Therapy for Anxiety Disorders

If you suffer from panic attacks, obsessive thoughts, unrelenting worries, or an incapacitating phobia, you may have an anxiety disorder. But you don’t have to live with anxiety and fear. Treatment can help, and for many anxiety problems, therapy is a good place to start. Certain types of therapy, such as cognitive behavioral therapy and exposure therapy, are particularly beneficial. These therapies can teach you how to control your anxiety levels, stop worrisome thoughts, and conquer your fears.

Treating anxiety disorders with therapy

When it comes to treating anxiety disorders, research shows that therapy is usually the most effective option. That’s because anxiety therapy—unlike anxiety medication—treats more than just the symptoms of the problem. Therapy can help you uncover the underlying causes of your worries and fears; learn how to relax; look at situations in new, less frightening ways; and develop better coping and problem-solving skills. Therapy gives you the tools to overcome anxiety and teaches you how to use them.

The anxiety disorders differ considerably, so therapy should be tailored to your specific symptoms and concerns. If you have obsessive-compulsive disorder, your treatment will be different from someone who’s getting help for anxiety attacks. The length of therapy will also depend on the type and severity of your anxiety disorder. However, many anxiety therapies are relatively short-term. According to the American Psychological Association, many people improve significantly within 8 to 10 therapy sessions.

Many different types of therapy are used to treat anxiety, but the leading approaches are cognitive behavioral therapy and exposure therapy. Each anxiety therapy may be used alone, or combined with other types of therapy. Anxiety therapy may be conducted individually, or it may take place in a group of people with similar anxiety problems.

Cognitive behavioral therapy for anxiety

Cognitive behavioral therapy (CBT) is the most widely-used therapy for anxiety disorders. Research has shown it to be effective in the treatment of panic disorder, phobias, social anxiety disorder, and generalized anxiety disorder, among many other conditions.

Cognitive behavioral therapy addresses negative patterns and distortions in the way we look at the world and ourselves. As the name suggests, this involves two main components:

• Cognitive therapy examines how negative thoughts, or cognitions, contribute to anxiety.
• Behavior therapy examines how you behave and react in situations that trigger anxiety.

The basic premise of cognitive behavioral therapy is that our thoughts—not external events—affect the way we feel. In other words, it’s not the situation you’re in that determines how you feel, but your perception of the situation. For example, imagine that you’ve just been invited to a big party. Consider three different ways of thinking about the invitation, and how those thoughts would affect your emotions.

Situation: A friend invites you to a big party.

Thought #1: The party sounds like a lot of fun. I love going out and meeting new people!	Emotions: Happy, excited
Thought #2: Parties aren’t my thing. I’d much rather stay in and watch a movie.	Emotions: Neutral
Thought #3: I never know what to say or do at parties. I’ll make a fool of myself if I go.	Emotions: Anxious, sad

As you can see, the same event can lead to completely different emotions in different people. It all depends on our individual expectations, attitudes, and beliefs. For people with anxiety disorders, negative ways of thinking fuel the negative emotions of anxiety and fear. The goal of cognitive behavioral therapy for anxiety is to identify and correct these negative thoughts and beliefs. The idea is that if you change the way you think, you can change the way you feel.

Thought challenging in cognitive behavioral therapy

Thought challenging—also known as cognitive restructuring—is a process in which you challenge the negative thinking patterns that contribute to your anxiety, replacing them with more positive, realistic thoughts. This involves three steps:

1. Identifying your negative thoughts. With anxiety disorders, situations are perceived as more dangerous than they really are. To someone with a germ phobia, for example, shaking another person’s hand can seem life threatening. Although you may easily see that this is an irrational fear, identifying your own irrational, scary thoughts can be very difficult. One strategy is to ask yourself what you were thinking when you started feeling anxious. Your therapist will help you with this step.
2. Challenging your negative thoughts. In the second step, your therapist will teach you how to evaluate your anxiety-provoking thoughts. This involves questioning the evidence for your frightening thoughts, analyzing unhelpful beliefs, and testing out the reality of negative predictions. Strategies for challenging negative thoughts include conducting experiments, weighing the pros and cons of worrying or avoiding the thing you fear, and determining the realistic chances that what you’re anxious about will actually happen.
3. Replacing negative thoughts with realistic thoughts. Once you’ve identified the irrational predictions and negative distortions in your anxious thoughts, you can replace them with new thoughts that are more accurate and positive. Your therapist may also help you come up with realistic, calming statements you can say to yourself when you’re facing or anticipating a situation that normally sends your anxiety levels soaring.

To understand how thought challenging works in cognitive behavioral therapy, consider the following example: Maria won’t take the subway because she’s afraid she’ll pass out, and then everyone will think she’s crazy. Her therapist has asked her to write down her negative thoughts, identify the errors—or cognitive distortions—in her thinking, and come up with a more rational interpretation. The results are below.

Challenging Negative Thoughts
Negative thought #1: What if I pass out on the subway?
Cognitive distortion: Predicting the worst More realistic thought: I’ve never passed out before, so it’s unlikely that I will on the subway.
Negative thought #2: If I pass out, it will be terrible!
Cognitive distortion: Blowing things out of proportion More realistic thought: If I faint, I’ll come to in a few moments. That’s not so terrible.
Negative thought #3: People will think I’m crazy.
Cognitive distortion: Jumping to conclusions More realistic thought: People are more likely to be concerned if I’m okay.

Replacing negative thoughts with more realistic ones is easier said than done. Often, negative thoughts are part of a lifelong pattern of thinking. It takes practice to break the habit. That’s why cognitive behavioral therapy includes practicing on your own at home as well.

Cognitive behavioral therapy may also include:

• Learning to recognize when you’re anxious and what that feels like in the body
• Learning coping skills and relaxation techniques to counteract anxiety and panic
• Confronting your fears (either in your imagination or in real life)

Exposure therapy for anxiety

Anxiety isn’t a pleasant sensation, so it’s only natural to avoid it if you can. One of the ways that people do this is by steering clear of the situations that make them anxious. If you have a fear of heights, you might drive three hours out of your way to avoid crossing a tall bridge. Or if the prospect of public speaking leaves your stomach in knots, you might skip your best friend’s wedding in order to avoid giving a toast. Aside from the inconvenience factor, the problem with avoiding your fears is that you never have the chance to overcome them. In fact, avoiding your fears often makes them stronger.

Exposure therapy, as the name suggests, exposes you to the situations or objects you fear. The idea is that through repeated exposures, you’ll feel an increasing sense of control over the situation and your anxiety will diminish. The exposure is done in one of two ways: Your therapist may ask you to imagine the scary situation, or you may confront it in real life. Exposure therapy may be used alone, or it may be conducted as part of cognitive behavioral therapy.

Systematic desensitization

Rather than facing your biggest fear right away, which can be traumatizing, exposure therapy usually starts with a situation that’s only mildly threatening and works up from there. This step-by-step approach is called systematic desensitization. Systematic desensitization allows you to gradually challenge your fears, build confidence, and master skills for controlling panic.

Systematic desensitization involves three parts:

Facing a Fear of Flying

• Step 1: Look at photos of planes.
• Step 2: Watch a video of a plane in flight.
• Step 3: Watch real planes take off.
• Step 4: Book a plane ticket.
• Step 5: Pack for your flight.
• Step 6: Drive to the airport.
• Step 7: Check in for your flight.
• Step 8: Wait for boarding.
• Step 9: Get on the plane.
• Step 10: Take the flight.

• Learning relaxation skills. First, your therapist will teach you a relaxation technique, such as progressive muscle relaxation or deep breathing. You’ll practice in therapy and on your own at home. Once you start confronting your fears, you’ll use this relaxation technique to reduce your physical anxiety response (such as trembling and hyperventilating) and encourage relaxation.
• Creating a step-by-step list. Next, you’ll create a list of 10 to 20 scary situations that progress toward your final goal. For example, if you final goal is to overcome your fear of flying, you might start by looking at photos of planes and end with taking an actual flight. Each step should be as specific as possible, with a clear, measurable objective.
• Working through the steps. Under the guidance of your therapist, you’ll then begin to work through the list. The goal is to stay in each scary situation until your fears subside. That way, you’ll learn that the feelings won’t hurt you and they do go away. Every time the anxiety gets too intense, you will switch to the relaxation technique you learned. Once you’re relaxed again, you can turn your attention back to the situation. In this way, you will work through the steps until you’re able to complete each one without feeling overly distressed.

Complementary therapies for anxiety disorders

As you explore your anxiety disorder in therapy, you may also want to experiment with complementary therapies designed to bring your overall stress levels down and help you achieve emotional balance.

• Exercise – Exercise is a natural stress buster and anxiety reliever. Research shows that as little as 30 minutes of exercise three to five times a week can provide significant anxiety relief. To achieve the maximum benefit, aim for at least an hour of aerobic exercise on most days.
• Relaxation techniques – When practiced regularly, relaxation techniques such as mindfulness meditation, progressive muscle relaxation, controlled breathing, and visualization can reduce anxiety and increase feelings of relaxation and emotional well-being.
• Biofeedback – Using sensors that measure specific physiological functions—such as heart rate, breathing, and muscle tension—biofeedback teaches you to recognize the body’s anxiety response and learn how to control them using relaxation techniques.
• Hypnosis – Hypnosis is sometimes used in combination with cognitive-behavioral therapy for anxiety. While you’re in a state of deep relaxation, the hypnotherapist uses different therapeutic techniques to help you face your fears and look at them in new ways.

Making anxiety therapy work for you

There is no quick fix for anxiety. Overcoming an anxiety disorder takes time and commitment. Therapy involves facing your fears rather than avoiding them, so sometimes you’ll feel worse before you get better. The important thing is to stick with treatment and follow your therapist’s advice. If you’re feeling discouraged with the pace of recovery, remember that therapy for anxiety is very effective in the long run. You’ll reap the benefits if you see it through.

You can also support your own anxiety therapy by making positive choices. Everything from your activity level to your social life affects anxiety. Set the stage for success by making a conscious decision to promote relaxation, vitality, and a positive mental outlook in your everyday life.

• Learn about anxiety. In order to overcome anxiety, it’s important to understand the problem. That’s where education comes in. Education alone won’t cure an anxiety disorder, but it will help you get the most out of therapy.
• Cultivate your connections with other people. Loneliness and isolation set the stage for anxiety. Decrease your vulnerability by reaching out to others. Make it a point to see friends; join a self-help or support group; share your worries and concerns with a trusted loved one.
• Adopt healthy lifestyle habits. Physical activity relieves tension and anxiety, so make time for regular exercise. Don’t use alcohol and drugs to cope with your symptoms, and try to avoid stimulants such as caffeine and nicotine, which can make anxiety worse.
• Reduce stress in your life. Examine your life for stress, and look for ways to minimize it. Avoid people who make you anxious, say no to extra responsibilities, and make time for fun and relaxation in your daily schedule.

from  http://www.helpguide.org

How to Stop Worrying

Worrying can be helpful when it spurs you to take action and solve a problem. But if you’re preoccupied with “what ifs” and worst-case scenarios, worry becomes a problem. Unrelenting doubts and fears can be paralyzing. They can sap your emotional energy, send your anxiety levels soaring, and interfere with your daily life. But chronic worrying is a mental habit that can be broken. You can train your brain to stay calm and look at life from a more positive perspective.

Why is it so hard to stop worrying?

Constant worrying takes a heavy toll. It keeps you up at night and makes you tense and edgy during the day. You hate feeling like a nervous wreck. So why is it so difficult to stop worrying?

For most chronic worriers, the anxious thoughts are fueled by the beliefs—both negative and positive—they hold about worrying.

On the negative side, you may believe that your constant worrying is harmful, that it’s going to drive you crazy or affect your physical health. Or you may worry that you’re going to lose all control over your worrying—that it will take over and never stop.

On the positive side, you may believe that your worrying helps you avoid bad things, prevents problems, prepares you for the worst, or leads to solutions.

Negative beliefs, or worrying about worrying, add to your anxiety and keep worry going. But positive beliefs about worrying can be just as damaging. It’s tough to break the worry habit if you believe that your worrying protects you. In order to stop worry and anxiety for good, you must give up your belief that worrying serves a positive purpose. Once you realize that worrying is the problem, not the solution, you can regain control of your worried mind.

Why you keep worrying

You have mixed feelings about your worries. On one hand, your worries are bothering you—you can't sleep, and you can't get these pessimistic thoughts out of your head. But there is a way that these worries make sense to you. For example, you think:

• Maybe I'll find a solution.
• I don't want to overlook anything.
• If I keep thinking a little longer, maybe I'll figure it out.
• I don't want to be surprised.
• I want to be responsible.

You have a hard time giving up on your worries because, in a sense, your worries have been working for you.

Source: The Worry Cure: Seven Steps to Stop Worry from Stopping You by Robert L. Leahy, Ph.D.

Worry and anxiety self-help tip #1: Create a worry period

It’s tough to be productive in your daily life when anxiety and worry are dominating your thoughts. But what can you do? If you’re like many chronic worriers, your anxious thoughts feel uncontrollable. You’ve tried lots of things, from distracting yourself, reasoning with your worries, and trying to think positive, but nothing seems to work.

Why trying to stop anxious thoughts doesn’t work

Telling yourself to stop worrying doesn’t work—at least not for long. You can distract yourself or suppress anxious thoughts for a moment, but you can’t banish them for good. In fact, trying to do so often makes them stronger and more persistent.

You can test this out for yourself. Close your eyes and picture a pink elephant. Once you can see the pink elephant in your mind, stop thinking about it. Whatever you do, for the next five minutes, don’t think about pink elephants!

How did you do? Did thoughts of pink elephants keep popping in your brain?

“Thought stopping” backfires because it forces you to pay extra attention to the very thought you want to avoid. You always have to be watching for it, and this very emphasis makes it seem even more important.

But that doesn’t mean there’s nothing you can do to control your worry. You just need to try a different approach. This is where the strategy of postponing worrying comes in. Rather than trying to stop or get rid of an anxious thought, give yourself permission to have it, but put off thinking any more about it until later.

Learning to postpone worrying:

1. Create a “worry period.” Choose a set time and place for worrying. It should be the same every day (e.g. in the living room from 5:00 to 5:20 p.m.) and early enough that it won’t make you anxious right before bedtime. During your worry period, you’re allowed to worry about whatever’s on your mind. The rest of the day, however, is a worry-free zone.
2. Postpone your worry. If an anxious thought or worry comes into your head during the day, make a brief note of it on paper and postpone it to your worry period. Remind yourself that you’ll have time to think about it later, so there’s no need to worry about it right now. Save it for later and continue to go about your day.
3. Go over your “worry list” during the worry period. Reflect on the worries you wrote down during the day. If the thoughts are still bothering you, allow yourself to worry about them, but only for the amount of time you’ve specified for your worry period. If the worries don’t seem important any more, cut your worry period short and enjoy the rest of your day.

Postponing worrying is effective because it breaks the habit of dwelling on worries in the present moment. Yet there’s no struggle to suppress the thought or judge it. You simply save it for later. As you develop the ability to postpone your anxious thoughts, you’ll start to realize that you have more control over your worrying than you think.

Worry and anxiety self-help tip #2: Ask yourself if the problem is solvable

Research shows that while you’re worrying, you temporarily feel less anxious. Running over the problem in your head distracts you from your emotions and makes you feel like you’re getting something accomplished. But worrying and problem solving are two very different things.

Problem solving involves evaluating a situation, coming up with concrete steps for dealing with it, and then putting the plan into action. Worrying, on the other hand, rarely leads to solutions. No matter how much time you spend dwelling on worst-case scenarios, you’re no more prepared to deal with them should they actually happen.

Distinguish between solvable and unsolvable worries

If a worry pops into your head, start by asking yourself whether the problem is something you can actually solve. The following questions can help:

• Is the problem something you’re currently facing, rather than an imaginary what-if?
• If the problem is an imaginary what-if, how likely is it to happen? Is your concern realistic?
• Can you do something about the problem or prepare for it, or is it out of your control?

Productive, solvable worries are those you can take action on right away. For example, if you’re worried about your bills, you could call your creditors to see about flexible payment options. Unproductive, unsolvable worries are those for which there is no corresponding action. “What if I get cancer someday?” or “What if my kid gets into an accident?”

If the worry is solvable, start brainstorming. Make a list of all the possible solutions you can think of. Try not to get too hung up on finding the perfect solution. Focus on the things you have the power to change, rather than the circumstances or realities beyond your control. After you’ve evaluated your options, make a plan of action. Once you have a plan and start doing something about the problem, you’ll feel much less worried.

Dealing with unsolvable worries

But what if the worry isn’t something you can solve? If you’re a chronic worrier, the vast majority of your anxious thoughts probably fall in this camp. In such cases, it’s important to tune into your emotions.

As previously mentioned, worrying helps you avoid unpleasant emotions. Worrying keeps you in your head, thinking about how to solve problems rather than allowing yourself to feel the underlying emotions. But you can’t worry your emotions away. While you’re worrying, your feelings are temporarily suppressed, but as soon as you stop, the tension and anxiety bounces back. And then, you start worrying about your feelings, “What’s wrong with me? I shouldn’t feel this way!”

The truth is that emotions—like life—are messy. They don’t always make sense and they’re not always pleasant. But as long as you can accept your feelings as part of being human, you’ll be able to experience them without becoming overwhelmed and learn how to use them to your advantage. The following tips will help you find a better balance between your intellect and your emotions.The only way out of this vicious cycle is by learning to embrace your feelings. This may seem scary at first because of negative beliefs you have about emotions. For example, you may believe that you should always be rational and in control, that your feelings should always make sense, or that you shouldn’t feel certain emotions, such as fear or anger.

Worry and anxiety self-help tip #3: Accept uncertainty

The inability to tolerate uncertainty plays a huge role in anxiety and worry. Chronic worriers can’t stand doubt or unpredictability. They need to know with 100 percent certainty what’s going to happen. Worrying is seen as a way to predict what the future has in store—a way to prevent unpleasant surprises and control the outcome. The problem is, it doesn’t work.

Thinking about all the things that could go wrong doesn’t make life any more predictable. You may feel safer when you’re worrying, but it’s just an illusion. Focusing on worst-case scenarios won’t keep bad things from happening. It will only keep you from enjoying the good things you have in the present. So if you want to stop worrying, start by tackling your need for certainty and immediate answers.

Challenging intolerance of uncertainty: The key to anxiety relief

Ask yourself the following questions and write down your responses. See if you can come to an understanding of the disadvantages and problems of being intolerant of uncertainty.

• Is it possible to be certain about everything in life?
• What are the advantages of requiring certainty, versus the disadvantages? Or, how is needing certainty in life helpful and unhelpful?
• Do you tend to predict bad things will happen just because they are uncertain? Is this a reasonable thing to do? What is the likelihood of positive or neutral outcomes?
• Is it possible to live with the small chance that something negative may happen, given its likelihood is very low?

Adapted from: Accepting Uncertainty, Centre for Clinical Interventions

Worry and anxiety self-help tip #4: Challenge anxious thoughts

If you suffer from chronic anxiety and worries, chances are you look at the world in ways that make it seem more dangerous than it really is. For example, you may overestimate the possibility that things will turn out badly, jump immediately to worst-case scenarios, or treat every negative thought as if it were fact. You may also discredit your own ability to handle life’s problems, assuming you’ll fall apart at the first sign of trouble. These irrational, pessimistic attitudes are known as cognitive distortions.

Although cognitive distortions aren’t based on reality, they’re not easy to give up. Often, they’re part of a lifelong pattern of thinking that’s become so automatic you’re not even completely aware of it. In order to break these bad thinking habits and stop the worry and anxiety they bring, you must retrain your brain.

Start by identifying the frightening thought, being as detailed as possible about what scares or worries you. Then, instead of viewing your thoughts as facts, treat them as hypotheses you’re testing out. As you examine and challenge your worries and fears, you’ll develop a more balanced perspective.

Stop worry by questioning the worried thought:

• What’s the evidence that the thought is true? That it’s not true?
• Is there a more positive, realistic way of looking at the situation?
• What’s the probability that what I’m scared of will actually happen?
• If the probability is low, what are some more likely outcomes?
• Is the thought helpful? How will worrying about it help me and how will it hurt me?
• What would I say to a friend who had this worry?

Cognitive Distortions that Add to Anxiety, Worry, and Stress
All-or-nothing thinking - Looking at things in black-or-white categories, with no middle ground. “If I fall short of perfection, I’m a total failure.”
Overgeneralization - Generalizing from a single negative experience, expecting it to hold true forever. “I didn’t get hired for the job. I’ll never get any job.”
The mental filter - Focusing on the negatives while filtering out all the positives. Noticing the one thing that went wrong, rather than all the things that went right.
Diminishing the positive - Coming up with reasons why positive events don’t count. “I did well on the presentation, but that was just dumb luck.”
Jumping to conclusions - Making negative interpretations without actual evidence. You act like a mind reader, “I can tell she secretly hates me.” Or a fortune teller, “I just know something terrible is going to happen.”
Catastrophizing - Expecting the worst-case scenario to happen. “The pilot said we’re in for some turbulence. The plane’s going to crash!”
Emotional reasoning - Believing that the way you feel reflects reality. “I feel frightened right now. That must mean I’m in real physical danger.”
'Shoulds’ and ‘should-nots’ - Holding yourself to a strict list of what you should and shouldn’t do and beating yourself up if you break any of the rules
Labeling - Labeling yourself based on mistakes and perceived shortcomings. “I’m a failure; an idiot; a loser.”
Personalization - Assuming responsibility for things that are outside your control. “It’s my fault my son got in an accident. I should have warned him to drive carefully in the rain.”

Worry and anxiety self-help tip # 5: Be aware of how others affect you

How you feel is affected by the company you keep, whether you’re aware of it or not. Studies show that emotions are contagious. We quickly “catch” moods from other people—even from strangers who never speak a word (e.g. the terrified woman sitting by you on the plane; the fuming man in the checkout line). The people you spend a lot of time with have an even greater impact on your mental state.

• Keep a worry diary. You may not be aware of how people or situations are affecting you. Maybe this is the way it’s always been in your family, or you’ve been dealing with the stress so long that it feels normal. You may want to keep a worry diary for a week or so. Every time you start to worry, jot down the thought and what triggered it. Over time, you’ll start to see patterns.
• Spend less time with people who make you anxious. Is there someone in your life who drags you down or always seems to leave you feeling stressed? Think about cutting back on the time you spend with that person or establish healthier relationship boundaries. For example, you might set certain topics off-limits, if you know that talking about them with that person makes you anxious.
• Choose your confidantes carefully. Know who to talk to about situations that make you anxious. Some people will help you gain perspective, while others will feed into your worries, doubts, and fears.

Worry and anxiety self-help tip #6: Practice mindfulness

Worrying is usually focused on the future—on what might happen and what you’ll do about it. The centuries-old practice of mindfulness can help you break free of your worries by bringing your attention back to the present. In contrast to the previous techniques of challenging your anxious thoughts or postponing them to a worry period, this strategy is based on observing and then letting them go. Together, they can help you identify where your thinking is causing problems, while helping you get in touch with your emotions.

• Acknowledge and observe your anxious thoughts and feelings. Don’t try to ignore, fight, or control them like you usually would. Instead, simply observe them as if from an outsider’s perspective, without reacting or judging.
• Let your worries go. Notice that when you don’t try to control the anxious thoughts that pop up, they soon pass, like clouds moving across the sky. It’s only when you engage your worries that you get stuck.
• Stay focused on the present. Pay attention to the way your body feels, the rhythm of your breathing, your ever-changing emotions, and the thoughts that drift across your mind. If you find yourself getting stuck on a particular thought, bring your attention back to the present moment.

Using mindfulness meditation to stay focused on the present is a simple concept, but it takes practice to reap the benefits. At first, you’ll probably find that your mind keeps wandering back to your worries. Try not to get frustrated. Each time you draw your focus back to the present, you’re reinforcing a new mental habit that will help you break free of the negative worry cycle.

from  http://www.helpguide.org

Can’t Sleep?

Do you struggle to get to sleep no matter how tired you are? Or do you wake up in the middle of the night and lie awake for hours, anxiously watching the clock? Insomnia is a common problem that takes a toll on your energy, mood, health, and ability to function during the day. Chronic insomnia can even contribute to serious health problems. Simple changes to your lifestyle and daily habits can put a stop to sleepless nights.

Can’t sleep? Understanding insomnia and its symptoms

Although insomnia is the most common sleep complaint, it is not a single sleep disorder. It’s more accurate to think of insomnia as a symptom of another problem, which differs from person to person. It could be something as simple as drinking too much caffeine during the day or a more complex issue like an underlying medical condition or feeling overloaded with responsibilities.Insomnia is the inability to get the amount of sleep you need to wake up feeling rested and refreshed. Because different people need different amounts of sleep, insomnia is defined by the quality of your sleep and how you feel after sleeping—not the number of hours you sleep or how quickly you doze off. Even if you’re spending eight hours a night in bed, if you feel drowsy and fatigued during the day, you may be experiencing insomnia.

The good news is that most cases of insomnia can be cured with changes you can make on your own—without relying on sleep specialists or turning to prescription or over-the-counter sleeping pills.

Symptoms of insomnia:

Difficulty falling asleep despite being tired Waking up frequently during the night Trouble getting back to sleep when awakened Exhausting sleep

Relying on sleeping pills or alcohol to fall asleep Waking up too early in the morning Daytime drowsiness, fatigue, or irritability Difficulty concentrating during the day

Causes of insomnia: Figuring out why you can’t sleep

In order to properly treat and cure your insomnia, you need to become a sleep detective. Emotional issues such as stress, anxiety, and depression cause half of all insomnia cases. But your daytime habits, sleep routine, and physical health may also play a role. Try to identify all possible causes of your insomnia. Once you figure out the root cause, you can tailor treatment accordingly.

• Are you under a lot of stress?
• Are you depressed or feel emotionally flat or hopeless?
• Do you struggle with chronic feelings of anxiety or worry?
• Have you recently gone through a traumatic experience?
• Are you taking any medications that might be affecting your sleep?
• Do you have any health problems that may be interfering with sleep?
• Is your sleep environment quiet and comfortable?
• Are you spending enough time in sunlight during the day and in darkness at night?
• Do you try to go to bed and get up around the same time every day?

Common mental and physical causes of insomnia:

Sometimes, insomnia only lasts a few days and goes away on its own, especially when the insomnia is tied to an obvious temporary cause, such as stress over an upcoming presentation, a painful breakup, or jet lag. Other times, insomnia is stubbornly persistent. Chronic insomnia is usually tied to an underlying mental or physical issue.

• Psychological problems that can cause insomnia: depression, anxiety, chronic stress, bipolar disorder, post-traumatic stress disorder. 
• Medications that can cause insomnia: antidepressants; cold and flu medications that contain alcohol; pain relievers that contain caffeine (Midol, Excedrin); diuretics, corticosteroids, thyroid hormone, high blood pressure medications.
• Medical problems that can cause insomnia: asthma, allergies, Parkinson’s disease, hyperthyroidism, acid reflux, kidney disease, cancer, chronic pain.
• Sleep disorders that can cause insomnia: sleep apnea, narcolepsy, restless legs syndrome.

Anxiety and depression: Two of the most common causes of chronic insomnia

Most people suffering from an anxiety disorder or depression have trouble sleeping. What’s more, the sleep deprivation can make the symptoms of anxiety or depression worse. If your insomnia is caused by anxiety or depression, treating the underlying psychological issue is the key to the cure.

Insomnia cures and treatments: Changing habits that disrupt sleep

While treating underlying physical and mental issues is a good first step, it may not be enough to cure your insomnia. You also need to look at your daily habits. Some of the things you’re doing to cope with insomnia may actually be making the problem worse.

For example, if you’re using sleeping pills or alcohol to fall asleep, this will disrupt your sleep even more over the long-term. Or if you drink excessive amounts of coffee during the day, it will be more difficult to fall asleep later. Oftentimes, changing the habits that are reinforcing sleeplessness is enough to overcome insomnia altogether. It may take a few days for your body to get used to the change, but once you do, you will sleep better.

Using a sleep diary to identify insomnia-inducing habits

Habits that make insomnia worse:

• drinking a lot of caffeine
• drinking or smoking before bed
• taking naps during the day
• an irregular sleep schedule

Some habits are so ingrained that you may overlook them as a possible contributor to your insomnia. Maybe your daily Starbucks habit affects your sleep more than you realize. Or maybe you’ve never made the connection between your late-night TV viewing or Internet surfing and your sleep difficulties. Keeping a sleep diary is a helpful way to pinpoint habits and behaviors contributing to your insomnia.

All you have to do is jot down daily details about your daytime habits, sleep routine, and insomnia symptoms. For example, you can keep track of when you go to sleep and when you wake up, where you fall asleep, what you eat and drink, and any stressful events that occur during the day.

Adopting new habits to help you sleep

• Make sure your bedroom is quiet, dark, and cool. Noise, light, and heat can interfere with sleep. Try using a sound machine or earplugs to hide outside noise, an open window or fan to keep the room cool, and blackout curtains or a sleep mask to block out light.
• Stick to a regular sleep schedule. Support your biological clock by going to bed and getting up at the same time every day, including weekends. Get up at your usual time in the morning even if you’re tired. This will help you get back in a regular sleep rhythm.
• Avoid naps. Napping during the day can make it more difficult to sleep at night. If you feel like you have to take a nap, limit it to 30 minutes before 3 p.m.
• Avoid stimulating activity and stressful situations before bedtime. This includes vigorous exercise; big discussions or arguments; and TV, computer, or video game use.
• Limit caffeine, alcohol, and nicotine. Stop drinking caffeinated beverages at least eight hours before bed. Avoid drinking alcohol in the evening; while alcohol can make you feel sleepy, it interferes with the quality of your sleep. Quit smoking or avoid it at night, as nicotine is a stimulant.

Preparing your brain for sleep

Your brain produces the hormone melatonin to help regulate your sleep-wake cycle. As melatonin is controlled by light exposure, not enough natural light during the day can make your brain feel sleepy, while too much artificial light at night can suppress production of melatonin and make it harder to sleep. To help naturally regulate your sleep-wake cycle and prepare your brain for sleep:

• Increase light exposure during the day. Take breaks outside in sunlight, remove sunglasses when it’s safe to do so, and open blinds and curtains during the day.
• Limit artificial light at night. To boost melatonin production, use low-wattage bulbs, cover windows and electrical displays in your bedroom, avoid bright light and turn off television and computer screens at least one hour before bed. If you can’t make your bedroom dark enough, try using a sleep mask.

Coping with shift work

Working nights or irregular shifts can disrupt your sleep schedule, requiring you to sleep during daylight hours. But you may be able to limit the adverse impact by practicing the healthy bedtime habits above, and following these tips:

• Adjust your sleep-wake cycle by exposing yourself to bright light when you wake up at night, use bright lamps or daylight-simulation bulbs in your workplace, and then wear dark glasses on your journey home to block out sunlight and encourage sleepiness.
• Limit the number of night or irregular shifts you work in a row to prevent sleep deprivation mounting up.
• Avoid frequently rotating shifts so you can maintain the same sleep schedule.
• Avoid a long commute that cuts into your sleep time. The more time you spend traveling home in daylight, the more awake you’ll become and the harder you’ll find it is to get to sleep.
• Make sleep a priority at the weekends or on your days off so you can pay off your sleep debt.
• Eliminate noise and light from your bedroom during the day. Use blackout curtains or a sleep mask, turn off the phone, and use ear plugs or a soothing sound machine to block out daytime noise.

Insomnia cures and treatments: Neutralizing anxiety when you can’t sleep

The more trouble you have with sleep, the more it starts to invade your thoughts. You may dread going to sleep because you just know that you’re going to toss and turn for hours or be up at 2 a.m. again. Or maybe you’re worried because you have a big day tomorrow, and if you don’t get a solid eight hours, you’re sure you’ll blow your presentation. But agonizing and expecting sleep difficulties only makes insomnia worse; worrying about getting to sleep or how tired you’re going to be floods your body with adrenaline, and before you know it, you’re wide-awake.

Learning to associate your bed with sleeping and sex, not sleeplessness

Self-help strategies for chronic worriers

Do you lie awake at night worrying about “what ifs” and worst-case scenarios? Constant worrying can keep you up at night and make you tense and edgy during the day. But chronic worrying is a mental habit you can learn how to break.

If sleep worries are getting in the way of your ability to unwind at night, the following strategies may help. The goal is to train your body to associate the bed with sleep, sex, and nothing else—especially not frustration and anxiety.

• Use the bedroom only for sleeping and sex.Don’t work, read, watch TV, or use your computer in bed or the bedroom. The goal is to associate the bedroom with sleep and sex, so that when you get in bed your brain and body get a strong signal that it’s time to nod off or be romantic.
• Get out of bed when you can’t sleep. Don’t try to force yourself to sleep. Tossing and turning only amps up the anxiety. Get up, leave the bedroom, and do something relaxing, such as reading, drinking a warm cup of caffeine-free tea, taking a bath, or listening to soothing music. When you’re sleepy, go back to bed.
• Move bedroom clocks out of view. Anxiously watching the minutes tick by when you can’t sleep—knowing that you’re going to be exhausted when the alarm goes off—is a surefire recipe for insomnia. You can use an alarm, but make sure you can’t see the time when you’re in bed.

It’s also helpful to challenge the negative attitudes about sleep and your insomnia problem that you’ve developed over time. The key is to recognize self-defeating thoughts and replace them with more realistic ones.

Challenging self-defeating thoughts that fuel insomnia
Self-defeating thought	Sleep-promoting comeback
Unrealistic expectations: I should be able to sleep well every night like a normal person. I shouldn’t have a problem!	Lots of people struggle with sleep from time to time. I will be able to sleep with practice.
Exaggeration: It’s the same every single night, another night of sleepless misery.	Not every night is the same. Some nights I do sleep better than others.
Catastrophizing: If I don’t get some sleep, I’ll tank my presentation and jeopardize my job.	I can get through the presentation even if I’m tired. I can still rest and relax tonight, even if I can’t sleep.
Hopelessness: I’m never going to be able to sleep well. It’s out of my control.	Insomnia can be cured. If I stop worrying so much and focus on positive solutions, I can beat it.
Fortune telling: It’s going to take me at least an hour to get to sleep tonight. I just know it.	I don’t know what will happen tonight. Maybe I’ll get to sleep quickly if I use the strategies I’ve learned.

Remember, replacing self-defeating thoughts takes time and practice. You may find it helpful to jot down your own list, taking note of the negative thoughts that pop up and how you can dispute them. You may be surprised at how often these negative thoughts run through your head. Be patient and ask for support if you need it.

Insomnia cures and treatments: Harnessing your body’s relaxation response

If you're easily wound and unable to let go of stress at the end of the day, you may benefit from relaxation techniques that take advantage of the body’s natural relaxation response, a state of restfulness that is the opposite of the stress response. Not only do relaxation techniques help you quiet your mind and relieve tension in the body, but they also help you fall asleep faster and get back to sleep more quickly if you awaken in the middle of the night. And all without the side effects of sleep medication!

A variety of relaxation techniques help you achieve the relaxation response, including:

• deep breathing
• progressive muscle relaxation
• meditation
• visualization
• yoga
• tai chi

Relaxation techniques that can help you sleep

• A relaxing bedtime routine. As a start to your relaxation practice, develop a calming bedtime routine. Focus on quiet, soothing activities, such as reading, knitting, or listening to soft music. Keep the lights low.
• Abdominal breathing. Most of us don’t breathe as deeply as we should. When we breathe deeply and fully, involving not only the chest, but also the belly, lower back, and ribcage, it can actually help our parasympathetic nervous system, which controls relaxation. Close your eyes and try taking deep, slow breaths, making each breath even deeper than the last. Breathe in through your nose and out through your mouth. You can try making each exhale a little longer than each inhale.
• Progressive muscle relaxation. Lie down or make yourself comfortable. Starting with your feet, tense the muscles as tightly as you can. Hold for a count of 10, and then relax. Continue to do this for every muscle group in your body, working your way up from your feet to the top of your head.

A step-by-step guide to developing a daily relaxation practice

It takes regular practice to learn these techniques and harness their stress-relieving power. Stick with it because the benefits can be huge. You can do them as part of your bedtime routine, when you are lying down preparing for sleep, and if you wake up in the middle of the night.

Insomnia cures and treatments: Using supplements and medication wisely

When you’re tossing and turning at night, it can be tempting to turn to sleep aids for relief. But before you do, here’s what you need to know.

Dietary supplements for insomnia

There are many dietary and herbal supplements marketed for their sleep-promoting effects. Although they may be described as “natural,” be aware that sleep remedies can still have side effects and interfere with other medications or vitamins you’re taking. For more information, talk to your doctor or pharmacist.

While scientific evidence is still being gathered for alternative sleep remedies, you might find that some of them work wonderfully for you. The two supplements with the most evidence supporting their effectiveness for insomnia are melatonin and valerian.

• Melatonin is a naturally occurring hormone that your body produces at night. While melatonin supplements—available as an over-the-counter supplement—don't work for everyone, they may be an effective insomnia treatment for you—especially if you’re an extreme “night owl” with a natural tendency to go to bed and get up much later than others.
• Valerian is an herb with mild sedative effects that may help you sleep better. However, the quality of valerian supplements varies widely.

Prescription sleeping pills for insomnia

While prescription sleep medications can provide temporary relief, it’s important to understand that sleeping pills are not a cure for insomnia. And if not used carefully, they actually make insomnia worse in the long run. It’s best to use medication only as a last resort, and then, only on a very limited, as-needed basis. First, try changing your sleep habits, your daily routine, and your attitudes about sleep. Evidence shows that lifestyle and behavioral changes make the largest and most lasting difference when it comes to insomnia.

When to consider seeking professional insomnia treatment

If you’ve tried the insomnia cures and treatments listed above and are still having trouble getting the sleep you need, a doctor or sleep disorder specialist may be able to help.

When to seek professional help for insomnia:

• If your insomnia doesn’t respond to self-help strategies
• If your insomnia is causing major problems at home, work, or school
• If you’re experiencing scary symptoms like chest pain or shortness of breath
• If your insomnia occurs almost every night and is getting worse

from  http://www.helpguide.org