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Don't Let the Fear of Sleeplessness Keep You From Sleeping Tonight

Here are some steps you can take when you are struggling to sleep that will minimize the anxiety driving your sleepless nights.
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TLC has just launched a television show called Here Comes Honey Boo Boo. This spin-off of the network's Toddlers and Tiaras follows the life of a 6-year-old pageant contestant... and it proves that in 2012, any idea can be made into a television show.

This is great news, because I have an idea that is going to win me an Emmy and allow me to help people with their sleep at the same time. Here is the premise of the program that I am calling Dream Big! The show's crew crisscrosses the country looking for the best sleepers reality TV can find. The cameras burst into a candidate's family room with an oversized check (I love the oversized check!) promising $1 million to Dad, and all Pop has to do to collect the cash is to fall asleep! The rules are simple. Dad is allowed to go to bed no earlier than 11 p.m. At that point the big sparkly Dream Big! hourglass will be turned over and put on his bedside table. All Dad has to do to win the money is to fall asleep before the hourglass runs out of sand in three hours. Easy, right?

But is it? Dad doesn't look so confident as the cameras are arranged in his bedroom. He looks even less confident when he understands that the world will be watching as he attempts to win the prize. Good luck Dad!

The show plays footage of Dad as he tosses, turns, puts pillows over his head, kicks the covers off, and generally goes crazy over the next three hours trying with all of his might to fall asleep. Watch your language, Dad, there are children watching! After the last of the sand trickles away, the hourglass, the cameras, and the check drive on to the next contestant. Dad can't believe he was not able to win the money. How is it possible that the same man who is never able to make it to the end of a Law & Order episode to see who did it can't nod off within three hours of getting into bed?

The answer is why millions of people will have insomnia tonight.

Most people think of sleep as the consequence of sleepiness, and it is. We become sleepier as the day goes on, and then we become more likely to sleep. This has to do, in large part, with the adenosine our brains accumulate with wakefulness. Adenosine, a neurotransmitter in the brain, makes us sleepy, so the longer we are awake, the sleepier we get.

If the equation were that simple, Dad would be depositing his prize money in the bank. Fortunately, there is another variable built in to the sleep equation: anxiety. Anxiety has the ability to trump sleepiness -- temporarily. This is a good thing. Imagine being in bed on the verge of falling asleep when suddenly you smell smoke. It's anxiety that allows you to overcome sleepiness, wake your family and get out of the burning home. If we were simply slaves to sleepiness, we would quickly perish in the flames.

While anxiety can be a big help during a house fire, it can be a big problem at other times. In our reality series, it's anxiety that keeps the million dollar check safely in the Dream Big! van. Humans don't tend to do well sleeping when they are trying to go to sleep. They do much better when they are trying to listen to a sermon, pay attention during a lecture on the Dewey Decimal system or, in my case, watch the musical Cats.

So while it is apparent that Dad was anxious about disappointing his family and losing an opportunity to win a large cash prize, why would so many have such difficulty sleeping on any given night? What is the average individual worrying about when he is unable to fall asleep?

The simple answer is often the individual who can't sleep is anxious about not sleeping. People fear many things: flying, heights, drowning, blood and bodily injuries, even death. Being awake is not a common fear. Most of us greatly enjoy being awake. Being awake is usually viewed as a good thing, just not when we are trying to sleep. When we are awake during a time we want to sleep, we get upset. We also get anxious about the consequences of not getting a good night's sleep and the impact it may have on the next day. So, by addressing this anxious reaction to not sleeping, we can prevent individuals from developing this circular response (can't sleep, anxious about not sleeping, even less likely to sleep, more anxious about not sleeping, repeat) and thus facilitate sleep.

Easier said than done, right? Here are some steps you can take when you are struggling to sleep that will minimize the anxiety driving your sleepless nights.

• See a sleepless night for what it truly is. I often invite my patients to make a list of all of the terrible things that will happen if they don't sleep well on a given night. I usually get things started with "feel sleepy during the day" and ask them for the next entry. It is surprising to me how many patients cannot even come up with a second con. While I do not recommend a night of fitful sleep, it's certainly not something to be feared; we have all pulled all-nighters for some reason or another, and we all survive the experience. Stand up to the fear and it will shrink rapidly.

• Go to sleep when you feel sleepy. As obvious as this sounds, it is surprising to me how often people go to bed every night at their "bedtime" yet struggle to initiate sleep at that time. Don't get married to a bedtime if it is not working for you -- make it later, it's okay (just don't make your wake up time later too or all you will accomplish is shifting your struggles).

• Don't perpetuate you sleep problems by napping, sleeping in, or sneaking sleep at other times of your schedule. Being a confident sleeper means that you stick to your schedule even after a difficult night.

Unless there is a van parked outside your home right now, a large cash prize is not riding on your sleep tonight. If you work to minimize the fear of insomnia though, you may receive a consolation prize worth more than the big check!

For more by Dr. Christopher Winter, click here.

For more on sleep, click here.