Sleep is an innate ability that usually doesn’t take much effort at all. I mean, how simple can it be to sleep? You just close your eyes, relax and get taken away to dreamland. But for many, many people, sleeping isn’t as easy as that. According to the U.S. Department of Health and Human Services, approximately 60 million people suffer from insomnia. The inability to sleep affects approximately 40 percent of women and 30 percent of men.
Sleep is meant to revive us and get us ready to live for another day. When people are denied sleep, the effects can be devastating. Famous author, F. Scott Fitzgerald once wrote, “The worst thing in the world is to try to sleep and not to.”
Insomnia is the sensation of daytime fatigue and impaired performance caused by insufficient sleep. In general, people with insomnia experience an inability to sleep despite being tired, a light, fitful sleep that leaves them fatigued upon awakening, or waking up too early.
Under debate is the question of whether insomnia is always a symptom of some other physical or psychological condition or whether in some cases it is a primary disorder of its own.
Common symptoms of insomnia include:
– feeling tired during the day
– having frequent headaches
– lack of concentration
– you wake up feeling tired and not refreshed
– sleeping better away from home
– taking longer than 30 or 40 minutes to fall asleep
– waking repeatedly during the night
– waking far too early and being unable to fall back asleep
– being able to sleep only with the aid of sleeping pills or alcohol
Insomniacs often complain of being unable to close their eyes or rest their minds for any period of time. In a stress-filled world, people are often plagued with unfinished to-do lists in their heads. When it’s quiet and time for sleep, many people have problems pushing those to-do lists aside in favor of dreamland.
The worst part of insomnia is wanting to sleep but being unable to. The mind races and is unable to rest and that makes you overly tired and barely able to function the next day. Sometimes insomnia lasts longer than just a few nights.
Insomnia, usually temporary, is often categorized by how long it lasts:
Transient insomnia lasts for a few days.
Short-term insomnia lasts for no more than three weeks.
Chronic insomnia occurs when the following characteristics are
– When a person has difficulty falling asleep, maintaining sleep, or has non-restorative sleep for at least three nights a week for one month or longer.
– In addition, the patient is distressed and believes that normal daily functioning is impaired because of sleep loss.
Chronic insomnia may also be primary or secondary, depending on the cause:
– Primary chronic insomnia occurs when it is the sole complaint of a patient.
– Secondary chronic insomnia is caused by medical or psychiatric conditions, drugs, or emotional or psychiatric disorders.
Some common types of secondary insomnia include:
– Sleep apnea is a sleep disorder caused by difficulty breathing during sleep. Persistent, loud snoring and frequent long pauses in breathing during sleep, followed by choking or gasping for breath are the main sighs of sleep apnea. For more information,visit www.sleepapnea.org.
– Restless Legs Syndrome is a sleep disorder characterized by unpleasant sensations (creeping, burning, itching, pulling or tugging) in the legs or feet, occurring mostly in the evening and at night. Moving the legs around tends to relieve the unpleasant sensation temporarily. For more information, visit www.rls.org.
– Sleep-wake schedule or circadian rhythm disorders are sleep disorders caused by having sleep-wake schedules that do not match up with your natural sleep schedule. People who work the night shift may suffer from this problem
– Insomnia due to medical conditions: Many common medical problems and the drugs that treat them can cause insomnia, including allergies, arthritis, heart disease, hypertension, asthma, Parkinson’s disease, attention deficit hyperactivity disorder, or hyperthyroidism. Physical discomfort (e.g. chronic pain) may also cause problems sleeping.
– Insomnia due to substance use or withdrawal: Many drugs and medications can cause sleep disturbances, either while taking them or while withdrawing from them. Alcohol,
stimulants, sedatives, and even long-term use of sleep medications can cause insomnia.
– Insomnia due to an emotional problem: Insomnia can be a symptom of a number of emotional difficulties. If you find that you worry excessively about numerous minor matters or if you have experienced sadness or a loss of interest in activities for a number of weeks consult your physician.
Sleep consists of two distinct states that alternate in cycles and reflects differing levels of brain nerve cell activity. During a normal night’s sleep, one progresses through these stages about five or six times:
Non-Rapid Eye Movement Sleep (Non-REM) sleep is also termed quiet sleep. Non-REM is further subdivided into three stages of progression:
– Stage 1 (light sleep).
– Stage 2 (so-called true sleep).
– Stage 3 to 4 (deep “slow-wave” or delta sleep).
With each descending stage, awakening becomes more difficult.
While there is no one cut and dried reason why some people can’t sleep, most experts agree that insomnia is brought on by stress,anxiety, medications, and/or caffeine – among other things. Transient
and short-term insomnia has many causes.
A reaction to change or stress is one of the most common causes of short-term and transient insomnia. This condition is sometimes referred to as adjustment sleep disorder.
The precipitating factor could be a major or traumatic event such as the following:
– An acute illness.
– Injury or surgery.
– The loss of a loved one.
– Job loss.
Temporary insomnia could also develop after a relatively minor event, including the following:
– Extremes in weather.
– An exam at school.
– Trouble at work.
In such cases, normal sleep almost always returns when the condition resolves, the individual recovers from the event, or the person becomes acclimated to the new situation. Treatment is needed
if sleepiness interferes with functioning or if it continues for more than a few weeks.
Fluctuations in female hormones play a major role in insomnia in women over their lifetimes. Such insomnia is most often temporary. The hormone progesterone promotes sleep. Levels of this
hormone plunge during menstruation, causing insomnia. When they rise during ovulation, women may become sleepier than usual.
During Pregnancy, the effects of changes in progesterone levels in the first and last trimester can disrupt normal sleep patterns.
Insomnia can be a major problem in the first phases of menopause, when hormones are fluctuating intensely. Insomnia during this period may be due to different factors that occur.
In some women, hot flashes, sweating, and a sense of anxiety can awaken women suddenly and frequently at night during the first months of menopause. In such women, hormone replacement therapy
may be beneficial.
Insomnia may also be perpetuated by psychological distress provoked by this life passage. In most cases, insomnia is temporary. Cases of chronic insomnia in women after 50 are more likely to be due
to other causes.
In one study, 20% of adults reported that light, noise, and uncomfortable temperatures caused their sleeplessness. Depending on the time of day too much or too little light can disrupt sleep. It is well
known that a person’s biologic circadian clock is triggered by sunlight and very bright artificial light to maintain wakefulness.
Insomnia is virtually never lethal except in rare cases, such the genetic disorder called fatal familial insomnia. This rare degenerative brain disease develops in late adulthood. It is progressive and the
individual develops intractable insomnia, which eventually becomes fatal.
As many as 200,000 automobile accidents in the US and 1,500 deaths from such accidents are caused by sleepiness. Studies continue to report that drowsy driving is as risky as drunk driving. Estimates on
fatigue as a cause of automobile crashes range from 1% to 56%, depending on the study.
Surveys in 2001 and 2002 reported that people with severe insomnia had a quality of life that was almost as poor as in people with chronic conditions such as heart failure. In these studies, people with
known depression or anxiety were not included.
In addition to more daytime sleepiness, people with insomnia complained of more attention and memory problems compared to good sleepers. Insomniacs also experience more irritability, mistakes at work, and poorer relationships with their family than people who sleep well.
Insomnia can have an effect on your waking behaviors such as job performance and thinking. In fact, sleep disorders will probably worsen some behaviors in the following way:
– Reduced concentration. Some experts report that deep sleep deprivation impairs the brain’s ability to process information.
– Impaired task performance. One study reported that missing only two to three hours of sleep every night for a week significantly impaired performance and mood.
– Effect on learning. Whether insomnia significantly impairs learning is unclear. Some studies have reported problems in memorization, although others have found no differences in test
scores between people with temporary sleep loss and those with full sleep.
The lack of sleep may also increase the activity of the hormones and pathways in the brain that can produce emotional problems.
Even modest alterations in waking and sleeping patterns can have significant effects on a person’s mood. Persistent insomnia may even predict the future development of emotional disorders in some
cases. Some investigators, in fact, are exploring the possibility of preventing psychiatric disorders by early recognition and treatment of insomnia.
In fact, the inability to sleep can be a major cause of depression.
Signs to look out for that link insomnia with depression include:
– waking in the middle of the night or early morning and being unable to get back to sleep
– loss of interest, energy, and appetite
– aggression and anti-social behavior
– aches and pains that have no physical explanation
Although alcohol and substance abuse can cause insomnia, the conditions may be reversed. For example, one survey reported that 14% of American adults use alcohol within a month to help them
sleep, with 2.5% reporting frequent use of alcohol to reduce sleep.
Sleep hygiene refers to sleep habits and conditions which promote sleep as opposed to habits such as drinking alcohol or caffeine in the evening, which make it hard for you to unwind and get
Sleep hygiene should be your first line of attack against insomnia, and it is often used in conjunction with stimulus control. Review your habits and make some changes in your routine to see if behavioral and
environmental changes improve your sleep.
Here are some tips for effective sleep hygiene habits:
– Establish a regular time for going to bed and getting up in the morning and stick to it even on weekends and during vacations.
– Use the bed for sleep and sexual relations only, not for reading, watching television, or working; excessive time in bed seems to fragment sleep.
– Avoid naps, especially in the evening.
– Exercise before dinner. A low point in energy occurs a few hours after exercise; sleep will then come more easily. Exercising close to bedtime, however, may increase alertness.
– Take a hot bath about an hour and a half to two hours before bedtime. This alters the body’s core temperature rhythm and helps people fall asleep more easily and more continuously. (Taking a bath shortly before bed increases alertness.)
– Do something relaxing in the half-hour before bedtime. Reading, meditation, and a leisurely walk are all appropriate activities.
– Keep the bedroom relatively cool and well ventilated.
– Do not look at the clock. Obsessing over time will just make it more difficult to sleep.
– Eat light meals and schedule dinner four to five hours before bedtime. A light snack before bedtime can help sleep, but a large meal may have the opposite effect.
– Spend a half hour in the sun each day. The best time is early in the day. (Take precautions against overexposure to sunlight by wearing protective clothing and sunscreen.)
– Avoid fluids just before bedtime so that sleep is not disturbed by the need to urinate.
– Avoid caffeine or other stimulants in the hours before sleep. A general recommendation is not to consume anything that might hinder your sleep 4-6 hours before your anticipated bedtime.
– Don’t drink alcohol before going to bed.
– If one is still awake after 15 or 20 minutes go into another room, read or do a quiet activity using dim lighting until feeling very sleepy. (Don’t watch television or use bright lights.)
– Give yourself a quiet time right before bed. One or two hours before you retire, take a few moments to spend quietly relaxing and meditating.
– Your bedroom should be exclusively for sleeping. Well, maybe one other activity, but avoid eating, reading, smoking, drinking or watching television in bed. The bedroom should be a peaceful place and when it is,
– If distracted by a sleeping bed partner, moving to the couch or a spare bed for a couple of nights might be helpful.
– If you can’t sleep — don’t stay in bed. Get out of bed, move to another room, and return to your bed when you are tired.
Sleep hygiene is just one of the behavioral techniques you can use to help with your insomnia.
STRESS MANAGEMENT AND RELAXATION
Learning to be physically and mentally relaxed before going to bed will help you fall asleep more quickly. Additionally, many relaxation techniques can be put to use when you wake up in the
middle of the night and need to get back to sleep.
Quieting your mind and body is not something that can be done immediately, so you should try to start winding down at least an hour before bed. Some people find that reading a book, taking a bath,
playing solitaire or working a crossword puzzle are good ways to slow down from activity of the day.
You may want to try one or more of the following activities:
– Progressive Muscle Relaxation (PMR) – PMR is a set of exercises you can use to reduce anxiety and stress at bedtime. PMR is a two-step process where you first tense certain muscle groups and then relax them. As you go through the process, you should be focused on actively tensing and then relaxing, helping to relax your mind as well as your body.
The procedure takes some time to learn, but after learning it, you can practice a shorter version of the exercises. When practicing PMR to help with sleep, you should plan to fall asleep before finishing all of the exercises.
– Diaphragmatic breathing – Learning to breathe slowly and deeply from your belly or diaphragm is a good way to slow down. To practice belly breathing, put a hand on your stomach and take slow breaths, letting your stomach expand as you breathe in. As you breathe out, relax your chest and shoulders. Concentrate on your breathing as you do it to encourage your mind away from stressful or anxious thoughts.
– Visual imagery relaxation – Practicing visual imagery means choosing peaceful, soothing thoughts to focus on which calm you and allow you to stop thinking of your to do list. Everyone’s peaceful situation is different, and you can choose to think about things that personally soothe you – a walk in the mountains, canoeing on a lake, swimming, petting your dog, etc. As long as the image doesn’t excite your mind, it should work.
You might also choose to focus on something that is very repetitious as a way of relaxing. For example, if you are a skier, you might imagine going to the slopes, zipping up your jacket, putting on your gloves and hat, tightening your boots, riding the chairlift and then the smooth and rhythmic motion of sinking your poles in and turning side to side as you ski down the mountain. Slowly going over every detail of a repetitious activity can be soothing and relaxing.
– Stress management – If you learn to deal with stress more effectively through meditation or self-guided imagery, you should be able to fall asleep more easily. Try the following suggestions to help reduce your stress:
– Change or resolve the things causing you stress when possible.
– Accept situations you can’t change.
– Keep your mind and body as relaxed as much as possible throughout the day.
– Give yourself enough time to do the things you need to do -including eating.
– Don’t take on too much and avoid unrealistic demands.
– Live in the present, rather than worrying about the past or fearing the future.
– Talk to your partner if there are problems in your relationship.
– Have some relaxing, non-competitive activities – something you do just for pleasure, for fun.
– Give yourself some ‘quiet time’ each day.
– Practice a relaxation technique or breathing exercises regularly.
– Anger management – Anger, anxiety and frustration can stand directly in the way of getting a good night’s sleep. You may feel angry or anxious when you go to bed or you may become angry and frustrated when you can’t go to sleep.
Regardless of the source of the anger, recognize that it keeps your mind occupied and your body tense, two conditions which don’t encourage sleep. A few things that might help you deal with your anger or anxiety:
– Exercise daily – it will help you release excess anger and frustration.
– Think about the cause of your anger. If there isn’t anything you can do to resolve it, move on. If you can resolve it, make steps to do so.
– Develop a method of releasing the anger by the end of the day, before you try to relax or go to sleep. For example, you might choose to write it down in your journal or talk to a spouse or friend about it. After you have processed the anger and let it out, try to move on
– Word and imagination games – For some, playing mental games at bedtime may not be helpful at all. But others find that engaging their mind in something unimportant can be a good way to unwind and shift attention away from actively trying to fall asleep. Try playing some mental games:
– Spell long words and sentences backwards.
– Think of a poem or song and then count how many a’s or b’s there are in it.
– Work your way through the alphabet thinking of a four-letter word beginning with each letter
– Repeat long pieces of poetry or prose.
– Recall in great detail a favorite painting, a piece of music or place.
Self-help strategies are usually effective and aren’t addictive. Using these alternatives to over-the-counter or prescription medication are less expensive than pharmacological treatment, have fewer side effects, and can provide longer lasting relief particularly when behavioral treatments are used as well.
Consider, too, altering your sleep environment. Put a board under your mattress if it sags or try putting your bed in a different position. Make sure your bedding is clean and that you are warm enough but not too hot.
If light troubles you, use thicker curtains or put a scarf or sleep mask over your eyes. If you feel more comfortable with a little light, leave the curtains open a little or use a night light.
A common cause of sleeplessness is noise. Use earplugs if it’s noise you can’t do anything about. Change your attitude toward the noise, too. People can sleep through high levels of noise. It’s not so much the level of the noise as it is how you feel about it that keeps you awake.
Use relaxation exercises to calm yourself and take your mind off of it. Take some diplomatic action to combat the noise that’s disrupting your sleep. If your family is being noisy while you’re trying to sleep, talk to them calmly about your need to sleep and ask them to please curtail the noise during bedtime hours.
Keep a radio or tape player by your bed and use it to mask other noise. Try playing a relaxation tape or CD such as nature noises that can put you in a calmer mood and make you better able to cope with distractions.
Research suggests that people who suffer from insomnia tend to be less confident and have lower self esteem than others. Therefore anything that you can do to increase your confidence or improve your self esteem is likely to help you sleep better. Once again there are very many self-help books available, or you may prefer to consult a counselor.