Q&A: Can’t Sleep Due to Temperature Sensitivity

A reader named Gunjan recently asked a question about trouble sleeping due to temperature changes at night. Here it is, lightly edited:

“It seems my body is very sensitive to temperature while I am sleeping. Many times it has happened that I went to bed at an optimal temperature. But as soon as my body sleeps, I wake up feeling too cold. Then I go to bed after switching off the fan or covering myself with the bed sheet but then I can’t sleep because I’m too hot. This is quite frustrating. . . . Does anybody . . . have any help to offer?”

Insomnia sufferers may have increased temperature sensitivity at nightA reader named Gunjan recently asked a question about trouble sleeping due to temperature changes at night. Here it is, lightly edited:

“It seems my body is very sensitive to temperature while I am sleeping. Many times it has happened that I went to bed at an optimal temperature. But as soon as my body sleeps, I wake up feeling too cold. Then I go to bed after switching off the fan or covering myself with the bed sheet but then I can’t sleep because I’m too hot. This is quite frustrating. . . . Does anybody . . . have any help to offer?”

Insomnia and Thermosensitivity

Insomnia may have something to do with compromised thermoregulation, but the issue has not been fully investigated, say authors of a paper on sleep and thermosensitivity. Evidence shows that older adults may have an impaired ability to recognize the most comfortable temperature for sleep, and this may relate to abnormalities in the area of the brain that evaluates comfort. Not much else is known.

But I’m never surprised when people complain of trouble sleeping related to temperature sensitivity. I have the problem myself. I’ve gone to bed in very hot and very cold situations and lain awake for a good chunk of the night. Like Gunjan, I regularly have to make small temperature-related adjustments in the middle of the night. Now, with some nights warm and others cool, is the season when it’s trickiest to get it right.

Temperature Changes at Night

Core body temperature varies by about 1.5 degrees Fahrenheit over the course of the 24-hour day. From a temperature high in the evening, it descends and reaches its low point some 1 to 3 hours before normal wake-up time. If you keep the bedroom windows open at night (a cool bedroom is good for sleep), the room temperature will likely drop as well. The combination of internal and environmental temperatures falling could easily explain why you might wake up feeling cold at night.

Covering yourself with a blanket or a bed sheet is the obvious way to make yourself comfortable enough to get back to sleep. But what if, like Gunjan, you then feel too hot?

Covering up can create a closed system where, once the skin temperature has risen enough to dilate the blood vessels close to the skin, the body heat then released has no place to go. It’s similar to the situation created by an electric blanket. The blanket continues to add heat to the body, increasing skin and core body temperatures. The heat the body would normally throw off is then trapped underneath the blanket. You wake up feeling too hot to sleep.

Here are two ways to keep from overheating at night:

  • Use sheets and blankets made of a breathable fabric such as cotton. Fabrics like polyester are more likely to trap heat rather than allow for its release.
  • When you cover up, see if keeping your feet outside the covers helps. You lose lots of heat through your extremities, so keeping them uncovered, or partially covered, may make you comfortable enough to sleep through the night.

Help for Sleep Onset Insomnia

It’s easier to go to sleep when core body temperature is falling, and people who have problems falling asleep—sleep onset insomnia—may have trouble cooling down at night.

Ideally, the temperature in the bedroom should be a little lower than is comfortable during the day. But there are also ways to facilitate internal heat loss. Activities that increase skin temperature eventually help to cool you down. Warming the skin dilates blood vessels close to the skin. This enables the release of body heat and a lowering of core body temperature to occur for a few hours after the activity ends, in turn facilitating sleep.

Early in the evening these activities may trigger processes that help you fall asleep:

  • Take a hot shower or bath
  • Spend time in a sauna
  • Do a resistance workout or aerobic exercise

As you’re winding down on cooler nights, mild heating of the hands and feet may dilate the blood vessels enough to facilitate heat loss, lowering your core body temperature and inducing sleep. But this is a losing strategy on the warmer nights. Lightly clad and barefoot is the way you want to be.

If you’re sensitive to temperature changes at night, what have you found that helps?

Q&A: Anxious About Sleep? Get Relief

Anxiety about sleep is a problem for some insomnia sufferers. Fear of sleeplessness is the main thing keeping them awake at night.

Here’s how sleep anxiety develops and how to tone it down.

Relieve fear of sleeplessness with cognitive and behavioral therapies.This week a woman (I’ll call her Gina) wrote to Ask The Savvy Insomniac with questions about sleep anxiety and sleep restriction.

 

 

 

 

I have had chronic insomnia since September. I honestly didn’t have any major life event that caused it. Just a few bad nights of sleep—and the anxiety started setting in. The worst part of it for me is that as soon as it nears “bedtime” my heart starts racing and I feel extremely anxious.

I am doing sleep restriction therapy (I’ve been averaging 5 hours per night) but I’ve had a few “slips” along the way. I tend to drift off to sleep on the couch (for about 5 or 10 minutes). How long does this take? I’ve been doing it for over a week and I haven’t seen any great improvements. I’m losing hope.

Anxiety About Sleep: How It Develops

Anxiety about sleep can develop during a stressful life event when sleep is difficult. It can also develop following several nights of bad sleep, regardless of what triggered them.

Being unable to sleep when you want to sleep is frustrating. Frustration may give rise to symptoms of physiological arousal: increased heart rate, blood pressure, respiratory rate, and body temperature. If you’re prone to developing chronic insomnia you may be particularly sensitive to what’s going on inside your body. Merely noticing signs of arousal at a time when the brain and body are supposed to be shutting down can cause anxiety.

It’s important to note when and where these unpleasant sensations are occurring. They’re not happening as you drive your 3-year-old to daycare or participate in a staff meeting. They’re happening at night when you’re in bed in the bedroom—where you’re supposed to be asleep.

After a few bad nights you may also begin to notice unpleasant symptoms during the daytime: lethargy, low mood, trouble thinking. Consciously or unconsciously, you might start to connect these these symptoms to your struggle for sleep at night. This, too, can give rise to anxiety or exacerbate existing anxiety.

Activities and projects may claim your attention during the daytime. But when nighttime rolls around and your physical and mental stamina are at low ebb, boom! The mere thought of going to bed makes you anxious, ramping up physiological arousal and increasing your anxiety still further.

Forget about sleep when you finally go to bed. Your odds of an easy send-off are nil.

If You’re Anxious About Sleep

Keep these things in mind. Sleep-related anxiety:

  • Is learned. It doesn’t just materialize out of nowhere but is rather conditioned through a process similar to the one described above (and likely predisposed by constitutional factors as yet unknown).
  • Is not your fault. Conditioned learning takes place at an unconscious level; you are not aware that it is occurring. So don’t play the blame game—it hurts rather than helps.
  • Can be unlearned. That’s where we’re heading now.

Some insomniacs who are anxious about their sleep respond to treatment with cognitive therapies. Cognitive restructuring, offered as part of cognitive behavioral therapy for insomnia (CBT-I), may help by dismantling some of the attitudes and beliefs that keep sleep anxiety alive. Other insomniacs have found that mindfulness meditation helps to alleviate sleep anxiety. Acceptance and commitment therapy is worth checking into as well.

Stimulus Control Therapy

For me personally, the two behavioral strategies I learned during CBT-I had the biggest impact on my sleep anxiety. By regularizing and solidifying my sleep, they helped to make fear of sleeplessness a thing of the past.

You’ve heard advice to the sleepless that counsels avoiding the bed except for sleep and sex? Well, this rather parsimonious view of how to use the bed has grown out of studies showing that stimulus control therapy (SCT) for insomnia works. The protocol is simple:

  1. Go to bed only when sleepy.
  2. Use the bed only for sleeping (and sex). Do not read, watch TV, eat, or do anything else in bed.
  3. If within 15 minutes you’re unable to sleep (estimate the 15 minutes; do not watch the clock), move to another room. Do a quiet activity—reading, knitting, watching TV—until you feel really sleepy. Then return to bed. The goal is to break the association between the bed and wakefulness and instead learn to associate the bed with falling asleep quickly.
  4. Repeat the above instruction as often as necessary.
  5. Get up at the same time every morning regardless of how much or how little you’ve slept.
  6. Do not take naps.

Sleep Restriction Therapy

The aim of sleep restriction therapy (SRT)—the treatment Gina is undergoing—is to restrict your time in bed so that most of your time there is spent sleeping rather than lying awake and worrying about sleep. The SRT process is somewhat involved and I’ve blogged about it elsewhere. Find out more by typing “sleep restriction” in the site search box above.

In response to Gina’s concerns about sleep restriction: avoid drifting off too early by engaging in evening activities that are not completely sedentary. And don’t lose hope because you’re failing to see improvements right away. It may take two or even three weeks before you notice appreciable benefits.

Take it from one who’s been there and done that: it’s worth the wait.

Q&A: Can Poor Sleep Show in the Face?

Can chronic insomnia make you less attractive? speed up the aging of skin? cause irreversible damage to your face?

I heard these concerns as I interviewed insomniacs for my book. But recently I decided to check into them after receiving an email from a woman whose anxiety about her appearance was extreme:

Very worried middle-aged woman

Can chronic insomnia make you less attractive? speed up the aging of skin? cause irreversible damage to your face?

I heard these concerns as I interviewed insomniacs for my book. But recently I decided to check into them after receiving an email from a woman whose anxiety about her appearance was extreme:

 

Ever since it all started eight years ago, my drive has always been an extreme fear of the insomnia’s impact on my physical appearance—especially my face. I just cannot let go of the pain of seeing my face ruined by sleeplessness! . . . Frankly, I look 10 years older than my biological age.

I am so afraid that my face is scarred (it certainly looks that way) and that it cannot recover after all these destructive years!

When we look in the mirror and see drooping eyelids and dark circles under our eyes, do we imagine we look worse than we actually do?

Effects of Sleep Quality on the Skin

There haven’t been any studies comparing the skin of insomniacs with the skin of good sleepers.

But three years ago I blogged about a study involving 60 women, half reporting good quality sleep with a duration of 7–9 hours and the other half reporting poor quality sleep lasting 5 hours or less. (Symptoms of these poor quality sleepers come close to meeting the criteria for a diagnosis of insomnia disorder.)

First the researchers inspected participants’ skin. Then they tested the skin, exposing it to ultraviolet light and subjecting it to a tape-stripping procedure that caused skin barrier disruption. They then observed how long it took participants’ skin to recover from these challenges.

Study Results

Compared with the good sleepers’ skin, the poor sleepers’ skin:

  • Showed more signs of aging skin (e.g., fine lines, uneven pigmentation, flabbiness, and less elasticity)
  • Took significantly more time to recover from the UV light exposure, with redness remaining higher over a period of 3 days

The good sleepers’ skin recovered 30% more quickly than the poor sleepers’ skin.

The study results suggest that insomnia sufferers’ concerns about the health and appearance of our skin are probably valid.

Effects of Sleep Deprivation on the Skin

In another study researchers took photographs to compare the faces of healthy adults in two different situations: (1) when they were well rested and (2) under conditions of sleep deprivation. (Again, acute sleep deprivation is not the same thing as insomnia—and certainly not the same thing as chronic insomnia—but research suggests that insomniacs may suffer from mild sleep deprivation at least some of the time.)

Twenty-three participants, all healthy adults, were photographed in the afternoon after a normal 8-hour night of sleep and again after sleep deprivation (a 5-hour night of sleep followed by 31 hours of continuous wakefulness). The photos were then viewed in a randomized order and rated by 65 untrained observers.

What the Observers Saw

You can probably guess what the results of the study were. Compared with well-rested faces, sleep-deprived faces were perceived as:

  • Less attractive
  • Less healthy
  • More tired

“Apparent tiredness was strongly related to looking less healthy and less attractive,” the researchers wrote. “The fact that untrained observers detected the effects of sleep loss in others” suggests that our sleep history gives rise to signs that can be noted by other people.

In other words, after several bad nights, the pasty complexion and dark circles we notice in the mirror are not just figments of our imagination. Others see them, too—and may judge us as less healthy and less attractive as a result. (Keep in mind, though, that the participants in this study were quite severely sleep deprived when the second round of photos was taken.)

What Can Be Done

If preserving your skin is important, then taking measures to improve your sleep might be one of the best preservatives. CBT for insomnia (or sleep restriction) is the No. 1 treatment for insomnia recommended by sleep experts. Find information about it by clicking “Blog” at the top of this page and typing CBT or sleep restriction in the site search box.

What about products that might help to preserve the skin? A dermatologist once recommended that I use CeraVe Moisturizing Cream. I like it well enough but have no way of knowing if it’s keeping my skin looking younger than it would otherwise be.

If you’ve found a skin product you like, please share it here

Q&A: Will Regular Rest Curb Sleep Anxiety?

“I have nights when I can’t sleep at all and other nights when I sleep a lot,” Philippa wrote last week. “If I don’t fall asleep straight away I find I often don’t sleep the whole night! Do you think sleep restriction would work for me?”

My answer to Philippa’s question is an unqualified “yes.” But first I want to look at sleep that’s inconsistent and unpredictable and how anxious it can make you feel.

Anxiety about sleep is treatable with CBT for insomniaMy sleep used to be erratic. Really, really erratic. The Sandman could come as early as 10 p.m. . . . but he might not show up till daybreak.

Occasionally I hear another insomnia sufferer voice a variation on the same complaint. Here’s what Philippa wrote last week:

 

 

I have nights when I can’t sleep at all and other nights when I sleep a lot. I don’t have a problem waking up at night and, if I do, I can go back to sleep. However, if I don’t fall asleep straight away I find I often don’t sleep the whole night! Do you think sleep restriction would work for me?

My answer to Philippa’s question is an unqualified yes. But before I talk about making sleep more regular, I want to look at sleep that’s inconsistent and unpredictable and how anxious it can make you feel.

Night-to-Night Sleep Variability

Actually, there’s not much talk about night-to-night variability in people’s sleep. We hear a lot about sleep need, but that’s always stated as an average, as in “most people need about 7 hours of sleep a night.”

But plenty of research shows there’s night-to-night variability in when, how long, and how well each person sleeps. Unsurprisingly, some people’s sleep is more variable than others’. According to a new paper published in Sleep Medicine Reviews, from night to night, your sleep is more likely to vary in duration, timing, or quality if

  • you’re young
  • you live alone
  • you’re a person of color
  • you’re a night owl
  • you’re overweight or obese
  • you have physical health conditions
  • you have bipolar or depressive symptoms
  • you’ve had lots of stressful life events
  • you have insomnia.

Insomnia and Sleep Variability

The word insomnia means “the condition of not being able to sleep.” Yet even if your insomnia is chronic, chances are you don’t sleep poorly every night. In fact, like Philippa, on some nights you probably sleep passably or even quite well. But good sleep is not dependable, and that’s a problem.

There may be certain situations you’ve identified that typically give rise to bad nights. For example, you may know your sleep will suffer after a bad day at work or if you have to give a speech the next day.

But the good and bad nights may not necessarily correspond to stressors you can put your finger on. And this lack of predictability can cause big-time anxiety. It certainly did for me.

A Pattern of Good and Bad Nights?

Is there an underlying pattern to insomniacs’ poor sleep and, if so, would discerning that pattern be reassuring? Maybe it would for some people with insomnia.

Researchers in Scotland looked at the sleep diaries of over 100 insomniacs and found a predictable pattern of good and bad nights in about two-thirds of the study participants. Most of these participants 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 wrote. A predictable pattern of good and bad nights might alleviate some anxiety about sleep.

In a study conducted at the University of Pennsylvania, investigators concluded that insomniacs can expect a “better-than-average” night’s sleep within 3 days—but that “good” sleep may come only 1 night in 6. This doesn’t sound very predictable or reassuring to me.

Take the Bull by the Horns

It might be helpful to keep a sleep diary and see if you can identify a pattern of good and bad nights. Seeing method in the madness might allow you to dispense with some of the uncertainty that’s probably contributing to your anxiety about sleep at night (and driving your insomnia).

But getting rid of erratic sleep—and making sleep predictable—is a more effective approach to curtailing anxiety about sleep. Undergoing CBT for insomnia, which includes sleep restriction therapy, is a good way to do that, research shows. And both this blog and my book, The Savvy Insomniac, are a testimonial to what CBT for insomnia—combined with regular exercise—has done for my sleep.

I’ve written more about sleep restriction therapy because it’s the part of treatment that helped me the most. To read more about it, just click on “Blog” at the top of this page, type “sleep restriction” in the site search box, and start browsing.

Q&A: Panic About Insomnia Relapse

Lately I’ve been hearing from people who improved their sleep using sleep restriction or full-blown CBT for insomnia (CBT-I) and then experience a relapse. They have a few bad nights and fear they’ve lost all the gains they made. Here’s how one reader recently described her plight:

“I realize that sometimes I will get scared when I have one or two bad nights once in a while. I’m afraid that insomnia will haunt me once again. Is this normal? What can I do?”

Insomnia sufferers should do something quiet at night until they're sleepyLately I’ve been hearing from people who improved their sleep using sleep restriction or full-blown CBT for insomnia (CBT-I) and then experience a relapse. They have a few bad nights and fear they’ll never sleep well again. Here’s how one reader recently described her plight:

 

 

I realize that sometimes I will get scared when I have one or two bad nights once in a while. I’m afraid that insomnia will haunt me once again. Is this normal? What can I do?

Normal or Abnormal?

When cognitive behavioral therapies for chronic insomnia work—and they do improve sleep for 70 to 80 percent of the insomniacs who try them—it can feel like such an achievement. “At last,” you think, “I’ve got this monkey off my back!”

In reality, though, only a minority of the people who undergo CBT-I report that their insomnia is “cured.” The rest of us experience occasional insomnia relapses.

As anyone who’s read The Savvy Insomniac knows, I went through CBT-I with a group of 4 other insomnia sufferers. At the final group meeting, the therapist gave us a handout on how to maintain the gains made during treatment and what to do in case of relapse. Not only are occasional relapses not abnormal; for many of us, they’re probably inevitable.

All Is Not Lost

The first relapse can feel like such a downer and provoke lots of anxiety. “What? I restricted my sleep only to end up right back where I started, and maybe even worse?” It’s easy to appraise the situation this way: you’re short on sleep, fatigued, and out of sorts. Everything about it feels depressingly déjà vu.

But all is not lost. What occurs during CBT-I is a process some scientists liken to a rewiring of the brain. Neural pathways related to new thoughts and behaviors are established as sleep becomes more regular and the bed and the bedroom come to be associated with sleep.

Older pathways active during insomnia do not disappear. Rather, the new pathways—to continue speaking figuratively—are superimposed on the old. With every good night of sleep, neural connections along the new pathways are strengthened. You expect to sleep well at night and you do.

The older pathways and ways of thinking are still there, though, and due to stress or anything else disruptive to sleep, they may regain some influence. Insomnia returns, and you’re as anxious about it as you ever were. But there’s good news, too: once the newer pathways are established, they’re easier to return to.

I’ll attest to this from personal experience. Before I went through CBT-I (and sleep restriction therapy), my bouts of insomnia could drag on for weeks. Now when I experience insomnia and (in rare cases) my fear of sleeplessness returns, I’m able to return to better sleep and dispense with the anxiety in a few days. I do it pretty much by following instructions I received during CBT-I. Here’s how:

What To Do in Case of Relapse

  • Don’t go to bed unless you’re sleepy. If after 15 to 20 minutes you’re not asleep, get up, go to another room, and do something quiet until you’re sleepy again. Then return to bed. If this doesn’t help after a few days, try the next suggestion.
  • Restrict your sleep by an hour or more for a few days. Be strict about getting out of bed at a consistent wake time—even on weekends.
  • Once your sleep is solid again, extend your time in bed by half-hour increments every 2 nights until you return to your desired bedtime.
  • Be sure to get daily aerobic exercise throughout the process.

If you’ve experienced a relapse of insomnia, please take a minute to share how you got your sleep back on track.

Q&A: Start Sleep Restriction Right for Best Results

“I’m on Day 4 of SRT and it isn’t going well,” Jenny wrote recently. “I finally had an appointment with a sleep therapist last week. He talked to me about SRT and gave me a 7-hour sleep window, from 11 p.m. to 6 a.m. My usual bedtime is 9:30 so I had some apprehensions. But I started 4 days ago.

“Since then I haven’t slept more than 3 hours a night. It’s really hard for me to stay up till 11, and then when I get in bed I’m wide awake! In the morning I’m so tired I can hardly keep my eyes open! Is this normal? I’m afraid I may be a treatment failure. Any advice?”

Before sleep restriction, keep a sleep diary for a week to ensure successRecently I’ve heard from a handful of people starting out with sleep restriction therapy (SRT), a treatment for insomnia. All were in a similar predicament. Here’s what Jenny wrote:

 

 

 

 

 

 

I’m on Day 4 of SRT and it isn’t going well. I finally had an appointment with a sleep therapist last week. He talked to me about SRT and gave me a 7-hour sleep window, from 11 p.m. to 6 a.m. My usual bedtime is 9:30 so I had some apprehensions. But I started 4 days ago.

Since then I haven’t slept more than 3 hours a night. It’s really hard for me to stay up till 11, and then when I get in bed I’m wide awake! In the morning I’m so tired I can hardly keep my eyes open! Is this normal? I’m afraid I may be a treatment failure. Any advice?

First Few Weeks of Treatment

The first few weeks of SRT are not much fun. Your time in bed is cut short at night and naps are not allowed. It can be hard to figure out what to do during the extra hours you’re up. In the daytime you may feel sleep deprived: exhausted, cranky, off your game.

Is this normal?

Research suggests it’s not abnormal. Results of a study of 16 insomniacs in the UK showed that while their sleep was greatly improved following SRT, during the first few weeks of treatment, they were sleep deprived. Like Jane Fonda said: no pain, no gain!

The Week Before Restriction Begins

Jenny’s experience of the first few days of SRT is not so unusual. But nowhere in her email—or in the others I received—was there any mention of having kept a sleep diary* during the week before treatment. Also, all 4 I heard from were starting SRT with rather generous sleep windows: 6.5, 7, and even 8 hours in bed. Yet they didn’t say how those sleep windows were established.

Maybe sleep diaries were kept—and the writers just didn’t mention them. Or maybe a therapist determined, based on a clinical interview, that starting out with a generous sleep window was the best way to treat insomnia in that particular person. (See my blog on paradoxical insomnia for more on this.)

But I suspect that at least some who wrote had plunged right in to sleep restriction without filling out a sleep diary the week before and that their sleep windows were set arbitrarily. This can make the first week of sleep restriction even rockier than it needs to be—and might lead people to think the treatment is failing and quit.

How Much Do You Sleep?

To set your sleep window (time allowed in bed) at the start of SRT, you need to know how much sleep you’re getting from night to night. Maybe you have a pretty good idea of that already. In reality, though, most insomnia sufferers are not very good at estimating sleep duration.

Keeping a sleep diary during the week before treatment won’t necessarily make your estimate more accurate—but it might. By noting in the diary how many times you wake up each night, how long the wake-ups last, and the variability in your sleep from night to night, you might get a more realistic read on the average number of hours you sleep.

Look Before You Leap

Regardless of whether keeping the diary clues you in to anything you didn’t already know, the results are an indication of how much your time in bed should be restricted at the start of sleep restriction:

  • You discover you’re a 6-hour sleeper? Start SRT with a 6-hour sleep window.
  • You’re sleeping 5 hours 15 minutes a night? Start with a 5.25-hour sleep window.
  • There’s one exception: most sleep experts (but not all) recommend starting SRT with nothing less than a 5-hour sleep window. So 4-hour sleepers are usually advised to start with a 5-hour window.

If you start with a too-small sleep window, you’ll wind up very sleep deprived. But if your sleep window is too generous (as I suspect may have been the case for Jenny and the others who wrote in), you’re likely to continue with the same broken sleep pattern you’ve known from before. This could sour you on sleep restriction even before you’re off the ground.

So keep a sleep diary for a week before starting SRT and set your sleep window accordingly. It’s the quickest path to success.

* Download this sleep diary from the National Sleep Foundation and make several copies for use during SRT.

What was your experience like during the first week of sleep restriction therapy?

Q&A: Should Night Owls Use Sleeping Pills?

Rob wrote to Ask The Savvy Insomniac complaining about insomnia and wondering if Belsomra might help.

Today’s blog post features his story and my response.

Rob wrote to Ask The Savvy Insomniac complaining about insomnia and wondering if Belsomra might help.

trouble functioning in the a.m. could indicate circadian rhythm disorder

I’ve had insomnia since my teens. Never could get to sleep before 2:30. And that’s when I’m lucky. Sometimes it’s 3:30 or 4.

I do everything I’m supposed to do. I work out at the gym every day. I have a few beers when I get home but that’s it. I use a blue light blocking app on my computer and anyway I’m usually off it by 11. But nothing I do changes the situation. I just don’t feel sleepy. No matter how sleep deprived I am, I feel wired.

When the alarm goes off at 7:20 I feel exhausted. Coffee doesn’t help. I fight to stay awake at the office and by the end of the week it’s a losing battle. Early morning meetings are the worst.

What saves me is being able to sleep in on weekends. That and sleeping pills. Ambien will sometimes put me to sleep by 1. So my question is: Do you think Belsomra could work for me?

Barking up the Wrong Tree

I’m no doctor, but I suspect that if Rob were to consult a sleep specialist, his diagnosis would not be insomnia disorder but rather delayed sleep phase disorder (DSPD). The symptoms he reports are classic:

  • a preference for going to sleep several hours later than normal
  • difficulty sleeping at more conventional times
  • feeling alert, not sleepy, at night
  • struggling to wake up and function in the morning
  • catching up on sleep on the weekends

Rob might not have a sleep problem if his work began at noon. But most jobs start earlier, and for people with DSPD, trying to function on a conventional schedule is a major ordeal. It can quickly lead to sleep deprivation and trouble meeting obligations. It limits prospects down the line.

A 25-Hour Circadian Period

We humans can’t choose our sleep time preferences. Whether you’re a night owl, an early bird, or somewhere in between depends on a mix of genetic factors. These preferences can be modified, though, and may also evolve with age-related changes.

Sleep experts have long suspected that people with DSPD have body clocks that run slow, taking longer to complete their daily cycle. While the average circadian period in humans is 24 hours 11 minutes, scientists have hypothesized that the period length in people with DSPD is closer to 25 hours.

The results of two recent studies confirm that circadian rhythms are quite a bit more delayed in people with DSPD than in normal sleepers:

  1. Investigators in Australia assessed study participants’ core body temperature rhythms over 78 hours and found that under conditions of a constant routine, DSPD patients’ temperature rhythms were delayed by about one hour a day. This suggests “that DSPD patients, on average, must advance their circadian rhythm by almost an hour each day to maintain stability of their sleep–wake cycle to the 24-hour world.”
  2. Using a similar, 30-hour study protocol, the same team found that melatonin secretion began almost 3 hours later in DSPD patients than in normal sleepers. While in normal sleepers the melatonin secretion began with a surge, in DSPD patients, it started out gradually.

No wonder people like Rob have trouble getting to sleep!

Therapies: Bright Light and Melatonin

The most effective treatment for night owls wanting to get to sleep sooner is not sleeping pills but rather bright light therapy. The light source can be the sun or a light box that disseminates light at 10,000 lux. Light exposure should occur first thing in the morning. The largest phase advances occur in sessions lasting for 2 hours.

Phase advances are also larger when morning bright light sessions are combined with a melatonin supplement taken late in the afternoon or around dinnertime. Combined with 0.5 mg of melatonin taken late in the afternoon, continuous exposure to bright light for 30 minutes early in the morning was found, in another recent study, to produce 75% of the phase shift that occurred with the 2-hour exposure.

But the bright light–melatonin regimen is not a cure for DSPD. Stop it and your circadian rhythms will revert to their natural cadence. This will also happen if you allow yourself to sleep in late on weekends. You’ll function best if you maintain the same sleep-wake schedule all 7 days of the week.

As for sleeping pills like Ambien and Belsomra, why assume the risks these pills confer when bright light therapy and melatonin supplements, which have few if any side effects, can work even better?

If you’re a night owl, have you tried bright light therapy and/or melatonin supplements? How have they worked?

Q&A: Light and Vitamin D for Seasonal Insomnia

Some people have trouble sleeping when the days get shorter. I’m one of them and so is Gabriel, who recently wrote in wondering how to improve his sleep:

“I was born close to the equator in Brazil, and I usually don’t have problems sleeping when I’m there or during the summer time in Canada, where I live now. But winter is around the corner, and my sleeping problems have just begun again. I usually go to bed at 11 p.m. but wake up around 3 a.m. However, in the summer my wake time is 7 a.m. I feel irritated, depressed and cannot concentrate. . . Is light treatment the way to go?”

Insomnia in colder months due to lack of sunlight and vitamin DSome people have trouble sleeping when the days get shorter. I’m one of them and so is Gabriel, who recently wrote in wondering how to improve his sleep:

 

 

 

 

 

 

 

I was born close to the equator in Brazil, and I usually don’t have problems sleeping when I’m there or during the summer time in Canada, where I live now. But winter is around the corner, and my sleeping problems have just begun again. I usually go to bed at 11 p.m. but wake up around 3 a.m. However, in the summer my wake time is 7 a.m. I feel irritated, depressed and cannot concentrate. . . Is light treatment the way to go?

Lack of Bright Light

Reduced light exposure probably accounts for Gabriel’s symptoms, including his insomnia at night. People who live in northern latitudes (residents of Canada fit the bill) get less exposure to sunlight starting in the middle of fall and continuing through March or April. This can alter circadian rhythms and destabilize sleep. It may be related to seasonal affective disorder (SAD).

Especially susceptible are those who commute in the dark and work all day in windowless offices, dimly-lit warehouses, and the like. Sunlight resets the body clock to run on a 24-hour cycle. Without daily exposure to sunlight (or to the blue-enriched light emitted by a light box), circadian rhythms may go out of sync. Secretion of the sleep-friendly hormone melatonin may be delayed in the evening. (Or, as I suspect in my case, it may begin too early, causing me to drift off and—like Gabriel—wake up too early.)

Sleep-related symptoms vary from person to person, but here are some you might recognize in yourself:

  • Sleeping more or less than usual
  • Trouble falling asleep or a tendency to fall asleep earlier than normal
  • Having an erratic sleep schedule
  • Trouble getting out of bed
  • Feeling groggy in the morning and tired during the day

Increase Your Exposure to Bright Light

Getting a healthy dose of exposure to sunlight every day may solve the problem. Take a walk outside or move your desk to the sunny side of the room.

Light treatment with a light box can also work. Light emanating from a light box mimics the blue-enriched light from the sun. Set it up so the light floods your work space but you’re not looking directly into it: this will likely increase your alertness and help stabilize your sleep. The amount of light exposure needed varies from one person to the next.

Get Enough Vitamin D

Another thing to consider is taking vitamin D supplements. Emerging evidence suggests that lack of the sunshine vitamin may contribute to insomnia and sleep problems in the wintertime, when the days are shorter and more overcast. The latest study published on this topic appeared last February, and the results strongly suggest that sufficient levels of vitamin D are important to maintaining healthy sleep. Among over 3,000 men ages 68 years and older,

  • lower serum vitamin D levels were associated with higher odds of short sleep duration (less than 5 hours a night), and
  • the sleep of men with low levels of vitamin D was less efficient.

The human body produces vitamin D with exposure to sunlight. So people living in northern latitudes are more likely than others to develop a vitamin D deficiency in the wintertime. Other risk factors for vitamin D deficiency are these:

  • Being female or older
  • Being obese or underweight
  • Having a physically inactive lifestyle
  • Having dark skin (The pigment melanin reduces the ability of the skin to manufacture vitamin D with exposure to sunlight.)

While the relationship between sleep and vitamin D is not fully understood, existing research suggests it’s probably a good idea to take a supplement, especially if during the colder months your sleep takes a turn for the worse. The Institute of Medicine recommends 600 international units (IUs) daily for people up to 70 years old and 800 units for people 71 years and older. But the safe upper limit for vitamin D is currently 4,000 IUs a day.

Do you have trouble sleeping in the colder months of the year? If you’ve tried using a light box, has it helped?