Clocking the Hours at Night

Does the sight of a clock at night make you anxious?

Here’s my solution to that.

Clock watching at night fuels anxiety and insomniaA student once described to me the lengths he had to go to in order to get to work on time. He was in my night class, and he was always struggling to stay awake.

“I get up at 4 every morning,” he explained. Or, he added, he was supposed to get up at 4. But often he overslept the alarm. So he’d devised a system where he set four alarm clocks – one at the head, one at the foot, and one on each side of the bed, all facing toward him – to go off at the exact same time. That’s what it took to wake him up. This was one sleep-deprived man!

A quadrumvirate of alarm clocks standing sentry at my bed is my personal vision of hell. Never mind that the piercing clamor in the morning would blast me through the roof. What the mere presence of those clocks would do to my nights is even worse. Knowing that their luminous faces were trained on me like four sets of malevolent eyes, waiting for a flicker of my eyelids to broadcast the passing of time, would seal the deal: I’d never get to sleep at all.

Clock-watching and sleep don’t mix, I’ve discovered through the years. It’s not that otherwise I’m unaware that time is passing. It’s that coming fact to face with a clock at night triggers tension, a reflexive response I haven’t been able to shake despite the many ways I’ve succeeded in improving my sleep in recent years.

I’m not the only insomniac who feels this way. “When you have to work the next day, I think its hard not to watch the clock,” Liz said in an interview on the phone. “You try not to. But when the hours are rolling by, you start to count the hours you’ve got left. It gets to be 3 or 4 in the morning, and you think, ‘Christ, I’ve got to be up by 6!’ That is anxiety …

I’ve learned to turn the clock in my study to the wall an hour or two before bedtime. And the alarm clock on my bedside table is a Brookstone, one of those back-lit types that don’t shine in the dark unless you press down on the top. It’s a small thing, but it’s done wonders for my sleep.

Night and Sleep Don’t Mix

Sleep scientists are still trying to figure out why 10 to 15 percent of us have trouble sleeping at night. Normal sleepers are in the majority; people with insomnia are the deviants.

But is insomnia really so odd in view of all the crimes and disasters that have occurred at night?

Sleep scientists are still trying to figure out why 10 to 15 percent of us have trouble sleeping at night. Normal sleepers are in the majority; people with insomnia are the deviants.

Nights in Ancient Greece

But looking back 2,700 years to the time when Hesiod wrote his Theogony has made me see the issue in a different light. Night, says Hesiod, was the mother of a spectacularly unsavory brood. Not only did she produce the brothers Sleep and Death. She also gave birth to the forces of Doom, Ridicule, Woe, Deception and Strife. And wouldn’t you know it, Strife went on to outdo her mother in pernicious progeny, giving birth to Famine, Combats, Contentions and Murders, not to mention Lawlessness, Lies and Recklessness.

Did many ancient Greeks sleep through the night in peace and tranquility? I have my doubts.

Let’s not forget the famed Trojan horse, whose hidden warriors emerged at night, opened the city gates to their warrior fellows, and so conquered Troy. Or the frightful nights of the Middle Ages, when the rear watchman patrolling the streets by torchlight offered scant protection from evil supernatural forces or criminal and political violence.

More Infamy at Night

“Night,” the Canadian poet Christopher Dewdney has written, “has been the traditional shelter for revolutions, military attacks, freedom fighters, and various insurgencies but it has also covered pogroms, suppressions and vigilantes. The lynch mobs of the American Wild West rode at night, as did the Ku Klux Klan.” Kristallnacht occurred at night, Dewdney points out, as did many Nazi atrocities committed against Jewish families in the Warsaw ghetto.

What about disasters caused unintentionally by human hands? The poison gas leak in Bhopal began shortly after midnight. The Exxon Valdez ran aground shortly after midnight as well. The partial meltdown of the nuclear reactor at Three Mile Island began around 4 in the morning.

Most murders occur at night. A majority of domestic violence and rapes do, too. Most deadly residential fires occur between midnight and 6 a.m.; most sudden infant deaths, between 10 p.m. and 10 a.m.

The mystery is not that 10 to 15 percent of us have persistent insomnia. It’s that normal sleepers sleep so well.

Drinking to Get to Sleep

The story on alcohol and sleep is complicated. About 10 to 14 percent of adults in the United States use alcohol as a sleep aid. While it generally degrades the quality of sleep, the use of alcohol does not predict the development of persistent insomnia, say the authors of a large longitudinal study published in January 2012 in the journal Sleep. But—and here’s the troubling part—twice as many insomniacs become problem drinkers as people who sleep well.

Here is one woman’s story of how alcohol led to trouble sleeping and insomnia.

Insomnia more likely when relying on alcohol for sleepI mentioned to a gastroenterologist that I was writing a book about insomnia.

“Alcohol,” he said in response. “If you want to understand insomnia, look at alcohol and coffee.” His assumption that alcohol and coffee are causal factors in insomnia is widely held, and eventually I checked it out.

The story on alcohol and sleep is complicated. About 10 to 14 percent of adults in the United States use alcohol as a sleep aid. While it generally degrades the quality of sleep, the use of alcohol does not predict the development of persistent insomnia, say the authors of a large longitudinal study published in January 2012 in the journal Sleep. But—and here’s the troubling part—twice as many insomniacs become problem drinkers as people who sleep well.

Marilynn’s Story of Sleep and Alcohol

“Insomnia’s been a problem since I was very young,” Marilynn told me in an interview. “Unless the house was totally dark and quiet, I couldn’t sleep.” At her house those conditions were hard to come by. Her parents “always partied on the weekend, and very, very frequently during the week. It was just a noisy house.” The TV was always on, blasting away because her father was deaf in one ear. At parties the booze flowed freely. “In our house the bar was a shrine.”

“I remember my mom having bridge club and somebody letting me taste their creme de menthe,” she said. Marilynn was 9.  “So I just helped myself one night when the babysitter was upstairs and I was downstairs at the bar. I remember taking a glass …  and filling it with creme de menthe and thinking I was going to be sick to my stomach. But I also remember waking up the next morning and walking into this horrendous mess (from the party) downstairs. And I thought, ‘I slept through this. That stuff helped me sleep.’”

Marilynn dipped into the liquor cabinet occasionally for help in sleeping through the parties and her parents’ loud fights. Then in high school she learned about the dangers of drinking and stopped. But her problem with sleep continued unabated. Several years later she raised the sleep issue with her ob/gyn. “He suggested drinking a glass of red wine at night. He said two would be OK, too. And it worked for quite a while.”

Developing Tolerance

Then she found herself needing to increase the amount. To the wine she added a whiskey chaser. This, too, worked for a while. But by the mid-1990s, her drinking was out of control. She was hiding bottles from her husband and doing strange things at night.

“I wasn’t going to sleep,” Marilynn said. “I was passing out. I didn’t know then that I was also getting up.”

But her husband knew, and he was hiding the evidence. Then one morning Marilynn went down to the kitchen and found barley soup splattered all over the kitchen cupboards.

“’Who made this mess?’” she recalled shrieking at her husband. She had, he told her, and similar things had happened before.

“I had no recollection,” she said. “As far as I was concerned, I had slept through the night.” Around the same time, Marilynn lost her teaching job. She realized then that she had to get help, and she got it through AA. But while she’s given up drinking, her insomnia persists.

“I think it’s kept me very scattered, disorganized and unambitious. It’s been very, very limiting,” she said. “Definitely, absolutely, it’s what led to my problem with alcohol.”

Sleep problems are no trivial matter, as the link between insomnia and the higher rate of alcoholism suggests. If you’re going to imbibe, say the experts, do it early in the evening. But if you’re looking for a sleep aid, you’d be wise to choose something else.

Good Nights, Bad Nights

Even people with insomnia sleep well from time to time. “I know on a sunny day after I’ve had a good night, I’m almost high,” Mary, a writer and former teacher, told me as we sat talking over cups of tea.

The day is wonderful after a good night’s sleep. But what about mornings after really bad nights?

Even people with insomnia sleep well from time to time.

“I know on a sunny day after I’ve had a good night, I’m almost high,” Mary, a writer and former teacher, told me as we sat talking over cups of tea. A long-time insomnia sufferer, Mary appreciates the good days in part because they’re rare, coming maybe one in 10. Yet when they occur, her productivity as a poet soars. The ideas are fresher and flow faster. The right word, elusive on a bad day, comes quickly. “It just feels wonderful,” she said.

Waking up stressed

The day is wonderful after a good night’s sleep. But what about mornings after really bad nights?

At my house they’re pretty grim. Awakening begins with a jumble of thoughts nattering away inside my head. It’s as if my brain never fully disengaged, so much does it seem to be stuck where it left off the night before. Half a dozen aches and pains clamor for attention, too: throbbing forehead, dry eyes, aching arms and shoulders, and a racing sensation in my stomach and chest. Thinking about the day ahead is overwhelming. I feel spent before the day even begins.

Is There a Pattern?

I’ve known all my life that these bad nights occur more often during times of stress. Beyond that, it never occurred to me to wonder if there was a pattern to the good nights and the bad.

Researchers in recent years have wondered just that: is there a predictable rhythm to insomniacs’ poor sleep? Their findings may be helpful to people with sleep problems.

  • Annie Vallieres and colleagues (Journal of Sleep Research, 2005) looked at the sleep diaries of over 100 insomniacs and found there was a predictable pattern of good and bad nights for about two-thirds of the subjects. The majority of them could count on a good night’s sleep after 1 to 3 bad nights. It could be reassuring to know that a better night’s sleep is just a day or two away, the authors write. Predictability of good and bad nights might alleviate some of the anxiety associated with poor sleep.
  • Cindy Swinkels, reporting in 2010 on a study she conducted for her PhD thesis, found that insomniacs can expect a “better-than-average” night’s sleep within 3 days. But “good” sleep may come only 1 night in 6.

What’s the take-home message here? One thing the research suggests is that people who worry about their sleep would do well to keep sleep diaries for a few weeks. If you find you sleep better after 1 or 2 days of bad sleep, recognizing this pattern could ease some of the worry, which may improve your sleep. Download and keep this two-week sleep diary recommended by the American Academy of Sleep Medicine to see if there’s a pattern to your bad nights.

But there’s nothing reassuring about having to slog through 5 nights of bad sleep to get to a good night. If this is your situation (or if your situation is worse, like Mary’s), then it’s time to look for help.

Doctors and the Sleeping Pill Question

The use of sleeping pills is on the rise, with 8 percent of Americans now using them at least a few nights a week. By some folks’ lights this is not a good thing. Doctors are too quick on the draw with the prescription pad, is a complaint I often hear.

But I’ve had more experience with doctors of the opposite persuasion, who declare they don’t do sleeping pills at all.

Some doctors are comfortable prescribing sleeping pills and others aren'tThe use of sleeping pills is on the rise, with 8 percent of Americans now using them at least a few nights a week. By some folks’ lights this is not a good thing. Doctors are too quick on the draw with the prescription pad, is a complaint I often hear.

But I’ve had more experience with doctors of the opposite persuasion, who declare they don’t do sleeping pills at all. I’ve moved quite a few times over the years and had to change health plans and doctors, and I’ve come across several of these pharmacological Puritans. The minute I mention even occasional use of sleeping pills for insomnia and ask for a prescription, I morph into Hester Prynne with a scarlet letter on my chest: “A” for Ambien.

I know these drugs have their downsides, and there are certainly reasons to avoid them. Arguably there are better ways to deal with insomnia over the long term. But if a prescription is simply not on the table for discussion, I have to wonder what century these doctors think they’re living in.

One Woman’s Experience

I met May as I was conducting interviews for my book. A soft-spoken retired mathematics professor, May had reported sleep problems to her doctors for years. One advised going to a mental health clinic, but aside from poor sleep she wasn’t having any problems so she didn’t pursue it. Another suggested taking Benadryl, but May had read that antihistamines had negative side effects so she decided not to do it. A third doctor simply checked a box for sleep problems on his patient history form and moved on.

One year May took matters into her own hands. “I took my cat’s Valium,” she said. “My cat was prescribed Valium and since he slept all the time, I tried taking them. Not every night, though — I’ve read too much about getting addicted. I took them just about five times a month. They were 2 mg tablets and I would break them in half.” One milligram of Valium – hardly enough to make a wombat blink – taken every five or six days was all it took to give May the best year’s sleep of her life.

Where, oh where, is the harm in that? I know some people are prone to abusing sleeping pills, and physicians are rightfully leery of prescribing them to patients they suspect might take that path. But May would be the last person to use pills unwisely, and after years of treating her as a patient, her doctors should have known that.

A Different Approach

Humor, I sometimes think, might be a way to avoid the awkwardness of raising the issue of sleeping pills with new GPs. The minute the doctor walks into the consulting room, I announce my credentials as a pharmacological conservative. “The truth is,” I tell the doctor, “I don’t like drugs. My mother was a Christian Scientist so I grew up thinking they were evil. I’ll never ask for an antibiotic. When I get a cold, not even Tylenol crosses my lips. But when it comes to getting to sleep, pure thoughts don’t always suffice …”

I’m sleeping a lot better these days, so I don’t feel the need for as many sleeping pills as before. But I don’t have much patience for pharmacological Puritans. If a doctor responds to my request for a prescription with a lecture, our relationship is history. I’m out the door.

 

Short Sleep Affects Personality

Short sleep—sometimes defined as sleeping less than 6 hours a night, and other times defined as sleeping less than 5—is associated with a higher risk of hypertension, obesity, and type 2 diabetes, investigators at Penn State Hershey have said. Some research has even shown there’s a link between short sleep and increased mortality.

Now a new study finds that short sleep also has effects on personality.

short-sleepShort sleepers get short-changed in more ways than one. Short sleep—sometimes defined as sleeping less than 6 hours a night, and other times defined as sleeping less than 5—is also associated with a higher risk of hypertension, obesity and type 2 diabetes, investigators at Penn State Hershey have said. Some research has even shown there’s a link between short sleep and increased mortality.

A new study published in the International Journal of Behavioral Medicine finds that short sleep also has effects on personality. European investigators Sakari Lemola and colleagues, after evaluating medical data on about 1,800 Americans aged 30 to 84, concluded that people who sleep less than 6 hours a night are less optimistic than people who sleep 7 to 8 hours a night, and that short sleepers have lower self-esteem.

Pessimism and low self-esteem are also characteristic of depression. But even when the researchers controlled for symptoms of depression, the relationship between short sleep and decreased optimism and self-esteem held up.

The Upshot

This study supports a growing awareness that the amount of sleep people get can affect their sense of well-being. And it adds to the body of research suggesting that short sleep is linked to poorer health. “Longitudinal studies indicate that optimism and self-esteem are predictors of better health rather than just consequences,” the authors write.

One limitation of the current study is that, unlike the protocol followed at Penn State Hershey, short sleep was assessed subjectively rather than being objectively validated in a sleep lab. And a major caveat in all the short-sleep studies is that none of them allow for assumptions about causality. Whether short sleep actually leads to lower optimism, lower self-esteem and poorer health or vice versa is not known.

Still, it gets harder and harder for anyone to say that people who consistently experience short nights should just buck up and bear them. If there’s any silver lining to the cloud, this is it.

Awake in the Middle of the Night

The bed—so sleep experts maintain—should only be used for sleep and sex. People who can’t sleep should get up and do something: iron shirts, look at picture books, plan a backyard stupa. Anything, for God’s sake, but toss and turn among the sheets.

I know I should follow this advice. But every fiber of my body cries out for staying flat on my back.

The bed—so sleep experts maintain—should only be used for sleep and sex. People who can’t sleep should get up and do something: iron shirts, look at picture books, plan a backyard stupa. Anything, for God’s sake, but toss and turn among the sheets.

This bit of advice has always put me off. Especially when I wake up in the middle of the night and can’t fall back to sleep, I’m bone-tired and brain-dead. I can barely face getting out from under the warmth of the covers to go to the bathroom, let alone contemplate walking downstairs, turning on a light and settling down with a book. Every fiber of my body cries out for staying flat on my back.

Making Hay While the Darkness Reigns

But I’ve met insomnia sufferers of the middle-of-the-night-awakening type who decided at some point that they were not going to take their wakefulness lying down.

My former colleague Claudia is a journalist with a greeting card business on the side. She used to lie awake fretting when she couldn’t fall back to sleep. Now when she wakes up at 1 a.m., she goes upstairs to make birthday cards.

“It’s like playing around,” she says. “It takes my mind off everything, and sometimes I think it helps me mellow out a little, too.” After working a couple of hours on her cards – an activity she says is fun but not cerebral – she crawls back into bed again and can usually get a few more hours of shut-eye. She’d rather deal with insomnia this way than take sleeping pills.

Marty is another example. Self-employed, he goes to bed around 9 p.m. and uses the time he’s awake in the middle of the night to work on an online newsletter. “I do my best writing between 2 and 5 in the morning, “ Marty says. Then he goes back to sleep for another hour and a half. He’d like to sleep more, and to get all his sleep at one go, but his body seems to have different needs.

Bimodal Sleep in Nights Past

Historian A. Roger Ekirch claims this pattern of broken sleep was actually common before 1800, when people lived without artificial lighting in their homes. Ekirch has found several references to nights in which people took their “first” sleep from about 9 or 10 p.m. to somewhere past midnight. Then they got up to brew a tub of ale or chat with neighbors, or they stayed in bed to pray, make love or meditate on dreams. At last they fell into a “second” or “morning” sleep that lasted until dawn.

Experiments conducted by sleep researcher Thomas Wehr in the 1990s suggest this bimodal pattern of sleep is the pattern humans might well fall into today in the absence of artificial lighting. Our modern lights-out period lasts for seven or eight hours a day year-round. But in temperate climates in the pre-industrial era, during the winter months when darkness lasted 14 hours, people spent a lot more time in rest and relaxation.

When Wehr re-created these conditions by giving his experimental subjects a 14-hour sleep window, they settled into a routine in which their sleep fell into two distinct periods. One came at the beginning of the “biological” night and one at the end, with a period or periods of quiet wakefulness in between. Wehr concluded that bimodal sleep may actually be more “natural” than the consolidated sleep period that is the norm today.

The notion may not be reassuring to insomniacs unable to turn middle-of-the-night awakenings to their advantage, or whose work or families demand that they be up at the crack of dawn. Nor does it jibe with the thinking of most sleep experts, who suggest that a consolidated period of sleep is for the insomniac the Holy Grail. But if segmented sleep really does come more naturally to some poor sleepers, then the Claudias and Martys may be better off going with the flow.