Early Treatment of Insomnia May Improve Mental Health

Insomnia and mental health problems go hand in hand. It’s firmly established now that insomnia can be a causal factor in depression and that treatment for insomnia can improve both sleep and mood.

A new study shows that insomnia may also be a causal factor in psychotic experiences such as paranoia and hallucinations, and that CBT for insomnia (CBT-I) may lead to better mental health. Here’s a quick look at the research and what it suggests for us.

Web-based cognitive behavioral therapy for insomnia improves sleep & moodInsomnia and mental health problems go hand in hand. It’s firmly established now that insomnia can be a causal factor in depression and that treatment for insomnia can improve both sleep and mood.

A new study shows that insomnia may also be a causal factor in psychotic experiences such as paranoia and hallucinations, and that CBT for insomnia (CBT-I) may lead to better mental health. Here’s a quick look at the research and what it suggests for us.

Sleep and Mood: An Intimate Relationship

People with mood disorders and other mental health problems often experience insomnia. Until recently their trouble sleeping was viewed as a symptom or a consequence of the mental health problem. Successful treatment of that problem would take care of the insomnia, too—or so they thought.

Then along came research that upset the apple cart. It showed that insomnia was sometimes a causal factor in depression, and that treatment with CBT for insomnia (CBT-I) helped to resolve both problems better than treatment for depression alone. This led to a related question: could other psychiatric symptoms linked with insomnia—paranoia, hallucinations, anxiety, mania—be triggered in part by insomnia and could treatment with CBT-I head off their development?

A Large-Scale Study

Paranoia and hallucinations have strong links to insomnia. Researchers in the UK recruited 3,755 university students with insomnia from 26 different college campuses to see if treating their insomnia with CBT-I would lessen their risk of experiencing these psychotic symptoms.

Randomly the researchers divided student participants into two equal groups. One served as a control group. Students in the other group participated in an individualized online insomnia treatment program called Sleepio.

Similar to other research-based online insomnia treatments (SHUTi and CBT for Insomnia, for example), Sleepio is a 6-week program that delivers CBT-I over the internet. It includes behavioral components such as sleep restriction and stimulus control; cognitive components that challenge unhelpful beliefs; and education about sleep and sleep hygiene.

Student participants in both groups also took a battery of pencil and paper tests at four different times during the 6-month study period to assess the severity of their insomnia symptoms and the state of their mental health. Statistical analysis of the data included looking at whether reductions in insomnia symptoms correlated with better mental health outcomes.

Insomnia Treatment Improves Sleep, Reduces Psychotic Symptoms

Here are the main results, all statistically signficant. Compared with participants in the control group, participants who underwent the Sleepio treatment ended the program with

  • greatly improved sleep
  • fewer experiences of paranoia and hallucinations

The Take-Away

The results of this relatively large study led to the following claims:

  1. Online insomnia treatment programs like Sleepio work for university-age students with trouble sleeping. They’re inexpensive and can be accessed at home.
  2. While insomnia might not be the principal cause of psychotic experiences, it may well be a contributing cause.
  3. CBT-I may have promise as an early intervention for some psychiatric problems.

Caveats for the Sleepless Whether or Not Mental Health Is an Issue

CBT-I, for all its effectiveness, involves commitment to a weeks-long process and the discipline to follow a rigorous set of guidelines. In this study there was a 50% drop-out rate among participants assigned to the Sleepio program—higher than the dropout rate for the control group. Feeling sleep deprived and lacking stamina, some insomniacs may be unsuccessful at completing a CBT-I program in the absence of face-to-face coaching and encouragement from a trained sleep therapist.

But 50% of the participants stuck with the Sleepio program long enough to reap sleep benefits. This success rate is comparable to that found in research on other web-based insomnia treatment programs.

Our options do not stop with online treatment programs. I’ve found it’s also possible to improve sleep by following instructions in books about CBT-I (see, for example, The Insomnia Workbook by Stephanie Silberman, The Insomnia Answer by Paul Glovinsky and Arthur Spielman, or chapter 8 of my book, The Savvy Insomniac). I myself used CBT-I to improve my sleep after reading a training guide for sleep therapists (Cognitive Behavioral Treatment of Insomnia: A Session-by-Session Guide by Michael Perlis and colleagues).

Regardless of how it’s accessed, CBT-I remains our best defense against sleepless nights and draggy days—and it may also preserve our mental health and well-being.

If you’ve tried CBT-I, how did you access treatment and how useful was it in helping to improve your sleep?

Paradoxical Insomnia: A Second Look at Treatments

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

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

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

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

A Subjective-Objective Discrepancy

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

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

A Heavy Burden

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

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

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

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

What Could Be Wrong? What Can Be Done?

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

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

How About CBT for Insomnia?

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

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

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

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Lifelong Insomnia? Don’t Give Up on It Yet

Have you had insomnia all your life? Have your parents said you were a poor sleeper even as a baby?

Trouble sleeping that starts early in life is called idiopathic insomnia. If insomnia is still the black box of sleep disorders, then idiopathic insomnia is the little black box inside the black box.

Here’s what is known about the disorder and options for management.

Lifelong insomnia can be treated by sleep specialist or therapistHave you had insomnia all your life? Have your parents said you were a poor sleeper even as a baby?

Trouble sleeping that starts early in life is called idiopathic insomnia. If insomnia is still the black box of sleep disorders, then idiopathic insomnia is the little black box inside the black box.

Here’s what is known about the disorder and options for management.

What Is Idiopathic Insomnia?

Idiopathic insomnia begins in childhood, sometimes at or soon after birth. Trouble falling or staying asleep or reduced sleep duration is pretty much a nightly affair regardless of situational changes. The disorder is uncommon, affecting less than 1% of the population.

There is no identifiable cause. The presumption is that idiopathic insomnia is driven mainly by biological factors, and at least some of them are probably inherited. Abnormalities in the circadian system or the homeostatic process may be involved and/or there may be a problem in the circuitry controlling sleep and waking in the brain.

A Chronic Sleep Disorder, but How Well Defined?

Idiopathic insomnia is a chronic sleep disorder with familiar insomnia symptoms:

  • Trouble falling or staying asleep, or sleeping long enough, for more than 3 months despite adequate sleep opportunity
  • Daytime distress and impairment, including reduced stamina, low mood, and trouble thinking and learning

Research on the defining features of idiopathic insomnia is mixed. On one hand are a few studies showing significant differences between people with idiopathic insomnia (IdI) and those with psychophysiological insomnia (PI), the garden-variety insomnia that typically develops later in adolescence or adulthood. PI is often triggered by a stressful event; situational factors do not figure in IdI. PI is said to persist mainly due to psychological and behavioral factors that develop in response to poor sleep: conditioned arousal in bed, poor sleep hygiene (going to bed early to catch up on sleep, for example), and anxiety about sleep. Psychological factors are less typical in IdI.

On the other hand is research showing no major differences between PI and IdI when assessed by polysomnography (the overnight test in the sleep lab) or by self-report of psychological symptoms. Research suggests that arousal levels are higher among people with IdI than in people with other kinds of insomnia, though, leading some sleep experts to speculate that IdI is simply a more severe manifestation of PI.

What Can Be Done?

Without scientific certainty about the causes of IdI or whether the disorder is distinct from other kinds of insomnia, IdI is best treated on a case-by-case basis by a sleep specialist. Following are options for treatment.

Especially if a person with IdI has misconceptions and/or anxiety about sleep,

  • Cognitive behavioral therapy for insomnia (CBT-I) may help. CBT-I typically consists of two behavioral components—stimulus control therapy and sleep restriction therapy—and a cognitive component designed to decrease psychological barriers to sleep. Sometimes just changing your attitude about sleep can bring about demonstrable sleep improvements.
  • Acceptance and commitment therapy (ACT) may help. ACT focuses on building mindfulness skills so that, rather than trying to suppress, manage, and control emotional experiences, people develop psychological flexibility and learn to behave in ways that reflect their values and increase well-being. This approach, too, can change the way you feel about sleep and in the process improve your sleep.

If round-the-clock hyperarousal is driving IdI, then therapies designed to decrease arousal may help.

  • Regular, moderate-to-vigorous exercise—activities such as aerobics, calisthenics, biking, running, and weight-lifting—has been shown in recent studies to increase total sleep time and decrease levels of cortisol (a stress hormone).
  • Yoga, too, has been shown to decrease feelings of arousal and promote stress tolerance.

Medication for Idiopathic Insomnia

The issue of sleeping pills for chronic insomnia is increasingly fraught. Many drugs approved for the treatment of insomnia, taken nightly over time, may degrade sleep quality and result in alarming side effects, especially in older adults.

That said, while the medication prescribed for IDI is usually a benzodiazepine or a Z-drug such as zolpidem or eszopiclone, a second pharmacological approach, according to a paper by Michael Perlis and Philip Gehrman, involves use of a melatonin agonist such as ramelteon (Rozerem). No studies of the effects of this sleeping pill on the sleep of adults with IdI have been conducted. But in two studies of children aged 6 to 12 years with chronic idiopathic childhood sleep-onset insomnia, melatonin put them to sleep significantly sooner—by 1 hour.

If you’re contemplating managing lifelong insomnia with drugs, get some professional advice. This is one place where you really need the help of a specialist knowledgeable in the medical treatment of chronic insomnia.

At what age did your trouble sleeping start? What kinds of treatments—if any—have helped?

Tai Chi When Insomnia Isn’t the Only Problem

Insomnia combined with other health problems is bound to cause distress.

But help is at hand. New research shows that tai chi reduced insomnia symptoms in breast cancer survivors, suggesting that it may help with insomnia linked to other health problems, too.

Tai chi may improve sleep for insomnia sufferers with other health problemsA reader wrote yesterday asking for advice: “I’ve been reading through your website but have yet to see an article on how to manage sleep with chronic illness. I’m currently experiencing health challenges that are keeping me awake at night. What would you recommend for people experiencing health issues, especially moderate to severe ones?”

Insomnia combined with other health problems is bound to cause distress. But help is at hand. New research shows that tai chi reduced insomnia symptoms in breast cancer survivors, suggesting that it may help with insomnia linked to other health problems, too.

When Insomnia Is Not the Only Problem

Sometimes insomnia is the only health problem a person has. But insomnia more commonly occurs in conjunction with other health issues—everything from mood disorders and chronic pain to gastrointestinal problems and heart disease.

Part of the solution when you’re in this situation (sometimes referred to as comorbid insomnia) lies in getting treatment for the associated health problem. This will involve consulting a medical or psychiatric specialist.

But even when treatment is successful at controlling other health problems, trouble sleeping often persists. Women successfully treated for breast cancer have twice the rate of insomnia as occurs in the general population, as well as depression and fatigue. This is hardly surprising: A diagnosis of breast cancer is distressing in and of itself, never mind the invasive (although often effective) treatment options. But then you never know if or when the cancer might come back. Such chronic health concerns take an emotional toll that can interfere with sleep.

CBT for Insomnia Can Help

Cognitive behavioral therapy (CBT) is the gold standard in treatment for insomnia these days. This combination of sleep restriction, stimulus control, and talk therapy has been shown to be an effective treatment for insomnia in cancer survivors. Research shows it’s also effective in relieving insomnia in people with depression and people with other psychiatric and medical conditions.

But CBT for insomnia is not widely available nor can everyone afford it. Besides, it can be challenging to adhere to the protocol. CBT does not suit everyone.

UCLA investigators wanted to find a more accessible, less expensive type of therapy for breast cancer survivors experiencing insomnia that would equal CBT in efficacy. So they conducted a randomized, partially blinded study pitting CBT against tai chi.

Why Tai Chi?

Tai chi, a practice involving slow, flowing movement combined with meditation and deep breathing, is said to alleviate stress and anxiety and promote energy and stamina. In the words of the study’s authors, tai chi emphasizes “control over physical function and arousal-related responsiveness . . . through the mindful performance of repetitious, nonstrenuous, slow-paced movement.”

This type of activity might have an effect on sleep. And in fact a handful of studies have shown that tai chi does indeed relieve insomnia symptoms.

So investigators recruited 90 breast cancer survivors, aged 42 to 83 years, who were experiencing insomnia, depression, and fatigue. Half of them then received three months of weekly instruction in CBT for insomnia. The other half received three months of weekly instruction in a westernized form of tai chi called tai chi chih.

Impressive Results

At 15 months following the start of treatment (one year after treatment ended), nearly half of the participants in both groups showed marked improvement in their sleep, or complete or nearly complete remission of their insomnia symptoms. Both groups also experienced a robust reduction in fatigue severity and depression.

The novelty of this result is that for these survivors of breast cancer, the practice of tai chi chih resulted in sleep improvements equivalent to those obtained with CBT. Tai chi may be similarly useful for insomnia sufferers with other distressing health problems.

Lowering Arousal, Reducing Inflammation

The mechanisms by which tai chi relieves insomnia symptoms aren’t understood. But research has shown that tai chi:

  • Cuts down on arousal of the sympathetic nervous system. The sympathetic nervous system becomes active when you detect a threat, increasing vigilance and triggering bodily preparations to fight or flee.
  • Reduces inflammation. Inflammation is part of the body’s response to infection and tissue damage and is necessary to the healing process. But when inflammation becomes chronic it leads to disease.

Both arousal and inflammation have a negative effect on sleep. So it follows that a practice such as tai chi, which reduces them, might help.

Tai chi is worth checking into for people with comorbid insomnia and other distressing health conditions. Classes are offered in many locales. You can even learn tai chi by watching YouTube videos or using a smartphone app.

If you’ve practiced tai chi, what effect, if any, did it have on your sleep?

Insomnia: Are GABA and Glutamate Involved?

Sleep is regulated by the brain. So it makes sense to look inside the brain to find out what might be hampering insomniacs’ ability to fall and stay asleep. Is there some substance under- or overrepresented in our brains? Something that keeps us conscious when our brains should be turned off?

A study published in PLoS One last month suggests a role for two important neurotransmitters, gamma-aminobutyric acid (GABA) and glutamate. Here’s a bit of background and what the new research tells us about the neurobiology of insomnia.

Insomnia may be characterized by reduced GABA and increased glutamate activity at bedtimeSleep is regulated by the brain. So it makes sense to look inside the brain to find out what might be hampering insomniacs’ ability to fall and stay asleep. Is there some substance under- or overrepresented in our brains? Something that keeps us conscious when our brains should be turned off?

A study published in PLoS One last month suggests a role for two important neurotransmitters, gamma-aminobutyric acid (GABA) and glutamate. Here’s a bit of background and what the new research tells us about the neurobiology of insomnia.

GABA, Hypnotist of the Brain

GABA is the most important inhibitory neurotransmitter of the central nervous system. Found throughout the brain, GABA-producing neurons help us fall and stay asleep. When the GABA neurons start firing, we get sleepier and sleepier and suddenly the lights go out. Most sleeping pills today—zolpidem (Ambien), eszopiclone (Lunesta), zaleplon (Sonata), and temazepam (Restoril)—work by enhancing the GABA system.

A deficiency of GABA might cause symptoms of insomnia. Two studies, published in 2008 and 2012, respectively, found lower levels of GABA in insomniacs’ brains than in the brains of normal sleepers. Both studies were conducted using magnetic resonance spectroscopy (MRS). MRS is similar to MRI but different in that it can determine the concentration of various neurotransmitters in the brain.

Results of the first study showed that insomniacs’ average brain GABA levels were lower by nearly 30 percent. Results of the second study were confirmatory, showing that insomniacs had significantly less GABA in two areas of the cerebral cortex. But in a third study, also published in 2012, insomniacs were shown to have higher levels of GABA in the occipital cortex than normal sleepers.

Current Study: Evidence for GABA’s Role Is Mixed

One difference between the studies showing reduced and increased brain GABA was the time when data were gathered. In the first two studies, the brain scans were administered in the morning. In the third, participants’ brains were scanned a few hours before bedtime.

So for the current PLoS One study, investigators scanned the brains of their subjects (20 insomnia patients and 20 good sleepers) twice: after they got up in the morning and in the evening before they went to bed. Prior to the scans, participants were screened with sleep-related questionnaires and spent two nights in a sleep lab. There, they underwent polysomnography to determine, objectively, how long and how solidly they slept.

On both nights in the lab, the insomniacs slept significantly less than the good sleepers. The first night, it took them longer to fall asleep and they awakened more frequently. On the second, they spent a significantly lower percent of the night in deep sleep. In short, their sleep was disrupted in all the ways insomniacs’ sleep typically is.

But the brains of the insomnia patients did not have any more or any less GABA than the brains of the normal sleepers. The one correlation that did emerge was between GABA in an area called the anterior cingulate cortex and objectively short sleep. Investigators concluded that reduced GABA levels may be a trait marker of objective sleep problems.

A Role for Glutamate

Glutamate plays a role opposite GABA. It’s the major excitatory neurotransmitter in the brain, found in abundance everywhere. When glutamate-producing neurons are firing, we’re alert and thinking and taking in the world around us.

Investigators in the current study compared the amount of brain glutamate in insomnia patients and controls in the morning and in the evening. Here, they found a significant difference: glutamate levels in the insomnia patients increased from morning to evening but did not increase in the normal sleepers. So higher levels of glutamate in the evening may reflect the hyperarousal many insomniacs experience at bedtime.

I wouldn’t bet the farm on it, though. The problem with these and other MRS studies is that they’re small (and very costly) and the results may or may not be confirmed in the next study down the line. Insomnia symptoms (or short sleep) may have something to do with reduced levels of GABA and increased glutamate at bedtime—and that’s all we can say for now.

What Makes You Vulnerable to Insomnia?

The causes of insomnia are still unknown, but many factors can make people more and less vulnerable to it.

A prospective study of Norwegian nurses offers new evidence of several factors, some well known and others that have gotten less attention in the past.

vulnerability to insomnia depends on several thingsWhen I set out to write my book about insomnia, I asked dozens of insomniacs what they thought had caused their insomnia. Several mentioned constitutional factors.

There are certainly grounds for thinking that a genetic component is involved. People who have a first-degree relative with insomnia are 7 times as likely to suffer insomnia as people without insomnia in the immediate family.

Other people I interviewed attributed their insomnia to stress at work or to family problems. Still others blamed their insomnia on an inability to quiet their mind at night.

The causes of insomnia are still unknown, but many factors can make people more and less vulnerable to it. A prospective study of Norwegian nurses offers new evidence of several factors, some well known and others that have gotten less attention in the past.

Anxiety and Depression

There’s plenty of evidence pointing to a relationship between insomnia and mood disorders. In the nurses’ study, where investigators reviewed data on 799 nurses collected at 2 time points 2 years apart, nurses higher on anxiety and depression measures in 2009 were significantly more likely to report insomnia symptoms in 2011.

The reverse relationship also held for insomnia and anxiety: nurses reporting insomnia in 2009 were more likely to have developed anxiety 2 years later. Surprisingly, although insomnia is widely understood to be a causal factor in depression, the nurses’ study found no evidence of this.

Morningness and Eveningness

The nurses in this study were all shift workers. Other research has suggested that people who dislike getting up early in the morning have an easier time adapting to shift work, where work at night is required.

In the current study, though, the nurses who disliked getting up early in the morning were actually more inclined to develop insomnia than the early risers. Other research has shown that people who like to get up early tend to have better lifestyle regularity and more regular sleep habits. Both these things tend to protect people from developing insomnia.

Personality Traits

Some people function quite well despite sleep loss while others feel drowsy and lethargic. (This is largely determined by genetic factors and is thus a stable trait.) Languidity—the tendency to experience drowsiness and lethargy after losing sleep—was found in the nurses’ study to predict an increase in insomnia symptoms over the 2-year period. No surprises here. Impairments in daytime functioning are classic symptoms of insomnia.

Another personality trait—flexibility, or the ability to sleep or stay awake at odd hours—has generally been known to protect against the development of insomnia. Among shift workers, this would be an especially useful trait. But in this study, a high score on flexibility had no positive or negative relationship with insomnia.

Smoking, Drinking, and Caffeine

The overall harmful effects of tobacco, alcohol, and caffeine on sleep are now well known. For many years insomnia was attributed to people drinking too much scotch or too much coffee.

More recently, studies have shown that people with insomnia do not typically drink more alcohol or caffeinated drinks than people who sleep well, and the nurses’ study supports this finding. None of these lifestyle factors predicted an increase in insomnia over time. In fact, nurses reporting insomnia symptoms in 2009 actually reported drinking less caffeine in 2011.

Bullying at Work

Several work-related stressors are known to increase the risk of poor quality sleep, and bullying—persistent exposure to negative actions from others—is one. Day-to-day contact with tyrannical bosses and manipulative supervisors often leads to psychological distress.

Nurses subjected to bullying at work reported more insomnia symptoms over time than the nurses working under better conditions. No surprises here: the worry and stress that result from bullying are two of the leading causes of sleep problems among workers.

Spillover Between Work and Family

Stress in one domain can affect another. In the nurses’ study, negative spillover from work to family and from family to work predicted an increase in insomnia symptoms over time. Conversely, insomnia led to reports of more work-to-family conflicts over time.

Shift Work

Finally, shift work, involving night work and rotating shifts, is known to precipitate insomnia. But in this group of nurses, the association did not hold. This unexpected result might be due to the young age of the nurses (average age 33) and their overall good health compared with shift-working nurses overall, many of whom likely self-selected out of the study.

What factors do you think led to your insomnia?

Insomnia: Holding Steady the Next Day

Will there ever be a morning-after pill prescribed for insomnia? Wouldn’t that be nice. Insomnia wouldn’t be half as bad if it weren’t so debilitating the next day. No fatigue to contend with, no brain fog, no low mood. White nights could even be enjoyable if we knew in the morning that we could resort to Plan B.

For now there’s no simple way to avoid insomnia symptoms that occur in the daytime. But there are ways to minimize their impact, whether the bad nights come often or just once in a while. Here are 6 habits I find useful and maybe you will, too.

Daytime affects of insomnia can be reduced by stretching and other activitiesWill there ever be a morning-after pill prescribed for insomnia? Wouldn’t that be nice. Insomnia wouldn’t be half as bad if it weren’t so debilitating the next day. No fatigue to contend with, no brain fog, no low mood. White nights could even be enjoyable if we knew in the morning that we could resort to Plan B.

For now there’s no simple way to avoid insomnia symptoms that occur in the daytime. But there are ways to minimize their impact, whether the bad nights come often or just once in a while. Here are 6 habits I find useful and maybe you will, too:

Eat a Healthy Breakfast

This might seem like a no-brainer, but with 18 percent of Americans older than age 2 regularly skipping breakfast, it’s worth a mention. Research suggests that eating a morning meal is beneficial in many ways: it lifts the mood and improves memory, and it makes you more active in the morning. Particularly when you’re feeling sluggish and sleep-deprived, a good breakfast is a must.

Make Judicious Use of Caffeine

It used to be that caffeinated beverages were on the “No Fly” list for people with insomnia. But expert opinion has changed. The thinking now is that while the caffeine-sensitive should avoid it within 8 hours of bedtime, it’s OK in moderation—and can even be helpful—as tolerated earlier in the day.

The trick is to discover what “as tolerated” means on days when you feel like drinking a whole pot of coffee. Caffeine has an average half-life of 5 to 6 hours (meaning that in 5 to 6 hours the amount of caffeine in the blood will have decreased by half). So most people can drink caffeinated beverages in the morning without fear of compromising sleep that night.

But many people experience a circadian slump somewhere in the middle of the afternoon. Particularly after a short night’s sleep, that’s when you really crave a pick-up. Is a 3 p.m. cappuccino going to set you up for another bad night?

Not necessarily, if you’re young or middle-aged. But it takes older adults longer to metabolize drugs. Keep this in mind as you decide when to drink that last cup of joe.

Drink Plenty of Water

Even mild dehydration can depress your mood, lower your ability to concentrate, and make tasks feel more difficult. It can also impair performance and short-term memory. So make a point of sipping often throughout the day. Keeping water on hand at your desk, or making frequent trips to the water cooler, could take the edge off a low mood and make it easier to accomplish what needs to be done.

Get Up and Move Around

Physical activity tends to elevate mood and alertness. New Zealand researchers found that subjects who reported higher levels of habitual physical activity also endorsed higher levels of interest, excitement, enthusiasm, and alertness—all qualities you may be short on if you’re short on sleep. Particularly if your work keeps you sedentary, make an effort to get up, move around a lot, and stretch at your desk. At lunchtime, take a walk.

Follow the Sun

Increasing your exposure to sunlight may also help to counteract symptoms of insomnia. Bright light tends to increase vitality and elevate mood. It’s also been shown to enhance alertness and cognitive performance. Even on cloudy days, daylight is 2 or 3 times brighter than normal office lighting. So make liberal use of it when you can. Particularly if you’re feeling sluggish, spend time outdoors or inside where there are plenty of windows.

Reorganize Your Day

You may not have much say in how you organize your day. Whatever tasks are on the schedule—make sales calls, teach a class, chair a meeting—you’ve just got to power through them, never mind that you’re exhausted when the day begins. But sometimes you can reset the agenda. After bad nights, juggle your tasks so you tackle the hard ones when you’re normally most alert and save the routine tasks for when you’re not.

Doing all these things may not have a big impact on your nights. But they may help you chart a steadier course during the day. That counts for something, don’t you think?