Anniversary Book Giveaway Marks Change in Blog

It’s time for a couple of announcements: The Savvy Insomniac came out four years ago today and we’re giving away 10 copies of the book to mark the occasion. Read on to find out how to get one yourself!

Announcement No. 2: I’ve been blogging weekly about insomnia for five years and now, starting in October, I’ll be posting once a month. I’m as committed as ever to offering news and perspective on issues related to sleep and insomnia. But other projects are calling and taking more time.

Here are the giveaway details. After that, a summary of popular blog topics you’ll hear more about in the future.

Still blogging about insomnia—now, once a month

It’s time for a couple of announcements: The Savvy Insomniac came out four years ago today and we’re giving away 10 copies of the book to mark the occasion. Read on to find out how to get one yourself!

Announcement No. 2: I’ve been blogging weekly about insomnia for five years and now, starting in October, I’ll be posting once a month. I’m as committed as ever to offering news and perspective on issues related to sleep and insomnia. But other projects are calling and taking more time.

Here are the giveaway details. After that, a summary of popular blog topics you’ll hear more about in the future.

Book Giveaway

First, heartfelt thanks to those of you who follow my blog. It’s one thing to visit a website now and then but quite another to sign up for news from a blogger who posts a 600- to 800-word story every week! Your interest in insomnia and insomnia treatments must be as deep and personal as mine.

For all the blogging I’ve done about sleep and insomnia, though, The Savvy Insomniac is the best and most comprehensive writing I’ve done on the subject. Anyone living in the US who hasn’t got a copy and wants one can use the contact form to let me know. The first 10 people who contact me with a question about sleep or insomnia (something you wonder about but haven’t found much information about) will get a copy of The Savvy Insomniac free of charge.

Don’t forget to include your mailing address. Overseas shipping rates are so exorbitant that I can’t ship books abroad. But inexpensive e-books continue to be available through Amazon and other online booksellers.

Here, now, are the blog topics most popular with Savvy Insomniac readers. Count on hearing more about them in the months ahead.

Insomnia Relief in the Form of a Pill

Sleeping pills don’t get great press these days, but they have great interest for Savvy Insomniac readers. Posts about Belsomra, the newest sleeping pill approved for the treatment of insomnia, consistently get the most views. Belsomra acts as a sedative by blocking transmission of orexin, a neurochemical that promotes arousal. Other orexin-blocking sleeping pills are in the works. I’ll write about them if and when they’re approved by the FDA.

Posts about sedating antidepressants are also popular. Since many sleeping pills have undesirable side effects, persistent insomnia is sometimes treated with low doses of a sedating antidepressant. Doxepin has been approved as Silenor for treatment of sleep maintenance insomnia. The others (trazodone, mirtazapine, amitriptyline) have not been sanctioned by the FDA as effective for insomnia. They do, however, have sedative properties.

Melatonin supplements are also of high interest to readers, especially in timed-release formulations. But melatonin is not a sleeping pill. Its usefulness lies in its ability to shift the timing of sleep. Melatonin is sometimes recommended to night owls whose daytime schedules make it necessary to go to sleep earlier than they would following their natural inclinations. It also helps lessen jet lag.

Insomnia: What’s Your Flavor?

Posts on the different types of insomnia are the next most visited category. Since the underlying causes of insomnia disorder remain unknown, insomnia is usually classified based on the symptoms people report.

Psychophysiologic (or psychophysiological) insomnia is the most common insomnia diagnosis given to those of us who report trouble sleeping at night and daytime impairments. Symptoms are both physiological (bodily tension and warmth, for example) and psychological (anxiety about sleep). Cognitive behavioral therapy (CBT) is now the first-line treatment for psychophysiologic insomnia.

A diagnosis of paradoxical insomnia may be made following a sleep study showing a large discrepancy between how much time a person reports sleeping and how much sleep is recorded on the polysomnogram (the test in the sleep lab). Treatment options vary and there’s no clear consensus on which works best.

Sleep Restriction for Insomnia Relief

Sleep restriction therapy comes in for a close third topic of interest to Savvy Insomniac readers. Offered as part of CBT-I or as a standalone therapy, sleep restriction has been found in research to improve several aspects of sleep.

Its appeal to readers of this blog may have to do with the sheer number of posts I’ve written on the topic (10) and the fact that it worked so well for me. Combined with daily exercise, sleep restriction helped me regularize my sleep and overcome my sleep anxiety. Invaluable gains, to me.

Seasonal Insomnia

Insomnia that varies seasonally is another topic that draws lots of readers. Environmental factors that occur in the spring and summer—too much light and too much heat—can easily interfere with falling and staying asleep.

Insomnia that starts in the fall and continues through the winter may be driven by other environmental factors. Lack of sunlight or other bright light is usually the culprit. Lack of vitamin D may be another factor. Expect to see an update on this topic coming fairly soon.

Don’t see a topic that interests you here? Use the contact form to ask a question about a topic that does interest you, and receive a free copy of The Savvy Insomniac.

And here’s a last request: please like and share blog posts you feel are helpful on Facebook, Twitter, and other social media. This will help The Savvy Insomniac blog remain discoverable to other insomnia sufferers looking for a better night’s rest.

Early Treatment of Insomnia May Improve Mental Health

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

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

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

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

Sleep and Mood: An Intimate Relationship

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

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

A Large-Scale Study

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

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

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

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

Insomnia Treatment Improves Sleep, Reduces Psychotic Symptoms

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

  • greatly improved sleep
  • fewer experiences of paranoia and hallucinations

The Take-Away

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

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

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

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

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

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

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

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

11+ Nighttime Activities for Sleep Restriction

Here’s a complaint I often hear from insomniacs going through sleep restriction therapy: it’s hard to stay awake until bedtime. A related frustration comes with suddenly having extra time on your hands.

“I don’t know what to do with myself till 2:30 in the morning!” an insomnia sufferer groused to me.

Here are variations on 11 activities aimed at keeping you awake until the clock says it’s time to head to bed.

Sleep restriction less difficult with enjoyable activities that keep you awakeHere’s a complaint I often hear from insomniacs going through sleep restriction therapy: it’s hard to stay awake until bedtime. A related frustration comes with suddenly having extra time on your hands.

“I don’t know what to do with myself till 2:30 in the morning!” an insomnia sufferer groused to me.

Here are variations on 11 activities aimed at keeping you awake until the clock says it’s time to head to bed.

A Trivial Topic? Think Again

Sleep restriction therapy involves first restricting your time in bed to just the number of hours you’re actually sleeping. Then you gradually add time in bed until you find your ideal sleep window. Normally, this means starting therapy with a later-than-usual bedtime, an earlier-than-usual rise time, or both.

If you’re new to sleep restriction, planning what to do in the run-up to a later bedtime may seem unnecessary.

“I’ll read,” you say, “I’ll watch TV, I’ll catch up with friends on Facebook. I’ll do what I always do at night, only I’ll stay up longer.”

Sticking to the familiar may not work and here’s why:

The first week you’re restricting your sleep you’ll probably feel somewhat sleep deprived. If even mild sleep deprivation is involved, passive activities like watching TV and reading can lead to nodding off well before the prescribed bedtime. This interferes with establishing a regular sleep schedule, which is one thing you’re trying to accomplish. The more you stick to your prescribed bed and wake times, the quicker the therapy will take effect.

Devices with screens (computers, iPads, iPhones) emit blue light, which blocks secretion of the sleep-friendly hormone melatonin. It’s helpful to install an app called f.lux or wear blue-blocker glasses if you use devices at night. Even so, being wedded to the screen in the hour leading up to bedtime is not a good idea, especially for people with sleep onset insomnia (people whose insomnia occurs at the beginning of the night).

Other Constraints on Nighttime Activities

Evening activities have to be quiet unless you live alone. Playing the saxophone may be fun for you but obviously not for other members of the household.

Evening activities can’t require a lot of physical or mental stamina. By then you’re usually low in the tank.

A walk outside might have appeal. But depending on who you are and where you live, it may not be safe to leave home after dark.

The Special Challenge of Sleep Anxiety

What to do in the run-up to bedtime can be especially challenging for sleep onset insomniacs, whose anxiety about sleep tends to escalate the later it gets. Clock watching adds to (or is a part of) that sleep-related anxiety. When undergoing sleep restriction there’s no getting around use of the clock for information about when it’s OK to go to bed.

Waiting until anxiety sets in to decide what to do can be risky. A glass of wine? A sleeping pill? You’re off the rails before you’ve even begun. Why add stress to the sleep restriction process by waiting too long to decide what you’re going to do in the extra time you’re up?

Take it from one who’s been there twice and who, knowing what she knows now, would do it somewhat differently. In the week before you start restricting your sleep (as you’re collecting information about your sleep and recording it in your sleep diary), come up with a list of activities you’re going to do when restriction begins, acquiring any supplies you’ll need in advance. Ideally, these activities should (a) be somewhat enjoyable (or at least tolerable), (b) offer mild mental stimulation, and/or (c) involve some movement.

This list of activities is hardly comprehensive. But maybe it will motivate you to come up with other activities that would suit you as well or better.

  1. Do (or Take Up) an Art or Craft:

  • Needlework (quilting, knitting, crocheting, embroidery).
  • Jewelry or beadwork.
  • Woodworking or leatherworking
  • Calligraphy.
  • Origami.
  • Sewing. Lay out a pattern and cut the fabric.
  • Any artistic activity, such as sketching or watercolor painting, as long as it doesn’t require much clean up.
  1. Make Lists:

  • To-do lists and grocery lists.
  • Travel checklists for different kinds of trips (road trips, air travel [overseas and domestic], business trips, camping.) Printed out before each trip, they make packing a lot easier.
  • Gift lists. Avoid panic during the holidays and at birthdays and other special occasions.
  • A bucket list. Think of everything you’d like to see and do while you’re still able to do it.
  1. Organize or Reorganize:

  • Your tool bench.
  • Your jewelry box(es).
  • Your music. If you have CDs, tapes, albums, or sheet music, arrange them by style, period, composer, or instrument.
  • Your herbs and spices. Group them as powders, whole spices, and herbs, or arrange them alphabetically.
  • The garage or the basement.
  1. Sort and Discard:

  • Books. Do one shelf at a time, separating them into keepers, throw-aways, and give-aways.
  • Clothing in closets and drawers.
  • Old photos. Put the ones you want to keep into albums or photo boxes.
  1. Redecorate:

  • Your walls. Take down wall art and replace it with other paintings, photos, prints, or posters.
  • Your shelves. Replace pottery and art objects with others.
  1. Bake Cookies or a Coffeecake.

  2. Do Light Housework:

  • Dust furniture.
  • Fold or iron clothes.
  1. Prepare for the Day Ahead:

  • Set the breakfast table.
  • Pack lunches.
  • Do prep work for the evening meal.
  1. Do Things You Enjoyed in the Past:

  • Play Solitaire.
  • Do a thousand-piece jigsaw puzzle.
  • Get out a telescope, look at the stars, and identify constellations.
  • Gather every small thing you’ve collected outdoors—flowers, nuts, leaves, shells, stones, feathers, pine cones—and look at them under a microscope.

The following two categories of activities may be too passive for some people but could work if combined:

  1. Look at Publications with Images:

  • Art books.
  • Coffee table books.
  • Catalogs.
  • Family albums.
  • Cookbooks. Use a post-it note to mark every recipe you want to try out.
  1. Using Headphones, Listen to:

  • Music.
  • Books on CD.
  • A podcast. (But avoid looking at screens.)

Before you start to restrict your sleep, make a list of activities you’re going to do in the run-up to bedtime. And who knows? You might even enjoy some of that extra time awake.

If you’ve gone through sleep restriction, what activity did you find was most helpful in keeping you awake till bedtime?

Q&A: Anxious About Sleep? Get Relief

Anxiety about sleep is a problem for some insomnia sufferers. Fear of sleeplessness is the main thing keeping them awake at night.

Here’s how sleep anxiety develops and how to tone it down.

Relieve fear of sleeplessness with cognitive and behavioral therapies.This week a woman (I’ll call her Gina) wrote to Ask The Savvy Insomniac with questions about sleep anxiety and sleep restriction.

 

 

 

 

I have had chronic insomnia since September. I honestly didn’t have any major life event that caused it. Just a few bad nights of sleep—and the anxiety started setting in. The worst part of it for me is that as soon as it nears “bedtime” my heart starts racing and I feel extremely anxious.

I am doing sleep restriction therapy (I’ve been averaging 5 hours per night) but I’ve had a few “slips” along the way. I tend to drift off to sleep on the couch (for about 5 or 10 minutes). How long does this take? I’ve been doing it for over a week and I haven’t seen any great improvements. I’m losing hope.

Anxiety About Sleep: How It Develops

Anxiety about sleep can develop during a stressful life event when sleep is difficult. It can also develop following several nights of bad sleep, regardless of what triggered them.

Being unable to sleep when you want to sleep is frustrating. Frustration may give rise to symptoms of physiological arousal: increased heart rate, blood pressure, respiratory rate, and body temperature. If you’re prone to developing chronic insomnia you may be particularly sensitive to what’s going on inside your body. Merely noticing signs of arousal at a time when the brain and body are supposed to be shutting down can cause anxiety.

It’s important to note when and where these unpleasant sensations are occurring. They’re not happening as you drive your 3-year-old to daycare or participate in a staff meeting. They’re happening at night when you’re in bed in the bedroom—where you’re supposed to be asleep.

After a few bad nights you may also begin to notice unpleasant symptoms during the daytime: lethargy, low mood, trouble thinking. Consciously or unconsciously, you might start to connect these these symptoms to your struggle for sleep at night. This, too, can give rise to anxiety or exacerbate existing anxiety.

Activities and projects may claim your attention during the daytime. But when nighttime rolls around and your physical and mental stamina are at low ebb, boom! The mere thought of going to bed makes you anxious, ramping up physiological arousal and increasing your anxiety still further.

Forget about sleep when you finally go to bed. Your odds of an easy send-off are nil.

If You’re Anxious About Sleep

Keep these things in mind. Sleep-related anxiety:

  • Is learned. It doesn’t just materialize out of nowhere but is rather conditioned through a process similar to the one described above (and likely predisposed by constitutional factors as yet unknown).
  • Is not your fault. Conditioned learning takes place at an unconscious level; you are not aware that it is occurring. So don’t play the blame game—it hurts rather than helps.
  • Can be unlearned. That’s where we’re heading now.

Some insomniacs who are anxious about their sleep respond to treatment with cognitive therapies. Cognitive restructuring, offered as part of cognitive behavioral therapy for insomnia (CBT-I), may help by dismantling some of the attitudes and beliefs that keep sleep anxiety alive. Other insomniacs have found that mindfulness meditation helps to alleviate sleep anxiety. Acceptance and commitment therapy is worth checking into as well.

Stimulus Control Therapy

For me personally, the two behavioral strategies I learned during CBT-I had the biggest impact on my sleep anxiety. By regularizing and solidifying my sleep, they helped to make fear of sleeplessness a thing of the past.

You’ve heard advice to the sleepless that counsels avoiding the bed except for sleep and sex? Well, this rather parsimonious view of how to use the bed has grown out of studies showing that stimulus control therapy (SCT) for insomnia works. The protocol is simple:

  1. Go to bed only when sleepy.
  2. Use the bed only for sleeping (and sex). Do not read, watch TV, eat, or do anything else in bed.
  3. If within 15 minutes you’re unable to sleep (estimate the 15 minutes; do not watch the clock), move to another room. Do a quiet activity—reading, knitting, watching TV—until you feel really sleepy. Then return to bed. The goal is to break the association between the bed and wakefulness and instead learn to associate the bed with falling asleep quickly.
  4. Repeat the above instruction as often as necessary.
  5. Get up at the same time every morning regardless of how much or how little you’ve slept.
  6. Do not take naps.

Sleep Restriction Therapy

The aim of sleep restriction therapy (SRT)—the treatment Gina is undergoing—is to restrict your time in bed so that most of your time there is spent sleeping rather than lying awake and worrying about sleep. The SRT process is somewhat involved and I’ve blogged about it elsewhere. Find out more by typing “sleep restriction” in the site search box above.

In response to Gina’s concerns about sleep restriction: avoid drifting off too early by engaging in evening activities that are not completely sedentary. And don’t lose hope because you’re failing to see improvements right away. It may take two or even three weeks before you notice appreciable benefits.

Take it from one who’s been there and done that: it’s worth the wait.

2017: Resolve to Improve Your Sleep

Do you have a persistent sleep problem? Make cognitive behavioral therapy for insomnia your No. 1 New Year’s resolution for 2017.

Here’s what you stand to gain, what may stand in the way, and where to find help.

CBT for insomnia should be your no. 1 resolution for the new yearDo you have a persistent sleep problem? Make cognitive behavioral therapy for insomnia your No. 1 New Year’s resolution for 2017.

Here’s what you stand to gain, what may stand in the way, and where to find help.

A Treatment That Improves Sleep

Cognitive behavioral therapy for insomnia is focused on boosting sleep drive and removing psychological barriers to sleep. It’s become the front-line treatment for chronic insomnia because it gets results. Most people who undergo therapy can expect to:

  • Improve sleep efficiency. In other words, you’ll cut the time it takes to fall asleep in half, and cut the number of nighttime awakenings—and their duration—in half.
  • Improve sleep quality. You’re likely to sleep more soundly and wake up feeling more refreshed in the morning.
  • Sleep moderately longer, especially if you’re young or middle aged.

So why hesitate?

The First (and Maybe Biggest) Barrier to “Yes”

If you’re like I was, the biggest barrier to trying cognitive behavioral therapy (CBT) for insomnia may be the belief that nothing can improve your sleep. This is actually a logical way of thinking if you’ve had insomnia for a long time. After years of trying to improve your sleep by means you’ve read about elsewhere—chamomile tea, talk therapy, relaxation exercises—and getting poor results, why would your expectations for CBT for insomnia be anything but low? Hope is hard to come by after years of insomnia and failed attempts to improve sleep.

Gearing up to try yet another insomnia treatment can reawaken hope. But it also opens up the possibility of failing again. Just how comfortable is that? Besides, undertaking CBT for insomnia involves going through a process—and that process may not sound particularly quick or easy. It can be hard to silence these objections and commit yourself to another insomnia treatment.

A Second Possible Barrier: Fear of Sleeplessness

The prospect going through sleep restriction (the part of CBT for insomnia that involves curtailing your time in bed and observing prescribed bed and rise times) may make you uneasy. Sleep restriction was a red flag for me.

What if, during my allotted time in bed, I never fell asleep at all? This was scary to contemplate. As described in Chapter 8 of The Savvy Insomniac, my sleep anxiety was sky high when I went through treatment and drove me to do some pretty strange things.

No doubt my fear of sleeplessness made the first few days of treatment harder. But the gains I made were quick in coming. By the fourth night of treatment, I was falling asleep at my designated bedtime and sleeping right through the night—a pattern that was touch and go for a while but has held up very well over time. My sleep anxiety is now a thing of the past.

Take some advice from a lifelong insomnia sufferer who dithered around for 11 years longer than she should have before finally taking the plunge: just do it.

Finding a Sleep Coach

CBT for insomnia is typically administered by a trained sleep therapist over the course of 6 to 8 weeks. This is still the preferred form of treatment for the many insomniacs who like the idea of face-to-face coaching (and have insurance covering treatment or can afford to pay for it themselves).

Here’s how to find a sleep therapist certified in behavioral sleep medicine:

Some behavioral sleep medicine professionals offer a condensed form of CBT-I called brief behavioral treatment for insomnia (BBTI). Therapy takes place over 4 weeks (rather than 6 to 8) and involves two face-to-face meetings with the therapist and two follow-up phone calls. Read more about it in this blog post about BBTI.

CBT for Insomnia Online

What if you live in the hinterlands and there are no behavioral sleep medicine therapists nearby? With access to the internet, you’re still in business. Three interactive online programs—SHUTi, Sleepio, and CBT for Insomnia—are excellent resources for insomniacs in far-flung locales and those on a limited budget:

  • The SHUTi program ($135 for 16 weeks of access and $156 for 20 weeks of access) was recently shown in a clinical trial to get results equivalent to those obtained in standard face-to-face CBT-I.
  • A clinical trial of the Sleepio program ($300 for 12 months of access) is under way right now.
  • The CBT for Insomnia program is a 5-session program created by Dr. Gregg Jacobs, author of Say Goodnight to Insomnia, for the nominal cost of $44.95.

Insomnia sufferers, suspend your disbelief and try this out. I can’t promise it will relieve your insomnia—but the odds are greatly in your favor.

Good night, and good luck.

What doubts do/did you have about CBT for insomnia?

Is Low BDNF a Marker of Insomnia?

We’re often told there’s no objective test of insomnia.

But now a research group in Switzerland is claiming they’ve found an objective marker of insomnia: brain-derived neurotrophic factor, or BDNF.

BDNF levels may distinguish insomniacs from normal sleepersWe’re often told there’s no objective test of insomnia. Brain waves aren’t very revealing when it comes to distinguishing insomniacs from normal sleepers. Tests of heart rate variability and metabolic rate have shown slight average differences between groups of people with and without insomnia, but they would not distinguish an individual insomniac from a normal sleeper.

Now a research group in Switzerland is claiming they’ve found an objective marker of insomnia: brain-derived neurotrophic factor, or BDNF.

What Is BDNF?

BDNF is a protein that promotes the survival of nerve cells and the growth of new neurons in the brain and spinal cord. It facilitates communication between neurons, which is important for learning and memory. In addition, BDNF is active in areas of the brain that control appetite and—importantly for this blog post—sleep.

BDNF, Stress, and Mood Disorders

But let’s forget about sleep momentarily and consider the impact of stress and mood disorders (two factors known to have a relationship to sleep) on BDNF levels. Acute stress—meaning stress that is relatively intense and short lasting—leads to an increase in BDNF levels. This increase in BDNF appears to play a part in helping us respond to a stressor, whether internal or from without. Our bodies fight off an infection. We escape from an attacker. BDNF levels return to normal.

But chronic stress (think of chronic inflammation or repeated sexual assaults) tends to decrease BDNF levels. In turn, low levels of BDNF, combined with predisposing and other precipitating factors, increase people’s susceptibility to mood disorders such as major depressive disorder. The neurotrophic hypothesis of depression holds that stress-related mood disorders occur due to a stress-induced decrease in BDNF expression.

Sleep and BDNF

It’s axiomatic now that stress has a relationship to sleep, negatively impacting sleep quality. In turn, poor sleep makes us less resilient to stress. Depression, too, has a close relationship to sleep: sometimes depression gives rise to insomnia and in other cases insomnia leads to depression. But until recently, there was little research on the impact of sleep and stress-related insomnia on BDNF levels.

So the Swiss researchers tackled the problem, assessing levels of BDNF in the blood serum of adults with and without insomnia. A total of 50 participants were screened for insomnia and divided into insomniacs (26) and normal sleepers (24). Here are the key findings:

  • Participants currently suffering from insomnia symptoms had significantly lower serum BDNF levels than the normal sleepers.
  • BDNF levels were significantly correlated with insomnia severity. The greater the insomnia severity, the lower the level of BDNF.

BDNF, Tiredness, and Fatigue

The same team examined the BDNF levels in 12 men who had recovered from occupational burnout. The investigators found that BDNF levels were significantly lower in the men reporting tiredness and fatigue (daytime symptoms associated with insomnia) than in men who did not report these symptoms.

Based on their results, the researchers have come up with a hypothesis. They suggest that chronic stress deregulates the body’s stress system, leading in the long term to insomnia and decreased BDNF levels. Thus low levels of BDNF may be an objective marker of insomnia. They also might account at least in part for the tight relationship between insomnia and depression.

Acute Sleep Deprivation Increases BDNF

There’s some good news in all of this. Remember that while chronic stress lowers BDNF levels, acute stress increases levels of BDNF.

Many studies have shown that acute sleep loss—loss of an entire night’s sleep, for example—leads to a rapid increase of BDNF in the brain. Even partial sleep deprivation, an acute stressor for the brain, seems to work this way. And increased brain BDNF is associated with improved sleep.

If this sounds like talk about sleep restriction, it should. In fact, the sleep investigator who sent the article on which this post is based made the claim outright, saying, “This is why sleep restriction works.”

Find more information about sleep restriction in my book, The Savvy Insomniac, and by clicking Blog at the top of this page. Type “sleep restriction” into the site search box and graze away.

Q&A: Will Regular Rest Curb Sleep Anxiety?

“I have nights when I can’t sleep at all and other nights when I sleep a lot,” Philippa wrote last week. “If I don’t fall asleep straight away I find I often don’t sleep the whole night! Do you think sleep restriction would work for me?”

My answer to Philippa’s question is an unqualified “yes.” But first I want to look at sleep that’s inconsistent and unpredictable and how anxious it can make you feel.

Anxiety about sleep is treatable with CBT for insomniaMy sleep used to be erratic. Really, really erratic. The Sandman could come as early as 10 p.m. . . . but he might not show up till daybreak.

Occasionally I hear another insomnia sufferer voice a variation on the same complaint. Here’s what Philippa wrote last week:

 

 

I have nights when I can’t sleep at all and other nights when I sleep a lot. I don’t have a problem waking up at night and, if I do, I can go back to sleep. However, if I don’t fall asleep straight away I find I often don’t sleep the whole night! Do you think sleep restriction would work for me?

My answer to Philippa’s question is an unqualified yes. But before I talk about making sleep more regular, I want to look at sleep that’s inconsistent and unpredictable and how anxious it can make you feel.

Night-to-Night Sleep Variability

Actually, there’s not much talk about night-to-night variability in people’s sleep. We hear a lot about sleep need, but that’s always stated as an average, as in “most people need about 7 hours of sleep a night.”

But plenty of research shows there’s night-to-night variability in when, how long, and how well each person sleeps. Unsurprisingly, some people’s sleep is more variable than others’. According to a new paper published in Sleep Medicine Reviews, from night to night, your sleep is more likely to vary in duration, timing, or quality if

  • you’re young
  • you live alone
  • you’re a person of color
  • you’re a night owl
  • you’re overweight or obese
  • you have physical health conditions
  • you have bipolar or depressive symptoms
  • you’ve had lots of stressful life events
  • you have insomnia.

Insomnia and Sleep Variability

The word insomnia means “the condition of not being able to sleep.” Yet even if your insomnia is chronic, chances are you don’t sleep poorly every night. In fact, like Philippa, on some nights you probably sleep passably or even quite well. But good sleep is not dependable, and that’s a problem.

There may be certain situations you’ve identified that typically give rise to bad nights. For example, you may know your sleep will suffer after a bad day at work or if you have to give a speech the next day.

But the good and bad nights may not necessarily correspond to stressors you can put your finger on. And this lack of predictability can cause big-time anxiety. It certainly did for me.

A Pattern of Good and Bad Nights?

Is there an underlying pattern to insomniacs’ poor sleep and, if so, would discerning that pattern be reassuring? Maybe it would for some people with insomnia.

Researchers in Scotland looked at the sleep diaries of over 100 insomniacs and found a predictable pattern of good and bad nights in about two-thirds of the study participants. Most of these participants could count on a good night’s sleep after 1 to 3 bad nights.

It could be reassuring to know that a better night’s sleep is just a day or two away, the authors wrote. A predictable pattern of good and bad nights might alleviate some anxiety about sleep.

In a study conducted at the University of Pennsylvania, investigators concluded that insomniacs can expect a “better-than-average” night’s sleep within 3 days—but that “good” sleep may come only 1 night in 6. This doesn’t sound very predictable or reassuring to me.

Take the Bull by the Horns

It might be helpful to keep a sleep diary and see if you can identify a pattern of good and bad nights. Seeing method in the madness might allow you to dispense with some of the uncertainty that’s probably contributing to your anxiety about sleep at night (and driving your insomnia).

But getting rid of erratic sleep—and making sleep predictable—is a more effective approach to curtailing anxiety about sleep. Undergoing CBT for insomnia, which includes sleep restriction therapy, is a good way to do that, research shows. And both this blog and my book, The Savvy Insomniac, are a testimonial to what CBT for insomnia—combined with regular exercise—has done for my sleep.

I’ve written more about sleep restriction therapy because it’s the part of treatment that helped me the most. To read more about it, just click on “Blog” at the top of this page, type “sleep restriction” in the site search box, and start browsing.

Q&A: Panic About Insomnia Relapse

Lately I’ve been hearing from people who improved their sleep using sleep restriction or full-blown CBT for insomnia (CBT-I) and then experience a relapse. They have a few bad nights and fear they’ve lost all the gains they made. Here’s how one reader recently described her plight:

“I realize that sometimes I will get scared when I have one or two bad nights once in a while. I’m afraid that insomnia will haunt me once again. Is this normal? What can I do?”

Insomnia sufferers should do something quiet at night until they're sleepyLately I’ve been hearing from people who improved their sleep using sleep restriction or full-blown CBT for insomnia (CBT-I) and then experience a relapse. They have a few bad nights and fear they’ll never sleep well again. Here’s how one reader recently described her plight:

 

 

I realize that sometimes I will get scared when I have one or two bad nights once in a while. I’m afraid that insomnia will haunt me once again. Is this normal? What can I do?

Normal or Abnormal?

When cognitive behavioral therapies for chronic insomnia work—and they do improve sleep for 70 to 80 percent of the insomniacs who try them—it can feel like such an achievement. “At last,” you think, “I’ve got this monkey off my back!”

In reality, though, only a minority of the people who undergo CBT-I report that their insomnia is “cured.” The rest of us experience occasional insomnia relapses.

As anyone who’s read The Savvy Insomniac knows, I went through CBT-I with a group of 4 other insomnia sufferers. At the final group meeting, the therapist gave us a handout on how to maintain the gains made during treatment and what to do in case of relapse. Not only are occasional relapses not abnormal; for many of us, they’re probably inevitable.

All Is Not Lost

The first relapse can feel like such a downer and provoke lots of anxiety. “What? I restricted my sleep only to end up right back where I started, and maybe even worse?” It’s easy to appraise the situation this way: you’re short on sleep, fatigued, and out of sorts. Everything about it feels depressingly déjà vu.

But all is not lost. What occurs during CBT-I is a process some scientists liken to a rewiring of the brain. Neural pathways related to new thoughts and behaviors are established as sleep becomes more regular and the bed and the bedroom come to be associated with sleep.

Older pathways active during insomnia do not disappear. Rather, the new pathways—to continue speaking figuratively—are superimposed on the old. With every good night of sleep, neural connections along the new pathways are strengthened. You expect to sleep well at night and you do.

The older pathways and ways of thinking are still there, though, and due to stress or anything else disruptive to sleep, they may regain some influence. Insomnia returns, and you’re as anxious about it as you ever were. But there’s good news, too: once the newer pathways are established, they’re easier to return to.

I’ll attest to this from personal experience. Before I went through CBT-I (and sleep restriction therapy), my bouts of insomnia could drag on for weeks. Now when I experience insomnia and (in rare cases) my fear of sleeplessness returns, I’m able to return to better sleep and dispense with the anxiety in a few days. I do it pretty much by following instructions I received during CBT-I. Here’s how:

What To Do in Case of Relapse

  • Don’t go to bed unless you’re sleepy. If after 15 to 20 minutes you’re not asleep, get up, go to another room, and do something quiet until you’re sleepy again. Then return to bed. If this doesn’t help after a few days, try the next suggestion.
  • Restrict your sleep by an hour or more for a few days. Be strict about getting out of bed at a consistent wake time—even on weekends.
  • Once your sleep is solid again, extend your time in bed by half-hour increments every 2 nights until you return to your desired bedtime.
  • Be sure to get daily aerobic exercise throughout the process.

If you’ve experienced a relapse of insomnia, please take a minute to share how you got your sleep back on track.