The chronic inability to quickly fall asleep and/or maintain sleep can be relentlessly debilitating, literally affecting one's ability to function normally. Sleep medications must be regarded as temporary aids as they merely minimize the problem and cannot cure it, often making the problem worse in the long run (side effects can include drug dependence, withdrawal symptoms, morning-after warnings, rebound insomnia and drug interactions, among others). A long-term cure for insomnia involves an understanding of the behavioral dynamics that create the problem and a program to correct them.

How does a person "fall asleep?" Most of us are unaware of the four stages we pass through from 'awake' to 'asleep.' Typically when we go to bed our minds are still thinking, churning a mix of the day's events, tomorrow's agenda and countless ideas, feelings, fears, occurrences and encounters. After a few minutes under the blankets normally our thoughts "slow down" and we begin to daydream, unconsciously drifting to imagery associated with relaxation, such as being on vacation, lying in a hammock with a good book or any mental picture you correlate with unwinding.

As both mind and body relax, muscles release tensions and we enter a light stage of hypnosis known as hypnoidal. We are dimly conscious but time is distorted and a mist of amnesia erases our thoughts, an essential process to attaining sleep. It is the formless and fuzzy hypnoidal stage that blots the moment of transition to unconscious sleep. We simply "drift" off. In this stage we are not consciously aware of anything going on around us; we are "sound asleep."

Knowing the four stages of the transition from awake to asleep enables us to treat insomnia with a simple strategy: eliminate the thinking stage and start the bedtime routine with imaginary visualizations associated with relaxation. It's helpful to conjure up actual, past personal experiences that you already associate with being relaxed (My husband imagines himself under a beach umbrella at a favorite resort of ours... and swears it puts him to sleep before I turn out the reading light). By beginning in the daydream stage your mind is quieted and allows you to be drawn into the hypnoidal stage and to unconscious sleep.

The process - in essence self-hypnosis - can be taught. I've had many clients learn the technique in a few sessions at my office with positive results. Using conscious connected breathing and guided imagery they become skilled at shifting from waking consciousness to a deeply relaxed, dreamlike state. While in this dream, or trance state, the mind is passive and susceptible to the transition into deep, or delta, sleep.

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