Why can't I sleep through the night?

The question:
 
Lately my sleep has been terrible. Sometimes I have trouble falling asleep, and other times I wake up around 4 AM and can’t get back to sleep. What’s going on?
 
The answer:
 
First of all, you’re not the only one struggling with this. Up to one-third of the population has chronic sleep problems, which can include trouble falling asleep, staying asleep, and waking up too early.
Here are some tips to help you get a better night’s rest:
 
Schedule “worry time” Worries – about work, relationships, finances – can contribute to difficulty falling asleep, or can wake you up in the middle night. Unfortunately, just trying to force yourself to “stop thinking” does not work very well.
 
It can be helpful to schedule a dedicated time to worry, 15 to 20 minutes, one to two hours before getting into bed. Find a quiet space, out of your bedroom. During your “worry time,” write down all the worries you have that day. Ask yourself “What can I do about this now?” Take a solution-focused approach. If there is something to be done immediately, do it. If not, schedule a time for the next day or later in the week.
 
Set a regular schedule It’s more important to establish a fixed wake-up time than a regular bedtime. We can control what time we wake up, but we can’t make ourselves fall asleep. If you are having sleep problems, eliminate daytime naps as these decrease the restorative value – or quality – of your sleep at night.
 
Reduce sleep-interfering activities In the several hours before bedtime, you should reduce (and ideally eliminate) caffeine, alcohol and tobacco use, and avoid strenuous exercise. Use your bed for two activities only – sleep and sex (no watching TV or working on your laptop in bed!).
 
Make your bedroom sleep-inducing Create a pleasant environment for sleep. Get a comfortable pillow. Use blinds or heavy curtains to create a dark room. Turn off phone ringers.
 
Make “going to bed” a soothing experience Set a pre-sleep routine that you follow each night, as this signals to your brain and body that it’s time to quiet down. This may include some form of meditation or relaxation, a warm bath or herbal tea. Get yourself ready for the next day, dim the lights and then mentally “put away” any ongoing problems or upcoming tasks.
 
Get out of bed if you can’t sleep. Don’t get into bed unless you are sleepy. If you have trouble falling asleep within about 20 minutes (or wake and can not go back to sleep) stay out of bed until you feel sleepy. Remember, don’t do anything stimulating when you get out of bed.
 
Challenge worries about sleep You may be kept awake by worries about not being able to sleep, or about the effect of a poor night’s sleep. Move your clock out of sight so that you are not “clock-watching.” Remind yourself that you can make it through a day even if you have had little sleep.
 
It can be tempting to rely on medications (prescription or over-the-counter) for sleep but these are a short-term solution only and guidelines do not recommend their use for longer than one to two weeks at most.

​Excerpted from Dr. Joti Samra’s “Ask the Psychologist” weekly column in The Globe and Mail.