I’m a take-charge person when it comes to managing chronic health problems, especially when solutions proposed by doctors are unsatisfactory. I hunt for solutions myself, reading a lot and sometimes coming up with a fix.
People come to my blog looking for solutions to their sleep problems. Some read about sleep restriction, a drug-free insomnia treatment, and decide to try it on their own. It’s not rocket science: insomnia sufferers who follow the guidelines often improve their sleep. It’s empowering to succeed.
But self-treatment is not the right approach for everyone. Sometimes insomnia is complicated by another disorder, or what looks like insomnia is actually something else. In both cases, the best thing to do is to have yourself evaluated by a sleep specialist ASAP.
Up Late at Night
Chris wrote in with questions about sleep restriction several months ago:
I recently started sleep restriction therapy about 3 days ago, and I’m not too tired during the day even though I barely slept the last two nights. Is this normal? I set my bed time at 3:30 a.m. and force myself to get up at 9:30 a.m. even if I haven’t slept too well. Should I restrict my time even more if I’m not too tired? Additionally, I find that I have anxiety when I am in bed sometimes. Do you think I should get out of bed if I am anxious?
Chris knows he experiences insomnia, but the symptoms he reports aren’t the classic symptoms of people with insomnia disorder.
- He’s “not too tired during the day” even though he “barely slept the last two nights”; many insomniacs during the first week of sleep restriction report feeling tired and out of sorts.
- He’s set his sleep window at 3:30 to 9:30; a more normal sleep window would be from 12 to 6. Maybe Chris works the evening shift and can’t get to bed until 3:30. But if this is his sleep window of choice, then maybe he has a circadian rhythm disorder—in which case sleep restriction would not be an appropriate treatment.
- He’s anxious when he’s awake in bed; many insomniacs are, too. But Chris’s anxiety could also be an indication of something else.
Chris’s situation sounds complicated and as though in starting sleep restriction he may be on the wrong track. My response to Chris and others like him is to suggest seeing a sleep specialist for an accurate diagnosis and guidance in managing the problem.
Sleepy in the Afternoon
Shelley contacted me via Ask The Savvy Insomniac. “Could sleep restriction help me?” was the subject line of her email.
I’ve had insomnia for 5 years now. Getting to sleep is no problem. But I wake up several times at night. It’s a drag. The alarm rings in the morning and it never feels like the night was long enough. I manage OK in the morning but after lunch I’m like the walking dead. Coffee doesn’t help. I fall asleep during meetings all the time and people notice. It’s embarrassing.
Nighttime wake-ups are a common symptom of chronic insomnia. But Shelley’s inability to stay awake during afternoon meetings gives pause.
It might seem logical that a person with insomnia would feel sleepy during the daytime, and some insomniacs report that they do. Other words that describe the feeling are tired, fatigued, and exhausted.
But the actual inclination to nod off involuntarily during the daytime is not as common in people with insomnia as it is in people with other sleep problems: sleep apnea, for example, and narcolepsy. It might sound counterintuitive, but a majority of insomniacs given opportunities to sleep during the day are no more likely to do so, say sleep experts, than people who sleep well at night. In fact, some studies show it takes insomniacs longer than normal sleepers to fall asleep during the daytime.
If Shelley has sleep apnea or narcolepsy, sleep restriction will do more harm than good. She needs to consult a sleep specialist and get a diagnosis before starting any type of treatment.
What looks like insomnia may not actually be insomnia disorder. Before you plunge into sleep restriction or any other insomnia treatment, see a doctor for a diagnosis or do lots of reading to make sure that what you’ve got is insomnia and not something else.