Insomnia and Emotional Memories Linked

Situations like being bullied at school, getting fired from a job or losing your train of thought during an important speech can feel mortifying when they occur. But in time, and with the help of sleep, the shame and embarrassment fade away. You can recall the experience without re-experiencing the emotional charge. This may not be the case for people with insomnia, results of a new study in the journal Brain suggest. Insomnia may involve disruption of the brain’s processing of emotional experience, burdening poor sleepers with emotionally charged memories. Here’s more about it.

Situations like being bullied at school, getting fired from a job or losing your train of thought during an important speech can feel mortifying when they occur. But in time, and with the help of sleep, the shame and embarrassment fade away. You can recall the experience without re-experiencing the emotional charge.

This may not be the case for people with insomnia, results of a new study in the journal Brain suggest. Insomnia may involve disruption of the brain’s processing of emotional experience, burdening poor sleepers with emotionally charged memories. Here’s more about it.

Biological Aspects of Insomnia

Insomnia used to be blamed mainly on bad habits and faulty thinking, but increasing attention is being paid to biological factors that underlie insomnia. Results of gene studies point to genetic factors that make people vulnerable to insomnia. Many insomnia risk genes are located in the limbic area of the brain, where the processing of emotion occurs. The possibility that insomnia has to do with disturbed emotion processing is what researchers in The Netherlands set out to investigate.

Past research has established a few things:

  • When people experience a novel emotional event, such being shown graphic photos of war victims, functional MRIs (similar to movies showing activity in the brain) show strong evidence of activity in the limbic system. However, recall of those photos at a later time does not involve limbic activity.
  • People with insomnia do not experience the same overnight resolution of emotional distress as normal sleepers do. In fact, studies conducted by Rick Wassing and colleagues showed that in insomniacs, emotional distress resulting from an unpleasant situation could linger for over a week.

A Working Hypothesis

People with insomnia are prone to fragmented sleep (particularly, fragmented REM sleep). It could be that in insomnia, an area or areas of the brain that typically go offline during sleep are not fully deactivated, resulting in continuing secretion of neurochemicals associated with alertness. One consequence could be the storage of long-term emotional memories that still retain ties to the limbic system and hence their emotional charge.

The research team decided to investigate the responses of normal sleepers and insomnia sufferers to novel emotional experiences and memories of past emotional experiences and then compare them. Their hypothesis was that in people with insomnia, brain activity during recall of distant emotional events would look more like brain activity during novel emotional events than in normal sleepers.

Preparing for the Study

Fifty-seven people participated, aged 18 to 70 years. Twenty-seven participants had a diagnosis of insomnia disorder and 30 were classified as normal sleepers.

At an intake interview participants shared information about shameful experiences they could recall from their past. Each participant also underwent a structural MRI brain scan and made a karaoke-style audio recording in which he/she sang along to a familiar tune.

A week later testing began. Throughout the testing, each participant was wired with electrodes to assess galvanic skin response (changes in sweat gland activity that would reflect the intensity of the participant’s emotional state) and was undergoing functional MRI that would capture and record activity in the brain.

An Ingenious Test of Emotional Intensity

There were two tests, the first involving measurement of participants’ reactions to a novel shameful experience. Participants in both groups, the insomnia sufferers and the normal sleepers, were told they would be exposed to recordings of their own singing and the singing of others, and that two researchers would be listening in. Then each participant had to listen to 16-second fragments of their own solo singing, unaccompanied by music. The fragments were intermixed with neutral stimuli consisting of fragments of the same song sung by a semi-professional singer. How’s that for a novel shaming experience!

The second test involved recall of five shameful events from the distant past. For 16 seconds participants were asked to remember each shameful experience. In between each shameful experience, participants were asked to recall a trivial non-emotional experience from the past. After recounting each memory, participants rated its emotional intensity.

What the Research Team Discovered

Analyzing the data, researchers found, predictably, that emotional stimuli were on average rated as more intense than neutral stimuli. In addition, data from subjective participant reports and assessment of galvanic skin response showed the following:

  • The response to novel neutral and novel emotional experiences was similar in people with insomnia disorder and normal sleepers
  • Normal sleepers’ response to remembered shameful events was similar to their response to remembered neutral events (i.e., the emotional charge that accompanied the original experience was gone).
  • People with insomnia, however, had a stronger response to relived shameful memories than to neutral memories (suggesting continuing involvement of the limbic system).

Movies of the Brain Are Confirmatory

From the functional MRIs, investigators found the following:

  • The shame participants felt as they listened to their own singing triggered intense limbic activity in the brains of both normal sleepers and people with insomnia
  • Although memories of past shameful experiences did not induce a limbic response in normal sleepers, in insomnia sufferers, they did. In fact, in the brains of people with insomnia, limbic activity was noted in many of the same areas active during novel emotional experiences, notably, the anterior cingulate cortex.

“The findings,” write the authors, “suggest that normal sleepers activate a markedly different brain circuit while reliving emotional memories from the distant past as compared to when they are exposed to novel emotional experiences. In patients with insomnia, however, the brain circuits recruited with reliving distant emotional memories overlapped with the circuits recruited during a novel emotional experience.”

The restless REM sleep that often characterizes insomnia may be attributable to a failure to deactivate a part of the brain that, if shut down, could enable more restorative sleep and quicker recovery from emotionally painful experiences. There are ways to treat insomnia behaviorally, and some work pretty well. But only when more research into the causes of insomnia is conducted will researchers be able to find a cure.

Do the findings of these researchers ring as true to you as they do to me?

What’s That Antidepressant Doing to Your Sleep?

Most—but not all—antidepressants tend to suppress and/or delay REM sleep (the stage associated with dreaming). This can be helpful for people with depression.

It’s not necessarily helpful for people with insomnia. In fact, REM sleep irregularities may be a causal factor in insomnia. So it pays to know a bit more about antidepressants if you’re taking them now or before you head down that path.

Most antidepressants suppress and delay REM sleepAntidepressants are the third most commonly taken medication in the United States today, prescribed for depression and health problems such as insomnia, pain, anxiety, headaches, and digestive disorders. Most—but not all—antidepressants tend to suppress and/or delay REM sleep (the stage associated with dreaming). This can help people with depression.

It’s not necessarily helpful for people with insomnia—or for people who might be inclined to sleep problems if pushed in the wrong direction. There’s mounting evidence that REM sleep irregularities may actually be a causal factor in insomnia. So it’s worthwhile knowing about the REM and other sleep effects of antidepressants if you’re taking them now or before you head down that path.

Importance of REM Sleep

Intact, sufficient REM sleep has many benefits. They include the enhancement and consolidation of learned tasks and skills in long-term memory and the regulation of emotion.

Fragmented REM sleep, in contrast, may lead to the inadequate processing of emotion and then to hyperarousal, in turn giving rise to insomnia. Loss of the final REM period, a phenomenon identified in some “short sleepers” (often defined as those who sleep less than 5 hours a night), may increase your appetite and make you more vulnerable to weight gain and obesity.

In short, reduced or compromised REM sleep is not something you generally want.

Selective Serotonin Reuptake Inhibitors (and Relatives)

SSRIs are widely prescribed because they’re effective for depression and have relatively few major side effects. But as a class, they tend to suppress REM sleep. (They may also bring about changes in the frequency, intensity, and content of your dreams.) They also tend to delay the onset of sleep and increase awakenings and arousals at night, reducing sleep efficiency.

If you have both depression and insomnia, it’s probably best to steer clear of SSRIs. But here’s a caveat. SSRIs and other drugs that act on the serotonin system (which is very complex) are known to have different sleep–wake effects on different people. Trying out a drug like fluoxetine (Prozac) may be the only way to ascertain for sure how it will affect your sleep.

The story is basically the same for serotonin and norepinephrine reuptake inhibitors (SNRIs). Drugs such as duloxetine (Cymbalta) and venlafaxine (Effexor XR) markedly suppress REM sleep and tend to disrupt sleep continuity.

Tricyclic Antidepressants

TCAs aren’t prescribed as often as SSRIs because they tend to cause more side effects. However, like SSRIs, most TCAs (except trimipramine) markedly suppress REM sleep. Also, TCAs like desipramine and protriptyline give rise to increased norepinephrine, which tends to promote wakefulness rather than sleep. In studies of desipramine, the drug degraded the sleep of people with depression by extending sleep onset latency, decreasing sleep efficiency, and increasing their number of awakenings at night.

Most TCAs are not sleep friendly. However, low-dose amitriptyline is known to have sedative effects and is sometimes prescribed for people with depression and insomnia.

Low-dose doxepin has been shown to have sedative effects as well, blocking secretion of histamine, a neurotransmitter associated with wakefulness. Sold today as Silenor, it’s the only antidepressant approved by the FDA for the treatment of insomnia. Clinical trials suggest that Silenor is effective in treating sleep maintenance insomnia but not insomnia that occurs at the beginning of the night.

Atypical Antidepressants

Some antidepressants are atypical in that they don’t fit neatly into any category. Although not approved for the treatment of insomnia (the requisite trials were never conducted), low-dose trazodone (Desyrel) and mirtazapine (Remeron) are often prescribed for people with insomnia because of their sedative effects. Unlike most antidepressants, these drugs have not been found to markedly suppress REM sleep. And the results of a very few studies suggest that they may help people fall asleep more quickly and sleep more deeply.

If you’re taking an antidepressant now (for whatever reason) and you think it may be interfering with your sleep, talk about it with your doctor. And if you’re having sleep problems and considering an antidepressant, be selective about the one you use.

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.

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?

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?

Do Sleep Spindles Play a Role in Insomnia?

Looking for an objective test of insomnia?

New research suggests there’s a relationship between insomnia and sleep spindles—sudden bursts of fast electrical activity that occur in the brain mostly during stage 2 sleep. Investigators at Concordia University in Montreal found that students with lower spindle activity reported more stress-related sleep problems than students whose spindle activity was high.

objective insomnia marker | fewer sleep spindles in EEGLooking for an objective test of insomnia? Unfortunately, no such test exists.

But scientists hunting for biomarkers of the disorder have noted subtle differences between insomniacs and normal sleepers in the electrical activity occurring in the brain at night. Some studies show that insomniacs spend less time in deep sleep; others show that insomniacs who awaken frequently at night get less REM sleep. Still others show that insomniacs are more prone to high-frequency brain waves during sleep.

New research suggests there’s also a relationship between insomnia and sleep spindles—sudden bursts of fast electrical activity that occur in the brain mostly during stage 2 sleep. Investigators at Concordia University in Montreal found that students with lower spindle activity reported more stress-related sleep problems than students whose spindle activity was high.

Importance of Sleep Spindles

Here's what sleep spindles look like.
Here’s what sleep spindles look like.

Sleep spindles occur throughout the night during periods of non-REM sleep, and more spindles occur in some people than in others. Yet in any individual, spindle density is quite stable from night to night come rain or shine. So spindle density is regarded as an individual trait.

Previous research has shown that sleep spindles protect us from being awakened by noise in the environment. So these short bursts of electrical activity contribute to sleep stability. Spindles have also been found to assist in the overnight retention of memories and enhance learning. Sleep spindle density also correlates with higher scores on tests of intelligence. In short, sleep spindles are highly beneficial.

Concordia Study

Thien Thanh Dang-Vu and colleagues enrolled 12 healthy, normal-sleeping Concordia University students to test their hypothesis that students with fewer spindles would have more trouble sleeping during periods of academic stress. They gathered baseline data from each student at the beginning of a winter semester, when stress levels were low. Students underwent polysomnography (an overnight sleep study) and a battery of pencil-and-paper tests assessing their sleep, stress levels, and mood. Then, during a high-stress period—the week prior to final exams—the students underwent a second round of testing to find out how the stress of exam week was affecting their sleep.

As expected, the lower the sleep spindle activity, the more likely a student was to report sleep problems. In particular, lower spindle density at the beginning of the night—as students were falling asleep—correlated with more sleep complaints in response to academic stress.

Implications

What this implies, the researchers say, is that alongside other factors that predispose us to insomnia—a family history of insomnia, depression or anxiety, hyperarousal, poor health, and pain—people whose brains generate fewer sleep spindles at night are more prone to develop insomnia than those whose spindling activity is high.

Why some people are champion spindlers and others are not is a question that still needs sorting out. But insomnia treatments that promote sleep spindles could only be a good thing. Whether in the form of medication or herbs or pre-sleep activities, I say, bring ’em on!

Six Misconceptions about Sleep and Insomnia

Most of us know that drinking coffee after dinner will probably disrupt our sleep and that regular exercise will improve it. But some ideas I see tossed out about sleep and insomnia are not quite accurate. Here are six misconceptions followed by information that is evidence based.

insomnia | many people have beliefs and attitudes about sleep that are not factualMost of us know that drinking coffee after dinner will probably disrupt our sleep and that regular exercise will improve it. But some ideas I see tossed out about sleep and insomnia are not quite accurate. Here are six misconceptions followed by information that is evidence based. Find sources by clicking the links in the blog.

Insomnia mainly has to do with a lack of REM sleep (when most dreaming occurs).

Overall, studies comparing people with insomnia to normal sleepers show that insomnia is associated with reductions in both deep sleep and REM sleep. Deep sleep enables the consolidation of memories for factual information and events, and persistent insomnia tends to interfere with this process. Shortened REM sleep, on the other hand, leads to alterations in the processing of emotion—another symptom of insomnia.

The fact that I don’t remember my dreams means I don’t get enough REM sleep.

No evidence shows that sufficient REM sleep is tied to the remembering of dreams. What does seem to be true is that people who remember dreams typically wake up more often during REM sleep than people who don’t remember dreams. But these awakenings are so brief that the dreamer may not be aware of them.

I need several hours of deep sleep to function well.

Young children spend about a third of the night in deep sleep. But the amount of deep sleep humans get declines dramatically during adolescence. The average middle-aged adult spends about 15 percent of the night in deep sleep, and older adults may get as little as 10 percent. As critical as deep sleep is to our ability to function, it accounts for a small percent of the total sleep we get. Our descents into deep sleep occur mostly in the first part of the night.

Rates of insomnia are highest among people in high-status, high-stress jobs.

Stress has a huge impact on sleep, and high stress reactivity may be a defining characteristic of people who develop insomnia. But all else equal, people who earn large salaries are not the ones most likely to toss and turn at night. People of low socioeconomic status with lower education levels are more vulnerable to insomnia than surgeons and CEOs.

Waking up for a stretch in the middle of the night is a sign that something is wrong with my sleep.

Not necessarily. Historical evidence suggests that until the widespread use of electric lighting, this segmented sleep pattern was not unusual. People went to bed soon after nightfall and woke up later to make love, tend to animals and crops, or simply lie awake with their minds adrift. Then they went back to sleep for the rest of the night.

Being awake in the middle of the night may be inconvenient, and with strategic use of light and sleep compression you may be able to whittle that wakefulness down. But if you’re functioning OK in the daytime, being awake at night does not signal something amiss.

If my sleep is lousy, I should make a point of going to bed earlier.

If you have insomnia, going to bed early will likely make the problem worse. The arousal system is fully engaged in the hours leading up to bedtime, early research has shown: most people have a hard time falling asleep in the evening. Here’s a better rule of thumb: If your sleep is lousy, make a point of staying up until you feel sleepy. Only then should you go to bed.

Questions or doubts about sleep or insomnia? Share them here, and I’ll do my best to respond and clarify.

Will Marijuana Help My Insomnia?

Some people tell me marijuana helps them sleep. Just last week a friend from college—I’ll call her Marcia–mentioned she’d tried it and was happy with the result.

Marcia’s insomnia came in the middle of the night. She’d wake up at 3 and was rarely able to get back to sleep. Ambien helped for a while. Then her doctor refused to renew her prescription, so Marcia made an appointment with a sleep therapist and went through CBT for insomnia . . . to no avail. She continued to wake up in the darkest hours. As a last resort she tried marijuana.

“Just two puffs” at bedtime enabled her to sleep uninterruptedly until 5 or 5:30 a.m. This was a surprise and a relief. But the bigger surprise came when she quit the marijuana and continued to sleep through the night.

marijuanaSome people tell me marijuana helps them sleep. Just last week a friend from college—I’ll call her Marcia–mentioned she’d tried it and was happy with the result.

Marcia’s insomnia came in the middle of the night. She’d wake up at 3 and was rarely able to get back to sleep. Ambien helped for a while. Then her doctor refused to renew her prescription, so Marcia made an appointment with a sleep therapist and went through CBT for insomnia . . . to no avail. She continued to wake up in the darkest hours. As a last resort she tried marijuana.

“Just two puffs” at bedtime enabled her to sleep uninterruptedly until 5 or 5:30 a.m. This was a surprise and a relief. But the bigger surprise came when she quit the marijuana and continued to sleep through the night.

Was she sleeping better now because she was less stressed out? I asked. Was she going to bed later and sleeping longer in the morning because she was being exposed to more sunlight in the evening? No other explanation I could come up with seemed to account for her situation. It looked like the marijuana really was what helped her sleep.

Medical Skepticism

Given the numbers of people who say marijuana makes them sleepy, you might wonder if the trend toward legalizing the drug will result in doctors prescribing it for insomnia one day. Don’t hold your breath. Now legal in 21 states and the District of Columbia, medical marijuana is being used to treat people with chronic pain, multiple sclerosis, cancer and AIDS. But doctors are skeptical about its potential as a sleep aid.

The doubts are partly based on the fact that marijuana is classified as a Schedule I drug. The US Drug Enforcement Agency considers cannabis to be as dangerous as heroin, LSD, and Ecstasy. (Yes, really!) Cannabis may well be sedating, this line of thinking goes, but the risk of developing tolerance and dependency far outweighs the benefits.

Medical skepticism is also based on studies of marijuana and sleep published in the 1970s (after 1970 it got much harder to obtain cannabis for investigative purposes). All these studies were small and relatively short in duration. In most of them, the experimental subjects were not people with insomnia. But although some subjects who used it reported sleeping longer and better, THC—the chemical responsible for most of marijuana’s psychological effects—was discovered to change the nature of sleep. It tended to

  • cause mild suppression of REM sleep in low doses
  • increase deep sleep or total sleep time at first, an effect that disappeared following a week of use
  • decrease both REM and deep sleep at high doses.

Regarding study subjects, design, length, and control of variables, though, these early studies were all over the map. They don’t tell us anything definitive about the effects of marijuana on sleep. And they certainly don’t tell us anything about its effects on people with insomnia.

New Information

Findings released last week from the University of Pennsylvania will likely foster more skepticism about marijuana’s viability as a sleep aid. Researchers looking for a relationship between sleep and marijuana use in data from a national health survey found that a history of marijuana use was associated with impaired sleep quality. The strongest association was found in adults who started using marijuana before age 15: they had about twice as many problems falling asleep and experiencing non-restorative sleep as adults who’d never used marijuana.

This study does not answer the question of whether marijuana use actually causes sleep problems. “All we can say is that there is an overlap” between marijuana use and sleep problems, lead investigator Michael Grandner told The Daily Beast on Wednesday.

Where We Go from Here

All this said, we don’t know the particulars of how the different cannabinoids in marijuana affect sleep. We don’t know enough to rule it out as a useful sleep aid in some instances. We’ll never know more unless investigators step up to the plate.

The current classification of marijuana as a Schedule I substance is clearly a deterrent to further study. Now that investigators have identified several legitimate medicinal uses for it, I’ll go along with the proposal set forth by Charles and Sandra Webb in the April issue of Hawai’i Journal of Medicine & Public Health. Cannabis should be rescheduled to a lower status, the Webbs say, “so as to reduce barriers to needed research and to humanely increase availability of cannabinoid medications to patients who may benefit.”

How does marijuana affect your sleep?