Is Insomnia a Hybrid State?

Some research suggests that insomnia is a hybrid state, when the brain is neither fully asleep nor fully awake.

Now there’s new evidence for this claim. A new study suggests that insomniacs’ inability to quiet the brain at night is linked to pockets of activity that show up in PET scans while the rest of the brain is asleep.

pet scanSome research suggests that insomnia is a hybrid state, when the brain is neither fully asleep nor fully awake.

Now there’s new evidence for this claim. A University of Pittsburgh study in the October issue of the journal Sleep suggests that insomniacs’ inability to quiet the brain at night is linked to pockets of activity that show up in PET scans while the rest of the brain is asleep.

I was thinking about the implications of this when I went to bed last night. Strange as it may sound, I think it may actually have helped me fall asleep. More about this following news of the study:

Glucose Metabolism During Sleep and Wake

Information processing and thinking require energy. So lots of glucose gets metabolized in the brain during the daytime. Much less glucose is metabolized at night, when the brain is fairly quiet.

The Pitt researchers wanted to assess metabolic activity in the brains of people with and without insomnia to see if there were differences at night and during the daytime. PET scans can measure the rate of metabolic activity occurring in different regions of the brain and render the information in images. So the researchers screened two groups of participants—44 insomniacs and 40 good sleepers—and administered PET scans when they were sleeping and after they woke up.

Summarizing the study results, Daniel Buysse, co-author and professor of psychiatry at the University of Pittsburgh, was quoted in TribLive.com, saying, “What we found is that the people with insomnia have regions of their brain that seem to not shut off as completely when they’re asleep.”

Pitt researchers have been pursuing this line of research for over a decade now. In 2004, results of their first (smaller) neuroimaging study of insomniacs and good sleepers were published, showing similar results.

Regions of Activity and Inactivity in the New Study

Which brain regions were unusually active during sleep? Compared with images of good sleeper brains, the images of insomniacs’ brains during sleep showed significantly higher metabolic activity in 3 key regions associated with

  • Thinking
  • Memory and self-reflection
  • Affect, or mood

This fits pretty neatly with the experience of insomnia, when at night the mind just doesn’t seem to be able to turn itself off. How familiar are thoughts like these: Can I meet my deadline tomorrow? It’s depressing that I handled the presentation so badly. What are they thinking about me now?

Just as interesting was the finding that these same regions of the brain were underactive in insomniacs after they woke up in the morning.

Ever have trouble hauling yourself out of bed? concentrating on your work? feeling low and out of sorts after a bad night’s sleep? Daytime symptoms of insomnia—lack of stamina, trouble thinking, moodiness—may also correspond to the level of metabolic activity occurring in various regions of the brain.

How I Fell Asleep Last Night

When the midnight train whistle sounded I was still engrossed in a novel. But I finally lay down to an internal dialog with myself as I waited to fall asleep:

How’s the spy in the novel going to get back to Viet Nam?

He’s already writing his memoirs in a 3- by 5-foot prison cell. It could get grisly. Bad choice for bedtime reading!

I forgot to read the election news.

Anything but the election! Get back to the character in the book!

I’m too hot. That’s a bad sign.

Throw off a cover, will you!

I might have trouble sleeping.

You’ll fall asleep eventually. You might be partway there.

Hmm.

What if parts of my brain were already asleep? What if at that moment I was experiencing exactly what the neuroimaging studies showed, with parts of my brain already sleeping and other parts resisting sleep? Could I entertain the notion that my brain was halfway released from its burden of consciousness when my mind and senses argued otherwise?

It must have been a comforting proposition. Because after that I was out.

Have you ever had the sensation of being partly awake and partly asleep? What did it feel like?

Naps & Sleep Restriction: Could This Be a Happy Marriage?

Lesley Gale was a light sleeper who began to have insomnia about 8 years ago. She consulted doctors and tried the remedies they proposed, but nothing seemed to work. Investigating on her own, she came upon a treatment called sleep restriction therapy, or SRT.

“I had heard of SRT before,” Gale wrote in an e-mail, “having seen a couple of documentaries on TV about it, and then did further reading on the Internet. But for years I dismissed it instantly as being absolutely impossible for me.” Napping was off limits during SRT, and this was a deal breaker.

Sleep restriction for insomnia may be easier to comply with if insomniacs are allowed a brief afternoon napLesley Gale was a light sleeper who began to have insomnia about 8 years ago. She consulted doctors and tried the remedies they proposed, but nothing seemed to work. Investigating on her own, she came upon a treatment called sleep restriction therapy, or SRT.

“I had heard of SRT before,” Gale wrote in an e-mail, “having seen a couple of documentaries on TV about it, and then did further reading on the Internet. But for years I dismissed it instantly as being absolutely impossible for me, as I’m sure a lot of other people initially react.

“‘I need my 8 hours,’ I thought. I couldn’t possibly stay awake until the early hours of the morning—I’m a confirmed morning lark, not a night owl.” Having to stay up late was not the only problem Gale foresaw. Napping, too, was off limits during SRT, and for years, this was a deal breaker. “I can’t live without naps,” she said.

SRT and Naps

SRT, a behavioral treatment for insomnia, involves restricting time in bed for a while and then slowly adding time back in as sleep improves. Restricting time in bed is helpful because it enables a robust build-up of sleep drive during the day. The greater your sleep drive at bedtime, the more readily you’ll fall asleep and the more likely you are to sleep through the night. Anything that interferes with the build-up of sleep drive will retard your progress. So napping is generally discouraged.

But napping has never been strictly prohibited. In the first weeks of SRT, insomniacs tend to experience mild sleep deprivation, which can sometimes result in overwhelming sleepiness during the day. Sleepiness is dangerous if you’re driving a car or operating machinery. People are advised to avoid such dangers by taking a nap, but to keep the nap short. “No more than 30 minutes,” is the advice my sleep therapist gave me.

A New Perspective on Napping

Then a few months ago, I read about a study being conducted by Nicole Lovato, a postdoctoral research associate at Flinders University. The purpose of Lovato’s study is to find out if adding a 20-minute afternoon nap before 5 p.m. to the SRT protocol will not only keep from undermining the treatment but will actually increase its success.

“Even though we know this treatment [SRT] works very well,” Lovato said, quoted in Medical Express, “a lot of patients feel so sleepy that they find it difficult to adhere to their new bedtime, which is often much later than the time they normally go to bed. . . . We’re hoping that daytime napping will make it easier for patients to adhere to their bedtime and get through the day when they’re undertaking sleep restriction therapy.”

Unlike long naps, short naps are unlikely to interfere with the sleep restriction process. When you first fall asleep, you’re in the lighter stages of sleep, and hovering in the lighter stages will not diminish sleep drive. During long naps, on the other hand, you’re likely to descend into deep sleep. Deep sleep is the stuff that reverses sleep drive, and that is what you want to avoid.

A Testimonial

I wanted to have the results of Lovato’s study in hand before blogging about it. But I mentioned the study in the comment section of another blog, and Lesley Gale, whose desperation to find a solution to her insomnia had prompted her to start SRT despite her reservations, saw the comment and responded this way:

“I’m only 2 weeks into SRT, and I was so excited when I read . . . about naps maybe being OK with SRT,” Gale wrote. “Not being able to have naps has really put me off trying SRT before. But a ‘micro nap’ has worked wonders for me twice this week. About 10 minutes each time, I felt invigorated afterwards, and it didn’t affect my nighttime sleep at all.

“I can’t express what a massive relief it has been! Will keep this new favourite tool only for when I’m feeling really, really sleepy during the daytime. Just having that possibility in the back of my mind has made me feel so much more relaxed about making it through till bedtime.”

The Results Aren’t In Yet, but . . .

Reading Gale’s story has prompted me to go ahead and write about adding brief naps to SRT. People are sometimes desperate for ways to manage their insomnia, and if being allowed a 10- or 20-minute power nap in the afternoon before 5 p.m. might make SRT more palatable and easier to comply with, surely the benefits of mentioning it will outweigh the harm. If you try it out, though, make sure to set an alarm clock to keep your nap short and sweet.

Sleep: Practice Makes Perfect? Maker of App Says Yes

Would you be willing to undergo nearly 24 hours of sleep deprivation if by doing so you could learn to fall asleep more quickly?

This is pretty much the bargain you make if you undergo Intensive Sleep Retraining (ISR), a treatment developed in Australia to help people with insomnia learn to fall asleep more easily. The idea behind ISR is that trouble falling asleep is mainly conditioned, involving negative beliefs about sleep, and worry about sleep loss, and poor sleep hygiene. The goal is to get rid of these impediments and make it easier to fall asleep.

A polysomnographic technologist says insomnia sufferers can achieve the same results using a new iPhone app.

SleepQWould you be willing to undergo nearly 24 hours of sleep deprivation if by doing so you could learn to fall asleep more quickly?

This is pretty much the bargain you make if you undergo Intensive Sleep Retraining (ISR), a treatment developed in Australia to help people with insomnia learn to fall asleep more easily. The idea behind ISR is that trouble falling asleep is mainly conditioned, involving negative beliefs about sleep, and worry about sleep loss, and poor sleep hygiene. The goal is to get rid of these impediments and make it easier to fall asleep.

How ISR Works

You spend one night in a sleep lab. There, you’re wired up with electrodes, and every 30 minutes you’re instructed to let yourself fall asleep. But you’re never allowed to sleep more than a few minutes. A lab tech comes in to wake you up and sees to it that you’re awake for the rest of the period. Then another 30-minute sleep trial begins.

The results? The few clinical trials conducted show that insomnia subjects who have undergone ISR are able to get to sleep faster and sleep longer. These gains have lasted up to 6 months.

But ISR is currently unavailable in the US. The treatment is expensive and not covered by insurance. Plus the idea of 24 hours of sleep deprivation can be off-putting. So why mention it?

A Sleep Training App

Michael Schwartz, a registered polysomnographic technologist, has developed an iPhone app that delivers sleep training in what he believes is a more palatable way. Called SleepQ, this inexpensive app is based on the principles of ISR and designed to give users repeated exposure to what it feels like to fall asleep at home.

Schwartz’s many years of work in hospital-based sleep centers have convinced him that the problem for many insomnia sufferers is not that we can’t fall asleep, but that we lose touch with what falling asleep feels like and confidence in our ability to do it. Practice with SleepQ at a time when the pressure to sleep is high—for a few hours late in the afternoon or early in the evening following any rough night of sleep, per Schwartz’s recommendation—gives users repeated exposure to what it feels like to fall asleep and helps restore confidence, he says. Like ISR, SleepQ also enables 24-hour training for people who want to do it.

How SleepQ Works

  • Lie down and relax in bed, holding your iPhone in one hand. Every time the phone emits a tone, give it a slight shake.
  • When the app no longer detects movement, it assumes you’re asleep. Then, the phone vibrates to wake you up.
  • The screen then displays this message: “Do you think you fell asleep?” Press “yes” or “no.”
  • Next, you’re instructed to leave the bed for a few minutes. The phone will vibrate to let you know when to return to bed for the next sleep trial.
  • 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.

How effective is SleepQ at relieving insomnia? So far, Schwartz can cite only anecdotal testimonials from patients he’s helped. But if you’re open to experimenting, $4.99 is not a lot to lose. For more information about the app, visit the SleepQ website.

A Tip for the Tired and Wired

I recently joined a friend to watch Cloud Atlas at her home. A bad choice for evening entertainment! This is a movie where evil is lurking around every corner.

New research on laboratory mice suggests why arousing activities have such a strong impact on sleep.

horror-movieI recently joined a friend to watch Cloud Atlas at her home. A bad choice for evening entertainment! This is a movie where evil is lurking around every corner, and the suspense in each of the six plotlines tied my stomach up in knots. We turned off the DVD player near bedtime, but unwinding enough to fall asleep took me nearly three hours. Even then my sleep was patchy and unsatisfying.

What we do and what we think about before bedtime has a big impact on our sleep. Aristotle had this figured out back in Ancient Greece. “The intellectual activities which cause wakefulness are those in which the mind searches and finds difficulties rather than those in which it pursues continual contemplation,” he wrote.

New research on laboratory mice suggests why arousing activities have such a strong impact on sleep. Researchers at UT Southwestern Medical Center have discovered two new proteins, one that tracks sleep need and the other that determines how long it takes to fall asleep. Their study, published last month in Proceedings of the National Academy of Sciences, showed that these two processes are separate, and that even mice that were sleep deprived did not fall asleep quickly when placed in an arousing environment.

Tired and Wired

The subjects in this experiment were three groups of mice with identical genes. The control group was allowed to sleep and wake up at will.

The two test groups were deprived of sleep for six hours. During this time, one test group underwent a series of cage changes. With each new cage change, the mice set about vigorously exploring their new surroundings for about an hour. Mice in the other test group were kept awake by a researcher gently tapping the cage or waving a hand in front of their faces.

When finally the mice in the two test groups were allowed to sleep, the second group dropped off right away. But the cage-exchange mice took as long to fall asleep as mice in the well-rested control group.

“The need to sleep is as high in the cage-changing group as in the gentle-handling group,” said Dr. Masashi Yanagisawa, lead author of the study, quoted in Science Daily. “But the cage-changers didn’t feel sleepy at all. Their time to fall asleep was nearly the same as the free-sleeping, well-rested control group.”

Moral of the Story

You can’t always control what happens in the evening, and it’s boring to be a shut-in while others are out having fun. But if sleep is what you’re after, follow the advice offered by Dr. A. Brigham in 1845: “Those who are liable to have disturbed sleep should take especial care that their evenings pass tranquilly.”

What kinds of evening activities typically disrupt your sleep?