Relief From Early Morning Insomnia

It may be true that the early bird gets the worm. But there’s no advantage to waking up before the birds—or so I’m told by insomnia sufferers who routinely wake up at 2:30 or 3 a.m. and can’t get back to sleep. It’s depressing to wake up too early night after night.

Here’s why early morning insomnia occurs and how to get your sleep cycle more in sync with daylight and darkness.

early morning awakening can be avoided by postponing sleepIt may be true that the early bird gets the worm. But there’s no advantage to waking up before the birds—or so I’m told by insomnia sufferers who routinely wake up at 2:30 or 3 a.m. and can’t get back to sleep. It’s depressing to wake up too early night after night.

Here’s why early morning insomnia occurs and how to get your sleep cycle more in sync with daylight and darkness.

A Timing Issue

Early awakening insomnia has to do with the body clock and the circadian system, which control internal processes that occur on a daily basis such as sleep and the secretion of melatonin (a hormone conducive to sleep).

Some people are simply born with a body clock that runs faster than normal due to genetic factors that run in families. Rather than completing a daily cycle every 24 hours or thereabouts, their internal clocks complete a daily cycle once every 23 or 23.5 hours. It’s an ongoing struggle for these early awakeners to keep their eyes open for evening meetings and concerts. Routinely they wake up at 3 and 4 a.m.

Circadian Factors in Older Adults

Lifelong early awakeners are relatively rare. But older adults commonly experience a shift in sleep timing that causes them to nod off and wake up earlier than they did when they were younger. This pattern is not due to a sudden shortening of the circadian period but rather to age-related changes in the circadian system.

Circadian rhythms tend to weaken with age. This weakening makes both the sleep and wake states less stable, leading to increased shifting between the two states. Older adults are thus more inclined to take naps during the daytime and wake up more often at night. Shifting often and easily between sleep and wake becomes the new normal.

Another effect of weakened circadian rhythms is the forward shifting of sleep timing that occurs in some older adults. In humans, the pressure to sleep mounts steadily during the day and is quite high in the evening. Throughout much of our lives, this pressure is counteracted by robust circadian forces working to keep us alert and awake until our normal bedtime (say, 11 p.m.). The weakening of these circadian forces makes it harder for older adults to stay awake in the evening and more likely that they will experience early awakening insomnia.

Postpone Sleep in the Evening

Regardless of what’s causing your early morning insomnia, the way to sleep longer in the morning is to postpone your bedtime. Here’s how:

  1. Get plenty of exposure to bright light in the evening. Light can have a big effect on the timing of sleep. Turn lights up full blast at about 7 p.m. and keep them on for a couple hours. If this doesn’t keep you from nodding off early, purchase a light box that emits light as strong as daylight. Set it beside you as you read or do whatever you do in the evening. In the summertime, take an evening walk.
  2. Avoid bright light early in the morning. Exposure to bright light soon after awakening will shift your body clock in the wrong direction, making you sleepy sooner rather than later in the evening. Keep lights dim and shades drawn early in the morning. Wear dark glasses if you go outside.
  3. Exercise late in the afternoon or early in the evening rather than early in the morning. Like light, activity can affect the timing of sleep. Early morning exercise will tend to make you sleepy early in the evening. But exercise late in the afternoon or early in the evening will help postpone the urge to fall asleep.
  4. Cut down on alcohol in the evening. Alcohol tends to make you sleepy when it enters your system. But 4 or 5 hours later, once it passes through your system, it tends to make sleep fitful and wake you up.
  5. Engage in pleasurable evening activities involving movement. Do crossword or jigsaw puzzles. Play the piano or take out a sketch pad and draw. Call friends and family. Take up quilting. Knit as you watch TV. Page through picture books and catalogues. Or try using a shiatsu massage pillow to see if the sensation is pleasurable while at the same time keeping you awake.

Exposure to evening light and habitual evening activities may not delay your sleep cycle to the extent you’d like. But awakening at 4:15 may end up feeling more palatable than awakening at 3:45.

Nap Rooms? Flextime Might Help More

There’s a campaign going to educate people about the importance of sleep. Some companies are responding by installing “nap rooms” where employees can catch a few winks during the workday (or the work night).

But access to a nap room at work would not improve my productivity or my health. Nor would it make me less prone to insomnia. What would help (if I were still going in to work everyday rather than working from home) would be the option to work on a flextime schedule in sync with my body clock. Here’s why:

Insomnia probably won't be alleviated by offering employee nap roomsThere’s a campaign going to educate people about the importance of sleep. Some companies are responding by installing “nap rooms” where employees can catch a few winks during the workday (or the work night).

Napping at work can reduce workplace sleepiness; decrease insomnia among and improve the health of shift workers; and improve learning, memory, and overall performance. What’s not to like?

But access to a nap room at work would not improve my productivity or my health. Nor would it make me less prone to insomnia. What would help (if I were still going in to work everyday rather than working from home) would be the option to work on a flextime schedule in sync with my body clock. Here’s why:

Regularity in Sleep and Wakefulness

I study sleep and insomnia partly to manage my own trouble sleeping, and one thing I’ve realized is that my body thrives on regularity. There’s a reason insomniacs are told to go to bed and get up at the same time every day: it helps keep the forces controlling sleep and waking in sync with one another and with daylight and darkness.

Really good sleepers can get away with sleeping pretty much whenever they want. But if I stray too far from my regular bed and rise times, I have insomnia.

Likewise, I feel better where there’s regularity in my days, and research suggests that having a daily routine is protective of sleep at night. Working, eating meals, exercising, even socializing at the same time everyday helps keep the body’s circadian forces in sync.

A nap room at work wouldn’t help me—and not just because napping now and then would interfere with my regular schedule, or because long naps can reduce the build-up of the sleep pressure that triggers sleep at night. The truth is that except when I’m sick, I simply can’t drop off during the daytime. I may feel exhausted but I’m never sleepy enough to fall asleep.

Work and Circadian Rhythms

I sleep and feel better when I work in the morning, when I’m most alert. But as an employee, often I had to work evening shifts. The effort it took to pay attention at evening meetings of school boards and townships I covered as a reporter (which were usually deadly dull) was so arousing that it took me hours to calm down enough to fall asleep.

Even worse were the split shifts I worked for a year in Mexico. I taught class from 7 to 10 a.m. and from 7 to 9 p.m. at night, 5 days a week. This schedule would have been doable for many people—5 hours a day in the classroom, with the entire midday stretch free to kick around town, visit the market, or see friends.

But it was awful for me. In the afternoons, knowing I had to teach again later the same day, I couldn’t fully relax (much less take a nap). Returning home after 9 p.m. and then having to wind down enough to fall asleep and be up for a 7 a.m. class was practically impossible. Insomnia kicked in big time and I was a mess.

“You can’t fight your body clock,” a friend said to me. Even then, before I knew anything about circadian rhythms and preferences, I sensed she was on to something big.

The Flextime Option

As a freelance writer–editor now, I set my own hours. It’s done wonders for my sleep. But not everyone has the option to give up regular paychecks.

Sleep-savvy employers—those who really understand the importance of sleep—will not just give their employees nap rooms. If the work itself does not preclude it, they’ll offer flextime options so that all employees—including the sleep challenged—can work when we’re most alert and most productive. It’s a win–win setup. So why not?

Have you been in a work situation where you had to “fight your body clock”? How did you manage? Were flextime options available? If they weren’t, might they have made a difference?

Back to Nature? Not for This Insomniac

Artificial lighting gets a bad rap in stories about sleep these days. Before Thomas Edison invented the light bulb, we’re told, our forebears slept longer than we do today.

There are reasons to think this might be true: Exposure to artificial lighting at night delays secretion of melatonin, in turn postponing sleep. Light at night can also reset the body clock, altering sleep timing and giving rise to circadian rhythm disorders and insomnia.

Advice for how to avoid these problems usually runs along the lines of dimming lights in the evening and getting plenty of exposure to sunlight during the day. Count me as a believer here. But the back-to-nature solutions some are touting? Meh, I’ll pass.

Electric lighting can be helpful and harmful to sleepArtificial lighting gets a bad rap in stories about sleep these days. Before Thomas Edison invented the light bulb, we’re told, our forebears slept longer than we do today.

There are reasons to think this might be true: Exposure to artificial lighting at night delays secretion of melatonin, in turn postponing sleep. Light at night can also reset the body clock, altering sleep timing and giving rise to circadian rhythm disorders and insomnia.

Advice for how to avoid these problems usually runs along the lines of dimming lights in the evening and getting plenty of exposure to sunlight during the day. Count me as a believer here. But the back-to-nature solutions some are touting? Meh, I’ll pass.

Camping

Some folks claim that camping is a sure path to better sleep. What better way to detach from our worries and synchronize our body clocks with terrestrial time than to pitch a tent in the woods? There’s science behind this claim:

  • Two years ago researchers reported that after a week of camping, eight adults experienced changes in the timing of their sleep, going to bed and waking up an hour earlier than usual and feeling more energetic in the morning.
  • In a more natural setting reported on in June, scientists found that people living without access to electricity in a remote community in Argentina slept 40 minutes longer in the summer and 60 minutes longer in the winter than people living with electric lighting 30 miles away.

As persuasive as these reports may be, living closer to nature is not going to improve my sleep. For one thing, I’m naturally an early riser. The prospect of awakening still earlier does not appeal.

And what about the bugs? All it takes is a mosquito buzzing around my head to get me swatting at the walls of the tent, and even if I manage to kill it I’m still wound up. And if that doesn’t keep me awake, the camping mattress will. I have yet to find a mattress that’s comfortable for my back.

Glamping

glamping

Glamping, or glamorous camping, might solve the mosquito problem and would certainly provide a comfy bed. But even if I could afford to “glamp,” I’d still be out in the middle of nature, and for all its virtues (I will admit there are some) nature isn’t quiet.

Nocturnal creatures were not raised by parents like mine, who insisted that to do anything but tiptoe around and whisper after 10 p.m. was inconsiderate and rude. Without so much as a by your leave, animals at night will shriek, snarl, snort, hoot, growl.

Light sleepers and insomniacs, exactly how is this going to improve our sleep?

A Glass House

glass-house

Here’s another shelter said to bring circadian rhythms into harmony with nature, deepen sleep, and boost our sense of well-being: the all-glass house. Its lack of privacy might give pause. Yet the all-glass house has one advantage over many glamping setups I’ve seen: it blocks out up to 85 percent of external noise.

 

 

Let’s Cut to the Chase

The main reason these back-to-nature solutions aren’t my cup of tea is that I’m a naturally short sleeper, and even the longest days of the year are not quite long enough for me. Going to bed at sundown—even when that means 10 p.m.—is a recipe for a terrible night’s sleep: tossing and turning, thinking existential thoughts, pondering insoluble problems. Who needs that when with the flick of a lamp switch I can pick up a book and fill my brain with happier thoughts?

Yes, I could read by candlelight or lantern. But that’s not nearly as convenient or easy on the eyes as the incandescent light beside my reading chair. I could also entertain myself in the dark by listening to a book on CD. But then I’m apt to nod off too early, and a too-early bedtime spells a night of insomnia for me.

I hear that some lucky people can actually enjoy periods of wakefulness at night. They let their minds wander and manage to achieve a relaxed, meditative state. But that’s not me. Artificial lighting saves me from the gloomy thoughts that are always ready to waylay me at night.

No doubt I’m sending the wrong message here: for every one of me there are a hundred teenagers texting and peering at their iPads at night and seriously shorting themselves on sleep. Turn off your devices, you sleepyheads, and turn out the lights!

But hey, Thomas Edison, here’s one insomniac who still thinks electric lighting is cool.

Eat Right to Sleep Tight

In the late Renaissance, many medical authorities were convinced that digestive processes controlled the duration of sleep. People slept as long as necessary to digest their evening meal.

That proposition fell by the wayside long ago—yet new evidence suggests that the timing of meals does affect our sleep. Particularly in people who are prone to insomnia, eating more regular meals, and eating dinner earlier in the evening, may be important keys to sounder sleep and good health.

Eating irregular meals, and iron-high snacks at night, is harmful to sleep and healthIn the late Renaissance, many medical authorities were convinced that digestive processes controlled the duration of sleep. People slept as long as necessary to digest their evening meal.

That proposition fell by the wayside long ago—yet new evidence suggests that the timing of meals does affect our sleep. Particularly in people prone to insomnia, eating regular meals, and eating dinner earlier in the evening, may be important keys to sounder sleep and good health.

In Sync

Regularity is a familiar theme to people with insomnia. “Go to bed and get up at the same time every day,” we hear again and again.

Good sleepers tend to do this naturally. Their stable, high quality sleep is a sign that their internal circadian rhythms are all synched up. These rhythms are established by the body clock, which hews to a 24-hour cycle with daily exposure to sunlight.

People with insomnia are not so regular about sleep. Over a two-week period, the authors of a study of daily activities and sleep found, insomnia subjects had over an hour of daily variability in when they went to bed and got up in the morning. This variability could throw their internal rhythms out of whack and lead to symptoms of insomnia.

But compared with normal sleepers, the insomniacs were also more variable in when they had meals and snacks. For them, lunch could vary by as many as 3 hours from one day to the next. The timing of their evening snacks had a range of almost 3 hours as well.

A Relationship between Eating and Sleeping         

Sunlight is not the only thing that keeps our circadian rhythms synched up. In addition to the master clock in the brain, which is set by the sun, many peripheral clocks are spread throughout our bodies. Some of them are sensitive to the timing of meals. Eating at odd hours disrupts their rhythm. Circadian rhythms are then thrown out of sync, and this invites insomnia.

“This finding highlights the potential importance of regular mealtimes,” the authors state. “Perhaps incorporating a regular meal schedule into treatment for those with insomnia could help to align the internal clock with a 24-hour light/dark cycle, which would contribute to healthier sleep.”

Avoid Iron-Rich Foods at Night

Another study suggests that eating foods high in iron at night is harmful to health. Not only does it alter circadian rhythms, but it may also increase our vulnerability to obesity, diabetes and other metabolic disorders.

This study was conducted on mice. One of the many peripheral clocks in mice and humans is located in the liver, an organ that regulates blood glucose levels. In this study, scientists found that dietary iron establishes the circadian rhythm of the liver.

Eating iron-rich foods during the daytime is healthy. Metabolic processes that ensue after a meal high in meat, beans, leafy green vegetables or dried fruit are not harmful when they occur in sync with the body’s natural rhythms.

But feeding iron to mice at a time when they would normally be asleep resulted in the clock in the liver going out of sync with the body clock in the brain, and a dysregulation of blood glucose levels. Particularly in shift workers, said investigators in ScienceDaily, eating foods high in iron at night could lead to obesity, diabetes and other metabolic disorders.

So if you’re a poor sleeper or prone to raiding the fridge at midnight, aim for regular meals and lighter midnight snacks.

What foods do you typically eat when you can’t sleep?

 

Blue Light's Effect on Sleep? It's Not All Bad

Blue light gets a bad rap these days in articles about sleepy teens. Exposure to blue light in the evening interferes with the secretion of melatonin (a sleep-friendly hormone), pushing circadian rhythms out of whack. This can lead to insomnia or sleep deprivation. Doctors are counseling teens and the rest of us to turn off devices that emit blue light—computers, tablets, and smartphones—in the run-up to bedtime.

This is sound advice as far as it goes. But the story on light is bigger than this simple warning suggests. Knowing how to manage your exposure to blue light can help you steer clear of sleep problems and increase your daytime stamina.

Blue light interferes with sleep and melatonin secretion at night but is beneficial during the dayBlue light gets a bad rap these days in articles about sleepy teens. Exposure to blue light in the evening interferes with the secretion of melatonin (a sleep-friendly hormone), pushing circadian rhythms out of whack. This can lead to insomnia or sleep deprivation. Doctors are counseling teens and the rest of us to turn off devices that emit blue light—computers, tablets, and smartphones—in the run-up to bedtime.

This is sound advice as far as it goes. But the story on light is bigger than this simple warning suggests. Knowing how to manage your exposure to blue light can help you steer clear of sleep problems and increase your daytime stamina.

“I Play Solitaire on My iPad at Night”

Screen time at night not just a temptation for teens. A grandmother I met the other day wondered if playing solitaire on her iPad in the middle of the night was contributing to her insomnia and making it harder to fall back to sleep.

I replied that it might be. Humans are most sensitive to the effects of blue light when our brains least expect it: late in the evening, at night, and early in the morning. The most intensive source of blue light is the sun. But the self-luminous screens of computers, iPads and iPhones emit blue light, too, at wavelengths that suppress melatonin. TV screens also emit blue light. But proximity to a light source matters. We position ourselves much closer to handheld devices and computers than we do to TVs, so the newer devices are more likely to interfere with sleep.

There’s an App for That

If you can’t bear to part with your iPad at night, there are ways to protect yourself from the light it emits. Dr. Craig Canapari recently posted an article containing helpful advice, and I’ll summarize it here:

  • Manually dim screens on devices at night
  • Visit Just Get Flux to download free software that automatically adjusts the color temperature of your computer screen according to the time of day
  • Get “night mode” software for your tablet or smartphone. The display will appear as white text on a black background.

You can also wear blue light-blocking glasses at night. A new study of teens shows that blue-blocker glasses with orange lenses allow for normal melatonin secretion and sleepiness to develop at night regardless of time spent looking at screens. But expect to pay more for these glasses than for a cheap pair of sunglasses with orange lenses. Cheap glasses will block blue light and other colors, too, so they won’t work well indoors.

Last but not least, use dim red lights as nightlights. Red light is least likely to suppress melatonin secretion and shift the rhythms of your body clock.

Soak Up the Rays During the Day

In the daytime, on the other hand, exposure to blue light is beneficial. Not only does it boost your attention, speed your reaction time and elevate your mood. It also helps you maintain a regular sleep/wake cycle.

But as the days grow shorter, you may miss out on daily exposure to the sun, a critical source of blue light. If you work in a windowless office, warehouse, or power plant and you commute in the dark, the daily resetting of your body clock enabled by sunlight does not have a chance to occur. Your circadian rhythms may go off track and your sleep take a turn for the worse.

A study just published in PLoS One illustrates this neatly. It was conducted at a polar base station at a time of year when crew members got no daily exposure to sunlight. Here’s what the researchers found:

  • When the subjects were working in standard indoor lighting for 2 weeks, they experienced a significant, 30-minute delay of melatonin secretion in the evening, and a decrease in sleep duration.
  • Working in blue-enriched white light for 2 weeks, they did not experience the delay in melatonin secretion. They slept longer and experienced a greater sense of wellbeing and alertness during the day. Daily exposure to blue-enriched light made the difference.

If you regularly miss out on the sun, consider investing in a light box, which will give you the daily dose of blue light your body needs. Better yet (but maybe something of a long shot), suggest the installation of blue-enriched white light at your workplace. The fact that it enhances work performance could sweeten the idea for the boss.

Have you noticed a seasonal pattern to your insomnia, where in the wintertime it tends to grow worse?

Sleep Well Despite Poor Work Conditions

Stressors at work— demanding bosses, looming deadlines, performance reviews, and the like—can fuel insomnia. But low light and the timing of work can also affect sleep. Lack of exposure to sunlight on the job and night or shift work may reduce total sleep time and deprive you of energy in your waking hours.

But you may be able to manage these less-than-optimal work conditions in ways that improve both your sleep and your stamina.

working without natural light has a negative effect on sleep and staminaStressors at work— demanding bosses, looming deadlines, performance reviews, and the like—can fuel insomnia. But low light and the timing of work can also affect sleep. Lack of exposure to sunlight on the job and night or shift work may reduce total sleep time and deprive you of energy in your waking hours.

But you may be able to manage these less-than-optimal work conditions in ways that improve both your sleep and your stamina.

Working without Natural Light

Working without the benefit of sunlight during the daytime has a surprisingly negative effect on sleep, a new study in the Journal of Clinical Sleep Medicine shows. The goal of the study was to compare the vitality and sleep of employees that worked in windowless cubicles to those of subjects whose workstations were exposed to natural light.

Not only did the 22 workers in the windowless cubicles report less activity during the daytime and poorer quality sleep. On average, they also got 46 minutes less sleep than the 27 employees who worked near windows.

Out of Sync

The timing of your workday can also interfere with your sleep. Nearly 15 million full-time American workers labor on schedules that involve night, rotating or irregular shifts, which necessitates the resetting of the body clock.

Having to work when you’d normally be asleep and to sleep when you’d normally be awake causes changes in the activity of genes, a study recently published in the journal Proceedings of the National Academy of Sciences shows. Genes control the production of proteins, and to function optimally, protein production needs to coordinate with the natural cycle of activity and rest.

When the body clock is reset, as occurs in people who do night and shift work, the number of genes synched up to the body’s natural circadian rhythms falls rather dramatically, pushing digestive and other physiologic processes out of whack. Ten percent of shift workers are regularly diagnosed with “Shift Work Sleep Disorder”—they feel sleepy on the job and have insomnia when it’s time to sleep.

Night owls may choose to work the night shift and, given their delayed circadian rhythms, this schedule suits them to a “T.” Others fare poorly. The years when I worked a split shift were the years when my insomnia was at its worst.

What’s a Worker to Do?

If low light is a problem at work,

  • Invest in a light box and use it (for tips on how to use a light box, see my blog on winter insomnia)
  • Go outside or to sunlit parts of the building during breaks.
  • If you do work near windows, keep the blinds open and, if necessary, use anti-glare shades for computer screens.

If the timing of your workday is a problem,

  • Aim for consistency in your sleep schedule. It may be tempting to alter your sleep schedule on weekends to maximize time with family and friends. But having to readjust to your weekday schedule on Monday may leave you struggling to stay alert at work and tossing and turning in bed.
  • Manipulate your exposure to light. Bright light in the work environment will help to keep you alert and on your toes. But exposure to sunlight on your way home from work will tend to delay sleep further. If your goal is to get to sleep immediately after work, wear dark glasses on the way home.
  • Make judicious use of caffeine. Drinking coffee at the beginning of your shift should not interfere with getting to sleep when you get home. But the caffeine-sensitive will want to avoid caffeine later in the work shift. If sleepiness becomes a problem, the better strategy is to get up and move around.

Q&A: What Is Melatonin Replacement Therapy?

I’ve just heard of melatonin replacement therapy, a reader wrote last week to Ask The Savvy Insomniac, and I’m wondering if I should look into it. I’m 61. I never used to have problems with insomnia but now I wake up a lot at night. Over-the-counter melatonin does nothing for me. Is the melatonin used in replacement therapy somehow different?

Melatonin-replacementI’ve just heard of melatonin replacement therapy, a reader wrote last week to Ask The Savvy Insomniac, and I’m wondering if I should look into it. I’m 61. I never used to have problems with insomnia but now I wake up a lot at night. Over-the-counter melatonin does nothing for me. Is the melatonin used in replacement therapy somehow different?

 

A Bit of Background

The hormone melatonin is a major player in the sleep system. Secreted by the pineal gland, it helps create strong biological rhythms that regularly put people to sleep and keep us sleeping through the night.

But often melatonin rhythms grow weaker with age. This occurs for three reasons, says Rüdiger Hardeland in a recent review paper on melatonin in aging and disease:

  • degeneration of neurons in the SCN (a.k.a. the body clock)
  • deterioration of neurons connected to the pineal gland
  • calcification of the pineal gland.

Any of these factors may result in insufficient production of internal melatonin, resulting in insomnia at the beginning or in the middle of the night.

Melatonin Replacement Therapy

It’s worth consideration if melatonin deficiency is your problem. In the US, two options for replacement therapy exist:

  • over-the-counter melatonin supplements, and
  • the prescription drug Rozerem, or ramelteon.

When caused by melatonin deficiency, trouble falling asleep at the beginning of the night responds well to treatment with melatonin supplements, Hardeland says. Over-the-counter melatonin, which is chemically identical to the melatonin produced in your body, may be effective even at low doses (e.g., 0.5 mg) and is the better option for people with sleep onset problems. If taking it close to bedtime doesn’t work, try taking it earlier in the evening. (See my blog on sleepy night owls.)

Replacement Therapy for Trouble Staying Asleep

But at low doses, OTC melatonin supplements are not going to help people who experience frequent wake-ups. The half-life of melatonin is just 20 to 45 minutes. It doesn’t have enough staying power to keep you sleeping through the night.

Higher dosages of melatonin—50 or 100 mg—have been proposed as a therapy for sleep maintenance insomniacs but have yet to be tested, Hardeland says, adding, however, that 300 mg of melatonin administered to ALS patients for up to 2 years was found to be safe.

If sleep maintenance is the issue, ramelteon, a drug more powerful than natural melatonin, is the better option, according to Hardeland. But it may not work for everyone. Trials of ramelteon have shown the improvements it produces in sleep maintenance to be modest. In a recent study of melatonin in elderly patients, the effects of the drug on sleep maintenance were “highly variable.”

A perfect solution for sleep maintenance insomnia caused by melatonin deficiency has yet to be invented. (Circadin, a time-release formulation of melatonin, is available by prescription in Europe. But with this drug, too, effects on sleep maintenance have been modest.)

If you’re a baby boomer or older, though, and your insomnia has developed with age, melatonin deficiency could be part of the problem. Replacement therapy is worth checking out.

The ADHD-Insomnia Connection

Got ADHD? Chances are you’ve got insomnia symptoms, too. About 92 percent of the subjects in a recent study of adults with ADHD reported going to bed late because they were “not tired” or “too keyed up to sleep.”

The sleep problems of adults with ADHD may be due to delayed (and possibly less stable) circadian rhythms. If you’ve got ADHD-related insomnia, treatments aimed at advancing circadian phase may help.

too-much-to-doGot ADHD? Chances are you’ve got insomnia symptoms, too. About 92 percent of the subjects in a recent study of adults with ADHD reported going to bed late because they were “not tired” or “too keyed up to sleep.”

Results of this study, from University of Alabama at Birmingham, show that the sleep problems of adults with ADHD are due to delayed (and possibly less stable) circadian rhythms. (Circadian rhythms are controlled by the body clock.) And, say UAB researchers, delays in sleep timing—and daytime sleepiness—correlate with more severe hyperactive-impulsive and inattentive ADHD symptoms. If you’ve got ADHD-related insomnia, treatments aimed at advancing circadian phase may help.

The Larger Picture

The new findings are in line with the results of other work. Investigators have found, for instance, that ADHD is associated with differences in type or expression of these circadian genes: CLOCK, BMAL1, and PER2.

The body’s production of sleep- and wake-friendly hormones is correspondingly delayed. Investigators in The Netherlands reported in a 2010 study that secretion of melatonin—which helps with sleep at night—began an average of 83 minutes later in adult subjects with ADHD than in adults without. Production of cortisol, which helps with waking up in the morning, is also delayed in people with ADHD.

Across the board, ADHD subjects tend to fall asleep later and wake up later than subjects without ADHD. The medical diagnosis for this delay in falling asleep, when uncomplicated by ADHD, is Delayed Sleep Phase Disorder. Treatments that work for people with DSPD may work for you if you’ve got ADHD.

Better Sleep, Less Sleepiness

  • Bright Light Therapy: A two-hour exposure to bright light (sunlight, or light from a light box) immediately upon waking up every morning is the most effective way to shift sleep to an earlier hour. But this may not jibe with your morning routine. In the winter you wake up to darkness, and continuous use of a light box may not be an option if you have to care for children or get ready for work. Do the best you can by turning up lights in your home full force, and spend as much time as possible by a light box in the first few hours of the day.
  • Melatonin Supplements: Over-the-counter melatonin supplements may also help shift your sleep forward when used every day. But melatonin is not a sleeping pill. It’s effective only when taken well before your internal melatonin secretion begins. For best results, take a tablet 5 to 7 hours before your normal bedtime (rather than right before bedtime, as advised on the label).
  • Rozerem: Ask your doctor about Rozerem (or ramelteon) if you’re interested in going the prescription drug route. Rozerem, approved by the FDA in 2005 for people with trouble falling asleep, purportedly behaves like a super-melatonin. Unlike most sleeping pills on the market today, it’s not known to have many side effects. Take it half an hour before you go to bed.

Shifting circadian rhythms forward may improve your sleep, cut down on daytime sleepiness, and—possibly—help control your ADHD symptoms.

If you’ve got ADHD, how often do you find yourself too keyed up to sleep?