Insomnia

Sleepless and Frustrated

This is really getting to be the pits. Here I am once again in the middle of the night — 3:35 A.M. — lying in bed wide awake. The house is dark and lonely. Everyone else is sound asleep. And I’d give just about anything if I could only join them. Getting up to go to the bathroom, I feel almost like a ghost — some lost, unsettled spirit moving about the house, haunting the forlorn night.

What now? Should I get up and go into the other room for a while and read? Or will this only wake me up even more? Maybe if I get back in bed and lie perfectly still, the feeling will just kind of come over me and I’ll finally drift off. Let’s give it a try…

Well, this is going nowhere fast. What is so freaking hard about falling asleep, anyway? I’ve seen it done before. I’ve done it myself thousands of times. There’s nothing to it. All you have to do is close your eyes and go to sleep. And yet…I’m still awake. What’s wrong with me? Sleep is such a wonderful, blissful thing — and I’m in such desperate need of it. I feel like I’ve been locked outside the gates of Paradise.

The cruel irony is that tomorrow at work, when I really do need to be awake, I’ll want nothing more than to sleep and I’ll have to fight to keep my eyes open. I’ll feel absolutely wiped out. And I’ve sure got a lot on my plate tomorrow. It’ll take every ounce of energy I’ve got just to keep alert and look fresh and enthusiastic.

Of course, worrying about all this now is not making it any easier to fall asleep. I’ve got to relax and quiet my mind. The thing to do is to totally clear my head; force myself not to think about anything. Okay, here it goes…Not thinking about anything…Not thinking about anything…Hey, that was pretty good! If I can keep this up for a while…Oh crap, now I’m thinking about not thinking about anything!

How did I ever come to this point? And what in the world can I do to get out of it? What is preventing me from getting a good night’s sleep?

Tantalized by Sleep

And so it goes. There’s nothing more frustrating when you want and need so badly to fall asleep — and stay asleep — and yet all you end up doing is lying there in bed, tossing and turning while the clock mercilessly ticks away the hours of the night. The more you try to reach for sleep, the more it seems to recede away from you. Is there a way out of this?

When it comes to dealing with issues like this, the first rule is: know your adversary. The problem of insomnia has always been somewhat misunderstood. It comes in so many different shapes and sizes; and there are so many potential causes to track down for each individual case. And it’s not always easy to communicate to doctors or to those around us exactly what we are experiencing. So, let’s see if we can’t shine a little light on this problem. Education is the first step to a solution.

Insomnia 101

Insomnia simply refers to an inability to get good sleep over a prolonged period of time. This includes trouble falling asleep, trouble staying asleep, waking up too early, or just getting bad sleep — shallow, fitful sleep that leaves you feeling unrestored. An important key to this definition is the presence of certain daytime symptoms: excessive tiredness, lack of energy, poor motivation, irritability, trouble concentrating, or even symptoms like headaches or stomach aches.

There are more than a few people out there who are in this situation. About 1 out of 3 adults report having occasional bouts with insomnia. It tends to affect women more than men (40% versus 30%) and is more prevalent among the elderly. It’s said that younger insomnia sufferers are more liable to have trouble falling asleep (sleep-onset insomnia), while in older sufferers, the problem tends to be one of staying asleep (sleep-maintenance insomnia).

We all have trouble getting a good night’s sleep every now and then; and an occasional night or two of tossing and turning is certainly no big deal. But if the situation persists much beyond this point, you may have a problem.

Doctors make a distinction between transient insomnia — not lasting more than a week — and chronic insomnia. Insomnia is considered chronic if the trouble lasts for more than a month. This affects a little under 10% of the adult population. When insomnia persists, it often strikes in a sort of intermittent pattern: a few nights of bad sleep, followed by a period of good sleep, followed by another string of bad nights, and so on.

Root Causes

Insomnia can be brought on by any number of things, but among the usual suspects, three go right to the top of the list. The first and probably most frequent cause of insomnia is anxiety — stress and worry brought on by such things as personal relationships, family issues, financial problems, job security, etc.

Another frequent culprit is when you body’s internal circadian rhythm and your daily schedule become out of sync with each other, often due to jet lag or shift-work — you keep telling yourself that it’s time to go to sleep, but your body disagrees. Next on the list is an unfavorable sleep environment: this could be anything from irritating noise disturbances to an uncomfortable room temperature to a worn out mattress.

Other potential causes include pain from an injury or medical condition, breathing difficulties, and a few other nagging disorders infamous for posing challenges to sleep: among them, restless leg syndrome (RLS), periodic limb movement disorder (PLMD), fibromyalgia, and gastroesophageal reflux (GER). Insomnia also happens to be a frequent side-effect of many medications.

For more on this, see: What’s Causing Your Insomnia?

It’s not too shocking to learn that psychology sometimes plays a role in insomnia. Many people experience something called psychophysiological insomnia (sometimes conditioned or learned insomnia). In the typical case, the sufferer has picked up certain negative associations with going to bed. Sometimes the pressure to get the right amount of sleep weighs so heavily that a sort of mental block develops. Call it performance anxiety. The ritual of getting ready for bed actually creates feelings of trepidation: Will I be able to fall asleep or will I toss and turn all night? This anxiety can build to the point where sleep becomes all but impossible. You don’t really like to think that your mind could be working against you like this. But hey, welcome to humanity.

The term “psychophysiological” could almost put you to sleep just by reading it. But notice how it carries the idea that our psychological state is interrelated to our physiological state. The mind affects the body and the body affects the mind. In fact, doctors aren’t always sure when diagnosing insomnia which is the symptom and which is the cause. Is insomnia caused by anxiety or is anxiety the result of insomnia? Does chronic pain cause sleepless nights or does sleep deprivation intensify the experience of pain? This is still a big question in sleep science.

Scientists know a lot more than they did even just a few years ago about how the brain uses neurochemicals to regulate the sleep-wake cycle. And it’s thought that at least some cases of insomnia may be linked to a breakdown of this mechanism. Research has traditionally centered on an inhibitory neurotransmitter called GABA (gamma-aminobutyric acid) which acts on the brain as a sort of braking mechanism. A deficiency of this could make it hard for the brain to slow down enough to make sleep possible.

The latest and most exciting research has focused on a neuromodulator, discovered in 1998, called orexin (aka hypocretin). Orexin seems to be instrumental in promoting wakefulness. And there’s good evidence that some cases of insomnia may involve an excess of this chemical messenger, telling the brain that it needs to be on and alert when it should be sleeping. The newest sleep aids work by blocking the orexin receptors in the brain so sleep can finally take over and do its thing.

Troubleshooting

Once you understand what type of insomnia you’re dealing with, the problem becomes much easier to address. So start out by asking yourself a few questions: How long have you been having trouble sleeping? Is this an isolated incident — a one or two night thing — or is it starting to become a pattern? Can you pinpoint exactly when it started? Do you have a history of insomnia?

Are you completely baffled about why you can’t sleep or is the cause more or less apparent? Can you tie your sleeplessness to something that’s going on in your life right now — a rough patch in your personal life, an unexpected crisis, or is it related in some way to a health issue? If the insomnia is intermittent, can you identify anything that might act as a trigger?

What form does your insomnia take? Do you struggle to drop off at night when you go to bed? Or is it more a matter of waking up in the middle of the night — or too early in the morning — unable to fall back asleep? When you do sleep, is it deep and restful or do you wake up feeling unrefreshed?

How seriously should you take a problem like insomnia? First, consider how many hours of sleep you think you might be losing. A whole night of tossing and turning can really suck the life out of you for the next day. But the effects of losing an hour or two of sleep a night, over a prolonged period of time, has an insidious way of creeping up on you. Pay close attention to the way your sleeplessness impacts you in the daytime. Do you feel excessively tired and groggy, unmotivated, irritable or depressed? Do you have trouble staying awake in certain situations?

A good rule for dealing with a problem of any kind is: never worry, but always be appropriately concerned. When you’re lying in bed in the dead of night, wide-awake, the last thing you want to do is obsess about not sleeping. People get themselves so frustrated and tied in knots over the idea of insomnia that they wouldn’t have a snowball’s chance of getting to sleep. At that moment you want to just let it go; calm down, relax, and know that you will get through this. Any concern you have about the situation should be compartmentalized into the sober light of day when you can rationally evaluate your situation and look for constructive solutions.

Finding Your Way Back to Sleep

If you’re serious about getting back your fair share of sleep, experts say the best place to start is by improving your “sleep hygiene.” That’s to say, making a point of doing things in your daily life (especially toward evening time) that are good for sleep and avoiding the things that aren’t. Of course, you can’t control every single thing that might affect your sleep. So focus on the things you can control.

A cardinal rule of good sleep hygiene is to stick to as regular a schedule as possible — go to bed and wake up at the same times each day. The idea is to train your body to be in perfect tune with the ebb and flow of night and day. So you’ll always be tired and sleepy at bedtime and ready to charge out of the gate in the morning. Another important component is your sleep environment. Make sure your bedroom and the bed you sleep on are as comfortable and sleep conducive as possible.

Also, watch what you eat and drink. A light snack before bed can be a good thing for sleep but avoid eating anything too rich or heavy if it bothers you. Try to eat dinner as early in the evening as you can, and, for heaven’s sake, don’t O.D. on caffeine. Most important is to just use common sense. You know the old wisdom: different things affect different people differently. So keep a lookout for the things that affect your sleep, both good and bad.

It may be that the most important element to sleep hygiene is your own state of mind as you go to bed. When you hit the sack, you want to make it a nice soft landing. So try not to spend the last few minutes hustling around doing last-minute chores. Avoid anything that might be stressful or anxiety-inducing. Instead, do something to help yourself unwind. Practice relaxation techniques. Do some deep breathing exercises. Just make sure you leave your worries and cares at the bedroom door.

Sleep Aids

What about prescription sleep aids or over-the-counter remedies? Some people get a little nervous when you start talking about sleeping pills. They’ve heard old stories about side-effects, addiction, and overdose. But much of this perception is badly out of date. Like all drugs, today’s prescription sleep aids aren’t perfect, but they’re light years ahead of the barbiturates and mallet-over-the-head tranquilizers of the bad-old-days. Under a doctor’s careful supervision, modern sleeping pills are safe and effective, and can be considered an appropriate response in many cases.

Over-the-counter medications are less effective than prescription pills, but they are safe and can be useful in a pinch. Taking them might be the right call when you really can’t afford to miss sleep. Many people find good results with herbal supplements like chamomile and valerian root. Sleep specialists are somewhat hesitant to endorse natural supplements because there haven’t yet been a lot of scientific studies to prove their efficacy — valerian being perhaps a notable exception. But you may find it worthwhile to engage in some careful and informed experimentation here. There is much evidence that melatonin supplements can have a positive effect on sleep, but keep in mind that they may not be appropriate for all types of insomnia.

Sleep aids are still considered temporary measures instead of long-term cures. Doctors say a better approach to persistent insomnia is through cognitive behavior therapy. This involves helping the patient make certain changes in behavior and attitudes about sleep, encouraging better sleep practices, improvements in sleep hygiene and so forth.

We’ll leave you with one last point: Don’t be shy about bringing up a sleep problem of any kind with your doctor — even if you have to make a special appointment to discuss it. People often don’t think to mention difficulties like this because they don’t consider bad sleep to be a real health issue. But it most certainly is! The quality of your sleep is absolutely crucial to your health and well-being. And if you’re teetering on the edge of drowsiness all day long because you can’t sleep at night, you could be an accident waiting to happen.

We hope that you’ll realize there really is a way out of this problem. We’re not suggesting any magic bullets or miracle cures that promise to make your problems vanish overnight. But there are plenty of proven ways to beat this thing and get your sleep back.

Insomnia is not something you should have to live with.