Sample Q & A

INSOMNIA TODAY: WHY WE NEED TO TALK ABOUT IT AND WHAT CAN BE DONE

1.   Q:  We hear quite a lot about sleep problems these days. A third of the people in the US suffer insomnia occasionally and 10 percent have more serious insomnia complaints. But why talk about it when insomnia is really a symptom of other problems? Shouldn’t we look into the causes of insomnia—modern lifestyles, bad habits, psychological problems—for answers?

A:  Insomnia can be a symptom of many health problems—from cancer and Parkinson’s to anxiety and apnea. But there’s been a sea change in thinking about it in recent years.

Scientists are now looking at chronic insomnia as a disorder itself. They’re not exactly sure how it develops. But it has a unique set of biological markers. And when insomnia occurs concurrently with other health problems, research shows that it isn’t necessarily a secondary issue. In fact it’s looking like the causality sometimes goes the other way.

2.   Q:  Can you give me an example of that? An instance where the research shows that insomnia can cause another health problem to emerge?

A:  Persistent insomnia makes you more vulnerable to lots of health problems—from hypertension and heart disease to obesity and diabetes. And now they’ve shown that insomnia is actually a causal factor in depression. Having chronic insomnia makes you twice as likely as someone without insomnia to develop clinical depression down the line.

3.   Q:  You’ve said that insomnia is not well understood. What do we know about how it develops—or is it just a big black box?

A:  The word is now that chronic insomnia is a “multifactorial” disorder–meaning many factors are probably involved. It was the biological aspects of insomnia that I found most fascinating as I was doing research for The Savvy Insomniac. Insomnia used to be attributed to psychological factors alone: you had it because you were repressing your emotions, or because you were a worrier or a perfectionist, or because it earned you sympathy from friends. It was a great relief to discover that these psychological theories about insomnia are not part of the discussion anymore.

4.   Q:  Can you tell us briefly about some of the new research?

A:  Sure. In some studies, researchers have compared activity in the brains of normal sleepers with activity in the brains of insomniacs. One thing they’ve found is that while good sleepers’ brains shut down completely at night, key areas in insomniacs’ brains continue metabolizing glucose even as the rest of the brain sleeps. We’re not just imagining that we’re awake; parts of the brain really ARE awake.

Another thing they’ve found is that people with insomnia tend to be more reactive to stress and have higher levels of stress hormones circulating in the blood. This suggests that insomnia is a disorder of “hyperarousal”—something that’s probably with us 24/7.

5.   Q: What about the environment we live in–that has to have an effect on our sleep. Isn’t insomnia basically a problem of modern times? We move too fast, we’re too attached to computers and iPhones, we worry a lot about money, pensions, jobs. That makes it harder to relax.

A:  If you go back about 140 years, when the US was industrializing and people were moving away from farms and into cities, you find that they were just as concerned about sleeplessness then as we are today—and for many of the same reasons. Too much noise, hustle and bustle, competition, overstimulation of the senses, and overtaxing of powers.

If you look further back in time, as far back as ancient Greece and Rome, you find that philosophers, too, wrote about sleeplessness. Wakefulness at night dates as far back as recorded history and probably farther. It may once have been adaptive—a good way to keep humans out of harm’s way after dark.

6.   Q:  So what can people with insomnia do to get more sleep? We hear mainly about sleeping pills. Is that our only choice?

A:  Sleeping pills have been a popular treatment for insomnia since the early decades of the 20th century. Before that, wine and sleeping potions made from opium poppies were common sleep aids. Throughout history, people have sought relief from sleeplessness in substances they could eat and drink. There are other options today.

7.   Q:  But do any of them work, and are they realistic? You know what they say in magazines—go to sleep and get up at the same time every day, don’t nap, get plenty of exercise, and so forth. It sounds an awful lot like boot camp.

A:  Tips like that can sound unappealing, and alone they may not be very useful for people who want better sleep.

Cognitive-behavioral therapy, or CBT, is the gold standard in drug-free treatments for insomnia today. It involves changes in habit and mindset. It’s been helpful for 70 to 80 percent of the people who’ve tried it. Definitely it helped me.

8.   Q:  Tell us more about it.

A:  If you have insomnia, the problem may be that it takes you a long time to fall asleep. Or it may be that once you get to sleep, you wake up several times during the night, or you may wake up early in the morning and not get back to sleep. In each of these cases, you’re spending quite a bit of your time in bed awake. Which is frustrating!

Among other things, CBT involves restricting your time in bed at first so your sleep can become more consolidated. The goal is to get you to fall asleep more quickly and sleep right through the night with fewer wake-ups. As your sleep becomes more solid, you extend your time in bed until you find your ideal sleep time—and then you stick with it.

9.   Q:  Restricting your time in bed doesn’t sound like much fun! But you say it worked for you?

A:  The first few days I went around feeling pretty miserable. That part certainly wasn’t fun! But by the end of the first week I was starting to feel better. I was sleeping more soundly and functioning better during the day. There’s more to it than this, though, and there are also other options for people looking for treatments that are drug free.

10. Q:  So are sleeping pills really as bad as they sound these days? Sleep eating, sleep driving, accidents, people admitted to emergency rooms—where is all this heading?

A:  Our public discussion of sleeping pills isn’t very nuanced, and that’s unfortunate. In the past decade, the pharmaceutical companies spent millions hyping their products, and now every time a figure like Kerry Kennedy slams into a truck and blames it on Ambien, it’s the sleeping pill that goes on trial. In reality, a very small percentage of people who use sleeping pills wind up doing things like sleep eating and sleep driving. Yet hype and hysteria are all we ever hear about sleeping pills.

Like all drugs, sleeping pills have side effects, and a few of the effects are sobering. But some people’s insomnia is intractable, and for them prescription sleep aids are a lifeline.

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