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.

Young, Sleepless, and Looking for Help

David walked in late to a presentation I was giving on managing insomnia. I’d surveyed my audience and launched into a talk for retirees. But here was David, a high school teacher in his early twenties, and I realized I was going to have to change the remarks I was about to make.

We think of insomnia as mainly an affliction of older adults. But the facts don’t bear this out.

Insomnia afflicts the young as well as the old, and stress is a causal factorDavid walked in late to a presentation I was giving on managing insomnia. I’d surveyed my audience and launched into a talk for retirees. But here was David, a high school teacher in his twenties, and I realized I was going to have to change the remarks I was about to make.

We think of insomnia as mainly an affliction of older adults. But the facts don’t bear this out. Data collected from the U.S. Behavioral Risk Factor Surveillance System showed the following:

  • Reports of sleep disturbance were highest among adults in the youngest age group, 18-24.
  • Tiredness and lack of energy were also highest among adults ages 18-24.

What’s more, 42% of the nearly 2,400 young adults surveyed in a study by the Harvard School of Public Health reported insomnia symptoms. That’s higher than the national average of 30%. What’s behind the sleep problems of millennials, the generation that started coming of age at the turn of the century?

Drivers of Insomnia in the Young

Trouble sleeping in millennials may be due to a circadian phase delay. The internal circadian period, which in humans averages a little more than 24 hours, expands in adolescence (for reasons unknown) and this longer circadian period can continue as people move into their twenties. The result is that they want to stay up late and get up later in the morning. Sleep preferences that conflict with school and work schedules are a setup for insomnia.

The phase delay could be exacerbated by use of blue light-emitting devices at night, which I blogged about last week.

But David had a different explanation for his insomnia. “I have trouble falling asleep sometimes,” he said. “But the main problem is that I wake up 2 hours before my alarm goes off. Either I go into a very light sleep or I don’t get back to sleep at all. It’s probably due to stress.”

Stress and Sleep Disturbance

Stress may well figure as one of the main culprits when insomnia shows up in the young. The American Psychological Association’s 2013 Stress in America survey showed that reports of lying awake at night due to stress were highest among the youngest adults and fell off as people aged. Here are the figures:

  • 52% of millennials reported stress-related insomnia, as did
  • 48% of gen Xers
  • 37% of baby boomers, and
  • 25% of seniors.

As for the main source of stress, millennials and gen Xers were most likely to say they were stressed by work, money and job stability. With unemployment among millennials running in the double digits for 6 years now and the average student loan debt at $30,000, it’s hardly surprising that employment and financial concerns would sabotage the sleep of the young.

Sacrificing Sleep to Get Ahead

Not only are young adults losing sleep to worry about money and jobs. TODAY.com has just publicized results of a Snooze or Lose survey that shows that millennials, much more than any other age group, believe that to get ahead in their careers, they must survive on less sleep. Here are the numbers:

  • 33% of adults ages 18-34 endorsed this belief, as did
  • 19% of adults ages 35-54, and
  • 6% of adults ages 55 and above.

Currently there’s a drive to raise awareness about sleep issues in teens. But I don’t see an effort being made to address the sleep problems of young adults trying to gain a toehold in the job market. Why not? Twenty-somethings who struggle with insomnia may cope with it in unhealthy ways, and once insomnia becomes chronic, it puts even the young at risk for depression, obesity and heart attacks.

Why not launch a public health campaign aimed at helping the young and sleepless at a time of life when the help would do most good?

If you’re in your twenties and have trouble sleeping, what do you think is the single biggest cause of your insomnia?

 

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.

Yoga for Seniors with Insomnia: Thumbs Up

Once on a whale-watching cruise, when the ship was rocking from side to side and I was clinging to the gunwale for dear life, I watched an 81-year old woman walk down the center of the boat with nothing to steady herself. The secret to her amazing sense of balance, she said, was 60 minutes of yoga practice every day.

A growing body of research shows that yoga also has a place among alternative treatments for insomnia. A new study of the effects of yoga on the sleep and functioning of older adults suggests how and why.

Yoga increases deep sleep and improves sleep quality in older adultsOnce on a whale-watching cruise, when the ship was rocking from side to side and I was clinging to the gunwale for dear life, I watched an 81-year old woman walk down the center of the boat with nothing to steady herself. The secret to her amazing sense of balance, she said, was 60 minutes of yoga practice every day.

 

A growing body of research shows that yoga also has a place among alternative treatments for insomnia.

One goal of yoga, said Jonathan Halpern, lead author of a new study exploring the sleep benefits of yoga in older adults, is to put a stop to the fluctuations of the mind. “As primary insomnia is very often related to stress, anxiety and uncontrolled thoughts and emotions,” Halpern told me, “you can appreciate how reducing the fluctuations of the mind even to some extent would have a positive effect on insomnia.”

Yoga in this study also led to improvements in several areas of daytime functioning, including stamina and mood.

Highlights of the Study

Sixty-seven subjects ages 60 and above completed the study. Those who received training in yoga attended 12 weeks of classes twice a week and did daily practice at home. Treatment included practice in yoga postures and three types of meditative exercises. Subjects who stuck with the protocol made significant gains:

  • In contrast to the control subjects, who received no treatment, the yoga subjects reported longer, more efficient sleep and improved sleep quality.
  • Those who practiced yoga at least 25 minutes daily also experienced 11.5 percent more deep sleep. This is an impressive result. As humans age, we get less deep sleep, when the secretion of growth hormone and the synthesis of brain proteins occur. Any activity that promotes deep sleep is likely to make sleep feel sounder and more restorative.
  • Yoga subjects also experienced improved daytime functioning: they reported managing better physically and socially, and feeling less depression, fatigue and stress.

“Daytime functioning is a general measure,” Halpern said, “but it probably results from the fact that people slept better at night, were less tired during the day and therefore could perform better physically, mentally and emotionally. Not at all rocket science,” he added. (For more on how yoga improves stress tolerance, click here.)

So if you’re older and open to alternative treatments for insomnia, yoga is worth checking out.

If you’ve tried yoga, what health benefits did you notice it had for you?

Your Sleep Need? Figure It Out Yourself

You’ve heard the advice to get 8 hours of sleep a night? Now they’re saying that 7 hours is the optimal amount of sleep–which may not be very cheering for most people with insomnia. Still our nights do not measure up.

If you have persistent insomnia, and if you fall short of the recommended 7 or 8 hours, it’s natural to wonder if you’re getting enough sleep. Here’s how to get a good sense of how much sleep you really need.

calculate your sleep need by keeping track of the hours you sleep on vacationYou’ve heard the advice to get 8 hours of sleep a night? Now they’re saying that 7 hours is the optimal amount of sleep–which may not be very cheering for most people with insomnia. Still our nights do not measure up.

As if that weren’t bad enough, the web is glutted with articles showing that short sleepers are vulnerable to a host of ailments: depression, heart disease, obesity, diabetes, dementia. Yikes! It’s a wonder any of us live past 65.

If you have persistent insomnia, and if you fall short of the recommended 7 or 8 hours, it’s natural to wonder if you’re getting enough sleep.

How Much Sleep Is Enough?

Sleep need—or sleep ability—varies a lot from one person to the next. Some people feel refreshed after 5 hours while others need 9. In normal sleepers, the duration of sleep is fairly consistent from one night to the next, so it’s easy to make inferences about sleep need. A person who under favorable conditions normally falls asleep at 11 and wakes up at 6 needs an average of 7 hours’ sleep a night.

But the sleep of people with insomnia is much more variable. Insomniacs are 60 percent more likely than good sleepers to sleep poorly on any given night. After a slew of bad nights, it feels heavenly to pop off a solid 8 hours. You wake up feeling rested and ready for the day—and this might lead you to infer that you need 8 hours a night to function at your peak.

But it’s a mistake to assume that the sleep you get on a night of recovery sleep is equivalent to the amount of sleep you need every night. It’s also wrong to assume that the 4 hours you more often get will suffice. The truth lies somewhere in between.

Track Your Sleep over Time

To find the amount of sleep you need for optimal functioning, keep track of the hours you sleep for a week or two and then take the average of that. This is probably closer to your daily sleep need.

But . . . this figure may be off the mark for people with persistent insomnia. Stress can interfere with sleep and make it hard to get an accurate read on sleep need. You may be slightly but chronically low in the tank.

A Better Way to Calculate Sleep Need

Eve Van Cauter, director of the Sleep, Metabolism and Health Center at the University of Chicago, suggested a better way to figure out sleep need or capacity in last week’s USA Today. Here it is:

Wait until you’re on vacation and free of the stressors connected to the daily grind. Once you’re away, go to bed at your usual time but do not set an alarm clock. The first few days you may sleep longer than normal to make up for the sleep debt you’ve accumulated at home.

Then, once your sleep stabilizes, start keeping track of how long you sleep. This, plus or minus 15 minutes, Van Cauter says, is as good a way as there is to get a handle on your daily sleep need.

Gardening: Antidote to Stress and Insomnia

Gardening is a real stress buster for me. I’m actually convinced it makes me less susceptible to insomnia.

I said the same thing on Facebook last May, posted this same photo, and got a ton of “likes.” Who knew so many people found gardening to be relaxing the way I do?

The truth is, it’s really only spring gardening that has this calming effect. Summer weeding and fall cleanup can feel a lot like chores. But the spring planting season: that’s when gardening helps relieve tension and puts me in a contemplative frame of mind.

gardeningGardening is a real stress buster for me. I’m actually convinced it makes me less susceptible to insomnia.

I said the same thing on Facebook last May, posted this same photo, and got a ton of “likes.” Who knew so many people found gardening to be relaxing the way I do?

The truth is, it’s really only spring gardening that has this calming effect. Summer weeding and fall cleanup can feel a lot like chores. But the spring planting season: that’s when gardening helps relieve tension and puts me in a contemplative state of mind.

A Relaxing Effect

There’s scientific support for the stress-reducing, mood-improving effects of gardening. Gardening decreases levels of the stress hormone cortisol. It also reduces anxiety and alleviates depression. One theory about why this occurs is that in digging in the dirt we’re exposed to bacteria called Mycobacterium Vaccae, stimulating the immune system and promoting the release and metabolism of serotonin.

Yet when I think about why it is that spring gardening helps me relax, what comes to mind first is that it involves activity, both mental and physical. Planting requires thought at the beginning of the season. Except for perennials poking their shafts above ground, the earth is a dark, blank canvas waiting to be filled in. Nature’s palette is as varied as any a painter might choose, yet the decisions about what to plant and where to plant are mine. It’s absorbing work.

Then as the season gets under way, I’m constantly changing my mind based on what I see. Do these lilies look good beside the hostas? Yes. Or no, they just don’t work. Dig them up and try planting them somewhere else. All this attention to the aesthetics of the garden takes my mind off troubles that otherwise might be nattering away inside my head.

The physical labor of planting a garden can be relaxing as well. The repetitive work needed to fill the annual beds and replenish perennials is conducive to meditation. Trowel in hand, I scoop enough earth out to create the right size hole, take hold of a seedling, position the root ball so it’s neither too low nor too high, fill in the rest of the hole with dirt, and tamp the soil down firmly on all sides. This I do again and again until I’ve got an entire bed full of pansies or pachysandra. The labor is not aerobic—the type of exercise said to be most effective for stress relief—but somehow it has a calming effect.

Last but not least, there’s the thrill of sitting back on my heels and admiring the sight.

Sleep Benefits—Really?

Any activity that reduces stress will help to hold my insomnia at bay, and gardening is no exception. But the season itself is also conducive to better sleep. Being outdoors and exposed to sunlight enables the body to produce more vitamin D, which is beneficial to sleep. And the days are lengthening in the springtime, which boosts my alertness and helps me postpone sleep until I’m really ready to conk out. Also, more sunlight and fewer gray days improve my mood, which in turn makes it easier to sleep at night.

Spring gardening works for me on many levels. If it’s not your cup of tea, find some other activity that involves mental engagement and physical activity. This is a good combination for stress reduction and sounder sleep.

If you find gardening to be relaxing, what about the activity do you think is most helpful to you?

 

Stressed-out Rats, Insomnia & Sleeping Pills

What can rats tell us about insomnia and sleeping pills? Plenty, it turns out.

I’m getting ready to give a talk on stress-related insomnia and I’ve come across a fascinating study published five years ago. Neuroscientists at Harvard used rats to uncover a novel insight about what may be going on in the human brain when stress interferes with our sleep, and a better way to calm the brain down.

rat-wheelWhat can rats tell us about insomnia and sleeping pills? Plenty, it turns out.

I’m getting ready to give a talk on stress-related insomnia and I’ve come across a fascinating study published five years ago. Neuroscientists at Harvard used rats to uncover a novel insight about what may be going on in the human brain when stress interferes with our sleep, and a better way to calm the brain down.

To introduce psychological stress—the type of stress that often underlies insomnia—in their rodent subjects, the investigators placed half of the rats in dirty cages previously occupied by a male competitor. (The other rats, placed in clean cages, were used as controls.) The smell of the rival rat—even though that rat was no longer present—and the inability to escape from the rival rat’s territory created a normal stress response in the cage exchange rats. Their temperature went up, and there was a big increase in neural activity in the brain. Clearly these rats were stressed out.

But it was not the initial stress response that the researchers wanted to study. They wanted to study what happened when the acute stress had subsided, when the rats finished exploring their new surroundings and finally went to sleep.

The control rats slept normally. But cage exchange rats took longer to fall asleep, woke up more frequently during the sleep period, and slept about 25 percent less than the control rats. All this was expected.

The Big Revelation

The news came when investigators looked at what was going on inside the rats’ brains.

Previously, scientists had assumed that sleep and wake-time were whole-brain states. Either the arousal system was in control (completely inhibiting the sleep system) or the sleep system was in control (completely inhibiting the wake system). There were no halfway states.

But analyzing the neural activity in the brains of the cage-exchange rats, the Harvard researchers did find evidence of what they call “an intermediate state.” What did it look like?

The sleep-promoting areas of the brain were fully active, reflecting strong sleep drive and clear evidence that parts of the brain were deeply asleep. At the same time, neurons in key areas of the brain active during wakefulness were firing away like crazy. Areas associated with fear, anxiety, and emotional processing were behaving as if the rats were wide awake.

“These results suggest that both sleep-promoting areas and part of the arousal system are most likely simultaneously activated during the period of stress-induced sleep disturbances,” the scientists said.

A Better Kind of Sleeping Pill

How did investigators get the sleep of cage-exchange rats to look normal? Not by enhancing activity of the sleep system—that system was already fully engaged. They enabled normal sleep by blocking activity in the areas of stress-induced arousal.

Most sleeping pills on the market today put us to sleep by enhancing activity of the sleep system. But the rat study, say these Harvard scientists, suggests that a more appropriate target for sleep medications would be tamping down activity in the arousal and emotion centers of the brain.

Does stress interfere with your sleep? How do you deal with it?

Time Management Tip for Shaky Sleepers

When I’m stressed out about having too much to do, it sometimes happens that just as I get in bed, I remember something important that I forgot. As in, I thought about paying the visa bill last week—it was the third week of the month—but I don’t think I wrote the check. There’s nothing like the thought of pissing away $200 on interest charges to whip my insomnia up.

But now I’ve found a way to manage all that.

Less stress and insomnia with a large posterboard calendarWhen I’m stressed out about having too much to do, it sometimes happens that just as I get in bed, I remember something important that I forgot. As in, I thought about paying the visa bill last week—it was the third week of the month—but I don’t think I wrote the check. There’s nothing like the thought of pissing away $200 on interest charges to whip my insomnia up.

Deadlines on the back burner can strike fear into my heart at night. “That article is due on Wednesday,” a little voice screams inside my head as I’m returning from the bathroom to bed, “and you haven’t begun find sources or figure out what you’re going to say. What were you thinking?”

Recipe for Insomnia

For me, feeling stretched too thin is a sure set-up for insomnia. During the daytime, I bounce from one urgent task to another and some fall through the cracks. Things I forget have a way of popping up to torment me at night.

But a few months ago, my sister made a suggestion that has cut down on my stress and helped my sleep. No expensive gadgets are involved; it’s as low-tech as 28 X 22-inch poster board and colored marking pens.

Enter the Master Monthly Calendar

For three months now I’ve been making a huge month-at-a-glance calendar. Not only is it big enough for me to write down everything I need to do every day. It’s big enough for me to see into the future and plan ahead. I can be proactive rather than reactive about the way I spend my time.

At the start of each month, I fill in ongoing commitments, such as my twice-weekly blogs and monthly bills. Then I write in deadlines for important work projects. Once they’re in, I consider each one. I estimate about how much time I’ll need to complete it, count backward to the day I need to start, and write it in. The more specific I can get about the tasks I need to do each day to meet a deadline, the more control I feel I have.

Adding More Detail

Once the have-to-do’s are in, I fill in the want-to-do’s: things I’d like to accomplish if I have time. Then each day I prioritize my list of tasks so the important ones get done in the morning when I’ve got a brain. The rest I tackle in the afternoon.

Of course, each month’s calendar is always a work-in-progress; I add and delete items according to what I accomplish and new projects that come up.

I’m not super organized by nature and, though I’m a list maker, it never occurred to me that having a big-picture time-management strategy like this one might help. But it does. My monster calendar is a real stress buster and holds the demons at bay at night.

Got any time management strategies you’d like to share? Please do!