A reader asks:

I have been suffering from chronic insomnia for several years. I have seen every doctor and tried every medication (both prescription and herb) imaginable and even spent the night in a sleep clinic, where they found no physical reasons for my sleep problem. My problem is that I can fall asleep just fine but then I awaken 2-3 hours later and never really fall back to sleep. I notice that when I do awaken after 2 hours, I am very hot and it takes me several hours to cool down. Once I do cool down, I am in and out of sleep (if I am lucky) for the rest of the night — changing blankets, going to the bathroom, etc. Do you have any thoughts about light therapy or any other suggestions?


This is a very specific question, but it raises general issues that will interest everyone. Your sleep quality and duration might improve if you adopted a later bedtime and built up more pressure to sleep. If you cannot stay awake for a later bedtime, late-evening bright light therapy might help. (Note that this is opposite to the time of day used for antidepressant treatment.) As for sleep meds, sometimes they begin to work only after you have restricted your sleep interval with later bedtime. Your problem may have been behaviorally conditioned over the years, now sustained primarily by the expectation for, and fear of early awakening. Try removing the clock as a stimulus: set the alarm and turn the clock away so that you can’t check it to verify that you are waking up after two hours. As for your heat sensations, sometimes this is the result, rather than the cause of early waking. If you are certain that you are warming up before you wake up, possibly try an aspirin at bedtime, which could serve to lower body temperature.