Four centuries ago, the Elizabethan writer Thomas Dekker accurately called sleep “the golden chain that ties health and our bodies together.”

Regular sleep is essential to physical and mental health. Insufficient rest can contribute to obesity, depression, anxiety, diabetes, high blood pressure, heart disease and a host of psychiatric and medical ailments. Breathing problems can also contribute to poor sleep—whether insomnia or sleep apnea. Other consequences can be inattentiveness, irritability and communication problems. And each of these conditions, in turn, may contribute to insomnia, creating a vicious cycle. Symptoms of insomnia include difficulty falling asleep; awakening often through the night, or too early; and not feeling well-rested after a night’s sleep.

Insomnia is a common symptom in people suffering from depression and anxiety. A good night’s sleep is generally considered to be about six to nine hours of uninterrupted rest, and feeling refreshed upon awakening. The amount of sleep a person needs may change over the years.

The body’s natural clock is called the “circadian rhythm,” a term coined by Franz Halberg in 1959 from Latin words circa, meaning “around” and diem (meaning “day). The natural rhythm is a roughly 24-hour cycle telling our bodies when to sleep and regulating other physiological processes. Our internal clock is affected by environmental cues like sunlight and temperature, as well as internal factors like drugs, alcohol, worrying and distractions.

An easy trap to fall into is to become overly reliant on sleep medication, which can lead to drug tolerance and dependence until the body starts to have difficulty falling asleep without the drug. Anti-anxiety medications (benzodiazepines) are notorious for this. Prescription drugs like Xanax or Klonapin should be reserved for their intended purpose (anxiety disorder, generally not insomnia) and used with caution. Medically approved sleep medications, when used, should only be taken for brief periods.

If you have trouble for 20 or 30 minutes, get up and go to a different room to engage in a quiet activity. Avoid turning on lights, sitting in front of a TV or computer, or otherwise stimulating your brain. Avoid worrying. Negative thoughts like “I’ll never get to sleep” or worrying about getting through the day tomorrow will make you more tense and awake.

As Dale Carnegie advised, “If you can’t sleep, then get up and do something instead of lying there worrying. It’s the worry that gets you, not the lack of sleep.”

A sleep diary can help document trends to review with a healthcare provider. See the one offered by the American Academy of Sleep Medicine at yoursleep.aasmnet.org/pdf/sleepdiary.pdf.

Bottom line is, there are as many solutions for insomnia as there are causes. A good night’s rest is no luxury. It is as necessary to mental and physical health as exercise and nutrition.

[Tom Rue is a Licensed Mental Health Counselor in New York, certified as a clinical mental health counselor by the National Board for Certified Counselors, and AMHCA Diplomate and Clinical Mental Health Specialist in Substance Abuse and Co-Occurring Disorders, and a Credentialed Alcoholism and Substance Abuse Counselor He can be reached at 845/513-5002 or www.choicesmhc.com.]

Sleep hygiene

• Consistency: Go to bed and get up at the same time each day, even on weekends.

• Light: Exposure to natural or full-spectrum lighting late in the day helps regulate the body clock.

• Environment: Keep the bedroom dark (pull the curtains, try a sleep mask), quiet, comfortable; keep hands and feet warm. Use your bed only for sleep and sexual activity, associating bed with sleep—not other activities like paying bills, talking on the phone, or watching TV.

• Diet: A light dinner will help you avoid going to bed hungry or too full.

• Exercise: Stretching and aerobics in the morning, and no less than three to four hours before bed improves restful sleep.

• Routine: Establish bedtime rituals, to remind your body it’s time to wind down, like a warm bath or shower, aromatherapy, reading, or soothing music.

• Relaxation: Evoke comforting imagery, use progressive relaxation, or deep breathing. Avoid stimulation, competitive games, exciting movies, or heated discussions just before bed.

Factors contributing to insomnia

Medications or supplements. Review any medications or supplements you take with your health care provider or pharmacist. Some might be better taken earlier in the day, though stopping prescriptions without consulting with the prescriber may have serious consequences.

Major surgery.

The birth of a child. Insomnia is common after giving birth, as new parents adjust to an infant’s sleep and feeding patterns.

Hypothyroidism

Hormonal changes occurring with menstruation.

Alcohol, stimulants and marijuana. Alcohol is a central nervous system depressant and interrupts sleep cycles. So do stimulants like caffeine or nicotine. Insomnia often occurs in those who are new in recovery from addiction or alcoholism, even up to a year. Marijuana is linked to an increased likelihood of sleeping problems, according to a study at the University of Pennsylvania in Philadelphia and presented at the SLEEP 2014 meeting. Instead, try a strong cup of chamomile or other soothing tea before bed with two or three tea bags.