How is a central London clinic successfully treating an illness that, for decades, medicine has failed to adequately address? The answer appears to be rooted in Selsick’s belief that insomnia is not merely a symptom of another, higher-order condition. For decades doctors would treat the primary condition – diabetes, cardiovascular disease, respiratory problems – expecting that fixing this would help the patient to sleep. This approach would often fail because, as one study puts it, insomnia is maintained by the “behaviours, cognitions and associations that patients adopt as they attempt to cope with poor sleep but that end up backfiring”.
Selsick believes that only by treating insomnia as a psychiatric disorder, with degrees of severity that range from mild to chronic, can the health service begin to develop and prescribe appropriate treatments. It is a pioneering attitude that is motivated not only by scientific curiosity, but by personal experience; Selsick knows insomnia’s debilitating effects first-hand.
Selsick became an insomniac in 1993, when he was 19 years old, staying on a kibbutz in the desert in Israel. It wasn’t just the heat that caused his sleeplessness; it was also the routine built around the heat. With temperatures reaching 40C, desert-dwelling people typically sleep from 11pm through to 3am, at which point they start work while it is still cool enough. At lunchtime, when the heat is at its most ferocious, they take a siesta. It was a custom that Selsick’s mind resisted; he would lie awake in the afternoons, feeling exhausted, but wired.
When he returned to South Africa to start his first year at university, studying medicine in Johannesburg, Selsick’s insomnia persisted and intensified. “It’s almost impossible to describe what it’s like, to someone who hasn’t had it,” he told me. One day on campus he saw an advert posted on a wall requesting volunteers for a sleep study. Selsick enrolled in the hope that he might discover what was happening to him.
The study hoped to find what effect, if any, calorie intake had on a person’s ability to fall asleep. Each experiment lasted for four days, during which Selsick and the other volunteers would stay overnight at the sleep clinic, one monitor strapped to their head, another, to monitor core body temperature, inserted into their rectum. Volunteers were kept to a specific diet. One week they would fast for 24 hours; the next eat three times their typical calorie intake. Then they were monitored to see what effect the food had on their sleep. “It turned out to not make a difference,” he recalled.
Inspired by the professor who ran the course, Selsick began a postgraduate degree in physiology, based within the sleep clinic, where he studied the functions of REM sleep – a phase that occurs sporadically through the night, characterised by rapid eye movements – then carried out research on the impact of central heating on sleep patterns. (The ideal temperature in which to sleep is cooler than you might think: just 18C. This is one of the reasons why insomnia affects a disproportionate number of people in nursing homes, where round-the-clock heating makes it harder for the human body to cool down in readiness for sleep.)
At this time, the use of psychotherapy to treat insomnia was still in a relatively early phase. Selsick estimates that it was 2005 before therapists began to undergo insomnia training, in order to apply research findings. When Selsick came to London in the late 90s as a trainee doctor at the Royal College of Psychiatrists, his own insomnia had passed. Still, he was astonished to find a widespread lack of interest within psychiatry toward insomnia. “Ask any patient with psychiatric conditions what troubles them,” he said. “Sleep is almost always at the top of the list.” Selsick started a mailing list for any psychiatrists who were interested in sleep and held a conference at which members shared their findings. The group caught the attention of his supervisor, Charlotte Feinmann, a consultant psychiatrist at University College London Hospitals (UCLH) who, while Googling “insomnia”, recognised Selsick’s name in a search result. She sent him a text message asking whether he would be interested in founding an insomnia clinic at the hospital.
“At that time nobody was treating insomnia,” Selsick recalled. “Mental health units weren’t taking insomnia patients; sleep disorder centres were not treating insomnia, partly because they were being run by respiratory physicians screening for sleep apnoea, who didn’t have the relevant skills.” A patient who did not fit that box would be “bounced around the NHS”, Feinmann said. While staff across the health service were aware of the need, Selsick said, they knew that if they were to take insomnia referrals they would be inundated.
Selsick accepted Feinmann’s offer and, in November 2009, his first two patients walked into the clinic. He started small – one afternoon a week. “I had no idea what I was doing,” he recalled. Indeed, in its early months, Selsick’s consultancy offered little more than routine advice on basic sleep hygiene, such as limiting caffeine intake (“not effective”) and some general tinkering with the dosage of whatever medication the patient was already taking (“not very effective”).
Then, a few months later, Selsick began to explore CBT. For those who suffer from insomnia, the bedroom is so strongly associated with wakefulness that the mere act of going to bed wakes the patient up, in much the same way that walking into a dentist’s office makes you anxious. CBT, which at the time was just starting to be used to treat insomnia in North America, works to change patients’ automatic, often unconscious, association of the bedroom with wakefulness and replace it with bedroom and sleep. “Immediately,” Selsick said, “our results were enormously better.”
Not everyone was convinced by the new programme. Selsick’s clinic is situated within the Royal London Hospital for Integrated Medicine, formerly known as the Royal London Homoeopathic hospital, a controversial centre for alternative treatments. The pharmacologist David Colquhoun once described the hospital as a “great national embarrassment”. Selsick believes that this association caused some GPs to not refer their insomniac patients. “When we explain that we are a psychiatry-led service that practices evidence-based medicine, those issues usually melt away,” he explained.
For those who make it through the door, Selsick provides an initial assessment in an attempt to find out what, of a constellation of different possibilities, is causing the sleeplessness. He screens for sleep disorders such as restless leg syndrome, which affects 2%-10% of people. Like other sleep clinics, he screens for sleep apnoea and other respiratory problems. But this is merely the first step in the process. Once these possible causes have been ruled out, Selsick asks a long list of questions, both practical (“What time do you go to bed?” “How long does it take to fall asleep?”) and probing (“What was occurring in your life when you first started suffering from insomnia?”).
Ideally, the patient’s answers establish a pattern, which can lead to a diagnosis. Sometimes that diagnosis is narcolepsy, nocturnal epilepsy or sleepwalking – one of the scores of conditions that can lead to sleeplessness. In other cases it is, simply, psychiatric insomnia.
When she was 13 years old, Zehavah Handler took a pen and scrawled a dot on her bedroom wall in north-west London. Lying on the bed, she could just pick out the mark in the milky glow of her nightlight. There, as the house settled around her, she would challenge herself to stare at the dot for as long as possible without blinking. The game became a ritual and, eventually, became the only way, she believed, that she could fall asleep – although it was often 4am before she finally drifted off.
In adulthood Handler, now 40 and a mother of four, still suffered from insomnia. She would wake at 7am to drop her children off at school, then lie down on the carpet of her bedroom. There she would watch the ceiling till mid-afternoon, her heart palpitating with exhaustion, when she would leave for the school pickup. After feeding and bathing the children, Handler would retire to her own bed. She would lie in bed for 12 hours, only sleeping for an hour or so before the dawn broke and the day’s grim routine began again.
When she began to experience memory loss and irritability, Handler visited her GP. After an 18-month wait, she entered Selsick’s office. “It was the first time I met a professional who acknowledged the problem and was truly empathetic.” Handler was admitted to UCLH’s clinic to be monitored overnight for sleep apnoea. On arrival, Handler found the consultant in charge that night “extremely dismissive” of Selsick’s clinic. She spent the first night in a nest of wires, like an android recharging its batteries, lying awake worried about whether or not the machines would know that she was just pretending to be asleep. Nevertheless, the results came back clear: she had no breathing issues, no twitching muscles. Selsick concluded that Handler was one of his many patients for whom insomnia is not a symptom of some other disorder, but the disorder itself.
In May 2016, Handler joined Selsick’s five-week course, along with nine other anxious patients. The programme takes place in a small room in the bowels of the hospital. Handler remembers that none of her fellow patients talked and few made eye contact, paralysed by the secret shame of the insomniac. “Everybody was very self-conscious,” she recalled. “We were wondering: ‘How’s it going to work? How much will we have to reveal of ourselves?”
A patient at the sleep clinic. Photograph: Sarah Lee/The Guardian
“The first thing I do ,” Selsick told me, “is dispel the myth that there’s a certain number of hours you are supposed to get. It is ingrained in us as if it’s absolute gospel that you are supposed to sleep eight hours a night. It’s not true.” Just like there is variation in shoe size, Selsick says, there is variation in the amount of sleep an individual requires. “Some people need six and a half, some people need nine and a half. It doesn’t make anyone abnormal.”
To figure out how much sleep they need, each attendee is told to start a sleep diary, recording what time they go to bed, what time they get up, how long it took to fall asleep and how many times they wake during the night. Next Selsick undoes the idea that a person should have a set bedtime. Typically, insomniacs will go to bed earlier or stay in bed longer in order to increase their sleep opportunity. The logic appears sound – if I’m not getting enough sleep, I should spend longer in bed to give myself more opportunity to sleep – but the anxiety invariably exacerbates the problem. Instead, patients are told to set a hard-and-fast time to wake up. “We tell them to always get up at the same time every day, regardless of how much they’ve slept, what time they’ve gone to bed, or what they’ve got to do that day.”
There must never be any lie-ins, and never any naps (chewing gum, Selsick says, keeps napping at bay). The theory is that if you get up at the same time every morning, you begin to feel sleepy at the same time every night, and, over the weeks, your bedtime will naturally become consistent. “We compress their time in bed down so that their sleep is more compact and tighter,” explained Selsick. A patient might start with a goal of six hours’ sleep. If they need to be up for work at 7am, this means they are forbidden from entering the bedroom till 1am. “That’s now your earliest permitted bedtime.”
Once a patient finds they are asleep for 90% of the time that they are in bed, they move that earliest bedtime forward by 15 minutes at a time. This behavioural technique is termed sleep efficiency, and despite its disarming simplicity, patients report astonishing results. “It was very hard going,” said Laurell Turner, a medical student who completed the programme in 2016. “By the end of the course I was exhausted. But despite my scepticism, the results were immediate.”
Selsick worked to break the negative associations Handler had with her bedroom. When insomniacs go to bed they often feel afraid of having to lie there frustrated and increasingly irritated. After a while the simple act of going to bed begins to wake an insomniac up. The bedroom becomes a trigger toward alertness, even fear. To counter this, Selsick urges patients to leave the bedroom after just 15 minutes if they are not yet asleep. All activity apart from sex and sleep is barred from the bedroom. Patients are even told to change their clothes in another room.
“Before, I would go to sleep in the afternoon and be in my room for 12 hours,” said Handler. I would make all my phone calls there, work on my laptop there, eat and watch TV in bed. That’s gone. All gone. I say goodbye to my room at about 7.20am and I don’t see it again until 1.30am when I go to bed.” The technique often feels counterintuitive; on the initial nights that a patient shuffles between bedroom and lounge every 15 minutes, they often sleep worse. “It’s extraordinarily hard to do,” she said. But after about five weeks, the negative psychological association of the bedroom with wakefulness has been broken, and replaced with new, positive connections. Selsick claims that, using these techniques alongside the moderation of stimulants such as caffeine, eight out of 10 patients get better, and half of these go into, he said, “complete remission”.
Studies show that CBT is the most effective long-term treatment for insomnia. But in order for it to be effective, it requires the patient to establish and maintain a stable routine. For patients who regularly cross time-zones, who often stay in unfamiliar hotel beds or who are unable to form a nightly ritual because of work, Selsick’s plan presents an impossible target. These patients want not a timetable to which they must stick, but a pill they can swallow.
Surprisingly perhaps, for a doctor who strongly advocates the use of CBT in treating insomnia, Selsick believes that sleeping pills should be far more widely prescribed in the UK. “There’s an incredible conservatism in the British medical establishment about prescribing for sleep,” he said. Much of this anxiety is focused on the addictive qualities of benzodiazepines. According to the neuroscientist Matthew Walker, sleeping pills do not provide “natural sleep,” can “damage health” and “increase the risk of life-threatening diseases”.
“The drugs, like any drug, are not without risk,” said Selsick. “But having untreated insomnia also comes with risks.” Selsick has met patients who, because of insomnia, have been forced to leave work and abandon careers. “I’ve had patients where it’s destroyed their marriages, where they have lost access to their kids because they are so tired that they can’t look after them properly.” Nevertheless, Selsick perceives a blanket policy among doctors whereby they refuse to medicate for sleep. This policy, he says, does patients a disservice. “Yes, CBT should be your first port of call prior to medication. But most places in the country do not have access to CBT. And not everyone who does CBT for insomnia gets better.”
The arrival of any epidemic brings commercial opportunities. In 2006, the manufacturer of the non-benzodiazepine sleeping pill Ambien estimated that the drug had been taken 12bn times worldwide and is worth $2bn a year in American sales. Pharmaceutical companies hoping to replicate this success are locked in a race to design a new sleeping pill without side-effects. The discovery, in 1998, of orexin, a hormone that essentially works as the brain’s alarm clock, turned the long march to develop a new kind of sleeping pill into a sprint.
For the past 15 years Jean-Paul Clozel – a cardiologist turned pharmacologist who in 1997, co-founded the Swiss biotech firm Actelion with his wife, Martine – has been leading the development of what he claims to be the side-effect-free sleeping pill. “Most sleeping pills are benzodiazepines,” says Clozel. “They induce something that feels like sleep, but in reality, it’s closer to anaesthetic sedation.” (Benzodiazepines are often used by anaesthetists.) Clozel’s pill, which he hopes to take to market in 2020, and which goes by the generic name Nemorexant, works differently. It limits the production of orexin, the hormone that keeps insomniacs awake, or causes them to wake up at the mildest provocation.
Nemorexant is not the first sleeping pill to target orexin. Since August 2014, more than a decade after work began on developing the drug, American doctors could prescribe Belsomra, also known as Suvorexant, which targets the same hormone. Within a month of its release, US doctors were writing an average of 4,000 Belsomra prescriptions a week. But the drug is not without risks. An FDA report on the safety of Belsomra, which is closely related to Clozel’s drug, quoted one patient who “woke up several times and felt unable to move her arms and legs and unable to speak”.
Nevertheless, in a country that is seemingly years away from rolling-out nationwide CBT programmes to treat insomnia, Selsick welcomes the chance to prescribe Neomorexint. “As it acts through a completely different pathway than other hypnotics, it would be nice to have it for those patients who have not responded to the standard treatments.”
In the meantime, Britain remains both ill-equipped and, seemingly, unwilling to deal with the growing insomnia epidemic. As victims of the woefully ignored Cinderella of medicine, sufferers struggle to stick with anything that claims to be a cure, leaving us stuck in folklore, with its colourful but contradictory advice. No sleeping pills are licensed for long-term usage, and apart from Selsick’s clinic, only a handful of private psychology services offer CBT to treat insomnia.
A plan to open an insomnia clinic at the sleep disorders centre at Guy’s hospital was scrapped due to fears that the demand would be too great. “They were concerned that demand would be so massive they would never meet their waiting list targets, which would result in being financially penalised,” Selsick said. This has resulted in the perverse situation where the more demand that exists to treat insomnia, the less likely it is to be met.
In May, to help ease the pressure on his oversubscribed clinic, Selsick commissioned the first insomnia training programme for GPs, an attempt to equip doctors to run, within their local surgeries, CBT sessions similar to those held at the clinic. Eventually, he hopes, this will mean that only the most extreme cases will need to be referred to him. Selsick hopes to run these courses, which are also open to nurses, psychologists, occupational therapists and mental health workers, twice a year and, in doing so, speed up the NHS’s capacity to deal with insomnia at a national scale.
Selsick’s clinic is the only surgery to consistently see a significant volume of patients. And consistency is, he said, the key. “The treatment is not rocket science,” he said. “It really isn’t. Our job, primarily, as therapists, is not so much to tell people what to do – because we could just give it to them as a handout – but to convince them to do it for long enough for it to work.”
For patients who successfully complete Selsick’s programme, the ability to sleep well changes life at an elemental level. To begin sleeping again is to feel as though you are being realigned with the universe and its guiding, imperceptible rhythms. “I am happier,” Handler told me, of her new life, post-insomnia. “My relationships have improved. I have more patience. I’m no longer walking in a permanent fog. I am available.”
There are occasional relapses, Handler said, usually brought on by a change in routine – a holiday away, Christmas – but by waking at a set time, leaving the bedroom after 15 minutes if she remains awake and re-implementing all of the rituals she learned at the Insomnia Clinic, it only takes a few nights to re-establish the routine.
The effect has been so transformative that Handler has decided to close her tourism business and, with Selsick’s support, retrain as a sleep counsellor. So great is her relief at learning how to sleep again that Handler wants to dedicate her life to helping others do the same; she plans to open her own insomnia clinic next year.
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End Sleepless Nights With These Natural Insomnia Remedies
We’re all familiar with that silly image of the person who resorts to counting sheep when they just can’t seem to fall asleep. But when you’re the one who’s been tossing and turning all night, insomnia is no laughing matter.
As many as one in four adults report suffering from mild insomnia, found a recent Harvard survey. That inability to fall and stay asleep could stem from a short-term issue, or be the result of a lifetime of poor sleep habits. Either way, it can’t be fixed with something like sleeping pills.
Here’s why insomnia happens, why you can’t rely on prescription meds to solve the problem, and how to develop healthier sleep habits for a lifetime of quality snoozing.
Why Insomnia Happens
Insomnia can be temporary—or it can be long-term. But regardless of how long you have to deal with it for, it’s never fun.
At some point or another, most of us will experience a short, unpleasant bout of insomnia. Often, it’s the result of stress or a change in routine (like a new work schedule or having a baby), or medications that mess with sleep like antidepressants, blood pressure meds, allergy meds, and corticosteroids. The good news is that usually, once you find a way to deal with the situation, your sleep pattern will get back to normal.
But other times, insomnia can become a long-term thing. Sometimes, that can happen as the result of a more serious health condition, like depression, anxiety, or sleep apnea. Other times, insomnia can stem from crappy sleep habits, like eating too many heavy snacks before bed, sleeping in an uncomfortable environment, or staying glued to your smartphone or tablet all night long.
Either way, missing out on sleep leaves you feeling exhausted, irritable, and generally unable to function during the day. And over time, it can put you at risk for health issues like obesity, high blood pressure, heart disease, and diabetes.
But no matter how long your insomnia lasts for, there’s usually a way to deal with the root of the problem and start sleeping better. And fortunately, there are plenty of options to consider.
Why You Should Steer Clear of Sleep Meds
Sleeping pills and other sleep-promoting pharmaceuticals can offer a short-term solution to a temporary bout of insomnia. And plenty of people use them. But often, prescription sleep aids come with unpleasant side effects like headaches, sore muscles, constipation, dry mouth, daytime fatigue, trouble concentrating, dizziness, and more. Add them all up, and they’re about as bad—if not worse–than your garden variety sleep deprivation.
Still, even if you’re one of the lucky few who don’t experience side effects from taking sleeping pills, you likely won’t benefit for long. Most people quickly build up a tolerance to the sedative effects of sleeping meds. Which either means that you have to take higher and higher doses to get the same effect, or they stop working altogether.
Taking sleeping pills is a lot like crash dieting. Sure, both might work in the short term. But if you want to up your odds of achieving longer, more restful sleep for a lifetime, you’ve really got to build healthy, pro-sleep habits.
Either way, it doesn’t add up to a healthy sustainable solution. Taking sleeping pills is a lot like crash dieting. Sure, both might work in the short term. But if you want to up your odds of achieving longer, more restful sleep for a lifetime, you’ve really got to build healthy, pro-sleep habits.
Fortunately, doing that is easier than you might think. Below, we’ll take a look at the multitude of lifestyle changes—both big and small—that you can make to help you sleep better. We’ll also explore proven herbal remedies that can give you a relaxation boost when you really need it, minus the side effects that tend to come with prescription meds.
Making Time for Exercise
In case you missed the memo, being physically active is essential for sleeping well. Mounting evidence shows that people who exercise regularly tend to snooze better than their couch potato counterparts—especially when it comes to those with chronic insomnia.
Not convinced? Consider this. One study, concluded that people who get 60 minutes of exercise five days per week have more normal REM sleep than non-exercisers. But you might not need to sweat it out for quite that long to reap the benefits. Other findings show that insomniacs who engage in thirty minute spurts of exercise just three or four times a week sleep for nearly an hour longer than sedentary folks, and wake up less frequently during the night.
And if you can swing it, working out in the morning might be even more beneficial, according to one recent study. Experts can’t say why, exactly, it could have something to do with morning exercise’s ability to help regulate the secretion hormones that help manage blood pressure, which may lead to better sleep.
Why is working out seemingly so beneficial? The mechanisms aren’t entirely known, but National Sleep Foundation experts say that it could have to do with exercise’s ability promote feelings of relaxation and reduce feelings of stress, anxiety, and depression. Staying active might also help to keep your body’s natural sleep-wake cycle in sync—particularly if you do it outside (more on that below).
Still, the explanation might be even simpler: Think about the days when you’re running around all day, or after you’ve wrapped up a really tough workout. Don’t you just feel more tired on those days compared to the ones where you just lay around all day and do nothing? Thought so.
Using Sunlight to Promote Healthy Melatonin Production
The sun might force you awake in the morning, but it’s also essential for helping you achieve restful sleep at night. That’s because your body relies on natural light to figure out what time it is, and determine whether to pump out energizing hormones or ones that leave you feeling relaxed and sleepy, like melatonin.
In other words, daylight helps your body’s natural clock—which is dictated by the 24-hour cycle of day and night—know when to feel awake and when to feel tired. When your hypothalamus—the gland responsible for regulating sleep and energy levels—senses a change in light, it tells your body to ramp up or ramp down its production of the sleep hormone melatonin. During the day, you feel energized and alert because you don’t produce much melatonin. At night, you produce more, so you feel sleepy.
One way to keep everything on schedule is by flooding your body with light as soon as you get out of bed, which sends a clear message to your body that it’s time to wake up. Try opening your blinds, exercising outside, or even going sans sunglasses on your way to work.
And throughout the day, keep the natural light flowing. Sit near a window at work, or hang out outside during your lunch break. (Doing so could help you sleep for nearly an hour longer, suggests one recent study.) On the weekends, plan a picnic or take a hike instead of watching Netflix and chilling on the couch all afternoon.
Taking Steps to Manage Stress
If you consistently find yourself lying in bed with your mind racing, stress could be stealing your ability to fall asleep. In fact, nearly 40% of Americans say that they often feel tired or fatigued because of stress, according to a 2013 American Psychological Association poll.
Nearly 40% of Americans say that they often feel tired or fatigued because of stress.
And it gets worse. When you’re wiped out during the day from not getting enough sleep, you tend to feel even more stressed, anxious, and irritable. Over time, the whole stress-sleep thing can turn into a vicious cycle. Which is why taking steps to manage your stress is so critical for achieving deeper, more restful sleep.
So should you start sitting cross-legged and singing Kumbaya before bed? Well, sure, if you want to. But if that’s not your style, don’t worry. There are plenty of other effective ways to ease feelings of stress and promote feelings of relaxation. A few to try:
- Journaling. You might think that writing stuff down would make you dwell on it. But when you focus on the things that you appreciate, you might actually sleep better. One recent study, published in Applied Psychology, found that students who wrote in a gratitude journal for just 15 minutes per night worried less at bedtime—and achieved better sleep.
- Yoga. The ancient practice doesn’t just help keep you limber—it can also help you better cope with stress. And the results can even be found at the physical level: One study published in Psychosomatic Medicine found that expert yoga practitioners had lower levels of inflammatory stress markers in their blood compared to beginners.
- Guided imagery. Experts say that mind games like guided imagery can help you doze off faster. And it couldn’t be simpler: While you’re lying down, picture yourself in a relaxing, peaceful place. Over time the image becomes a sort of signal to your brain that it’s time to nod off.
- Progressive muscle relaxation. Because relaxing your physical body can be just as effective as relaxing your mind. Try repeatedly tensing and releasing your toes to the count of 10, recommend experts at the University of Maryland Medical Center, Sleep Disorders Center. It’s crazy simple, but it can actually help relieve pent up energy and help you feel more relaxed.
- Going to sleep early. It sounds counterintuitive, but trying to turn in earlier might make your worries sort of disappear on their own. Compared to people who go to sleep early, those who stay up late are more likely to be overwhelmed by repetitive negative thoughts, found one study published late last year.
Eating Pro-Sleep Foods—and Avoiding Sleep Stealers
It might seem surprising, but the things that you eat and drink could play a role in whether you drift off to sleep soundly or spend half the night tossing and turning. In fact, many edibles actually contain chemical properties that can make you feel relaxed or drowsy.
To help fight insomnia, consider adding some of these foods to your dinner menu or noshing on them for a nighttime snack.
- Cheese. Like your Thanksgiving turkey, cheese is rich in tryptophan. Tryptophan is an amino acid that’s needed to produce the neurotransmitter serotonin, which your body needs in order to feel relaxed and sleepy.
- Almonds. The crunchy nuts, too, contain plenty of grog-inducing tryptophan. But that’s not all. Almonds are a good source of both calcium and magnesium, two minerals that experts say are important for achieving quality sleep.
- Salmon. You’ll snooze better if your body has adequate levels of the omega-3 fatty acid DHA, found one British study published in the Journal of Sleep Research. Of course, other omega-3-rich fish like tuna, sardines, or mackerel can get the job done, too.
- Whole grain crackers. It’s not just a coincidence that you immediately want to take a nap after chowing down on a carb-heavy meal. Carbs cause your body’s blood sugar levels to spike, which appears to play a role in regulating your body’s sleep-wake clock, suggests a recent Japanese study. Still, you’ll probably get a stomachache and end up tossing and turning all night—by devouring a gigantic bowl of pasta. So pick a lighter option, like a handful whole grain crackers.
- Cherries. They’re the only edible source of the sleep hormone melatonin, so consider having a bowlful for dessert. If they’re not in season, opt for thawed frozen cherries or a glass of tart cherry juice. Drinking two glasses daily helped people with insomnia sleep for 90 more minutes, found one study published in the Journal of the Federation of American Societies for Experimental Biology.
- Low-fat milk. If uncomfortable heartburn keeps you up at night, try a glass of moo juice. The combo of high protein and low carbs can keep acid reflux at bay. Plus, it’s a good source of calcium, which helps keep your body’s melatonin production in check.
- Bananas. The yellow fruits have everything going for them. They’re rich in sleep-promoting carbohydrates and tryptophan, but that’s not all. Bananas also contain potassium and magnesium, which can help promote muscle relaxation.
But eating the right stuff isn’t the only way that food impacts your sleep, though. Steering clear of the wrong edibles and drinkables is equally important. A few to avoid in the name of getting a better night’s rest:
- Coffee and other caffeine-rich stuff. It might go without saying, but we’re going to say it anyway. Coffee can stay in your system for as long as six hours—which means that even a late afternoon cup could have an impact on your sleep. If you’re aiming to get to bed by 11, avoid coffee and other high-caffeine things like black tea, cola, and dark chocolate after 5pm.
- Alcohol. A nightcap will make you feel drowsy while you drink it, but alcohol can lead to middle of the night wake-ups that can cause you to feel overtired in the morning.
- Spicy foods. Can’t get enough sriracha? Save it for lunchtime. One International Journal of Psychophysiology study found that when people who consumed hot condiments (like Tabasco sauce or mustard) before bed took longer to fall asleep and achieved less restful sleep compared to when they skip the stuff. Researchers aren’t totally sure why spicy foods mess with your sleep, but it could be because they raise your body temperature.
- Fatty foods. People who eat high-fat fare tend to be more sleep-deprived compared to those who eat less of the stuff, says the National Sleep Foundation. That could be because heavy, greasy food is harder on your digestive system, and is more likely to cause sleep-stealing stomach discomfort.
Make Sleep-Friendly Lifestyle Changes
You’re exercising, getting plenty of exposure to natural light, and are eating better. It all adds up to good stuff, sleep wise, but there are other lifestyle changes you could be making to snooze more soundly. A few to consider:
- Powering down in the evening. The blue light emitted from your smartphone, tablet, or computer is sort of like an electronic version of caffeine: It leaves your brain feeling revved up, rather than relaxed and ready for sleep. Make it a point to turn off your devices at least an hour before turning in.
- Showering at night instead of in the morning. The heat from a warm, pre-bedtime shower sends the message to your nervous system that it’s time to relax and slow down, encouraging you to feel sleepy. Which seems way more useful at night than first thing when you wake up, right?
- Sniffing lavender before bed. You might not think so, but scent can have a powerful effect on your mood. Consider taking advantage of aromatherapy to fill your bedroom with aromas that are thought to ease anxiety and promote relaxation, like lavender, spikenard, vetiver, frankincense, myyrh, and clary sage.
Finally, don’t discount the powerful effect of a super comfortable bedroom. If you’ve ever spent a night tossing and turning because of a too-hot room or wonky mattress, you know that feeling uncomfortable can make it almost impossible to fall—and stay—asleep. (And if you already suffer from chronic pain, the whole problem becomes even worse.)
To make your bedroom as pro-snooze as possible, consider making these changes:
- Turn down the temp. Most experts agree that the ideal temperature for sleep is somewhere between 60 and 72 degrees. Experiment with the thermostat to see what’s right for you.
- Turn off the lights. Exposure to artificial light when you’re trying to sleep isn’t just annoying—it suppresses your body’s production of the sleep hormone melatonin. Use blackout curtains, put black tape over your clock or stereo system, or wear an eye mask if you have to.
- Turn down the noise. Unless you live alone (and sometimes, even then) it can be hard to ensure that your living space will be quiet when you try to go to sleep. Wear earplugs if you have to, or consider investing in a white noise machine to block distracting sounds.
- Pick comfortable bedding. No one wants to wake up in the middle of the night in a pool of their own sweat. Stick with bedding made from natural fibers like cotton, wool, silk, bamboo, and linen. Avoid synthetic fabrics like polyester that trap heat and moisture.
- And a comfortable mattress. If your mattress is more than seven years old, it could be worn out—and costing you a better night’s sleep. If you don’t have the best mattress or your bed shows signs of wear (like deep impressions) or you consistently wake up sore in the morning, it might be time to think about investing in a new sleep surface. Shameless plug: take a look at our selection of mattresses if you’re in the market!
Natural Remedies for Sleep
If conventional sleep meds might be bad for you, does that mean all-natural herbal ones are a better choice? Sure, there’s evidence that they can be. But they’re not a substitute for practicing good sleep hygiene. Instead, think of them as potential tools to make your smart sleep habits work even harder.
(However, just because a remedy is natural doesn’t automatically mean that it’s healthy or effective. While these herbal options are generally considered to be safe, you should always get the green light from your doctor before taking any new supplements or natural remedies.)
OK, glad we got that out of the way. Here, sleep-promoting herbal remedies that could make it easier for you to nod off:
- Chamomile tea. Simple, delicious, and effective. Chamomile tea has been used as a relaxation aid for centuries, but it’s more than just a folk remedy. One review found that the stuff acts as a mild sedative, helping to calm the nerves, reduce anxiety, and ease insomnia. And don’t be afraid to make a strong brew. Some experts recommend using two or three tea bags to get the full, sleep-promoting effect.
- St. John’s wort. The yellow, weed-like flower is commonly used to ease depression symptoms like anxiety and insomnia, and you can steep it to make a tasty tea. Just take care to avoid direct sunlight when you take the stuff, since St. John’s wort can make your skin more sensitive to UV rays.
- Valerian. Like chamomile tea, folk practitioners have turned to the root of this flowering plant to easy anxiety and promote relaxation. And it works: According to a review of sixteen studies, valerian root is shown to help people doze off faster and sleep more soundly. It might not be ideal for long-term use, though, so talk with your doctor before starting a valerian regimen.
- Kava. The root has long been a favorite among Pacific Islanders for promoting relaxation. In fact, one analysis found that kava was significantly more effective at treating anxiety than a placebo, and some preliminary research suggests it could also help treat insomnia. But like valerian, long-term use of the stuff isn’t advised, since it could have a negative impact on your liver.
- Passion flower. The tropical flower acts as a mild sedative—and, bonus, it tastes delicious. Try steeping a teaspoon of passion flower in boiling water for 10 minutes before drinking—and drifting off to dreamland.
- Melatonin. You can find melatonin, the hormone that regulates your sleep-wake cycle, in tart cherries. But eating a bowlful every night can get boring—not to mention expensive. Melatonin supplements can give you the same sleep-inducing benefit, minus the full belly. To determine the right dose for you, talk with your doctor.
- California poppy. People don’t often want to feel sluggish and lethargic. But when you do—like right before bed—make California poppy your pick. Steep the bright orange leaves in hot water for at least 10 minutes to make a tea that’ll erase your anxiety and leave you feeling relaxed and ready for bed.
Consider Meeting With Your Doctor
If you’ve tried natural remedy after natural remedy and are still having difficulty sleeping, it’s a good idea to talk about your insomnia with your doctor. Together, you can discuss your symptoms, which could point to underlying health issues that might be making it harder for you to fall asleep. She can also review any prescriptions that you’re taking to see whether they might be interfering with your ability to nod off.
Have you found a way to manage your insomnia?
Marygrace Taylor is a health and wellness writer based in Philadelphia. She’s covered healthy sleep and sleep hygiene for Amerisleep and other outlets since 2014. She also writes about diet and nutrition, women’s health, and fitness for outlets like Healthline, Men’s Health, and Prevention.
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Natural Sleep Aids: Home Remedies to Help You Sleep
Disturbed sleep is more than an inconvenience that leaves you dragging the next day: it can affect your emotional and physical health. It negatively affects your memory, concentration and mood, and it boosts your risk for depression, obesity, type 2 diabetes, heart disease and high blood pressure.
Happily, there are easy, natural fixes that can improve your sleep, says Charlene Gamaldo, M.D. , medical director of Johns Hopkins Center for Sleep at Howard County General Hospital.
“It’s not always necessary to get a prescription for a sleep aid,” she says. “There are natural ways to make adjustments to your sleeping habits.”
Five tips for better sleep
Drink up. No, not alcohol, which can interfere with sleep. Gamaldo recommends warm milk, chamomile tea and tart cherry juice for patients with sleep trouble.
Though there isn’t much scientific proof that any of these nighttime drinks work to improve your slumber, there’s no harm in trying them, Gamaldo says. She recommends them to patients who want treatment without side effects or drug interactions.
“Warm milk has long been believed to be associated with chemicals that simulate the effects of tryptophan on the brain. This is a chemical building block for the substance serotonin, which is involved in the sleep-wake transition,” Gamaldo says.
Chamomile tea can also be helpful. “It’s believed to have flavonoids that may interact with benzodiazepine receptors in the brain that are also involved with the sleep-wake transition,” she says.
Plus, chamomile tea doesn’t have caffeine, unlike green tea or Earl Grey. Finally, tart cherry juice might support melatonin production and support a healthy sleep cycle.
Exercise . Physical activity can improve sleep, though researchers aren’t completely sure why. It’s known that moderate aerobic exercise boosts the amount of nourishing slow wave (deep) sleep you get.
But you have to time it right: Gamaldo says that aerobic exercise releases endorphins, chemicals that keep people awake. (This is why you feel so energized after a run.)
It can also raise core body temperature; this spike signals the body that it’s time to get up and get going. If you’re having trouble sleeping, try to avoid working out within two hours of bedtime.
Use melatonin supplements . “Melatonin is a hormone that is naturally released in the brain four hours before we feel a sense of sleepiness,” Gamaldo says. It’s triggered by the body’s response to reduced light exposure, which should naturally happen at night.
These days, though, lights abound after it’s dark outside—whether it’s from your phone, laptop or TV. This exposure to unnatural light prevents melatonin release, which can make it hard to fall asleep. Luckily, melatonin is available in pill form at your local pharmacy as an over-the-counter supplement.
Just make sure that you consistently buy the same brand. “Because melatonin supplements are unregulated by the FDA, the per-pill dosages and ingredients may differ from manufacturer to manufacturer. Stick with one brand, and don’t buy it online from an unknown source,” Gamaldo cautions.
Keep cool. “The ideal temperature for your thermostat is between 65 and 72 degrees,” Gamaldo says. Women who are going through menopause and experiencing hot flashes should keep the room as cool as possible and wear cotton or breathable fabrics to bed.
Go dark. It’s known that the light from a smartphone interferes with sleep. But what about your bathroom light? If you have the urge to go at night, don’t flick on the lights. “The latest recommendation is to use a flashlight if you need to get up at night,” Gamaldo says, because it offers less visual disruption. And remember: If you do wake up for a bathroom break, it might take up to 30 minutes to drift back off. This is completely normal, she says.
Each night, as millions of Americans slumber peacefully, millions more can’t fall asleep or stay asleep. For some, it’s just a now-and-then hitch. For others, insomnia is a chronic problem that affects mood, daytime alertness and performance, and emotional and physical health.
Chronic insomnia often starts out innocently enough. Stress or trouble at home or work interferes with sleep for a few nights. But then the habits that come along with not sleeping—looking at the clock, lying in bed wide awake, worrying about not getting to sleep—can stick. Soon just the sight of your bed or the tick of the clock toward 10:00 pm can trigger anxiety and render you wide awake.
Loosening the grip of chronic insomnia can take time and effort. Some of the sleepless turn to medications. One widely used behavioral approach, called stimulus control therapy, aims to break harmful sleep habits and thoughts over the course of several weeks. A new approach that uses a 25-hour program called intensive sleep retraining may be enough to break the cycle in a day.
Sleep boot camp
Intensive sleep retraining works like this: The night before undergoing the program, a person with chronic insomnia sleeps (or stays in bed) no more than five hours. The next day, he or she reports to a sleep lab around bed time. The next 25 hours are divided into 50 thirty-minute sessions. During each one, the person tries to fall asleep. If successful, the participant is woken up after just three minutes of sleep, asked if he or she had been asleep, and told that he or she had indeed fallen asleep.
The sleep deprivation that builds up over the course of this pattern helps even the most hard-core insomniac fall asleep a few times. The goal of the therapy is to help people feel what it’s like to fall asleep rapidly and learn that they can do it.
In a head-to-head trial, Australian researchers tested intensive sleep retraining against other treatments for insomnia. They randomly assigned 79 people with chronic insomnia to four groups: one session of intensive sleep retraining, one session of intensive sleep retraining followed by five weeks of stimulus control therapy, five weeks of stimulus control therapy alone, or no treatment. All participants attended five weekly information sessions in which they learned about better sleeping habits (called sleep hygiene).
Six weeks after beginning the trial, participants who got intensive sleep retraining were falling asleep faster than those who didn’t get it. The combination of intensive sleep retraining and stimulus control therapy worked best. The results were published in the journal Sleep.
Do this at home?
An editorial accompanying the article called the work a “stunning demonstration” that should help drive the development of new non-drug therapies for insomnia.
As the researchers themselves point out, though, intensive sleep retraining is expensive. Many people who need it can’t afford it. A self-administered version that could be done at home would bring it within reach of anyone with a good alarm clock, a steadfast partner, and the fortitude to sleep no more than three minutes every half hour over the course of an entire day. Let’s hope that the Australian study stimulates the creation of such home programs.
What to do When You Can’t Sleep
People with insomnia tend to have trouble falling asleep, staying asleep throughout the night, or they wake up too early in the morning. There are ways to help with each of these patterns:
Tips for falling asleep
- Carve out at least 30 minutes of wind-down time before bed in which you do something relaxing, such as read a book. Dim the lights in the house slightly for an hour or so before bed.
- Disconnect from close-range electronic devices such as laptops, phones, and tablets, as the light from their screens can alert the brain and make it harder to fall asleep.
- In order to calm your mind, do a breathing or relaxation exercise.
- If you get into bed and cannot fall asleep after 20 minutes, get up and return to another space in the house to do a relaxing activity, such as reading or listening to music. Lying in bed awake can create an unhealthy link between your sleeping environment and wakefulness. Instead, you want your bed to conjure sleepy thoughts and feelings only.
- Wake up at the same time every day. Even if you have a hard time falling asleep and feel tired in the morning, try to get up at the same time (weekends included). This can help adjust your body’s clock and aid in falling asleep at night.
What to Do if You Can’t Sleep
Because so many people get insomnia, a lot of research has been done on how to beat it. Lucky for you, right? Not all of these tips work for everyone, but one or two might help you:
- Write in a journal before you go to bed. This practice clears your mind so you won’t have all those thoughts crowding your brain when you’re trying to sleep.
- Sleep in a dark, comfortable room. Light signals your body that it’s time to be awake, so you want to avoid it at night. But if you are really afraid of the dark, it’s OK to try a dim night-light. And being hot and sweaty or shivering from the cold can easily keep you up.
- Don’t sleep with a pet. This can be a tough habit to break, but your lovable dog or cat could be keeping you awake. As your pet cozies up to you or makes noise, it could wake you from a peaceful sleep. Try sleeping without your pet for a couple nights to see if you sleep better that way.
- Don’t drink any caffeinated beverages (like soda or iced tea) after about 3:00 in the afternoon. Caffeine is a stimulant and might keep you awake.
- Don’t exercise at night. Keep your exercise to earlier in the day — never within a couple hours of when you go to sleep.
- Once you’re lying in bed, try a peaceful mind exercise. For instance, count backward from 100 with your eyes closed. By the time you get to 10 (yawn) we hope you’ll feel very sleepy. And by 5, we hope you’ll feel yourself drifting off … 3, 2, 1, ZZZZZZZZZZZZZZZZ.
Reviewed by: Mary L. Gavin, MD Date reviewed: September 2015
Insomnia will often improve by making changes to your bedtime habits. If these don’t help, your GP may be able to recommend other treatments.
If you’ve had insomnia for more than four weeks, your GP may recommend cognitive and behavioural treatments or suggest a short course of prescription sleeping tablets as a temporary measure.
If it’s possible to identify an underlying cause of your sleeping difficulties, treating this may be enough to return your sleep to normal.
The various treatments for insomnia are outlined below.
Good sleeping habits
Your GP will be able to advise you about what you can do at home to help you sleep. This is known as “sleep hygiene” and includes:
- establishing fixed times for going to bed and waking up
- creating a relaxing bedtime routine
- only going to bed when you feel tired
- maintaining a comfortable sleeping environment that’s not too hot, cold, noisy or bright
- not napping during the day
- avoiding caffeine, nicotine and alcohol late at night
- avoiding eating a heavy meal late at night
Read more about self-help tips for insomnia
Cognitive and behavioural treatments
If changing your sleeping habits doesn’t help, your GP may be able to refer you for a type of cognitive behavioural therapy (CBT) that’s specifically designed for people with insomnia (CBT-I).
The aim of CBT-I is to change unhelpful thoughts and behaviours that may be contributing to your insomnia. It’s an effective treatment for many people and can have long-lasting results.
CBT-I may include:
- stimulus-control therapy – which aims to help you associate the bedroom with sleep and establish a consistent sleep/wake pattern
- sleep restriction therapy – limiting the amount of time spent in bed to the actual amount of time spent asleep, creating mild sleep deprivation; sleep time is then increased as your sleeping improves
- relaxation training – aims to reduce tension or minimise intrusive thoughts that may be interfering with sleep
- paradoxical intention – you try to stay awake and avoid any intention of falling asleep; it’s used if you have trouble getting to sleep, but not maintaining sleep
- biofeedback – sensors connected to a machine are placed on your body to measure your body’s functions, such as muscle tension and heart rate; the machine produces pictures or sounds to help you recognise when you’re not relaxed
CBT-I is sometimes carried out by a specially trained GP. Alternatively, you may be referred to a clinical psychologist.
The therapy may be carried out in a small group with other people who have similar sleep problems, or one-to-one with a therapist. Self-help books and online courses may also be used.
Sleeping tablets (hypnotics) are medications that encourage sleep. In the past, they were frequently used to help with insomnia, but they’re used much less often nowadays.
They will generally only be considered:
- if your insomnia is severe
- as a temporary measure to help ease short-term insomnia
- if the good sleep habits and cognitive and behavioural treatments mentioned above don’t help
Doctors are usually reluctant to recommend sleeping tablets in the long-term because they just mask the symptoms without treating the underlying cause.
They can also cause potentially dangerous side effects, such as drowsiness the following morning, and some people become dependent on them.
If they are recommended, you should have the smallest effective dose possible for the shortest time (usually no more than two to four weeks).
Over-the-counter sleeping pills
A number of sleeping tablets are available to buy over the counter (OTC) from pharmacies. These are usually a type of antihistamine medicine that causes you to feel drowsy.
Taking OTC sleeping tablets regularly isn’t usually recommended if you have insomnia, because it’s not clear how effective they are, they don’t tackle the underlying cause of your sleeping difficulties and they can cause side effects.
In particular, they can cause you to feel drowsy the next morning, which can make activities such as driving and operating machinery dangerous.
Speak to your GP for advice if you find yourself needing to take OTC sleeping tablets regularly.
Benzodiazepines are prescription medicines that can reduce anxiety and promote calmness, relaxation and sleep. Your GP may prescribe them for a short time if you have severe insomnia or it’s causing extreme distress.
Examples of benzodiazepines include temazepam, loprazolam, lormetazepam, diazepam and nitrazepam.
Long-term treatment with benzodiazepines isn’t usually recommended because they can become less effective over time and some people become dependent upon them.
They can also cause a number of side effects, including:
- drowsiness and dizziness, which can persist into the next day
- finding it difficult to concentrate or make decisions
- feeling emotionally numb
You should avoid driving if you feel drowsy, dizzy, or unable to concentrate or make decisions, as you may not be able to do so safely.
Z–drugs are a newer type of medicine that work in a similar way to benzodiazepines and are similarly effective. They include zaleplon, zolpidem and zopiclone.
As with benzodiazepines, long-term treatment with Z–drugs isn’t normally recommended because they can become less effective over time and some people become dependent on them.
They’re usually only prescribed for a maximum of two to four weeks.
Side effects of Z-drugs can include:
- drowsiness and dizziness, which can persist into the next day
- feeling and being sick
- increased snoring and breathing problems during sleep
- dry mouth
Z–drugs can also sometimes cause psychiatric reactions, such as delusions, nightmares and hallucinations. Contact your GP if you experience any of these effects.
Read the National Institute for Health and Care Excellence (NICE) guidance on zaleplon, zolpidem and zopiclone for the short-term management of insomnia for more information.
For adults aged 55 or over, a medication called Circadin is sometimes used to help relieve insomnia for a few weeks. It contains a naturally occurring hormone called melatonin, which helps to regulate the sleep cycle.
Circadin is usually only recommended for three weeks at first, but it can be continued for a total of 13 weeks if it helps.
Common side effects of Circadin include:
- cold-like symptoms
- back pain
- joint pain
Treatments that aren’t recommended
The following treatments aren’t normally recommended for insomnia, because it’s not clear how effective they are and they can sometimes cause side effects:
- antidepressants (unless you also have depression)
- chloral hydrate
- herbal remedies, such as valerian extract
- complementary and alternative therapies, such as acupuncture, hypnotherapy and reflexology