How did you sleep last night? For the 19 percent of people in the United States who suffer from chronic insomnia, the answer is "not so good." Insomnia is especially common in women. In part, this is because they experience it due to hormonal shifts during late pregnancy and menopause. But that's not all.

"Women also have more medical conditions that cause insomnia, like depression, fibromyalgia, anxiety and restless leg syndrome," says Deborah Yaeger, M.D., a psychiatrist at the OHSU Center for Women's Health. All of these things can lead to chronic insomnia.

So how do you know if you have chronic insomnia? Here are some guidelines:

• You're getting less than about seven or eight hours of sleep each night 
• You have difficulty
  • Falling asleep, 
  • Staying asleep, or 
  • Waking up too early in the morning 
• You have struggled with sleep at least three nights per week for at least three months 
• Your insomnia is hurting your ability to function during the day 

The good news is that there's hope. Dr. Yaeger works with clinical psychologist Teni Davoudian, Ph.D. to lead cognitive behavioral therapy for insomnia groups several times each year. Dr. Davoudian built the program here at the OHSU Center for Women's Health, based on work done at Stanford University and the U.S. Department of Veterans Affairs. 

"It's incredibly effective therapy," says Dr. Yaeger. "But you have to be willing to make behavioral changes." 

First, you establish a routine you can stick to. Patients maintain a sleep diary and set a wake up time that they stick to seven days a week. "We all play games with ourselves on the weekend," says Dr. Yaeger. "The problem is that you make your body feel like it has jetlag." 

During the group meetings, Dr. Yaeger and Dr. Davoudian analyze patients' sleep diaries and suggest behavioral changes that could help improve their sleep.  

For example, if you wake up in the middle of the night and can't fall back asleep, you need to get out of bed. "When you lie awake at night, your bed gets associated with worry and anxiety instead of with sleep," says Dr. Yaeger. "Get up and return when you feel sleepy again." 

Insomnia can be complicated, but the success of the cognitive behavioral therapy group speaks for itself. In the most recent session, all six women who completed the program made major strides, ultimately resulting in more and better sleep. 

The next session starts in February and you can call 503-418-4500 to sign up. In the meantime, here are some sleep tips from Dr. Yaeger: 

• Wake up every day at the same time 
• Exercise, but make sure it's well before you plan to go to bed 
• Don't clock watch. Staring at the clock at night causes anxiety, making insomnia even worse. 
• When your alarm goes off, get up and stay up. 
• Relax for an hour before bedtime. Turn off your devices and do things that put you in the frame of mind for sleep. 
• Check out phone features and apps that can help you create good sleep routines.

Above all, while it's easier said than done, don't try to sleep. "Sleep is a natural event," says Dr. Yaeger. "Just allow it to come."