Six Tips for Overcoming Sleep Onset Insomnia

Poor sleeping conditions such as those found on planes can interfere with anyone’s sleep. But sleep onset insomniacs may find them particularly challenging, accustomed as we are to not falling asleep very quickly and being bothered by things that other sleepers readily tune out.

Why is it so hard for some insomniacs to fall asleep and what can help? Following are six ways to hold sleep onset insomnia at bay.

Poor sleep conditions compound the problem of sleep onset insomniaIt’s been 10 years since I experienced persistent sleep onset insomnia, but I was reminded of what my nights used to feel like when recently I took a red-eye flight on Spirit Airlines.

Conditions on that plane were not conducive to sleep: seats locked in the upright position; flight attendants whose nattering could be heard over the noise of the engines; dim lighting rather than darkness; kicks to my seat as the 6-footer behind me shifted around in his coach class cubicle; turbulence. I didn’t sleep a wink.

Conditions like these can interfere with anyone’s sleep. But sleep onset insomniacs may find them particularly challenging, accustomed as we are to not falling asleep very quickly and being bothered by things that other sleepers readily tune out.

Why is it so hard for some insomniacs to fall asleep and what can help? Following are six ways to hold sleep onset insomnia at bay.

What Brain Waves Reveal About Insomnia

Research has shown that people with insomnia have a different pattern of cortical activity as we’re drifting off to sleep. Compared with good sleepers, insomniacs are more prone to high-frequency brain waves in the sleep onset period. Once sleep onset has occurred, delta, or slow, waves take longer to appear. This is often taken as evidence of hyperarousal. At night, and possibly during the daytime as well, people with insomnia have higher levels of cortical arousal.

Results of recent study argue otherwise. Here, in the sleep onset period, sleep onset insomniacs were found to experience less high-frequency brain activity than sleep maintenance insomniacs (those who tend to wake up in the middle of the night). But the high-frequency activity in the sleep onset insomniacs took longer to decline. Authors of this study suggest that sleep onset insomnia may be the result of “some form of fast wakefulness inhibition” rather than an expression of cortical hyperarousal.

Relief for Sleep Onset Insomnia

Whatever may be the case, habits I’ve developed over the past 10 years enable me to fall asleep quickly now (barring nights when I’m trying to sleep on a plane). They may help you, too:

  1. Adopt a regular sleep schedule. Be especially regular about getting up at the same time every day—even on weekends. This can be a challenge if you have an erratic daytime schedule or an active social life. If you find you’re really sleepy, catch up on sleep by allowing yourself to go to bed somewhat earlier than normal rather than sleeping in late. The problem with sleeping much later than usual to catch up on sleep is that it sets you up for trouble falling asleep the next night.
  2. Break the association between your bed and wakefulness by reserving your bed (and the bedroom) for sleep and sex. Reading, TV and movie watching, surfing the net, playing video games—all this should happen outside the bedroom. Only go to bed when you’re sleepy enough to fall asleep.
  3. Exercise late in the afternoon or early in the evening. Exercise warms your body up. This triggers an internal cooling mechanism, and when your body is cooling down it’s easier to fall asleep. Aerobic exercise is best but rigorous strength training may work as well.
  4. Observe a wind-down routine in the hour leading up to bedtime. Have the same routine—shower, put on pajamas, brush teeth, read or look at picture books—every night. Your brain will learn to expect that this sequence of activities ends in sleep.
  5. If clock watching at night makes you anxious, turn your clocks to the wall starting at about 9 or 10 p.m. Use a backlit alarm clock on your bedside table—the kind that stays dark at night except when you press the button on top.
  6. If you have to fly at night, arm yourself beforehand with all the accoutrements I forgot to pack in my carry-on: neck pillow, eye mask, earplugs. As for Spirit Airlines, they may say they’re the company with the newest fleet of planes, but seats that keep you locked in an upright position do not lend themselves to a good night’s sleep!

If you often fly at night, what measures do you take to get a decent night’s sleep?

Sleep (Re)Training for Insomnia

What does falling asleep feel like? Good sleepers may never bother with the question. One minute they’re conscious and the next minute they’re out. But if you have chronic insomnia, falling asleep (or back to sleep) can feel like a tiresome slog.

Insomnia sufferers may actually lose touch with the feeling of falling asleep. So Sleep Technologist Michael Schwartz created a smartphone app to put people back in touch and increase their confidence and ease in falling asleep.

Insomnia sufferers relearn the feeling of falling asleepWhat does falling asleep feel like? Good sleepers may never bother with the question. One minute they’re conscious and the next minute they’re out. But if you have chronic insomnia, falling asleep (or back to sleep) can feel like a tiresome slog.

Insomnia sufferers may actually lose touch with the feeling of falling asleep, some have claimed. So Sleep Technologist Michael Schwartz created a smartphone app to put people back in touch and increase their confidence and ease in falling asleep.

Racing Thoughts and Brain Activity at Night

An independent study has found the smartphone app, called Sleep On Cue, to be accurate at detecting the start, or onset, of sleep. But let’s step back, for a moment, and imagine a typical insomniac night.

It’s after midnight and you’re obsessing about your deadlines tomorrow. Or you’re thinking about how to fight your way out from under all your student loans. The next thing you know the clock on your bedside table says it’s 2 a.m. In desperation, you stare at the clock face, willing time to stop. By 3 a.m. you’re still awake and hopping mad about it!

Maybe you have spent the last 4 hours with your entire brain spinning along in problem-solving mode. Chances are, though, that if on such a night you were undergoing a sleep study, your brain waves would tell a somewhat different story. Beta waves, fast wave activity commonly observed in people who are are thinking and solving problems, might be mixed in with alpha waves (slower waves linked to more relaxed states) and even slower theta waves, heralding the start of Stage 1 sleep.

Detecting the Lighter Stages of Sleep

But would it feel like you were actually sleeping? Research has shown that people woken up in Stage 1 sleep are often unaware that they’ve been asleep. In this liminal state, people can drift back and forth between sleep and wakefulness for quite some time before descending further into more sustained sleep, which is called Stage 2.

Stage 2 sleep is characterized by a predominance of theta waves and by features called sleep spindles and K complexes. Awoken in Stage 2 sleep, people are somewhat more likely to be able to sense that they were asleep.

But people with insomnia may not be as apt to report they were sleeping. Investigators have speculated that with all the nighttime baggage accompanying chronic insomnia—anxiety about sleep loss, lack of confidence in sleep ability, negative beliefs about sleep, increased beta wave activity during sleep—some insomniacs may simply lose touch with the feeling of falling asleep.

A Sleep Training Smartphone App

When a call went out for an inexpensive way to detect the start of sleep at home, Schwartz developed Sleep On Cue. A recent study comparing it to polysomnography (the test used in overnight sleep studies) found that Sleep On Cue was accurate at predicting the onset of Stage 2 sleep.

Why is this important? For one thing, the app (which costs $4.99) may prove to be useful in helping to administer intensive sleep retraining—an insomnia treatment developed in Australia—inexpensively in people’s homes.

But for readers of this blog, the immediate value of this app may lie in its potential to train or retrain insomnia sufferers to recognize what falling asleep feels like. This could alleviate some of the worry and anxiety about sleep and insomnia and thus make it easier to fall asleep and fall back to sleep.

Here’s How the App Works

Sleep On Cue works best, Schwartz says, if you conduct your training sessions when the pressure to sleep is high: late in the afternoon or early in the evening after a poor night’s sleep.

  1. Lie down and relax in bed, holding your smartphone in one hand. The phone will periodically emit a soft tone. Every time you hear the tone, give the phone a slight shake.
  2. When the app no longer detects movement, it assumes you’re asleep. Then, the phone vibrates to wake you up.
  3. The screen then displays this message: “Do you think you fell asleep?” Press “yes” or “no.”
  4. Next, you’re instructed to leave the bed for a few minutes. The phone will then vibrate to let you know when to return to bed for the next sleep trial. In this way, you begin to relearn what falling asleep feels like and gain confidence in your ability to do it.
  5. You decide when to end each training session. The screen then displays a graph with feedback about your sleep ability and your awareness of your sleep.

Here’s a link to the Sleep On Cue website. At $4.99, it’s not much of an investment and the payoff could be great.

If you’ve tried Sleep On Cue, did it improve your sleep and, if so, how?

How Much Melatonin Is Really in That Supplement?

Supplementary melatonin is the fourth most popular natural product used by adults in the United States and the second most popular given to children.

But supplements like melatonin are not subject to the same quality controls as prescription medications. A new study of melatonin sold over-the-counter shows that information on the label often does not reflect the content of the product.

Melatonin content may differ from amount listed on labelSupplementary melatonin is the fourth most popular natural product used by adults in the United States and the second most popular natural product given to children. It can change the timing of sleep, ease jet lag, and help night owls shift to an earlier sleep schedule. Occasionally it’s used to correct a melatonin deficiency, or for insomnia (although for insomnia it’s unlikely to yield much benefit).

But supplements like melatonin are not subject to the same quality controls as prescription medications. A new study of melatonin sold over-the-counter shows that information on the label often does not reflect the content of the product. Here are the details:

Testing for Melatonin and Serotonin

The researchers tested the contents of 30 different melatonin supplements sold in Canada (likely similar to melatonin sold in the United States). Among them were products with 16 different brand names (the names were not published), in 5 different strengths, and in 7 different formulations, some containing herbal additives and others without. They wanted to see how closely the amount of melatonin listed on the label matched the melatonin content of the actual supplement.

They also screened for serotonin. Serotonin is a precursor of melatonin found in the herbal extracts with which commercial melatonin is often combined.

Variation in Melatonin Content

Holy cow! The actual melatonin content of the supplements varied quite a lot from the content listed on the labels. Some labels overstated the amount of melatonin contained in the product. The worst offender here was a capsule listed as containing 3 mg of melatonin that actually contained about 0.5 mg.

Other labels greatly underrepresented the amount of melatonin in the product. The worst offender here was a chewable tablet listed as containing 1.5 mg of melatonin that actually contained nearly 9 mg. (This is particularly concerning since chewable tablets are most often taken by children.)

Not only was the melatonin content of the product off by more than 10% of the listed content in about 71% of the products tested. As shocking as this may seem, the melatonin content varied widely from lot to lot of the same product. While the first lot of the chewable tablets cited above contained nearly 9 mg of melatonin, the second lot contained only 1.3 mg. That’s a variation of 465%.

Variation Could Be a Problem

Does the dose of melatonin you take matter? To some extent, yes, say the authors of a commentary on the study. Suboptimal doses might be ineffective. Taking too low a dose might lead you to believe melatonin didn’t work when a higher dose would.

Higher-than-advisable doses could lead to undesirable side effects. Too high a dose would be risky for people taking medications that interact with melatonin, or those who are pregnant or have diabetes. And the long-term effects of supplementary melatonin on prepubertal children are still unknown.

Overall Conclusions

So what are we to do with this information in light of the fact that the researchers haven’t revealed the names of the products they studied? Here’s a summary of what they learned, which, if you take or are contemplating taking melatonin, is worth consideration.

  • The least variable products overall were those containing the simplest mix of ingredients: the tablets or sublingual tablets with melatonin added to a filler. Apparently, added herbal extracts tend to make products more variable.
  • Except for the chewable tablet cited above, capsules generally showed the greatest lot-to-lot variability in melatonin content. (However, the melatonin content of some capsules was within 10% of the content listed on the label).
  • Unexpectedly, the three liquid products tested showed fairly high stability and low lot-to-lot variability.
  • The melatonin content of products listed as containing 1 or 1.5 mg of melatonin was quite a bit more likely to diverge from what was claimed than were products listed as containing higher doses. Products purportedly containing 1.5 mg of melatonin were also quite a bit more variable from lot to lot.

Unlisted Serotonin

Eight of the 30 products tested contained unlisted serotonin. While the presence of serotonin is hard to explain in supplements containing just melatonin and a filler, it might be expected in supplements containing herbal extracts. In one such product, a capsule listed as containing 3 mg of melatonin plus lavender, chamomile, and lemon balm, the serotonin content was assessed at 74 micrograms.

Serotonin raises significant health concerns if taken in excess, the Canadian authors say. It can lead to a condition called serotonin syndrome, which can be mild or fatal and “exacerbated by interactions with other medications, such as selective serotonin reuptake inhibitors and the analgesic tramadol.”

I’d like to see the content of supplementary melatonin sold in the U.S. tested and reviewed by brand and formulation. ConsumerLab? Otherwise for people using over-the-counter melatonin (or interested in trying it) it’s a kind of Wild West situation when it comes to knowing which brand to buy. Pharmacists and doctors who prescribe melatonin may be better informed. Comments?

Sleep and Body Weight: A Close Relationship

“If you weigh too much, maybe you should try sleeping more.”

This commentary in the journal Sleep caught my eye. Flip as it sounds to a person who would sleep more if she could, it points to a relationship between sleep and body weight that should be widely publicized.

Sleep can also affect your ability to keep weight off. As for the relationship between insomnia and body weight, the latest news is surprising. Read on for details:

Insomnia with short sleep increases susceptibility to overweight“If you weigh too much, maybe you should try sleeping more.”

This commentary in the journal Sleep caught my eye. Flip as it sounds to a person who would sleep more if she could, it points to a relationship between sleep and body weight that should be widely publicized.

Sleep can also affect your ability to keep weight off. As for the relationship between insomnia and body weight, the latest news is surprising. Read on for details:

Sleep Deprivation and Weight Gain

It’s established now that sleep deprivation increases feelings of hunger (or interferes with feelings of satiation). Sleep deprivation occurs when sleep is arbitrarily restricted—as it might be during a research project in a sleep lab, when participants’ sleep is restricted to 4 hours a night—or when work or family responsibilities keep you from getting the sleep you need. Either way, the tendency is to eat more. And the more you eat, the more weight you gain.

People who are chronically sleep deprived don’t only tend to put on weight. They also risk developing metabolic syndrome, which is linked to serious medical problems like heart disease and diabetes.

So if the bathroom scale is inching upward every time you weigh yourself, consider not just changes to diet and exercise but also allowing more time for sleep if—and this an important caveat—you’re actually able to get more sleep. A mere 30 minutes more sleep a night can help with weight loss and greatly improve your long-term health.

Short Sleep and Body Weight

People who are short sleepers by nature—those who routinely sleep less (sometimes quite a bit less) than 6 hours a night—are also more susceptible to weight gain and obesity than those whose nights are longer. A study conducted over a period of 13 years showed that every extra hour of sleep duration was associated with a 50% reduction in risk of obesity.

Short sleep is also associated with impaired glucose tolerance and insulin resistance. Thus short sleepers are more at risk for developing diabetes as well.

Sleep Duration Is Not the Whole Story

But routinely shortened sleep is not the only sleep issue associated with weight problems. Research is showing now that sleep quality is related to the ability to lose weight and keep it off.

Unlike sleep duration, which can be objectively measured with polysomnography, sleep quality cannot be assessed objectively. So it’s typically measured with questions similar to these:

  • Do you regularly have trouble sleeping?
  • What’s the overall quality of your sleep?
  • How often do you experience a sense of well-being during the day?

One recent study found that better sleep quality and being a “morning person” correlated with successful weight loss maintenance. Compared with current enrollees in a weight loss program, people who’d lost at least 30 pounds and kept the weight off for at least a year reported significantly better sleep quality and were more often early risers.

In another study, investigators compared people who maintained a loss of at least 10% of their body weight to people who regained their lost weight. Men (but not women) who were successful at shedding pounds and keeping them off reported significantly better sleep quality (but not more sleep) than the weight regainers.

Do Insomniacs Typically Have Weight Problems?

Not necessarily, if results of the latest study can be believed. Researchers in Germany compared the body mass index (BMI) of 233 patients with “severe and chronic insomnia . . . showing objectively impaired sleep quality” to the BMI of 233 age- and gender-matched good sleepers. The results were surprising:

  • BMI, insomniacs: 23.8 kg/m2 (The “normal” BMI range is 18.5 to 24.9.)
  • BMI, good sleepers: 27.1 kg/m2

On average, the chronic insomniacs weighed significantly less than the good sleepers. If confirmed by other research, the result should be somewhat reassuring to those of us concerned about the consequences of insomnia. It would also lend support to the idea that insomnia has less to do with insufficient sleep than with excessive arousal (or hyperarousal) that may affect us 24/7.

Do you find yourself eating more after a couple bad nights?

Paradoxical Insomnia: A Second Look at Treatments

Paradoxical insomnia: a diagnosis given to people whose sleep studies show they sleep a normal amount but who perceive they sleep much, much less. When I wrote about it in 2015, the word was that cognitive behavioral therapy (CBT)—the gold standard in treatments for insomnia—might not be an effective treatment for it.

But a brief testimonial that recently appeared in American Family Physician argues otherwise. Here’s an update on this puzzling sleep disorder.

Paradoxical insomnia may respond to treatment with CBT & therapies lowering arousalParadoxical insomnia: a diagnosis given to people whose sleep studies show they sleep a normal amount but who perceive they sleep much, much less. When I wrote about it in 2015, the word was that cognitive behavioral therapy (CBT)—the gold standard in treatments for insomnia—might not be an effective treatment for it.

But a brief testimonial that recently appeared in American Family Physician argues otherwise. Here’s an update on this puzzling sleep disorder.

A Subjective-Objective Discrepancy

Time and again we hear that people with insomnia tend to underestimate sleep duration. Up to 50 percent of the time, the electroencephalograms (the graphic records of brain waves produced during overnight sleep studies) of insomnia sufferers reporting insufficient sleep look the same as those of normal sleepers, registering 7 or 8 hours of sleep.

But in people with paradoxical insomnia, the discrepancy between their sleep study results and their subjective assessment of their sleep is huge. The woman whose story appeared in American Family Physician perceived that she was routinely “awake all night.” Yet when she finally went in for an overnight sleep study, the record of her brain waves showed she’d slept a total of 7 hours and 18 minutes. She couldn’t believe it.

A Heavy Burden

You might think, since paradoxical insomniacs are getting a normal amount of sleep, that their insomnia symptoms would be less severe than those of “objective” insomniacs, whose sleep studies show they get less (sometimes considerably less) than 7 or 8 hours. Paradoxical insomnia may sound like “insomnia lite.”

Apparently it isn’t. Research has shown that paradoxical insomniacs tend to be more confused, tense, depressed, and angry than normal sleepers. They also have a higher metabolic rate, which suggests an overall higher level of arousal.

In-depth analyses of brain activity at night attest to this heightened arousal. Compared with objective insomniacs, paradoxical insomniacs experience more high-frequency activity, and less low-frequency activity, in the brain at night. Their sleep is light and vigilant.

Yet it’s often hard for people with paradoxical insomnia to convince others that anything is wrong. When the woman writing in American Family Physician complained about not having slept all night, her husband countered with insistence that she’d slept soundly the whole night. Her friends and colleagues were skeptical too, noting that she had a normal amount of energy and competence at work. She felt increasingly tormented—“not only because of the insomnia,” she wrote, “but also because of a loss of trust from my husband and friends. They said they wondered whether I was pretending just to get sympathy.”

What Could Be Wrong? What Can Be Done?

Scientists can’t explain exactly what the problem is. One hypothesis holds that paradoxical insomnia has something to do with sleep quality, and that treatments that train paradoxical insomniacs to perceive sleep when they’re objectively determined to be asleep may help. (See my other post about paradoxical insomnia here.) But adjusting people’s perceptions may not necessarily resolve all their insomnia symptoms or improve their long-term health.

Other researchers have proposed that paradoxical insomnia occurs due to heightened brain activity during sleep, a condition which is accurately perceived by those who experience it but will require more sophisticated measures to assess scientifically. If it’s true that in paradoxical insomnia the main barrier to satisfying sleep is excessive brain activity and vigilance at night, then therapies designed to lower arousal levels—exercise, yoga, meditation—may help.

How About CBT for Insomnia?

Some experts have expressed doubts about whether CBT for insomnia (CBT-I) has the potential to work as well for paradoxical insomnia as it does for the more common psychophysiologic insomnia. The main value of CBT-I is its ability to help people fall asleep more quickly and decrease nighttime wake-ups. At least when their sleep is assessed objectively, paradoxical insomniacs don’t usually have these particular problems.

But CBT-I also helps to dispel negative beliefs and excessive worry about sleep, which can make any type of insomnia worse. It was an effective insomnia treatment for the woman writing in American Family Physician. “After receiving cognitive behavior therapy,” she wrote, “I began to feel much better and now am able to sleep well most of the time.”

So if it feels like you’re hardly sleeping at all, consult a sleep doctor or a sleep therapist for a proper diagnosis and help in improving your sleep. There may be more insomnia treatment options than you think.

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Coffee: The Sleepless, Too, Can Enjoy the Benefits

I love coffee and I’m always glad to hear coffee is beneficial to my health. Two new studies—one of humans and the other of mice—add to this growing body of knowledge.

Yet coffee contains caffeine, and people with insomnia are often advised to cut down on caffeine because it interferes with sleep. Is there a middle course the sleepless can steer to avoid the harms and reap the benefits?

Coffee | insomnia sufferers can enjoy health benefits & avoid the harmsI love coffee and I’m always glad to hear coffee is beneficial to my health. Two new studies—one of humans and the other of mice—add to this growing body of knowledge.

Yet coffee contains caffeine, and people with insomnia are often advised to cut down on caffeine because it interferes with sleep. Is there a middle course the sleepless can steer to avoid the harms and reap the benefits?

Decaf is always an option. Caffeinated coffee may be OK, too—if you’re willing to experiment. Here’s more on that following a brief look at the new findings:

Coffee Reduces Mortality

The latest study of coffee and mortality found that coffee drinkers live longer than non-coffee drinkers. In this large, multi-ethnic study, people who drank one cup a day were 12% less likely to die than non-coffee drinkers. The odds were even better for people who drank two or three cups a day: they were 18% less likely to die.

The particular chemical or compound in coffee that protects against heart disease, cancer, respiratory disease, stroke, diabetes, and kidney disease is still unknown. But it probably isn’t the caffeine. Coffee’s life-protecting benefits were significant for people who drank caffeinated coffee and for those who drank decaf. They were significant for smokers and non-smokers; African-Americans, Asians, Latinos, and whites; and people of all ages.

Caffeine Reduces Pain Sensitivity

Pain can interfere with sleep. But a growing body of literature suggests that lack of sleep or poor quality sleep increases our sensitivity to pain, and that insomnia exacerbates existing pain and predicts new-onset pain.

In a new study, Boston researchers found that sleep deprivation in healthy mice increased their pain sensitivity. The greater the sleep deprivation, the more exaggerated were their responses to pain. After a period of normal sleep, their reaction to pain was much less pronounced.

Then, while still in a state of sleep deprivation, the mice were given caffeine or modafinil (a drug that promotes alertness). Their pain tolerance increased, similar to what they experienced after a full period of normal sleep. So if you’re experiencing pain and trouble sleeping, a caffeinated beverage like coffee may reduce your pain more effectively than drugs prescribed for pain relief.

Reaping the Benefits, Avoiding the Harms

It looks like moderate coffee drinking is associated with better health and resilience to pain. But if you’re prone to insomnia, you’ll need to do a bit of experimenting to find out when and how much you can drink without harming your sleep.

Here are some facts to be aware of as you’re figuring it out:

  • The effects of caffeine vary greatly from one person to the next. This is largely attributable to genetic factors. Drinking coffee later in the day may keep you wakeful and degrade the quality of your sleep, or it may not affect your sleep at all.
  • Research has shown that early risers tend to be the most sensitive to caffeine. People who go to bed and wake up somewhat later have less caffeine sensitivity, and the sleep of night owls may not be affected by caffeine at all.
  • People metabolize caffeine at widely varying rates. The average half life of caffeine (the point at which the amount of caffeine in the blood has decreased by half) is 5 to 6 hours. But the half life of caffeine can vary from 2 to 12 hours. Smokers typically metabolize caffeine quickly; pregnant women, slowly. And we all metabolize caffeine more slowly as we age.

Timing Is Important, Too

When you can safely drink your last cup of coffee may depend in part on the insomnia symptoms you have. For example, I have sleep onset insomnia, or trouble falling asleep at the beginning of the night. I find that drinking coffee after 2 p.m. can keep me wakeful so I avoid coffee later in the day.

But Lesley, who comments on my posts from time to time, has trouble with sleep maintenance insomnia, falling asleep easily at the beginning of the night but waking up in the middle of the night. After successfully working to consolidate her sleep with sleep restriction, she worked out for herself a different coffee drinking routine:

I know I’m pretty caffeine sensitive and for a long time drank only decaffeinated drinks. . . . After reading recent research . . . on caffeine’s effects on sleep and the body clock, I’ve now added caffeine back into my daily routine. I have sleep maintenance insomnia plus an early to bed/early to rise body clock, and I commonly struggle to stay awake in the evenings, and even the late afternoon.

But with much experimentation I’ve found that one instant coffee in the late afternoon and another about 2.5 hours before bedtime helps massively, without affecting me getting to sleep. Of course we’re all different in our tolerance to caffeine, and it’s very much trial and error. But it’s an extremely useful tool to be aware of.

Lesley puts it well: with a bit of trial and error experimentation, we insomniacs may be able to have our coffee and drink it, too.

If you’re a coffee drinker, how does it affect your sleep?

Alzheimer’s Disease: Are You, Poor Sleeper, at Risk?

I talk quite a bit about dementia and Alzheimer’s disease with family and friends. Our parents are drifting into cognitive impairment, asking the same questions again and again and struggling to find words to express themselves, and we wonder if we’re destined for the same fate.

The concern may be justified in middle-aged adults with chronically poor sleep, according to new research on sleep and two proteins involved in Alzheimer’s disease. Here’s more about the study and its relevance to people with insomnia and other sleep disorders.

Proteins linked to Alzheimer's a function of insufficient deep sleepI talk quite a bit about dementia and Alzheimer’s disease with family and friends. Our parents are drifting into cognitive impairment, asking the same questions again and again and struggling to find words to express themselves, and we wonder if we’re destined for the same fate.

The concern may be justified in middle-aged adults with chronically poor sleep, according to new research on sleep and two proteins involved in Alzheimer’s disease. Here’s more about the study and its relevance to people with insomnia and other sleep disorders.

Poor Sleep and Cognitive Impairment

Previous research has shown that poor sleep increases the risk of cognitive impairment. And mild cognitive impairment—trouble thinking and memory loss—is one of the first signs of Alzheimer’s disease. The cognitive declines and memory problems gradually worsen as deposits of two proteins—amyloid beta and tau—grow thicker and thicker, causing brain tissue to atrophy and die. To date the disease is irreversible.

But “poor sleep” can take different shapes and forms:

  • Sleep apnea, or pauses in breathing that occur repeatedly throughout the night, leaving sleepers feeling unrested in the morning.
  • Restless legs syndrome, in which sleep is disrupted by involuntary leg movements in the first half of the night.
  • Insomnia, consisting of trouble falling asleep, staying asleep, or waking up early in the morning, and related daytime complaints

Which feature of some or all of these sleep disorders might hasten development of amyloid plaques in the brain? The researchers suspected the problem had to do with deep, or slow wave, sleep, which is associated with feeling rested and restored in the morning. So they set out to see if disrupted slow wave sleep would bring about increased levels of amyloid beta in the brain.

Who They Studied, What They Did

Seventeen healthy adults ages 35 to 65 participated in the study, none with sleep problems or cognitive impairment. Each participant wore a wrist watch-type device to monitor their sleep. After several nights of wearing the device, participants spent a night in a sleep lab. There, they underwent a sleep study that involved wearing headphones.

Half of the participants were allowed to sleep without interruption. The other half experienced sleep disruption. Every time they entered deep sleep, they were subjected to beeps that grew louder and louder until their slow waves disappeared and were replaced by brain waves characteristic of lighter sleep.

The participants subjected to the beeps reported feeling tired and unrefreshed in the morning although they slept as long as usual. Most did not recall awakening during the night. All participants underwent a spinal tap so researchers could test for levels of amyloid beta and tau in the spinal fluid.

The procedure was repeated a month later, when the participants originally allowed to sleep uninterruptedly were subjected to the beeps and the others were allowed to sleep without interruption. Another spinal tap was conducted in the morning to measure protein levels.

Disrupted Deep Sleep and Harmful Proteins in the Brain

The results supported researchers’ contention about the effects of disrupted slow wave sleep:

  1. Participants’ amyloid beta levels were up by 10 percent after a single night of disrupted slow wave sleep
  2. In addition, levels of tau were significantly higher in participants whose wrist monitors showed they’d slept poorly during the week before the spinal tap

So disrupted slow wave sleep increased amyloid beta levels after just one night and tau levels after several days of poor sleep. Evidently, one function of slow wave sleep is to help rid the brain of byproducts that collect there during the day. When deep sleep is compromised, amyloid beta and tau start to accumulate. Development of cognitive impairment and Alzheimer’s is then more likely to occur.

Alzheimer’s and Poor Sleep in Perspective

So does the overall risk of developing Alzheimer’s increase with every poor night’s sleep? Probably not. Lead author Yo-El S. Ju, cited in a Washington University press release, said it’s unlikely that a single night or even a week of poor sleep has much effect on overall risk of developing Alzheimer’s disease. Amyloid beta and tau levels probably go back down the next time the person has a good night’s sleep, she said.

It’s people with chronic, untreated sleep disorders who should be concerned. Here, too, a dose of perspective is in order. Slow wave sleep occurs during the first half of the night. People who suspect they have sleep apnea, which occurs throughout the night, or restless legs syndrome, which occurs during the first half of the night, would be wise to see a sleep specialist for diagnosis and treatment.

People with chronic insomnia may have cause for concern as well—and maybe not so much. These investigators did not find that excess amyloid beta and tau had anything to do with sleep duration or sleep efficiency. Further, it’s never been shown that the main problem for people with insomnia is insufficient slow wave sleep. Some insomniacs experience a reduced percentage of slow wave sleep. Yet in others, slow wave sleep is intact.

The underlying problem in insomnia may instead involve restless REM sleep, which typically occurs in the second half of the night. It may have nothing to do with the development of amyloid plaques in the brain.

In any event, chronic insomnia can be treated (although the causes remain largely unknown). Click on “insomnia treatment” in the tag cloud to the right for more information.

7 New Insomnia Genes: What’s in It for Us

A flurry of articles recently announced the discovery of seven new risk genes for insomnia. In an era when new genes are being identified for everything from infertility to schizophrenia, you might regard this discovery as simply the soup du jour.

Not me. Growing up when trouble sleeping was attributed to psychological factors, coffee, and alcohol, I was elated by this news. We stand to gain so much from knowing the genetic underpinnings of insomnia.

Causes of insomnia are closer to being figured outA flurry of articles recently announced the discovery of seven new risk genes for insomnia. In an era when new genes are being identified for everything from infertility to schizophrenia, you might regard this discovery as simply the soup du jour.

Not me. Growing up when trouble sleeping was attributed to psychological factors, coffee, and alcohol, I was elated by this news. We stand to gain so much from knowing the genetic underpinnings of insomnia.

A Biological Basis for Insomnia

The most immediate benefit of the discovery is that it affirms what scientists have suspected for years: there is a biological basis for insomnia. This is common knowledge among sleep researchers but not so well known among members of the public or even doctors. They may still blame insomnia on psychological factors and poor self-control and dismiss it as a complaint unworthy of attention or treatment.

“Insomnia is all too often dismissed as being ‘all in your head,’” said Eus Van Someren, a lead researcher on the project, quoted in a press release. “Our research brings a new perspective. Insomnia is also in the genes.”

Genes contain the information needed to make proteins, and proteins do most of the work in the cells in our bodies and brains. The identification of insomnia risk genes suggests that vulnerability to insomnia has a neurobiological basis. It is likely driven by an excess or deficit of key neurochemicals or abnormalities in the circuitry of the brain.

What the Discovery Doesn’t Mean

People sometimes confuse the idea of genetic risk with biological determinism—the belief that hereditary factors are the sole determinants of who we are and the health challenges we face. The assumption is that if constitutional factors predispose a certain disease or health condition, then nothing can be done to alter its course.

There are a small number of irreversible diseases caused by mutations in a single gene. If you’re born with a certain mutation in the HTT gene, for example, you inevitably develop Huntington disease. Nothing can be done to change this.

But most diseases and conditions—insomnia included—are complex. No single gene determines whether you get them or not. Multiple genetic factors likely come into play, increasing the odds of developing a disorder but not making it inevitable. Environmental, social, psychological, and behavioral factors may play as big a role in determining whether you develop insomnia or not.

It might be possible to inherit several insomnia risk genes but, thanks to a privileged set of circumstances, never experience trouble sleeping a day in your life. Likewise, despite being biologically predisposed to experience insomnia, you may be able to manage the disorder some or even most of the time with cognitive and behavioral techniques.

Benefits of Genetic Studies

Genetic studies such as this one will enable scientists to trace the pathways by which insomnia develops and identify the biological mechanisms involved. In turn, insomnia treatments can be developed that alter these particular systems, rather than being aimed at systems merely suspected of involvement. Drugs can be developed to target the root causes of insomnia rather than simply tranquilizing the brain.

Other Discoveries and Implications

  • The insomnia risk genes are known to be associated with disorders that often occur with insomnia: restless legs syndrome, anxiety disorders, depression, and type 2 diabetes. Likewise, insomnia was found to have a shared genetic background with neuroticism and poor sense of well-being, traits that often occur in people with insomnia.
  • Some genetic variants associated with insomnia in women were different from the variants associated with insomnia in men, so the biological mechanisms driving insomnia may in some cases be different. If this is true, insomnia treatments prescribed for women may in some cases need to be different from those prescribed for men.

Every new genetic study brings us closer to the time when trouble sleeping will be treated based on the cause of the insomnia rather than its symptoms. Surely that’s something to celebrate!