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?

Acupuncture for Insomnia: An Update

This summer I saw a cousin of mine who lives in San Francisco. He was using acupuncture for insomnia and happy with the results.

I’ve always wondered about acupuncture as a potential treatment for insomnia, so now and then I check the literature. Here’s a summary of recent thinking about it.

Insomnia may respond to acupuncture treatmentsThis summer I saw a cousin of mine who lives in San Francisco. He was using acupuncture for insomnia and happy with the results.

Back when I lived on the West Coast, I tried acupuncture for help in managing stress (the usual trigger for my insomnia) and also got results. A single session of acupuncture—followed by use of foul-smelling herbs I was to boil and drink as tea—really helped to calm me down.

I still wonder about acupuncture as a potential treatment for insomnia, so now and then I check the literature. Here’s a summary of recent thinking about it.

Why Might Acupuncture Work for Insomnia?

The underlying problem for people with insomnia is said to be hyperarousal. Insomniacs’ brains are unusually active at night, suggesting hyperarousal of the central nervous system. Whether and how acupuncture could calm the brain is yet to be worked out.

There’s also evidence that insomniacs are more physiologically aroused than normal sleepers. We tend to have elevated metabolic rates and, at night, lower heart rate variability, suggesting involvement of the autonomic nervous system (the system controlling things we can’t consciously direct, such as breathing and heartbeat). Hyperarousal in insomniacs suggests too much activity of the sympathetic branch of the autonomic nervous system (associated with stress and the fight-or-flight response).

Acupuncture has a direct effect on the autonomic nervous system, say Wei Huang and colleagues at the Emory University School of Medicine. It’s been shown to influence known indicators of autonomic activities such as blood pressure, heart rate, and heart rate variability. It’s used to manage cardiovascular diseases such as hypertension and cardiac arrhythmia. It’s also been shown to regulate neurotransmitters and hormones important to the sleep–wake cycle.

Acupuncture may work by tamping down the physiological arousal that makes it harder for insomniacs to go to sleep and stay asleep at night. But how it does so remains unknown.

What About Clinical Trials?

Some reviewers have found that acupuncture has overall positive effects on sleep. Study participants have reported that acupuncture helps them:

  • Fall asleep more quickly
  • Sleep more efficiently
  • Sleep longer
  • Have better-quality sleep

Other reviewers have not found convincing evidence that acupuncture helps people sleep longer or better. A survey of literature through 2011 concludes that there’s not enough “high-quality evidence” either to support or refute acupuncture as an effective treatment for insomnia.

A Standard Hard to Meet

By high-quality evidence reviewers often mean the results of double-blinded, randomized clinical trials—the gold standard for studies of a treatment on human beings. This type of study involves comparing an active treatment to a sham treatment (a medication to a placebo pill, for example), assigning participants to either the active treatment or the placebo treatment in a random manner, and making sure that neither participants nor clinicians know who’s getting what.

This standard is hard to meet in studies of acupuncture, David Mischoulon says in a commentary in the Journal of Clinical Psychiatry. Fake acupuncture—needles placed in positions known not to affect sleep, or acupuncture with nonpenetrating needles—is often used as a sham treatment. But acupuncture practitioners always know whether they’re administering active or fake treatment and may subtly communicate this to trial participants, compromising study results.

Also, the contribution of the “placebo effect” to acupuncture study results is apparently considerable. Says Mischoulon, “We found that believing that one was receiving an active intervention seemed to correlate with clinical improvements more so than which intervention was actually received.”

Mischoulon and others have proposed different types of sham treatments for use in future acupuncture trials. Hopefully they will supply the high-quality evidence needed to settle the issue of whether and in which situations acupuncture might work as a treatment for insomnia.

Different Acupuncture Points

Meanwhile, other researchers have trained their attention on which acupuncture points seem to help insomniacs the most. These are believed to have calming effects:

  • PC-4 Ximen (in the middle of the forearm with palm side up)
  • GV-14 Dazhui (on the back at the base of the neck)
  • PC-6 Neiguan (just above the wrist with palm side up)
  • EX-HN1 Sishencong (at the top of the head)
  • BL-15 Xinshu (on the upper back just right of the spine)

In summary, the evidence on acupuncture’s effectiveness for insomnia is still mixed. But it’s got one big advantage over sleeping pills. Its safety and lack of side effects have been demonstrated again and again.

If you’ve tried acupuncture for relief from insomnia, please let us know how it worked.

Why Are Insomniacs Prone to Hyperarousal?

My insomniac nights are rare these days—but I had one last week. Nearing bedtime, it felt like a train was running through my body with the horn at full blast.

The mechanisms underlying hyperarousal are still unknown. But according to a study recently published in the journal PNAS, it may be linked to fragmented REM sleep and unresolved emotional distress. Here’s more:

hyperarousal is a common daytime symptom of insomniaMy insomniac nights are rare these days—but I had one last week. Nearing bedtime, it felt like a train was running through my body with the horn at full blast.

Earlier that evening I’d returned to a place where I had a humiliating experience a few years ago. Being at that place made it feel like the incident was happening again. The emotions it recalled were so powerful that at midnight I was still too aroused to fall asleep. I had a bad night and woke up to what I call an “insomniac day”: the feeling of being depressed and anxious at the same time.

Insomnia is often described as a problem of “hyperarousal,” and when I look for signs of hyperarousal in myself, this sort of situation comes to mind. It starts with a powerful emotion (like humiliation or excitement) and with what I’ve come to feel is an impaired ability to calm down. I have coping strategies that work pretty well in the daytime. But if something triggers strong emotion in the evening, I’m sunk.

The mechanisms underlying hyperarousal are still unknown. But according to a study recently published in the journal PNAS, it may be linked to fragmented REM sleep and unresolved emotional distress. Here’s more:

Sleep Helps Regulate Emotion

Sound sleep helps stabilize emotional memories in long-term memory. It also reduces their emotional charge. Being robbed at gunpoint just 2 blocks from your house is a frightening experience. But if you sleep well that night, the next day, although you’ll recall the robbery clearly, the fear accompanying it will be less distressing than it was the day before.

Rapid eye movement (REM) sleep, associated with dreaming, plays an important part in this process. Intact REM sleep enables us to regulate negative emotion and wake up in a better frame of mind. But when REM sleep is fragmented, as often occurs in insomnia, less resolution of emotional memories can occur. In this study, scientists looked for relationships between fragmented REM sleep, slow-resolving emotional distress, hyperarousal, and insomnia.

Shame and Other Self-Conscious Emotions

In the past, scientists investigating REM sleep’s role in emotion regulation have looked at its effects on basic emotions like fear and anger. But the authors of this study claim that people more often need help with problems involving self-conscious emotions such as pride, guilt, embarrassment, humiliation, and shame.

In this study, they focus on shame because “it may interfere the most with healthy psychological functioning. . . . By obstructing effective coping mechanisms, shame often hinders therapeutic progress, to the point that it may even lead to a negative therapeutic outcome.”

A Two-Part Study

Thirty-two people participated in the first part of the study, 16 with insomnia disorder and 16 with normal sleep. They spent two nights in a sleep lab undergoing polysomnography, a test that records brain waves. They also filled out a questionnaire about the frequency and content of their dreams.

Participants whose brain waves indicated more frequent arousals and who experienced increased eye movement during REM sleep (i.e., the insomnia sufferers) experienced more thought-like (rather than dream-like) mental activity at night. Investigators concluded that a higher “nocturnal mentation” score could be used as a stand-in for the experience of restless REM sleep.

For Part 2, about 1,200 participants in the Netherlands Sleep Registry filled out a battery of questionnaires concerning nocturnal mentation, the duration of emotional distress after a shameful experience, insomnia severity, hyperarousal, and a host of related phenomena.

Hyperarousal Linked to Slow-Dissolving Distress

The researchers analyzed their data using sophisticated statistical techniques and here’s what they concluded:

  • The overnight resolution of distress from shame (and likely other negative emotions) is compromised in people with insomnia
  • This deficit may result from a build-up of unprocessed emotion and contribute to hyperarousal
  • This deficit seems in part to develop due to restless REM sleep (with frequent arousals and high-density eye movements) and thought-like nocturnal mentation.

If all this is true, then insomnia treatments need to target restless REM sleep. No treatment available now has been specifically shown to do that. Still, given that cognitive behavioral therapy for insomnia (CBT-I) has been shown to help people with insomnia and depression, another disorder characterized by irregularities in REM sleep, it might be the best treatment on offer now.

Insomnia: Is Hyperarousal a Problem 24/7?

Hyperarousal is a term I mention when people want a quick explanation for what’s behind insomnia. The word seems to resonate. Think of hyper- as in “excessive” or “extreme”; arousal, meaning “activation” or “animation.” Or plain old hyper, meaning “very excited, nervous, or active.”

“Hyperarousal” is a pretty good way to describe the feeling of insomnia at night. But is there a test for it? Does it happen only at night, or do insomniacs experience hyperarousal 24/7?

Insomnia sufferers are hyperaroused around the clockHyperarousal is a term I mention when people want a quick explanation for what’s behind insomnia. The word seems to resonate. Think of hyper- as in “excessive” or “extreme”; arousal, meaning “activation” or “animation.” Or plain old hyper, meaning “very excited, nervous, or active.”

Many people with insomnia tell me they have an overactive mind at night. They’re chewing over a problem and just can’t stop. Or they’re thinking ahead and worrying they won’t have time to get everything done.

Some insomniacs talk about feeling wired: “Something will wake me up,” Amy explained in an interview, “and my heart’s racing and it can feel almost like an adrenaline feeling. I’m nervous and I can’t shut down—that’s the experience I have.”

“Hyperarousal” is a pretty good way to describe the feeling of insomnia at night. But is there a test for it? Does it happen only at night, or do insomniacs experience hyperarousal 24/7?

Measures of Hyperarousal in Body and Brain

When researchers test for physiological arousal, the differences that show up between people with insomnia and normal sleepers are fairly small. On measures of heart rate, metabolism, stress hormones, and possibly body temperature, the tests show, on average, that insomniacs are cranked up a notch—but just a notch—higher on the arousal scale than normal sleepers.

Studies of brain waves at night—when they involve something called power spectral analysis—are slightly more revealing. Normal sleepers’ brains cycle tidily through all the sleep stages.

The brains of people with insomnia cycle through all the sleep stages as well. But mixed in with the usual theta and delta waves are high-frequency wave forms normally associated with being awake and alert and solving problems. This beta activity that shows up in insomniacs’ brains at night suggests that low-level information processing may be occurring even as we sleep. It’s commonly cited as evidence of insomniacs’ hyperarousal at night.

These differences between insomniacs and normal sleepers may help explain the trouble we have tuning out, mentally and physiologically, at night. But neither the physiological differences nor the beta activity at night are considered to be definitive proof of insomnia.

Hyperarousal in the Daytime

You might not think that hyperarousal describes how insomnia feels during the daytime. When morning comes, your complaint is probably that you’re not aroused enough. You feel fatigued and low energy, brain-fogged and unable to think clearly. It’s a major struggle to function, let alone get through the day.

But these complaints may actually be manifestations of hyperarousal during the daytime. European researchers used high-density electroencephalography (a fine measure of electrical activity in the brain) to investigate the brain waves of insomniacs and normal sleepers when they were awake. They placed electrodes on participants’ scalp and took readings when they were in a resting state, with (1) eyes open and (2) eyes closed.

  • With their eyes open, the participants with insomnia had comparatively lower alpha power. (Alpha waves are prominent when we’re in a relaxed state of consciousness and not making an effort to do anything.) Lower alpha power would be consistent with less ability to calm down and less ability, in the face information overload, to filter out what’s unimportant or irrelevant.
  • With their eyes closed, the insomniacs experienced significantly more beta power than did the normal sleepers. In the authors’ words, “The widespread high power in a broad beta band reported previously during sleep in insomnia is present as well during eyes closed wakefulness, suggestive of a round-the-clock hyperarousal.”

If insomnia really does derive from round-the-clock hyperarousal, then treatments focused only on extending sleep may not do much to mitigate our daytime symptoms. Better solutions will improve the quality of both our nights and our days.

If you have insomnia, do you experience a feeling of hyperarousal during the daytime? How exactly does it feel?

Restless REM Sleep May Lead to Hyperarousal

Do you tend to dwell on upsetting thoughts? Does your arousal thermostat feel like it’s set too high, making it hard for your body to relax and fall or stay asleep? Insomnia is often described as a disorder of hyperarousal, yet how and why the hyperarousal develops is unclear.

Now a team of 13 sleep scientists from three countries have taken findings from different lines of research, conducted a study of their own, and come up with a plausible explanation for why our minds and bodies feel like they’re stuck in overdrive and just can’t stop. Here’s what may lie behind our trouble falling and staying asleep.

insomnia, characterized by fragmented REM sleep, leads to slow emotional processingDo you tend to dwell on upsetting thoughts? Does your arousal thermostat feel like it’s set too high, making it hard for your body to relax and fall or stay asleep? Insomnia is often described as a disorder of hyperarousal, yet how and why the hyperarousal develops is unclear.

Now 13 sleep scientists from three countries have taken findings from different lines of research, conducted a study of their own, and come up with a plausible explanation for why our minds and bodies feel like they’re stuck in overdrive and just can’t stop. Here’s what may lie behind our trouble falling and staying asleep.

Two Kinds of Sleep

Whether we sleep poorly or well, our nights are composed of two kinds of sleep: REM sleep, when most dreaming occurs and when the eyes move rapidly from side to side; and non-REM, or quiet, sleep. The deepest stage of non-REM sleep is called slow-wave sleep.

In the past, scientists thought that insomnia probably had to do with a dysfunction related to slow-wave sleep or some other feature of non-REM sleep. This may be the case for some people with insomnia.

But the results of two recent studies suggest that the problem may lie elsewhere. The findings show that sleep maintenance insomnia (the type of insomnia involving middle-of-the-night awakenings) is characterized by fragmented REM sleep.

Importance of REM Sleep

There’s solid evidence now that REM sleep—most of which occurs in the second half of the night—helps us process negative emotions such as fear and anger and self-conscious emotions such as guilt, embarrassment, humiliation, and shame. In studies where participants are forced to rise too early, they often wake up in a bad mood.

The reason is that they’ve gotten insufficient REM sleep, say sleep scientists, and the full processing of emotion has not had a chance to occur. As a result, any negative emotion they experienced the previous day may still retain its emotional charge.

There’s also preliminary evidence that fragmented REM sleep (such as that found in insomnia) hinders the overnight resolution of emotional distress.

Authors of the current study, published in Proceedings of the National Academy of Sciences, wanted to take this research further. They predicted that fragmented (or restless) REM sleep could interfere with the overnight resolution of emotional distress, thus contributing to the accumulation of arousal, and eventually hyperarousal, associated with insomnia.

A Two-Part Study

First, the researchers tested 32 people—16 with insomnia disorder and 16 normal sleepers—in a sleep lab for two nights. The object was to find out if restless REM sleep correlated with the frequency of participants experiencing thought-like rather than dream-like mental activity at night (as assessed by questionnaires). Thought-like nocturnal mentation—when we’re mentally chewing on a problem, for example—is specifically associated with restless REM sleep.

In addition, the researchers looked for relationships between restless REM sleep, duration of emotional distress, and chronic hyperarousal in data compiled on 1,199 people participating in the Netherlands Sleep Registry. The NSR is a psychometric database created to facilitate research on factors that discriminate people with insomnia from people without sleep complaints.

Restless REM Sleep, Emotional Distress, Hyperarousal

The investigators used sophisticated statistical methods to analyze their data, and here’s what they found:

  • Compared with normal sleepers, insomniacs were slower to recover from long-lasting emotional distress. The more severe the insomnia, the slower the recovery.
  • Thought-like mental activity was more frequent among insomniacs than normal sleepers, and it was significantly associated with emotional distress lasting overnight (but not with short-lasting distress resolved during the previous day).
  • The more severe the insomnia, the more people reported symptoms of hyperarousal.
  • Long-lasting emotional distress accounted for 62.4% of the association between hyperarousal and the thought-like mental activity occurring during restless REM sleep.

What It Means for Us

The findings conformed to researchers’ expectations. So here’s their explanation for why insomniacs, both mentally and physiologically, keep going and going and can’t seem to relax into sound, consolidated sleep: mental activity we experience at night—which is associated with fragmented REM sleep (and increased eye movement density)—interferes with the overnight resolution of emotional distress. So we awaken with the distress still in place, which ramps up arousal. Over time, this could lead to a state of chronic hyperarousal.

It sounds plausible to me. Your thoughts?

Insomnia: Finding Method in the Madness

It used to be that the only predictable thing about my insomnia was that it occurred at times of high drama. Anticipation of a trip to the Canary Islands? Nothing like a little excitement to keep me awake at night. Difficulties with a colleague at work? Stress, too, was a set-up for trouble sleeping. Whenever my life got the least bit interesting or challenging, sleep went south.

But sleep is easier to manage now that I’m able to see more patterns in my insomnia and the insomnia of others.

Insomnia may occur in patterns which can be figured outIt used to be that the only predictable thing about my insomnia was that it occurred at times of high drama.

Anticipation of a trip to the Canary Islands? Nothing like a little excitement to keep me awake at night. Difficulties with a colleague at work? Stress, too, was a set-up for trouble sleeping. Whenever my life got the least bit interesting or challenging, sleep went south.

Nothing was reassuring about this pattern. I never knew when a situation was going to come along to wreck my sleep or how long the insomnia would last. Resolving the situation didn’t necessarily fix my sleep. The insomnia could last for a few days or weeks, a vicious cycle spooling on and on. It felt like sleep was completely beyond my control, and that was scary.

“Sleep reactivity” is the term researchers at Henry Ford Hospital have coined for a trait they’ve identified in people who, when feeling the least bit stressed out, are likely to experience trouble sleeping. Whatever lies behind this trait—hyperarousal, or a bit of unfortunate wiring in the brain—I have it in spades. But it’s easier to manage now that I’m able to see more patterns in my insomnia and the insomnia of others.

Seasonal Insomnia

For instance, there’s a seasonal aspect to insomnia that I’ve noted in the past few years. Starting around Thanksgiving and continuing through mid-March, my blog on winter insomnia attracts lots of readers. The story they tell is something like the one I used to tell: they start nodding soon after dinner and feel tired enough to drop off. Yet if the nodding prompts them to go to bed, try as they may, they can’t sleep.

A similar thing happens beginning in June. Suddenly lots of people are reading my blog on summer insomnia, complaining that they’ve got a sleep problem.

Both problems have to do with exposure to daylight—in the winter, there’s too little for some of us, and in the summer, too much—and the solution often lies in adjusting our exposure to bright light. Yet people who suddenly find themselves struggling with insomnia can’t always connect the dots and see a pattern. All they know is that their sleep seems to be deteriorating. And if this creates anxiety, sleep goes from bad to worse.

A Cyclic Pattern

Some people say they can’t predict when insomnia will occur from one day to the next. But even the worst sleepers report that some nights are better than others. “All week I got just 2 or 3 hours a night,” someone will tell me. “Then last night I got 8!”

Research shows that night-to-night sleep continuity in people with insomnia is quite variable, but that the variability often occurs at intervals. Normal sleepers can expect to get a good night’s sleep after a relatively poor one. But the average insomniac struggles through 3 lousy nights before she gets a good one. For some insomniacs, the ratio of good nights to bad is even worse: 1 to 5.

The terrific bouts of insomnia I used to have followed roughly the same trajectory: several nights of poor sleep followed by a night when I slept like the dead—only to have the pattern repeat like a broken record again and again.

I tended to focus on the bad nights and ignore the good. Now I wonder: if I’d seen not just the bad nights but rather a pattern of bad nights alternating with the good; if I’d understood that with the good nights, I was paying off my sleep debt in one fell swoop, would it have made my insomnia more tolerable?

Maybe so and maybe not. One good night in 4 is pretty cold comfort.

A Pattern I Had to Break

In any event, on the good nights I allowed myself to sleep in. That was a big part of my problem. Back then I had no use for alarm clocks. I wanted to sleep as long as possible to recoup all the sleep I’d lost. So I might not wake up until 9 a.m.

That felt fabulous . . . until night came around again. Then my insomnia and anxiety about my sleep were back with a vengeance. Without the knowledge of circadian rhythms and sleep drive that I later acquired, without understanding that I would thrive much better with a fixed wake-up time, I was sabotaging myself again and again.

Bodies don’t always behave predictably, and sleep can seem like the most fickle of friends. But sometimes there’s method in the madness—if we just make an effort to discover what it is.

Insomnia That Feels "Almost Physical"

“I feel very anxious at night,” a reader recently wrote. “I tell myself that there is no reason to be anxious, but it feels almost physical. And it doesn’t matter what I do (meditation, relaxation), I still can’t sleep.”

Insomnia, many of us are told, is mainly a psychological problem. So the physical sensations that accompany it can be unnerving: the fluttering heartbeat, the muscle tension, the racing feeling radiating from torso to extremities, the overheating, the sweaty skin. Yet these sensations should tip us off that insomnia is not just in the head.

burgerA reader wrote to Ask The Savvy Insomniac over the weekend to describe her problem with insomnia.

“I feel very anxious at night,” she said. “I tell myself that there is no reason to be anxious, but it feels almost physical. And it doesn’t matter what I do (meditation, relaxation), I still can’t sleep.”

Insomnia, many of us are told, is mainly a psychological problem. So the physical sensations that accompany it can be unnerving: the fluttering heartbeat, the muscle tension, the racing feeling radiating from torso to extremities, the overheating, the sweaty skin. Yet these sensations should tip us off that insomnia is not just in the head.

A.L. Kennedy, writing about her insomnia in Sunday’s Guardian, remembers adolescence as the time when she first experienced the willfulness of her body: “The term ‘fast asleep’ promised I might be locked safely and quickly away from harm. But my body wouldn’t let me leave. Insomnia,” she says, “was my first intimation of my body’s unreliability.”

If sleep were available on demand, we insomniacs wouldn’t have a problem. Yet at least where sleep is concerned, the body seems to have a mind of its own. No matter how much we crave sleep, the body doesn’t necessarily fall in line.

Changing Habits and Mindset

Sleep therapists claim that insomniacs have more control over our sleep than we think. Sleep is a basic human need and it occurs naturally in everyone. The problem for insomniacs, they say, is that we adopt habits and attitudes that interfere with sleep (erratic sleep schedules, for instance, or a belief that we can’t survive on less than six hours a night). Change these habits and attitudes and our sleep will improve.

Count me as a believer . . . up to a point. I’m all in favor of sleep restriction and other behavioral treatments for insomnia. I think it’s good to examine beliefs and attitudes that may be hindering sleep. There’s plenty of research showing that these strategies work, and they’ve certainly helped me.

Physiological Challenges

At the same time, it’s important to understand that our bodies and brains behave differently from the bodies and brains of people who sleep well. New research is turning up evidence that

  1. even when asleep, the insomniac brain tends to remain active in some areas. One is the precuneus, which plays a role in memory, visual processing, and self-reflection. Metabolic activity here “may contribute to the subjective experience of self-awareness” at night, researchers say.
  2. some insomniacs may be deficient in GABA, the neurochemical responsible for shutting the brain down at night.
  3. in insomniacs, physical exercise produces greater malleability in a part of the brain that controls movement. This suggests, says investigator Rachel Salas, that insomnia is not a nighttime disorder. “It’s a 24-hour brain condition, like a light switch that is always on.”
  4. a part of the brain called the left caudate nucleus is underutilized by insomniacs when we’re thinking. This condition can be reproduced in good sleepers by disrupting their slow-wave, or deep, sleep.

These studies are preliminary, yet they square with the hyperarousal theory of insomnia and suggest an imbalance in the arousing and calming forces inside insomniacs’ bodies and brains. If insomnia “feels almost physical,” that’s because it really is.

What are some of the physical sensations you experience at night when you can’t sleep?

Insomnia and Hyperarousal

Lots of factors can push you in the direction of persistent insomnia: chronic stress, rumination and worry, and too much time in bed, to name a few.

Another factor that increases your susceptibility to insomnia is physiologic “hyperarousal,” sleep experts say.

Insomniacs may experience hyperarousal night and dayLots of factors can push you in the direction of persistent insomnia: chronic stress, rumination and worry, and too much time in bed, to name a few.

Another factor that increases your susceptibility to insomnia is physiologic “hyperarousal,” or so some experts say. Measures of heart rate, metabolism, stress hormones, and body temperature have shown that insomniacs are cranked up a notch higher than normal sleepers.

At first blush the idea may seem like a stretch. When you think of what hyperarousal might look like, you think of multi-taskers who can scarf down an order of General Tso’s while answering email and jabbering on the phone. Or maybe you think of the person who crowds you at the checkout counter or who tailgates your car.

If you have trouble sleeping, chances are these profiles don’t fit yours. You’re more likely to slog through the day, hard-pressed to muster enough energy and sharpness to do your job. It’s tough to imagine this kind of exhaustion could square with being hyperaroused.

Looking for Hyperarousal

The notion of hyperarousal hit home for me when I came across a metric designed to assess people’s vulnerability to stress-related sleep disturbance – the Ford Insomnia Response to Stress Test (FIRST).* Take an abbreviated version yourself:

How likely is it that you’ll having trouble sleeping

  • after a bad day at work?
  • after an argument in the evening?
  • before an important meeting the next day?
  • before a trip?

If your answer is “likely,” if your sleep is prone to disruption by stressors that good sleepers can often park at the bedroom door, this could be a sign of physiologic hyperarousal – at least in the eyes of the researchers who created the FIRST. Christopher Drake and colleagues claim this sleep-related vulnerability to stress, combined with other measures of arousal in our bodies and brains, make people vulnerable to persistent insomnia.

Thursday’s blog will examine a way to lower your arousal levels and increase your tolerance to stress.

* Stress-related sleep disturbance and hyperarousal