Ebb Insomnia Therapy: The Silver Bullet We’ve Been Waiting For?

The company name has changed. So has the wearable part of this sleep-promoting medical device.

But the product launch at selected sleep centers is still set for the final months of 2017, with full production capacity expected next year. Here’s an update on a device that will add to research-based treatment options for people with insomnia.

Ebb Insomnia Therapy helps people fall asleep more quicklyThe company name has changed. So has the wearable part of this sleep-promoting medical device.

But the product launch at selected sleep centers is still set for the final months of 2017, with full production capacity expected next year. Here’s an update on a device that will add to research-based treatment options for people with insomnia.

What It Is

The Ebb Insomnia Therapy device was developed by Ebb Therapeutics (formerly Cerêve, Inc.). Worn at night, it consists of a soft headband (rather than the plastic cap envisioned last year) attached by a tube to a temperature regulator that sits on a bedside table. Fluid is continuously pumped through the part of the headband that rests against the forehead, cooling it down. Research has shown that by cooling the forehead, the device reduces metabolic activity in the front part of the brain and hastens the onset of sleep.

Excessive Brain Activity at Night

The bane of many insomnia sufferers at night is a mind that keeps going and going and doesn’t want to stop. Such thinking and other executive activities (planning, decision-making) are functions of the frontal cortex, or the front part of the brain, involving the metabolizing of glucose.

Functional brain imaging studies—movies of processes occurring in the brain—have shown that the brains of normal sleepers are mainly quiet at night. No activity is detected in the frontal areas. In contrast, imaging studies conducted by Ebb Therapeutics founder Eric Nofzinger have revealed a great deal of metabolic activity occurring at night in the brains of insomniacs, including activity in the frontal cortex. Published images show that at night, the brains of people with insomnia are “lit up like Christmas trees.”

Cooling the Brain

Why might cooling the brain help? For starters, our core body temperature tends to rise in the daytime and fall at night. Previous research has shown that we tend to fall asleep more readily when our core body temperature is on the downward part of the cycle.

Two early studies conducted on people with insomnia showed that cooling the forehead at night

  • reduced participants’ core body temperature, and
  • reduced metabolic activity in the brain, particularly in the frontal cortex.

When Nofzinger and colleagues conducted a third, larger study (randomized and placebo controlled), they found that wearing the device significantly reduced the amount of time it took insomnia sufferers to fall asleep.

Compared With Current Insomnia Treatments

Many medications for insomnia have unwanted side effects. Ebb Insomnia Therapy is reported to have no appreciable side effects and classified as low risk by the FDA. As for its effectiveness, only time will tell how well it stacks up against insomnia drugs such as Ambien and Belsomra. New insomnia treatments like Ebb are only required to perform significantly better than sham treatment or placebo pill to gain FDA approval.

Cognitive behavioral therapy for insomnia (CBT-I), currently the gold standard in insomnia treatments, requires effort and commitment to a rigorous, weeks-long therapeutic process. Ebb Insomnia Therapy is relatively effortless. All it involves is wearing a headband at night. Some insomnia sufferers may begin to benefit right away, according to the company website. Others may take time to adjust to the device and need to use it anywhere from 2 to 4 weeks before seeing sleep improvements.

Limitations

The device will not be sold over the counter. It requires a prescription from a licensed physician or a licensed nurse practitioner. Nor has Ebb Therapeutics said how much it will cost. The company has taken out several patents, though, so the device will not be cheap. In addition, a new fluid cartridge will need to be purchased every three months. The device and cartridges are not expected to be reimbursable by health insurance companies anytime in the near future.

It’s doubtful the device will solve the sleep problems of every insomniac. The studies show that Ebb Insomnia Therapy reduces the time it takes to fall asleep and users report, after 30 days, that it improves sleep quality. Nowhere is the company claiming the device cuts down on night-time wake-ups or increases total sleep time, two items on the wish list of many insomnia sufferers.

Even so, it may be the silver bullet that at least some insomniacs have been waiting for. Particularly if you feel your sleep problem is driven by a yammering brain that just won’t stop, Ebb Insomnia Therapy is certainly worth checking out.

Insomnia: How Do You Score?

You may know you’ve got insomnia. But could you prove it?

Researchers use pencil-and-paper tests to assess different aspects of sleep: sleep quality, insomnia severity, sleep reactivity, and sleep-related beliefs. If you’re unfamiliar with these questionnaires, you may find it interesting to look at them and see how you score.

How do you score on tests given to people with insomniaYou may know you’ve got insomnia. But could you prove it?

There is no lab test for insomnia that would back you up.

An overnight sleep study, then?

Maybe—but probably not. Sleep studies don’t discriminate very well between insomniacs and good sleepers.

Genetic factors?

There may be genetic markers associated with insomnia, but researchers have no definitive understanding of what they are or how they add up to insomnia. The diagnosis of insomnia disorder is still made subjectively, based on questions and answers about sleep.

The list of questions doctors often ask to make the determination is fairly short and sweet.  But researchers use pencil-and-paper tests to assess different aspects of sleep: sleep quality, insomnia severity, sleep reactivity, and sleep-related beliefs. If you’re unfamiliar with these questionnaires, you may find it interesting to look at them and see how you score.

At the Doctor’s Office

If you take your complaints about sleep to the doctor, he or she may attempt to rule out other disorders before asking questions related to insomnia. You’ll get a diagnosis of insomnia disorder if

  • you have trouble falling or staying asleep, or sleep that doesn’t feel restorative, at least 3 times a week,
  • your sleep problem has persisted for at least 3 months, and
  • you experience impairment(s) during the daytime: moodiness, for example, or trouble concentrating or a lack of stamina that interferes with social, occupational, and other types of functioning.

Researchers, however, use pencil-and-paper assessment tools to evaluate subjects’ sleep and sleep improvements. Following are some of these questionnaires, downloadable as PDF files.

Pittsburgh Sleep Quality Index (PSQI)

In 1989 University of Pittsburgh sleep scientists introduced the PSQI in an attempt to quantify an aspect of sleep acknowledged to be important but difficult to measure.

The scoring of the PSQI questionnaire—with 19 self-rated questions—is a bit involved, but explicit scoring instructions are given at the end of the test. (Five more questions are to be answered by your bed partner or roommate if you have one. But these questions are not scored.) The 19 self-rated questions are divided into 7 “component” scores. The component scores are then added together to get the global score, which can range from 0 to 21. A global score of over 5 is indicative of poor sleep quality.

Sample question: During the past month, how often have you had trouble sleeping because you wake up in the middle of the night or early morning?

Insomnia Severity Index (ISI)

Some people experience insomnia occasionally while others experience it practically every night. The severity of a person’s insomnia may predict how likely he or she is to respond to various treatments. So it’s seen as a key variable to take into account when diagnosing insomnia and recommending a treatment, and when assessing improvements in study participants’ sleep.

Scores on this 7-item ISI questionnaire range from 0 to 28. Trouble sleeping is considered to be severe enough to warrant a diagnosis of insomnia disorder if scores are 8 or higher.

Sample question: How worried/distressed are you about your current sleep problem?

Ford Insomnia Response to Stress Test (FIRST)

The FIRST is the newest of the tests, introduced in 2004. This questionnaire is said to measure people’s overall level of “sleep reactivity,” a trait hypothesized to increase the likelihood of a person’s sleep being disturbed during stressful situations. The claim is that people who score higher on the FIRST are more likely to develop persistent insomnia.

FIRST scores range from 9 to 36. Scores of 20 and above indicate that stressful situations experienced prior to sleep—or the anticipation of stressful situations ahead—may routinely knock your sleep off track and make you vulnerable to chronic insomnia. Access this questionnaire by looking at Table 1 on the third page of this article about stress-related sleep disturbance.

Sample questions: How likely is it for you to have difficulty sleeping (a) after an argument? (b) before having to speak in public?

Dysfunctional Beliefs and Attitudes About Sleep Scale (DBAS)

If you don’t sleep well, you may find yourself having negative thoughts about sleep. Over time, these thoughts may coalesce into ideas, attitudes, and beliefs about sleep that give rise physiological arousal, making it harder TO sleep. In turn, the sensations of increased warmth, muscle tension, and faster heart rate that accompany arousal reinforce the negative thoughts, giving rise to a vicious circle.

The 16-item DBAS identifies misconceptions about sleep and assesses how big a role these and other cognitive factors likely play in perpetuating a person’s insomnia. A high score suggests that dysfunctional beliefs and attitudes may be a significant component of your insomnia, amenable to treatment with cognitive therapies.

Sample item: When I sleep poorly on one night, I know it will disturb my sleep schedule for the whole week.

If you’re curious enough to take any of these tests and end up learning something about your sleep, please take a moment to share it by leaving a comment. Thanks!

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.

Does Insomnia Carry a Social Stigma?

My aunt and uncle from LA recently visited me here in Ann Arbor. I spent a fair amount of time with them when I lived on the West Coast, and over the years we’ve had lots of intimate conversations. They’d read my book, The Savvy Insomniac, and the first thing they said about it was this:

“We never knew you had such a problem with insomnia.” Implicit was a question: Why didn’t you ever mention it to us?

hiding-insomniaMy aunt and uncle from LA recently visited me here in Ann Arbor. I spent a fair amount of time with them when I lived on the West Coast, and over the years we’ve had lots of intimate conversations. They’d read my book, The Savvy Insomniac, and the first thing they said about it was this:

“We never knew you had such a problem with insomnia.” Implied was a question: Why didn’t you ever mention it to us?

I was actually surprised to find out I hadn’t spoken about my sleep problem with these family members. I answered as truthfully as I could:

“There’s a stigma attached to insomnia,” I said, or something to that effect. “I didn’t use to say much about my trouble sleeping. I didn’t want people making assumptions about me, like I had big psychological problems or I was making a mountain out of a molehill, or something like that.”

A Pervasive Social Stigma

Part of what motivated me to study insomnia was the social stigma I felt was attached to it. I wanted to understand where it came from and why it’s so enduring.

Other insomnia sufferers also perceive this stigma. A number I’ve spoken with feel that family and friends don’t understand what it’s like to struggle with persistent insomnia, and that they make negative judgments about people who have it (or they would judge us poorly if they knew). So we end up keeping the complaint to ourselves . . . and feeling like we’ve got to tough it out on our own rather than reaching out for help.

Still other insomnia sufferers say they have no reservations about discussing their sleep problem, adding that the normal reaction they get is sympathy. I overheard a sleep therapist say there was no stigma attached to insomnia, and I wondered if the stigma was finally dying out.

But recent studies exploring the experience of insomnia suggest the stigma persists. Of 24 insomnia patients interviewed at the University of North Texas, “38 percent of the sample directly admitted to feeling stigmatized about their problem sleeping,” and “more discussed it indirectly in terms of isolation and feeling different.”

Do You Feel This Way?

These testimonials are taken from the study above and from similar studies conducted in Scotland and Pittsburgh. See if they reflect a part of your experience with insomnia:

  • “I felt like it was . . . a disgrace? Like why am I weak and why can I not get over this? It’s a thing you feel a little bit guilty about. You know, I am tough and strong and I can do this myself. That was one reason I waited [to look for help].”
  • “I feel embarrassed even to discuss about my sleeplessness, why I’m so tired, why I’m dull, why I’m not performing maybe to my friends’ expectations . . . to the world, it is a problem you can sort out.”
  • “When I tell my family I have it, they all laugh. They say I need to see a psychiatrist. I thought I was nuts. . . . [Even now] I can’t really talk about it with anyone except my doctor.”
  • “Other people think you’re a freak” . . . “a liar” . . . “a hypochondriac.”
  • “People might see that some days I do okay but not most days. . . . I think they wonder if I’m faking when I talk about how hard things are.”

Beyond Embarrassment and Isolation

This sense of being misunderstood, and the shame and isolation that can take root in those of us who suffer insomnia, is apparently fairly common. These feelings and attitudes get serious treatment in The Savvy Insomniac. The overall aim is to encourage people to move beyond them and see persistent insomnia as a serious health problem deserving of attention.

For now, in case you’re resigned to carrying on as a poor sleeper, keep these things in mind: chronic insomnia compromises day-to-day functioning and long-term health. Avoid mentioning it to friends and family if you must–but do continue to look out for help.

Are you guarded about discussing your sleep problem with others? If so, why?

Insomnia in the Middle of the Night

Does your sleep problem involve waking up in the middle of the night once or several times and then trouble falling back to sleep? Sleep maintenance insomnia is actually the most common form of insomnia, and it’s more common as people age. Here’s a quick review of the possible causes and what can be done.

sleep-maintenance-insomniaDoes your sleep problem involve waking up in the middle of the night once or several times and then trouble falling back to sleep? Sleep maintenance insomnia is actually the most common form of insomnia, and it’s more common as people age. Here’s a quick review of the possible causes and what can be done.

Having to pay a bathroom call at night will of course wake you up. Anything you can do cut down on the need to do that—eating an earlier dinner, drinking less in the evening, changing the time you take a medication (with an OK from the doctor)—will help. Other possible reasons for unwanted wake-ups include:

  • Age-related degeneration of neurons connected with the body clock. This results in weaker circadian rhythms, declining levels of melatonin (a hormone helpful to sleep), and more frequent shifts between sleep and waking.
  • Health problems involving chronic pain.
  • A higher rate of “cyclic alternating patterns”—repetitive brainwave patterns that occur during non-REM, or quiet, sleep, which cause your sleep to become less stable.

Reducing Nighttime Wake-ups

I’ll start by describing a behavioral strategy that may be helpful and then move on to medication.

  • Consolidate your sleep by reducing your time in bed. This is one key aim of Sleep Restriction Therapy, which I’ve blogged about many times. Simply delay your bedtime for an hour or more while continuing to get up at the same time every morning. Research suggests that the increased sleep pressure that builds up when you postpone bedtime will cut down on wake-ups at night. This strategy is known to work for adults of all ages.
  • If you suspect that a lack of melatonin is involved, you could ask your doctor about testing for melatonin deficiency (blood, urine, or saliva tests will work). You could also buy a test kit online, collect a sample and send it away to a lab yourself (I don’t, however, have information on the reliability of these labs). If your middle-of-the-night wake-ups are related to a melatonin deficiency, my blog on Melatonin Replacement Therapy describes the treatment options that exist–none perfect.

Prescription Medication

Many doctors frown on the nightly use of hypnotics. Although the FDA has approved a few of them for use without short-term restriction (Lunesta and Ambien CR, for example), concerns about side effects and the potential of these sleeping pills to cause drowsiness in the morning make physicians leery of prescribing them. This is especially true for older patients, whose bodies process drugs more slowly and who are thus more likely to experience unwanted effects.

As occurred in the 1980s and 1990s, physicians are now prescribing more sedating antidepressants and antipsychotics for patients with sleep maintenance insomnia. (Unfortunately, there have been few controlled studies assessing the efficacy of these drugs for insomnia.) Here are some examples:

  • Silenor. This low-dose formulation of doxepin is the single antidepressant drug that has been approved by the FDA for the treatment of sleep maintenance insomnia. Controlled studies have shown that it cuts down on nighttime wake-ups. The brand-name drug is expensive; generic doxepin is chemically identical and will work just as well . . . if it does work.
  • Trazodone. This sedating antidepressant was the best-selling drug for insomnia until the turn of the 21st century (and may now enjoy renewed popularity). The few short-term studies of the drug as a treatment for insomnia suggest that low doses (100 mg or less) cut down on wake time in the middle of the night. See my blog on trazodone for details.
  • Seroquel and Klonopin. See my blog on Off-Label Meds for Insomnia for information on these drugs. Here I’ll offer an addendum: the fact that these drugs are now available as generics (and therefore inexpensive) makes it unlikely that they’ll ever be tested for efficacy in treating insomnia. They may be effective for sleep maintenance insomnia—but any evidence now is based on observation only.

One last note on medication for middle-of-the-night awakeners: The sleeping pill zaleplon (a.k.a. Sonata) has not been approved for use in the middle of the night. But it has a very short half-life (1 hour) and tests are under way to evaluate the safety of middle-of-the-night dosing. A new study shows that while Ambien CR taken at bedtime interfered with the consolidation of memories at night, 10 mg of zaleplon taken in the middle of the night did not. Other studies have shown no residual grogginess in insomniacs at 4 hours after taking zaleplon. The drug may be an option for those looking to get back to sleep more quickly.

If you have sleep maintenance insomnia, what strategies and medications have you tried, and have they worked?

Q & A: Is What I’ve Got Insomnia?

Recently I was telling a new acquaintance about my book.

“Insomnia?” she said. “How do you define that? My problem is that I wake up several times every night. Does that qualify as insomnia?”

dont-knowRecently I was telling a new acquaintance about my book.

“Insomnia?” she said. “How do you define that? My problem is that I wake up several times every night. Does that qualify as insomnia?”

“That depends,” I replied, and then I rattled off the medical definition of insomnia: trouble getting to sleep or staying asleep, awakening too early, or nonrestorative sleep; and distress or impairment in key areas of functioning during the day. “Do you feel impaired during the daytime?”

“I have a lousy memory,” she said. Then she launched into a litany of lost remembrances: trips taken, family gatherings, books read. The relationship of sleep and memory is a hot topic these days and she was curious: did her longstanding memory problems and frequent wake-ups mean she was suffering from insomnia? (And if she could get rid of the wake-ups, would her memory improve?)

First Impressions

A good diagnostician or sleep specialist would interview her further before reaching a conclusion; I am neither of these things and don’t pretend to be.

Yet my impression was that—whether or not her symptoms would meet the medical definition of insomnia—she didn’t have a lot to worry about. This woman owns a successful business with stable roots in the community where she lives, and she’s endowed with a vibrant personality, fabulous communication skills, and energy to burn.

Most insomniacs I know present a different picture and tell a different story. Asked about their daytime symptoms, and they talk about everything from fatigue and exhaustion to moodiness and brains that limp along in second gear. Memory impairment, too, is a common complaint, and it’s certainly one of mine.

More Information

Appearances can be deceiving, yet my sense was that if this woman would be given a diagnosis of insomnia, she had a rather mild case. She confirmed this a minute later when she told me what she does when she wakes up at night. “I roll over,” she said, “and I fall right back to sleep.”

I felt a sharp stab of envy: what wouldn’t any red-blooded insomniac give, when we wake up at 2 or 3 a.m., to be able to roll over and fall right back to sleep?

I kept the thought to myself, though, and made a suggestion about how she might improve her sleep. And about this, I’m a believer: no matter the shape and size of a sleep problem, there are probably ways to make it better.

But the memory issue? There’s a question scientists may be working to answer for a long, long time.

What kind of insomnia do you have, and do you experience any negative effects during the day?

Fear of Sleeplessness: How and Why

I spent years in denial about my fear of sleeplessness. Just how mixed up would I look if I admitted to an anxiety that undoubtedly made my insomnia worse?

I didn’t know anything about emotion then, or how people come to fear things like dogs or water or sleeplessness. I’ve come a long way since.

fearI spent years in denial about my fear of sleeplessness. Just how mixed up would I look if I admitted to an anxiety that undoubtedly made my insomnia worse? The thought that I could be afraid of sleeplessness made me feel small and weak. It suggested that part of my sleep problem was learned, and that I was at fault for not being able to unlearn it.

I didn’t know anything about emotion then, or how people come to fear things like dogs or water or sleeplessness. I’ve come a long way since.

What Is Emotion?

When we talk about emotion, we’re usually referring to the visible expression of private feelings: grief following the death of a loved one, excitement at winning a trip to Hawaii, anger at mistreatment by a boss.

But for scientists, emotion has a different meaning. It refers not to feelings we’re aware of—or to the expression of these feelings—but rather to biological systems that evolved to detect and help us respond to important changes in the environment. Neuroscientist Antonio Damasio explains it this way: “For certain classes of clearly dangerous or clearly valuable stimuli in the internal or external environment, evolution has assembled a matching answer in the form of emotion.”

The Fear System

Each emotion is a separate system unto itself, involving different neural pathways in different parts of the brain. The fear system is among the most ancient, fundamental to human survival in a world full of predators.

The fear system is part of our make-up today. If we catch sight of a man waving a gun, that information engages the fear system, traveling rapidly to the brain and triggering the physical impulse to run or hide.

The fear system works with lightening speed; no thinking is required. “This system does its job unconsciously,” writes neuroscientist Joseph LeDoux, “literally before we actually know we are in danger.” Only after the fear system has done its work are we conscious of being afraid.

Some Fears Are Acquired

Some fears develop as the result of a single negative experience. After getting bitten by a pit bull, you fear dogs. After a car accident, you’re afraid to drive on the highway.

Other fears develop following several unpleasant incidents. A series of low test scores results in the development of test anxiety. A series of concerts in which you play badly gives rise to performance anxiety.

Fear of Sleeplessness

Fear of sleeplessness may develop in a similar way. Persistent nocturnal wakefulness and anticipation of fatigue the next day, coupled with the bodily arousal this unpleasant thought gives rise to, might be just the right ingredients to create a fabulous fear-of-sleeplessness stew. Over time, darkness and the bed—or merely thoughts about the darkness and the bed—come to trigger anxiety. We’re as conditioned to fear sleeplessness at night as Pavlov’s dogs were to salivate at the ringing of a bell.

We have no say in the development of such fears, and once they form, they’re hard to get rid of. But there are therapies aimed, among other things, at decreasing the fear of sleeplessness. I’ll write about them in Monday’s blog.

What fears do you have relating to insomnia?

Quick Quiz on Sleep

How much do you know about sleep? See if you can answer these eight questions correctly. Check your answers at the bottom of the page.

computer-quizHow much do you know about sleep? See if you can answer these eight questions correctly. Check your answers below.

1. Most dreams occur

a)      At the beginning of the night

b)      In the middle of the night

c)       At the end of the night

2. We sleep most deeply

a)      At the beginning of the night

b)      In the middle of the night

c)       At the end of the night

3. In a sleep cycle, we move from light sleep to deep sleep and back to light sleep, and then into REM sleep. How many sleep cycles do we typically go through each night?

a)      2-3

b)      4-5

c)       6-7

4. Rapid eye movement (REM) sleep is when most dreams occur. During quiet (non-REM) sleep, the brain is mostly inactive. The 3 stages of non-REM sleep are stage 1 (very light), stage 2, and stage 3 (deep sleep). Healthy adults spend the greatest percentage of the night in

a)      Stage 2 sleep

b)      Deep sleep

c)       REM sleep

5. During deep sleep, there’s a spike in

a)      testosterone

b)      Melatonin

c)       Growth hormone

6. The pineal gland starts secreting melatonin

a)      About 2 hours before bedtime

b)      When it gets dark outside

c)       Just before we enter deep sleep

7. Which of the following is untrue? As we age,

a)      We get slightly more REM sleep

b)      We get less deep sleep

c)       Men experience more dramatic sleep stage changes than women.

8. Which is the most common sleep problem?

a)      Restless legs syndrome

b)      Insomnia

c)       Sleep apnea

 

ANSWERS

  1. C. About 80 percent of our dreams occur in the last half of the night.
  2. A. Deep sleep is discharged in the first half of the night.
  3. B. 4-5 cycles/night
  4. A. About 50 percent of the night is spent in stage 2 sleep.
  5. C. The production of growth hormone spikes during deep sleep.
  6. A. Melatonin secretion begins about 2 hours before bedtime.
  7. A. REM sleep slightly decreases as we age.
  8. B. Insomnia is the most common sleep problem.

How did you fare? Let me know if any of these answers need explaining.