Alzheimer’s Disease: Are You, Poor Sleeper, at Risk?

I talk quite a bit about dementia and Alzheimer’s disease with family and friends. Our parents are drifting into cognitive impairment, asking the same questions again and again and struggling to find words to express themselves, and we wonder if we’re destined for the same fate.

The concern may be justified in middle-aged adults with chronically poor sleep, according to new research on sleep and two proteins involved in Alzheimer’s disease. Here’s more about the study and its relevance to people with insomnia and other sleep disorders.

Proteins linked to Alzheimer's a function of insufficient deep sleepI talk quite a bit about dementia and Alzheimer’s disease with family and friends. Our parents are drifting into cognitive impairment, asking the same questions again and again and struggling to find words to express themselves, and we wonder if we’re destined for the same fate.

The concern may be justified in middle-aged adults with chronically poor sleep, according to new research on sleep and two proteins involved in Alzheimer’s disease. Here’s more about the study and its relevance to people with insomnia and other sleep disorders.

Poor Sleep and Cognitive Impairment

Previous research has shown that poor sleep increases the risk of cognitive impairment. And mild cognitive impairment—trouble thinking and memory loss—is one of the first signs of Alzheimer’s disease. The cognitive declines and memory problems gradually worsen as deposits of two proteins—amyloid beta and tau—grow thicker and thicker, causing brain tissue to atrophy and die. To date the disease is irreversible.

But “poor sleep” can take different shapes and forms:

  • Sleep apnea, or pauses in breathing that occur repeatedly throughout the night, leaving sleepers feeling unrested in the morning.
  • Restless legs syndrome, in which sleep is disrupted by involuntary leg movements in the first half of the night.
  • Insomnia, consisting of trouble falling asleep, staying asleep, or waking up early in the morning, and related daytime complaints

Which feature of some or all of these sleep disorders might hasten development of amyloid plaques in the brain? The researchers suspected the problem had to do with deep, or slow wave, sleep, which is associated with feeling rested and restored in the morning. So they set out to see if disrupted slow wave sleep would bring about increased levels of amyloid beta in the brain.

Who They Studied, What They Did

Seventeen healthy adults ages 35 to 65 participated in the study, none with sleep problems or cognitive impairment. Each participant wore a wrist watch-type device to monitor their sleep. After several nights of wearing the device, participants spent a night in a sleep lab. There, they underwent a sleep study that involved wearing headphones.

Half of the participants were allowed to sleep without interruption. The other half experienced sleep disruption. Every time they entered deep sleep, they were subjected to beeps that grew louder and louder until their slow waves disappeared and were replaced by brain waves characteristic of lighter sleep.

The participants subjected to the beeps reported feeling tired and unrefreshed in the morning although they slept as long as usual. Most did not recall awakening during the night. All participants underwent a spinal tap so researchers could test for levels of amyloid beta and tau in the spinal fluid.

The procedure was repeated a month later, when the participants originally allowed to sleep uninterruptedly were subjected to the beeps and the others were allowed to sleep without interruption. Another spinal tap was conducted in the morning to measure protein levels.

Disrupted Deep Sleep and Harmful Proteins in the Brain

The results supported researchers’ contention about the effects of disrupted slow wave sleep:

  1. Participants’ amyloid beta levels were up by 10 percent after a single night of disrupted slow wave sleep
  2. In addition, levels of tau were significantly higher in participants whose wrist monitors showed they’d slept poorly during the week before the spinal tap

So disrupted slow wave sleep increased amyloid beta levels after just one night and tau levels after several days of poor sleep. Evidently, one function of slow wave sleep is to help rid the brain of byproducts that collect there during the day. When deep sleep is compromised, amyloid beta and tau start to accumulate. Development of cognitive impairment and Alzheimer’s is then more likely to occur.

Alzheimer’s and Poor Sleep in Perspective

So does the overall risk of developing Alzheimer’s increase with every poor night’s sleep? Probably not. Lead author Yo-El S. Ju, cited in a Washington University press release, said it’s unlikely that a single night or even a week of poor sleep has much effect on overall risk of developing Alzheimer’s disease. Amyloid beta and tau levels probably go back down the next time the person has a good night’s sleep, she said.

It’s people with chronic, untreated sleep disorders who should be concerned. Here, too, a dose of perspective is in order. Slow wave sleep occurs during the first half of the night. People who suspect they have sleep apnea, which occurs throughout the night, or restless legs syndrome, which occurs during the first half of the night, would be wise to see a sleep specialist for diagnosis and treatment.

People with chronic insomnia may have cause for concern as well—and maybe not so much. These investigators did not find that excess amyloid beta and tau had anything to do with sleep duration or sleep efficiency. Further, it’s never been shown that the main problem for people with insomnia is insufficient slow wave sleep. Some insomniacs experience a reduced percentage of slow wave sleep. Yet in others, slow wave sleep is intact.

The underlying problem in insomnia may instead involve restless REM sleep, which typically occurs in the second half of the night. It may have nothing to do with the development of amyloid plaques in the brain.

In any event, chronic insomnia can be treated (although the causes remain largely unknown). Click on “insomnia treatment” in the tag cloud to the right for more information.

A Different Pathway to Chronic Insomnia

Let’s say you grow up in a family of champion sleepers, yourself included. At college, you sail through rowdy dormitory life sleeping like a log. Job interviews, stressful to some, don’t faze you. By 27, you’ve landed a good job and in a few years earned enough for a down payment on a house. Sleep is still dependable and stays that way for a decade.

Then, coinciding with a move and the birth of a second child, you find yourself wide awake at your normal bedtime, staring at walls. Soon this becomes the rule rather than the exception. Before you know it you’ve developed chronic insomnia. How can sleep go from good to bad so quickly?

Stress and poor sleep can lead to chronic insomnniaLet’s say you grow up in a family of champion sleepers, yourself included. At college, you sail through rowdy dormitory life sleeping like a log. Job interviews, stressful to some, don’t faze you. By 27, you’ve landed a good job and in a few years earned enough for a down payment on a house. Sleep is still dependable and stays that way for a decade.

Then, coinciding with a move and the birth of a second child, you find yourself wide awake at your normal bedtime, staring at walls. Soon this becomes the rule rather than the exception. Before you know it you’ve developed chronic insomnia. How can sleep go from good to bad so quickly?

How Insomnia Develops

For decades sleep scientists have been trying to work out how chronic insomnia develops. The main model they’ve proposed looks something like this:

  1. Predisposing factors are presumed to exist in everyone who develops chronic insomnia. They include such observable factors as (a) parental history of insomnia, (b) high sleep reactivity (a tendency to sleep poorly before and after stressful events such as giving a speech or having an argument; and to be highly reactive to caffeine, jet lag, and interpersonal stressors), and (c) poor health—all associated with biological challenges to sleep.
  2. Precipitating factors come next: major life stressors that often trigger an episode of insomnia such as a job loss, marriage, or relocation to a different town.
  3. Perpetuating factors are the habits some people then adopt for insomnia relief—taking naps, going to bed early, sleeping in on weekends—that actually make their sleep worse.
  4. Conditioned arousal of the cerebral cortex is the final step in in the process. Lying awake for long stretches of the night opens the door to worry and rumination. This brain activity can spill over into sleep and keep insomnia going indefinitely.

This may be how chronic insomnia develops in some people. There may also be alternative pathways to insomnia. A large community-based study (Evolution of Pathways to Insomnia Cohort) was recently conducted to figure out what those alternative pathways might be. Working with data from that study, Michigan researchers have concluded that even people who have no evident predisposition to insomnia may develop chronic insomnia through a process involving sleep system sensitization. Here’s more on what they found.

From Normal Sleep to Insomnia in Just One Year

In this prospective study, thousands of participants filled out a series of questionnaires at the start of the study and one and two years later. The Michigan researchers looked at the 262 participants who did not have insomnia at the start of the study but who, by year 1, had developed it.

These participants might be expected to have characteristics predisposing poor sleep from the start (a mother with insomnia, for example, or high sleep reactivity). But not all of them did. A total of 60 participants tested low for sleep reactivity at the start of the study (on the Ford Insomnia Response to Stress Test, or FIRST). But by year 1, these 60 people had jumped an average of 4 points on the FIRST, indicating a significant increase in sleep reactivity. Over two-thirds went from low sleep reactivity to very high sleep reactivity following major life stress and the onset of insomnia in the space of just one year. At year 2, the high sleep reactivity persisted regardless of whether their insomnia was chronic or not.

A Different Path to Chronic Insomnia

In a nutshell, here’s the take-away:

  • People with apparently low vulnerability to insomnia (like the person described at the beginning of this blog post) can develop high sleep reactivity in conjunction with major life stress and an episode of insomnia.
  • Stress exposure leading up to insomnia appears to sensitize the sleep system. This lends support to the idea that insomnia itself may be a perpetuating factor in chronic insomnia. Every episode may trigger neurobiological changes that increase the risk of subsequent bouts of insomnia, just as every experience of depression increases the risk of future depression.
  • High sleep reactivity, once it develops, is persistent.

No matter how or why your insomnia develops, don’t wait to look for help. Take action right away.

Q&A: Can Poor Sleep Show in the Face?

Can chronic insomnia make you less attractive? speed up the aging of skin? cause irreversible damage to your face?

I heard these concerns as I interviewed insomniacs for my book. But recently I decided to check into them after receiving an email from a woman whose anxiety about her appearance was extreme:

Very worried middle-aged woman

Can chronic insomnia make you less attractive? speed up the aging of skin? cause irreversible damage to your face?

I heard these concerns as I interviewed insomniacs for my book. But recently I decided to check into them after receiving an email from a woman whose anxiety about her appearance was extreme:

 

Ever since it all started eight years ago, my drive has always been an extreme fear of the insomnia’s impact on my physical appearance—especially my face. I just cannot let go of the pain of seeing my face ruined by sleeplessness! . . . Frankly, I look 10 years older than my biological age.

I am so afraid that my face is scarred (it certainly looks that way) and that it cannot recover after all these destructive years!

When we look in the mirror and see drooping eyelids and dark circles under our eyes, do we imagine we look worse than we actually do?

Effects of Sleep Quality on the Skin

There haven’t been any studies comparing the skin of insomniacs with the skin of good sleepers.

But three years ago I blogged about a study involving 60 women, half reporting good quality sleep with a duration of 7–9 hours and the other half reporting poor quality sleep lasting 5 hours or less. (Symptoms of these poor quality sleepers come close to meeting the criteria for a diagnosis of insomnia disorder.)

First the researchers inspected participants’ skin. Then they tested the skin, exposing it to ultraviolet light and subjecting it to a tape-stripping procedure that caused skin barrier disruption. They then observed how long it took participants’ skin to recover from these challenges.

Study Results

Compared with the good sleepers’ skin, the poor sleepers’ skin:

  • Showed more signs of aging skin (e.g., fine lines, uneven pigmentation, flabbiness, and less elasticity)
  • Took significantly more time to recover from the UV light exposure, with redness remaining higher over a period of 3 days

The good sleepers’ skin recovered 30% more quickly than the poor sleepers’ skin.

The study results suggest that insomnia sufferers’ concerns about the health and appearance of our skin are probably valid.

Effects of Sleep Deprivation on the Skin

In another study researchers took photographs to compare the faces of healthy adults in two different situations: (1) when they were well rested and (2) under conditions of sleep deprivation. (Again, acute sleep deprivation is not the same thing as insomnia—and certainly not the same thing as chronic insomnia—but research suggests that insomniacs may suffer from mild sleep deprivation at least some of the time.)

Twenty-three participants, all healthy adults, were photographed in the afternoon after a normal 8-hour night of sleep and again after sleep deprivation (a 5-hour night of sleep followed by 31 hours of continuous wakefulness). The photos were then viewed in a randomized order and rated by 65 untrained observers.

What the Observers Saw

You can probably guess what the results of the study were. Compared with well-rested faces, sleep-deprived faces were perceived as:

  • Less attractive
  • Less healthy
  • More tired

“Apparent tiredness was strongly related to looking less healthy and less attractive,” the researchers wrote. “The fact that untrained observers detected the effects of sleep loss in others” suggests that our sleep history gives rise to signs that can be noted by other people.

In other words, after several bad nights, the pasty complexion and dark circles we notice in the mirror are not just figments of our imagination. Others see them, too—and may judge us as less healthy and less attractive as a result. (Keep in mind, though, that the participants in this study were quite severely sleep deprived when the second round of photos was taken.)

What Can Be Done

If preserving your skin is important, then taking measures to improve your sleep might be one of the best preservatives. CBT for insomnia (or sleep restriction) is the No. 1 treatment for insomnia recommended by sleep experts. Find information about it by clicking “Blog” at the top of this page and typing CBT or sleep restriction in the site search box.

What about products that might help to preserve the skin? A dermatologist once recommended that I use CeraVe Moisturizing Cream. I like it well enough but have no way of knowing if it’s keeping my skin looking younger than it would otherwise be.

If you’ve found a skin product you like, please share it here

Insomniacs: Are We Dreaming About Sleeplessness?

Rapid eye movement sleep (REM sleep) is when most dreams occur. Episodes of REM sleep also help defuse negative emotions and improve the learning of motor skills.

Until recently, insomnia wasn’t thought to be a problem of REM sleep. Insomnia, the thinking went, was caused mainly by phenomena occurring—or failing to occur—during quiet, or non-REM, sleep: insufficient deep sleep, for example, or wake-like activity occurring in other stages of non-REM sleep, resulting in insufficient or poor sleep.

In the past few years, though, REM sleep has become a suspect in the quest to identify what causes people to wake up frequently in the middle of the night and too early in the morning. (This type of insomnia is called sleep maintenance insomnia). Here’s more about this intriguing proposition.

Insomnia sufferers may be remembering dreams of sleeplessness rather than lying awake for hoursRapid eye movement sleep (REM sleep) is when most dreams occur. Episodes of REM sleep also help defuse negative emotions and improve the learning of motor skills.

Until recently, insomnia wasn’t thought to be a problem of REM sleep. Insomnia, the thinking went, was caused mainly by phenomena occurring—or failing to occur—during quiet, or non-REM, sleep: insufficient deep sleep, for example, or wake-like activity occurring in other stages of non-REM sleep, resulting in insufficient or poor sleep.

But in the past few years, REM sleep has become a suspect in the quest to identify what causes people to wake up frequently in the middle of the night and too early in the morning. (This type of insomnia is called sleep maintenance insomnia). Here’s more about this intriguing proposition.

Do Insomniacs Really Underestimate Sleep Time?

It’s said that insomniacs tend to underestimate the amount of sleep they get. Polysomnography (PSG), the test conducted in the sleep lab, often shows that insomnia sufferers are sleeping more than they think.

Investigators now agree that PSG, as conducted and scored in standard fashion, is too crude a measure to capture what’s going on in disturbed sleep. Finer measures are needed. One such measure involves counting the number of arousals and micro-arousals—brief awakenings—during sleep.

In a seminal study published in 2008, a team of German scientists used PSG, sleep time estimates of study participants, and micro-arousal analysis to ascertain what the differences were between insomniacs and good sleepers. The results showed that compared with good sleepers, insomniacs

  • Got less non-REM and REM sleep overall
  • Experienced more micro-arousals during both non-REM and REM sleep, but the number of micro-arousals during REM sleep was more pronounced: about 2 to 3 times larger than the number experienced by good sleepers. Further, the more REM sleep insomniacs got, the greater was the mismatch between their sleep time as recorded by PSG and the sleep time reported by the insomniacs themselves.

These results suggest that (1) it may be disturbances that occur during REM sleep, more so than during non-REM sleep, that account for the discrepancy between PSG-measured sleep and insomniacs’ perception of their sleep, and (2) disturbed REM sleep may be the main problem for people with sleep maintenance insomnia.

How Disturbed REM Sleep Might Develop

Not much brain activity occurs during non-REM sleep. But REM sleep is marked by a mix of arousal in some parts of the brain and quiescence in other parts. The same group of scientists in a 2012 paper describe REM sleep as “a highly aroused ‘paradoxical’ sleep state requiring a delicate balance of arousing and de-arousing brain activity.” This brain activity involves many different groups of neurons. The over- or underexpression of any of these groups might disturb that “delicate balance,” causing fragmented REM sleep.

This idea fits in with the dominant explanation for chronic insomnia: it’s a manifestation of hyperarousal, which may come about in part due to stress. Stressful life experiences often cause sleep loss. If the poor sleep continues, then sleeplessness and worry about the daytime consequences themselves become stressors and insomnia becomes a chronic affair. The chronic stress accompanying chronic insomnia also leads to changes in the brain. These changes could cause REM sleep fragmentation and disrupted or poor sleep.

Remembering Dreams of Sleeplessness

The idea of REM sleep fragmentation as a driver of sleep maintenance insomnia also fits with the continuity hypothesis of dreaming, which posits that the content of dreams comes from everyday concerns. Not much research exists on the content of insomniacs’ dreams. What is known is summarized in a paper published in Sleep Medicine Reviews:

  • Compared with normal sleepers, insomniacs tended to experience themselves more negatively in their dreams
  • Problems that occurred in dreams were related to current real-life concerns
  • Health problems also appeared more frequently in insomniacs’ dreams.

People with chronic insomnia are prone to worry about sleep loss and its consequences, and these concerns might well dominate the content of our dreams. And if we’re experiencing lots of micro-arousals as we’re dreaming, the content of those dreams would be more accessible to conscious recall. Instead of actually lying awake for hours at night, sleep maintenance insomniacs might be awakening briefly but often to dreams of sleeplessness, making it feel like we’re sleeping less than we are.

Precisely how REM sleep becomes fragmented remains to be seen. But the finding that REM sleep is significantly unstable in sleep maintenance insomniacs is a step in the right direction.

Does the idea of REM sleep instability as a driver of sleep maintenance insomnia seem plausible to you?

Psychophysiologic Insomnia: What It Is & How to Cope

Psychophysiologic insomnia: This was my diagnosis when I finally decided to see a doctor about my sleep. I didn’t like the sound of it. “Psycho” came before “physiologic,” and to me the implication was that my trouble sleeping was mostly in my head.

My insomnia felt physical, accompanied as it was by bodily warmth, muscle tension, and a jittery feeling inside. I was anxious about sleep, too, and my thoughts weren’t exactly upbeat. But surely putting the psycho before the physiologic was putting the cart before the horse?

Psychophysiologic insomnia is a sleep problem involving physical and mental factorsPsychophysiologic insomnia: This was my diagnosis when I finally decided to see a doctor about my sleep. I didn’t like the sound of it. “Psycho” came before “physiologic,” and to me the implication was that my trouble sleeping was mostly in my head.

My insomnia felt physical, accompanied by bodily warmth, muscle tension, and a jittery feeling inside. I was anxious about sleep, too, and my thoughts weren’t exactly upbeat. But surely putting the psycho before the physiologic was putting the cart before the horse?

Don’t let the terminology put you off the way I did. Psychophysiologic insomnia (I’ll call it PPI) is a problem in which constitutional vulnerabilities, situational factors, habits, and dysfunctional thinking are so intertwined that it’s hard to sort them out. Here’s a brief description and recommendations on how to manage it.

A Diagnosis Based on Symptoms

No objective test can reliably distinguish between normal sleepers and people with PPI. So the diagnosis is made based on symptoms alone. In PPI as in other types of insomnia, the wakefulness may occur at the beginning, in the middle, or at the end of the night. But people with PPI also:

  • have a lot of anxiety about sleep
  • are prone to intrusive thoughts and involuntary rumination
  • feel physically wound up
  • fall asleep at unusual times and places
  • experience daytime impairments such as fatigue, moodiness, and trouble thinking

Polysomnography (PSG)—the test administered overnight in a sleep lab—is not usually recommended because it doesn’t discriminate well between people with PPI and normal sleepers. But PSG results show that overall, people with PPI sleep less, and spend more time in lighter stages of sleep, than people who sleep well. (In contrast, the PSG results of people with paradoxical insomnia look normal, even though sufferers may feel like they’re getting 1 or 2 hours of sleep at best.)

How PPI Develops

Often it begins in adolescence or early adulthood, showing up as light sleep or periodic episodes of poor sleep.* Some people are naturally more susceptible than others. This may be true, sleep expert Peter Hauri has written, because of “an inherent, mild defect in the sleep-wake system, i.e., either excessive strength of the reticular activating system [the arousal system] or a weakness in the inhibitory, sleep-inducing circuits. Because the sleep-wake balance in such patients might lean toward wakefulness, such people would be suffering from an occasional, neurologically based poor night of sleep long before developing serious insomnia.”

Stressful situations lead to more extended bouts of poor sleep. Sooner or later, concern about sleep sets in. This is when insomnia starts to get “serious,” to use Hauri’s word. Looking for ways to reestablish better sleep, people change their habits—trying harder to sleep, going to bed early, taking naps—in ways that actually make sleep worse. The bed and the bedroom come to be associated with not sleep but rather with wakefulness and worry about sleep.

Thus begins the vicious cycle where long stretches of wakefulness in bed, accompanied by feelings of tension, begin to condition arousal of the brain, in turn fueling more bodily arousal. What began as light sleep or an occasional stress-related bout of insomnia has become a chronic affair.

Management Options

Once the PPI train pulls away from the station, it’s hard to get off. For decades I tried every trick in the book—sleeping on the couch, watching nature programs, listening to white noise, scenting my pillows, rhythmic breathing, drinking tea made from Chinese herbs. Nothing worked for long or without cost.

The good news is that PPI, unlike some other types of insomnia, responds well to treatment with cognitive behavioral therapy for insomnia (CBT-I). (While the name might suggest that it’s similar to conventional talk therapy, CBT-I is mainly focused on helping people modify habits.) For me, sleep restriction therapy, a treatment offered as part of CBT-I, was especially useful. Sleep restriction led to an awareness that my sleep could be reliable if I timed it right.

Equally important, though, for people whose insomnia feels physical (like mine) is finding a way to tamp the physiological arousal down. What works best for me is daily aerobic exercise. Research also suggests that mind-body therapies such as yoga, tai chi, and mindfulness meditation are helpful in this regard.

If this sounds like the type of insomnia you’ve got, check into CBT-I and physical training. There’s nothing to lose and much to gain.

How do you manage your insomnia? Has your strategy worked?

* Lee-Chiong T. Sleep Medicine: Essentials and Review. New York: Oxford University Press; 2008: 84.

Poor Sleep Affects Impulse Control

Ever notice that on some days you’ve got better impulse control than on others? I see this when it comes to my resolve to avoid certain foods.

Sometimes my reserves of willpower feel abundant. That last piece of chocolate cake? Save it for the husband. Other times I turn into a slavering Homer Simpson. The cake is so enticing that in a red-hot minute it’s down the hatch.

A new review article by researchers from Clemson University suggests that not just impulsive eating but a lack self-control in general may be attributable to poor sleep habits and poor sleep. This claim will resonate with many insomnia sufferers, so here’s a summary of the authors’ key points.

Poor sleep can lead to a loss of self-controlEver notice that on some days you’ve got better impulse control than on others? I see this when it comes to my resolve to avoid certain foods.

Sometimes my reserves of willpower feel abundant. That last piece of chocolate cake? Save it for the husband. Other times I turn into a slavering Homer Simpson. The cake is so enticing that in a red-hot minute it’s down the hatch.

A new review article by researchers from Clemson University suggests that not just impulsive eating but a lack self-control in general may be attributable to poor sleep habits and poor sleep. This claim will resonate with many insomnia sufferers, so here’s a summary of the authors’ key points.

Decisions, Decisions, Decisions

Decision-making is daily part of life: whether to tackle a difficult task or postpone it, whether to vent anger or try to chill out, whether to exercise, whether to have a third drink, whether to stay up late watching a movie. The choices we make depend in part on our reserves of self-control. Among other things, self-control enables us to resist “pleasurable impulses to better meet long-term goals.” It also helps in the regulation of social behaviors.

Our capacity for self-control is limited. Failures may occur mainly due to a depletion of physiological resources. After hewing to the straight and narrow and holding impulsive behaviors in check for a while, so the thinking goes, our internal resources are depleted, “much as a muscle becomes fatigued following physical exertion.” To date, research has focused on levels of glucose—the body’s main source of energy—as being the main indicator of available internal resources. When blood glucose levels are low, the body tends to conserve (rather than utilize) glucose, in turn reducing energy and our capacity to exert self-control.

On the other hand, the loss of self-control may be attributable mainly to psychological processes and motivation. Belief in willpower and personal motivation—I CAN resist that chocolate cake and I WILL resist it to look good at the beach—enables people to exert self-control at times when they’re faced with the dilemma of whether to trade short-term pleasure for long-term gain. It’s likely that both psychological and physiological processes underlie the loss of self-control, the authors state.

A Relationship Between Self-Control and Sleep

Quite a bit of research shows that sleep deprivation and insomnia have negative effects on health and quality of life. There’s much less research on the question of how inadequate sleep affects self-control, but investigators in a few studies have found that sleep deprivation decreased self-control and increased interpersonal hostility. Here’s what the authors suggest may be behind poor sleep’s effects on self-control:

  • The circadian system influences the timing of sleep, hunger, and the metabolizing of glucose. Sleep deprivation alters circadian rhythms and has a negative effect on the ability to metabolize glucose, processes which could impair self-control.
  • Irregular bedtimes and being chronically short on sleep are known to interfere with the restorative functions sleep performs, such as the healing of damaged tissue and the stabilizing of mood. This too could lead to a loss of self-control, which in turn could perpetuate poor sleep habits.
  • Neuroimaging studies show that sleep deprivation decreases activity in the prefrontal cortex, a brain area important in making decisions and moderating social behavior. These higher-level prefrontal regions, which normally put the brakes on drives and emotional responses generated by lower subcortical regions, may not be able to function optimally, which could also result in a loss of self-control.

Poor sleep whatever its provenance (sleep apnea, restless legs syndrome, or insomnia) may increase your vulnerability to all kinds of injudicious behaviors, from overeating and binge drinking to overspending and yelling at the boss. When impulse control is in short supply, look for ways to improve your sleep.

In what areas is it hard for you to maintain self-control?

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 at Night, Running on Empty All Day

People usually think of insomnia as a problem of the night, but it’s more than that. Poor sleep puts a damper on the day and affects our performance on the job.

This week is Sleep Awareness Week. To call attention to the fact that the effects of chronic insomnia are 24/7, I’m posting my final book trailer, where I discuss the daytime symptoms of insomnia and offer a few tips for coping after bad nights.

People usually think of insomnia as a problem of the night, but it’s more than that. Poor sleep puts a damper on the day, as Kim, a nurse I interviewed, explains: “Generally, I experience insomnia just about every night. The older I get, the more I pay for it the next day. I am groggy and grumpy and I can’t think straight. But I’m usually OK until the afternoon and then it’s pure hell. I get really sleepy about 2 p.m. and have to just keep on working until I get things done.”

Not only do our bad nights leave us feeling lousy the next day. They also affect our performance on the job. A review of the occupational effects of insomnia found that insomnia symptoms

  • increase the risk of accidents in the workplace
  • reduce productivity on the job, and
  • inhibit career advancement.

This week is Sleep Awareness Week. To call attention to the fact that the effects of chronic insomnia are 24/7, I’m posting my final book trailer, where I discuss the daytime symptoms of insomnia and offer a few tips for coping after bad nights. Take a listen and see if you relate!

Insomnia at Night, Running on Empty All Day