An occasional sleepless night is nothing to worry about. But if insomnia bothers you for three weeks or longer, it can be a real medical problem. Some medical problems that lead to insomnia in women include:

• Depression and anxiety disorders.
• Over-activity of the thyroid gland.
• Heart or lung conditions that cause shortness of breath when lying down.
• Allergies and early-morning wheezing.
• Menopausal symptoms such as hot flashes.
• Any illness, injury or surgery that causes pain and/or discomfort, such as arthritis, which interrupts sleep.
• Any disorder (urinary, gastrointestinal or neurological) that makes it necessary to urinate or have a bowel movement during the night.
• Side effects of certain medications, such as decongestants and cortisone drugs.

Other things that lead to insomnia are:

• Emotional stress.
• Lack of a sex partner.
• Too much noise when falling asleep. This includes a snoring partner.
• Stimulants such as caffeine from coffee, tea, colas or chocolate and stay awake pills such as NoDoz.
• A lack of physical exercise.

The first line of treatment for insomnia is to look for and address the cause. For example, estrogen can help treat hot flashes in menopause. It comes in oral tablets or in a patch that is applied to the skin. Medication and other measures may be needed to treat other conditions that keep you from getting a full night’s sleep.

Do you have trouble falling or staying asleep because of: Pain or discomfort due to illness or injury? The need to wake up to use the bathroom? Hot flashes?
Has your sleep been disturbed since you began taking medication of any kind?
Do you still have trouble sleeping after 3 weeks, with or without self-care procedures? (See page 39)

Many old-fashioned remedies for sleeplessness work well. Next time you find yourself unable to sleep, try these time-tested cures:

• Get regular exercise, but don’t exercise for two hours before you plan to go to sleep.
• Avoid caffeine in all forms after lunchtime. Coffee, tea, chocolate, colas and some other soft drinks contain this stimulant as do certain over-the-counter and prescription drugs. Check the labels for ingredients.
• Avoid long naps during the day. Naps decrease the quality of nighttime sleep.
• Avoid more than one or two servings of alcoholic beverages at dinner time and during the rest of the evening. Even though alcohol is a sedative, it can disrupt sleep. Always check with your doctor about using alcohol if you are taking medications.
• Have food items rich in the amino acid L-tryptophan such as milk, turkey or tuna fish before you go to bed. Eating foods with carbohydrates such as cereal, breads and fruits may help as well. Do not, however, take L-tryptophan supplements.
• Take a nice, long, warm bath before bedtime. This soothes and unwinds tense muscles, leaving you relaxed enough to fall asleep.
• Read a book or do some repetitive, calm activity. Avoid distractions that may hold your attention and keep you awake, such as watching a suspense movie.
• Make your bedroom as comfortable as possible. Create a quiet, dark atmosphere. Use clean, fresh sheets and pillows and keep the room temperature comfortable, neither too warm nor too cold.
• Ban worry from the bedroom. Don’t allow yourself to rehash the mistakes of the day as you toss and turn.
• You’re off duty now. The idea is to associate your bed with sleep.
• Develop a regular bedtime routine. Locking or checking doors and windows, brushing your teeth and reading before you turn in every night primes you for sleep.
• Count those sheep! Counting slowly is a soothing, hypnotic activity. By picturing repetitive, monotonous images, you may bore yourself to sleep.
• Try listening to recordings made especially to help promote sleep. Check local bookstores.
• Don’t take over-the-counter sleeping pills or someone else’s sleep medicine. Only take sleep medicine with the advice of your doctor. Ask your doctor about taking an over-the-counter antihistamine, such as Benadryl. It may help promote sleep.