Sleep Onset Insomnia: 8 Do’s and Don’ts for Better Sleep

Sleep-onset insomnia—trouble falling asleep at the beginning of the night—has been one of the biggest challenges in my life. By now, having gone through insomnia therapy and spent decades observing how changes in behavior and the environment affect my sleep, I know what I need to do—and what not to do—to get the best night’s sleep I can.

If you’ve got sleep-onset insomnia, here are 8 do’s and don’ts that may help to regularize your sleep.

Sleep-Onset Insomnia can be minimized by changing habitsSleep onset insomnia—trouble falling asleep at the beginning of the night—has been one of the biggest challenges in my life. By now, having gone through insomnia therapy and spent decades observing how changes in behavior and the environment affect my sleep, I know what I need to do—and what not to do—to get the best night’s sleep I can.

If you’ve got sleep onset insomnia, here are 8 do’s and don’ts that may help to regularize your sleep.

Do These Things to Fall Asleep Faster:

  • Get up at the same time every day, including on weekends. This one of the hardest—but most important—habits to adopt, and frankly it’s one I struggle with to this day. Especially after a late night or two, it’s hard to stay the course and get up at 6 a.m. But if I don’t stick pretty rigidly to what I’ve decided is the best rise time for me, if I allow myself more than a little flexibility, my sleep goes off the rails. Making up lost sleep at the beginning of the night, rather than at the end, is by far the easier course.
  • Sign off all devices with screens at least an hour before you usually go to bed—and that includes eReaders and smartphones. If you’re a news junkie like me, watching out for headlines so you can read new stories the minute they come out, this can feel like major deprivation. Yet the light emitted by these screens has been shown time and again to interfere with melatonin secretion, delaying sleep onset—exactly what none of us wants.
  • Get regular exercise and eat regular meals. Aerobic exercise late in the afternoon works best for me, and adhering to my daily workout routine has become so ingrained that when I miss my exercise fix my body doesn’t feel like winding down at night. Regular exercise and regular meals—in fact, regularity in almost all activities because it helps regularize internal circadian rhythms—will likely help you sleep better.
  • Pay attention to the temperature of your bedroom and make adjustments early if necessary. The ideal temperature for sleep is a few degrees lower than what you’re comfortable with during the daytime. So, particularly as research suggests that people with insomnia may have trouble down-regulating internal body temperature, get the window fan going well before bedtime so that by the time it comes you’re not too hot to sleep.

Don’t Do Things That Perpetuate Trouble Falling Asleep:

  • Don’t watch the clock at night. Nothing triggers my anxiety about sleep as much as glancing at the clock at, say, 1 a.m. and realizing I’m not sleepy yet. This is one association—between the clock registering time late at night and trouble sleeping—that I’ve never gotten rid of despite my improved sleep. Turning my clocks toward the wall after about 10 p.m. solves the problem, and it might help you sleep better, too.
  • Don’t jump in bed the minute you get home even if you get home late. For me, heading to bed right away gives my brain permission to trot out all the unfinished business of the day and chew on it while I toss and turn in bed. If you get home late, put on your pajamas, brush your teeth and so forth. But then take 20 or 30 minutes to unwind—read a book or listen to music—before you hit the sack.
  • Don’t stay in bed if, after 15 or 20 minutes, you find you can’t sleep. For me, remaining in bed almost always results in continuing wakefulness, exactly the opposite of what I want. Instead, get up and do some quiet, low-stimulation activity—page through catalogs, make a travel list, cull your bookshelves—until you feel sleepy. Then head back to bed.
  • Don’t beat yourself up—when you’ve adopted all the sleep-friendly habits you possibly can—if you’re still feeling wakeful when your normal bedtime comes around. There’s a genetic component to insomnia, and there are genetic factors that determine sleep onset latency. One day, it may be possible to alter gene expression and so improve sleep. For now, acceptance of the occasional bad night is something it pays all of us to learn to do.

If sleep onset insomnia is your problem, what behaviors seem to make it worse and which behaviors, if any, seem to help?

Was My Insomnia Due to Lack of Light?

A daily routine and daily exposure to sunlight help regulate sleep. Research backs this up and I see it in myself. My best sleeps come after days when I get up and out and do the things I do at the usual time.

Last night my sleep went off the rails, and I’m convinced the problem was at least partly related to light. Let me explain.

Insomnia can develop with too little exposure to daylightA daily routine and daily exposure to sunlight help regulate sleep. Research backs this up and I see it in myself. My best sleeps come after days when I get up and out and do the things I do at the usual time.

Last night my sleep went off the rails, and I’m convinced the problem was at least partly related to light. Let me explain.

An Unusual Tiredness

My husband and I were viewing old slides last night, and around 9 p.m. I complained about how tired I was.

“Why?” he asked. Normally at 9 p.m. my evening has barely begun.

I couldn’t explain it. I’d gotten up at the regular time, had coffee, eaten regular meals. Worked in the morning, exercised late in the afternoon. Had a glass of wine before dinner and a decent night’s sleep the night before. Nothing that came to mind could explain how really bone tired I felt.

Staving Off Sleep

Even so, I didn’t go to bed right away. If I’ve learned anything about sleep, it’s that going to bed early can start people like me on a path to perdition. It can lead to:

  • Sleep onset insomnia, or trouble falling asleep at the beginning of the night
  • Sleep maintenance insomnia, or broken sleep with awakenings every hour or two
  • Early awakening insomnia, or waking up in the twos, threes, or fours and being unable to fall back to sleep

So tired though I was, I headed for my favorite easy chair, where I typically read for a couple hours until I’m sleepy enough to fall asleep. Then at some point I went to bed.

A Short Night—Or Was It?

The next thing I knew I woke up in the dark and it felt like morning. I hurried to turn off the alarm clock because my husband was going to sleep in. But when I looked at the time (my clock stays dark at night except when I press the button on top) I saw it wasn’t even close to 5:30, my normal wake-up time. It was only 2:15.

So I went back to bed. At the next awakening, I asked my husband what time it was and he whispered it was almost 5:30. I turned off the alarm.

Only it wasn’t 5:30, and I didn’t turn off the alarm, I later learned from my husband. That whispered exchange must have been a dream. Because when I went downstairs and turned on a light, the clock on the stove said 4 a.m.

What the heck?!

I’d thought my early awakening insomnia was a thing of the past. It was so far from normal now that I was determined to parse it out.

Reconstructing My Day

Two clues lay beside the easy chair where I sat down to read last night.

  • My book: It was open two pages beyond the bookmark, where I’d stopped reading the night before. Guess I didn’t read for very long!
  • Medicine I take every night to help with digestion: Two capsules lay on the desk beside the chair together with a full glass of water, untouched.

Obviously I’d fallen asleep in my chair way earlier than usual. But what had knocked me out so quickly and completely that I forgot to take my medicine? Read just two pages when normally I’d read for at least two hours?

Was Lack of Light the Culprit?

Suddenly it came to me. I had done something out of the ordinary in the middle of the afternoon. I went to a concert, where for two hours I sat under low light listening to Haydn string quartets.

That wasn’t all: the first violinist was super-animated as he played and kept swinging his feet up into the air. Every time those feet came off the ground I thought of a plane taking off, and that image juxtaposed onto the Haydn was jarring. I decided to close my eyes—and kept them closed for the rest of the concert.

So for two hours in the afternoon, at a time when my brain would normally be exposed to light, I sat in near-total darkness. That, added to our half-hour session viewing slides in a dark living room, might have affected my body clock, causing sleepiness to occur earlier than usual and early morning wake-ups.

Bright Light Exposure: Rules to Live By

As ubiquitous as it is, light might not seem like it would have much impact on sleep. But it does. People contending with circadian rhythm disorders have to pay special attention to light, and light or a lack thereof may figure in insomnia, too. Keep these things in mind:

  • Lack of sufficient light exposure during the daytime tends to have a negative effect on sleep duration and sleep quality. Get exposure to sunlight every day by spending time outside or inside near a window.
  • Exposure to bright light early in the morning will help you fall asleep earlier.
  • Exposure to bright light in the evening tends to delay the onset of sleep.

 

Lifelong Insomnia? Don’t Give Up on It Yet

Have you had insomnia all your life? Have your parents said you were a poor sleeper even as a baby?

Trouble sleeping that starts early in life is called idiopathic insomnia. If insomnia is still the black box of sleep disorders, then idiopathic insomnia is the little black box inside the black box.

Here’s what is known about the disorder and options for management.

Lifelong insomnia can be treated by sleep specialist or therapistHave you had insomnia all your life? Have your parents said you were a poor sleeper even as a baby?

Trouble sleeping that starts early in life is called idiopathic insomnia. If insomnia is still the black box of sleep disorders, then idiopathic insomnia is the little black box inside the black box.

Here’s what is known about the disorder and options for management.

What Is Idiopathic Insomnia?

Idiopathic insomnia begins in childhood, sometimes at or soon after birth. Trouble falling or staying asleep or reduced sleep duration is pretty much a nightly affair regardless of situational changes. The disorder is uncommon, affecting less than 1% of the population.

There is no identifiable cause. The presumption is that idiopathic insomnia is driven mainly by biological factors, and at least some of them are probably inherited. Abnormalities in the circadian system or the homeostatic process may be involved and/or there may be a problem in the circuitry controlling sleep and waking in the brain.

A Chronic Sleep Disorder, but How Well Defined?

Idiopathic insomnia is a chronic sleep disorder with familiar insomnia symptoms:

  • Trouble falling or staying asleep, or sleeping long enough, for more than 3 months despite adequate sleep opportunity
  • Daytime distress and impairment, including reduced stamina, low mood, and trouble thinking and learning

Research on the defining features of idiopathic insomnia is mixed. On one hand are a few studies showing significant differences between people with idiopathic insomnia (IdI) and those with psychophysiological insomnia (PI), the garden-variety insomnia that typically develops later in adolescence or adulthood. PI is often triggered by a stressful event; situational factors do not figure in IdI. PI is said to persist mainly due to psychological and behavioral factors that develop in response to poor sleep: conditioned arousal in bed, poor sleep hygiene (going to bed early to catch up on sleep, for example), and anxiety about sleep. Psychological factors are less typical in IdI.

On the other hand is research showing no major differences between PI and IdI when assessed by polysomnography (the overnight test in the sleep lab) or by self-report of psychological symptoms. Research suggests that arousal levels are higher among people with IdI than in people with other kinds of insomnia, though, leading some sleep experts to speculate that IdI is simply a more severe manifestation of PI.

What Can Be Done?

Without scientific certainty about the causes of IdI or whether the disorder is distinct from other kinds of insomnia, IdI is best treated on a case-by-case basis by a sleep specialist. Following are options for treatment.

Especially if a person with IdI has misconceptions and/or anxiety about sleep,

  • Cognitive behavioral therapy for insomnia (CBT-I) may help. CBT-I typically consists of two behavioral components—stimulus control therapy and sleep restriction therapy—and a cognitive component designed to decrease psychological barriers to sleep. Sometimes just changing your attitude about sleep can bring about demonstrable sleep improvements.
  • Acceptance and commitment therapy (ACT) may help. ACT focuses on building mindfulness skills so that, rather than trying to suppress, manage, and control emotional experiences, people develop psychological flexibility and learn to behave in ways that reflect their values and increase well-being. This approach, too, can change the way you feel about sleep and in the process improve your sleep.

If round-the-clock hyperarousal is driving IdI, then therapies designed to decrease arousal may help.

  • Regular, moderate-to-vigorous exercise—activities such as aerobics, calisthenics, biking, running, and weight-lifting—has been shown in recent studies to increase total sleep time and decrease levels of cortisol (a stress hormone).
  • Yoga, too, has been shown to decrease feelings of arousal and promote stress tolerance.

Medication for Idiopathic Insomnia

The issue of sleeping pills for chronic insomnia is increasingly fraught. Many drugs approved for the treatment of insomnia, taken nightly over time, may degrade sleep quality and result in alarming side effects, especially in older adults.

That said, while the medication prescribed for IDI is usually a benzodiazepine or a Z-drug such as zolpidem or eszopiclone, a second pharmacological approach, according to a paper by Michael Perlis and Philip Gehrman, involves use of a melatonin agonist such as ramelteon (Rozerem). No studies of the effects of this sleeping pill on the sleep of adults with IdI have been conducted. But in two studies of children aged 6 to 12 years with chronic idiopathic childhood sleep-onset insomnia, melatonin put them to sleep significantly sooner—by 1 hour.

If you’re contemplating managing lifelong insomnia with drugs, get some professional advice. This is one place where you really need the help of a specialist knowledgeable in the medical treatment of chronic insomnia.

At what age did your trouble sleeping start? What kinds of treatments—if any—have helped?

Insomniacs, Let There Be Light

If you’re prone to insomnia when it’s chilly outside, the problem may have to do with too little exposure to daylight in the colder months of the year. Working in well-lit conditions and using a light box may help to relieve your insomnia symptoms.

Use a light box early in the morning or in the evening, depending on your insomnia symptomsEvery November I hear increasing numbers of complaints about insomnia. Some people say they feel sleepier in the evening, go to bed early, and wake up at 3 a.m., unable to get back to sleep. Others toss and turn for hours before falling asleep only to oversleep their alarm clocks.

If you’re prone to insomnia when it’s chilly outside, the problem may have to do with too little exposure to daylight in the colder months of the year. Working in well-lit conditions and using a light box may help to relieve your insomnia symptoms.

A new meta-analysis suggests that bright light may be an effective form of therapy for insomnia all year round. But the effectiveness will depend on several things, including the timing of the light exposure and the intensity of the light. Here’s more about it.

A Gold Standard for Night Owls and Early Birds

The use of bright light therapy to treat circadian rhythm disorders—situations involving a mismatch between a person’s preferred sleep time and the alternation of daylight and darkness—is now standard practice. Results of the meta-analysis back these practices up:

  • Night owls tend to fall asleep and wake up quite late, missing morning activities. Their body clocks run slow, completing a daily cycle every 25 to 26 hours. Treatment calls for use of a light box immediately on waking up. Early exposure to bright light shifts their sleep cycle to an earlier hour and helps synchronize their circadian rhythms to the 24-hour day.
  • Early birds are usually struggling to keep their eyes open after 8 p.m. Their body clocks run fast, completing a cycle every 23 to 23.5 hours. The usual advice to early birds is to use the light box in the evening to postpone sleep and tune their internal rhythms to the 24-hour day.

Circadian Rhythm Factors in Insomnia

Surprisingly, the meta-analysis offers even more support for the idea that bright light therapy can improve the sleep of insomniacs. This may be due in part to the design of the studies reviewed. But it also suggests there may be a circadian component in insomnia, an idea that has been around a while. “Circadian rhythm factors may be involved in insomnia in several ways,” sleep investigators Leon Lack and Richard Bootzin have written in textbook on treating sleep disorders.*

People with sleep onset insomnia—trouble falling asleep at the beginning of the night—may have a mild version of the night owl problem. Our body clocks may run a little bit slow, completing a cycle once every 24.5 hours (rather than every 24 or every 24.2 hours, which in humans is the estimated norm). In certain situations—reduced exposure to light; sleeping in on weekends; working evening shifts—our internal sleep–wake rhythm may move farther and farther away from the daily alteration of daylight and darkness, exacerbating our trouble falling asleep.

Likewise, older adults who are increasingly prone to nod off after dinner may wake up feeling wired at their usual bedtime and have a tough time returning to sleep. Or if they do succeed in sleeping through the night, like early birds, they may not be able to sleep past 3 in the morning.

Light Exposure: Time It Right

Light can have a phase-shifting effect on the circadian system and blocks secretion of melatonin, a hormone associated with the night. So bright light may be used to shift sleep to a slightly earlier hour (which may help sleep onset insomniacs) or to prolong wakefulness in the evening. But the light exposure has to come at the right time of day.

Sleep onset insomniacs (whose goal is to get to sleep more easily) will—like night owls—want to expose themselves to bright light immediately upon waking up in the morning. The human body is most sensitive to light when it’s least expected. So half an hour’s exposure to bright light emitted from a light box as you’re getting dressed, eating breakfast, and reading the paper will be much more helpful than a longer exposure to light delivered later in the morning.

Older insomnia sufferers prone to drifting off too early in the evening may be able to remain up and alert until later if—while they relax after dinner with a book or in front of the TV—they do so in a room flooded with light (or better yet, seated next to a light box, which emits a lot more light than standard lighting fixtures). Delaying bedtime may also help to consolidate sleep at night and possibly extend sleep a little later in the morning.

Higher Intensity Light for Better Results

Authors of the meta-analysis found that in the insomnia studies they analyzed, the higher the light intensity, the greater was the effect. So if you’re shopping for light boxes, pay attention to the intensity of light different products emit. A light box that delivers light at the intensity of sunlight (10,000 lux) will give you the biggest bang for your buck.

If you’ve used a light box, what effect (if any) has it had on your sleep?

* Leon Lack and Richard Bootzin, “Circadian Rhythm Factors in Insomnia and Their Treatment,” in Treating Sleep Disorders: Principles and Practice of Behavioral Sleep Medicine, ed. Michael Perlis and Kenneth Lichstein (Hoboken: Wiley, 2003), 305-34.

Restless REM Sleep May Lead to Hyperarousal

Do you tend to dwell on upsetting thoughts? Does your arousal thermostat feel like it’s set too high, making it hard for your body to relax and fall or stay asleep? Insomnia is often described as a disorder of hyperarousal, yet how and why the hyperarousal develops is unclear.

Now a team of 13 sleep scientists from three countries have taken findings from different lines of research, conducted a study of their own, and come up with a plausible explanation for why our minds and bodies feel like they’re stuck in overdrive and just can’t stop. Here’s what may lie behind our trouble falling and staying asleep.

insomnia, characterized by fragmented REM sleep, leads to slow emotional processingDo you tend to dwell on upsetting thoughts? Does your arousal thermostat feel like it’s set too high, making it hard for your body to relax and fall or stay asleep? Insomnia is often described as a disorder of hyperarousal, yet how and why the hyperarousal develops is unclear.

Now 13 sleep scientists from three countries have taken findings from different lines of research, conducted a study of their own, and come up with a plausible explanation for why our minds and bodies feel like they’re stuck in overdrive and just can’t stop. Here’s what may lie behind our trouble falling and staying asleep.

Two Kinds of Sleep

Whether we sleep poorly or well, our nights are composed of two kinds of sleep: REM sleep, when most dreaming occurs and when the eyes move rapidly from side to side; and non-REM, or quiet, sleep. The deepest stage of non-REM sleep is called slow-wave sleep.

In the past, scientists thought that insomnia probably had to do with a dysfunction related to slow-wave sleep or some other feature of non-REM sleep. This may be the case for some people with insomnia.

But the results of two recent studies suggest that the problem may lie elsewhere. The findings show that sleep maintenance insomnia (the type of insomnia involving middle-of-the-night awakenings) is characterized by fragmented REM sleep.

Importance of REM Sleep

There’s solid evidence now that REM sleep—most of which occurs in the second half of the night—helps us process negative emotions such as fear and anger and self-conscious emotions such as guilt, embarrassment, humiliation, and shame. In studies where participants are forced to rise too early, they often wake up in a bad mood.

The reason is that they’ve gotten insufficient REM sleep, say sleep scientists, and the full processing of emotion has not had a chance to occur. As a result, any negative emotion they experienced the previous day may still retain its emotional charge.

There’s also preliminary evidence that fragmented REM sleep (such as that found in insomnia) hinders the overnight resolution of emotional distress.

Authors of the current study, published in Proceedings of the National Academy of Sciences, wanted to take this research further. They predicted that fragmented (or restless) REM sleep could interfere with the overnight resolution of emotional distress, thus contributing to the accumulation of arousal, and eventually hyperarousal, associated with insomnia.

A Two-Part Study

First, the researchers tested 32 people—16 with insomnia disorder and 16 normal sleepers—in a sleep lab for two nights. The object was to find out if restless REM sleep correlated with the frequency of participants experiencing thought-like rather than dream-like mental activity at night (as assessed by questionnaires). Thought-like nocturnal mentation—when we’re mentally chewing on a problem, for example—is specifically associated with restless REM sleep.

In addition, the researchers looked for relationships between restless REM sleep, duration of emotional distress, and chronic hyperarousal in data compiled on 1,199 people participating in the Netherlands Sleep Registry. The NSR is a psychometric database created to facilitate research on factors that discriminate people with insomnia from people without sleep complaints.

Restless REM Sleep, Emotional Distress, Hyperarousal

The investigators used sophisticated statistical methods to analyze their data, and here’s what they found:

  • Compared with normal sleepers, insomniacs were slower to recover from long-lasting emotional distress. The more severe the insomnia, the slower the recovery.
  • Thought-like mental activity was more frequent among insomniacs than normal sleepers, and it was significantly associated with emotional distress lasting overnight (but not with short-lasting distress resolved during the previous day).
  • The more severe the insomnia, the more people reported symptoms of hyperarousal.
  • Long-lasting emotional distress accounted for 62.4% of the association between hyperarousal and the thought-like mental activity occurring during restless REM sleep.

What It Means for Us

The findings conformed to researchers’ expectations. So here’s their explanation for why insomniacs, both mentally and physiologically, keep going and going and can’t seem to relax into sound, consolidated sleep: mental activity we experience at night—which is associated with fragmented REM sleep (and increased eye movement density)—interferes with the overnight resolution of emotional distress. So we awaken with the distress still in place, which ramps up arousal. Over time, this could lead to a state of chronic hyperarousal.

It sounds plausible to me. Your thoughts?

Insomnia: Too Much Alpha Wave Activity at Night

The brains of people with insomnia are active at night, even during quiet sleep. This activity isn’t often noted in sleep studies, where the point is to identify dominant wave forms. But looking closer, scientists are discovering slight but crucial differences in insomniacs’ brain waves at night, which may explain our trouble falling and staying asleep.

“Alpha wave intrusion” is a term used to describe the wake-like brain activity observed during the deep sleep of people with fibromyalgia and major depression. Now a new study in the Journal of Sleep Research presents evidence of abnormal alpha wave activity in insomniacs’ brains at night. Here are the two main findings:

Insomnia is characterized by greater alpha wave activity at nightPicture the brain at night. It’s mostly quiet except during rapid eye movement (REM) sleep. Then clusters of neurons in the brain stem start firing away like mad. These bursts of activity are perfectly normal during REM sleep, alternating with periods of quiet non-REM sleep through most of the night.

The brains of people with insomnia are more active at night—even during non-REM sleep. This activity isn’t often noted in sleep studies, where the point is to identify dominant wave forms. But looking closer, scientists are discovering slight but crucial differences in insomniacs’ brain waves at night, which may explain our trouble falling and staying asleep.

Alpha wave intrusion is a term used to describe the wake-like brain activity observed during the deep sleep of people with fibromyalgia and major depression. Now a new study in the Journal of Sleep Research presents evidence of abnormal alpha wave activity in insomniacs’ brains at night. Here are the two main findings:

Trouble Falling Asleep

The descent from wakefulness into deep sleep occurs fairly quickly in healthy sleepers. The pressure to pay off the day’s sleep debt is strong, compelling a rapid descent into deep (slow-wave) sleep.

But in people with sleep onset insomnia, who typically take more than 30 minutes to fall asleep at night, the descent takes quite a bit longer, research shows. Insomniacs—for unknown reasons—seem to have reduced sleep pressure. Not only does it take us longer to fall asleep. It also takes us longer to descend into deep sleep, the really restorative stuff.

Why the Slow Descent?

The research team investigating alpha wave activity looked at the sleep studies of 18 good sleepers and 10 insomniacs and found one difference that occurred before sleep began. Alpha waves—associated with a relaxed, meditative state of consciousness that occurs when the eyes are closed—are predominant in the period leading up to sleep. They’re generated by neurons firing at frequencies of 7.5 to 12.5 cycles per second.

As the healthy sleepers in the study were falling asleep, the alpha rhythms in their brains began to fluctuate and decay. But the alpha wave activity in insomniacs’ brains continued going strong.

Sleep onset insomnia may have something to do with decreased alpha variability, the researchers concluded. Insomniacs are relaxed and ready for sleep—yet (again for unknown reasons) we remain stuck in alpha mode.

Waking Up at Night

Alpha waves may also play a role in sleep maintenance insomnia. Polysomnogram studies show that normal sleepers awaken at least a few times a night but are mostly unaware of these awakenings.

People with sleep maintenance insomnia, in contrast, are conscious of waking up at night. These awakenings make our sleep feel fitful and less restorative. (And some sleep maintenance insomniacs are told their problem involves alpha wave intrusion following a sleep study.)

Adults spend up to 80% of the night in non-REM sleep, and in the alpha wave study, different kinds of alpha activity occurred in the brains of healthy sleepers and insomniacs throughout non-REM sleep. Brief arousals in the healthy sleepers were characterized by alpha waves that stayed well below the frequency of alpha waves during conscious wakefulness.

But the alpha frequencies in participants with insomnia rebounded to wake levels. In this situation, a sleeper might be easily awakened by noise or movement and memories could be formed. It might account for why so many insomniacs complain of light and/or broken sleep.

The Take-Away

Higher alpha frequencies during brief arousals and lower alpha variability at the approach of sleep fit with the hyperarousal theory of insomnia, which suggests that people prone to insomnia experience higher levels of arousal around the clock. As for how to correct these alpha abnormalities, we’ll have to wait and see.

Sleep: Practice Makes Perfect? Maker of App Says Yes

Would you be willing to undergo nearly 24 hours of sleep deprivation if by doing so you could learn to fall asleep more quickly?

This is pretty much the bargain you make if you undergo Intensive Sleep Retraining (ISR), a treatment developed in Australia to help people with insomnia learn to fall asleep more easily. The idea behind ISR is that trouble falling asleep is mainly conditioned, involving negative beliefs about sleep, and worry about sleep loss, and poor sleep hygiene. The goal is to get rid of these impediments and make it easier to fall asleep.

A polysomnographic technologist says insomnia sufferers can achieve the same results using a new iPhone app.

SleepQWould you be willing to undergo nearly 24 hours of sleep deprivation if by doing so you could learn to fall asleep more quickly?

This is pretty much the bargain you make if you undergo Intensive Sleep Retraining (ISR), a treatment developed in Australia to help people with insomnia learn to fall asleep more easily. The idea behind ISR is that trouble falling asleep is mainly conditioned, involving negative beliefs about sleep, and worry about sleep loss, and poor sleep hygiene. The goal is to get rid of these impediments and make it easier to fall asleep.

How ISR Works

You spend one night in a sleep lab. There, you’re wired up with electrodes, and every 30 minutes you’re instructed to let yourself fall asleep. But you’re never allowed to sleep more than a few minutes. A lab tech comes in to wake you up and sees to it that you’re awake for the rest of the period. Then another 30-minute sleep trial begins.

The results? The few clinical trials conducted show that insomnia subjects who have undergone ISR are able to get to sleep faster and sleep longer. These gains have lasted up to 6 months.

But ISR is currently unavailable in the US. The treatment is expensive and not covered by insurance. Plus the idea of 24 hours of sleep deprivation can be off-putting. So why mention it?

A Sleep Training App

Michael Schwartz, a registered polysomnographic technologist, has developed an iPhone app that delivers sleep training in what he believes is a more palatable way. Called SleepQ, this inexpensive app is based on the principles of ISR and designed to give users repeated exposure to what it feels like to fall asleep at home.

Schwartz’s many years of work in hospital-based sleep centers have convinced him that the problem for many insomnia sufferers is not that we can’t fall asleep, but that we lose touch with what falling asleep feels like and confidence in our ability to do it. Practice with SleepQ at a time when the pressure to sleep is high—for a few hours late in the afternoon or early in the evening following any rough night of sleep, per Schwartz’s recommendation—gives users repeated exposure to what it feels like to fall asleep and helps restore confidence, he says. Like ISR, SleepQ also enables 24-hour training for people who want to do it.

How SleepQ Works

  • Lie down and relax in bed, holding your iPhone in one hand. Every time the phone emits a tone, give it a slight shake.
  • When the app no longer detects movement, it assumes you’re asleep. Then, the phone vibrates to wake you up.
  • The screen then displays this message: “Do you think you fell asleep?” Press “yes” or “no.”
  • Next, you’re instructed to leave the bed for a few minutes. The phone will vibrate to let you know when to return to bed for the next sleep trial.
  • You decide when to end each training session. The screen then displays a graph with feedback about your sleep ability and your awareness of your sleep.

How effective is SleepQ at relieving insomnia? So far, Schwartz can cite only anecdotal testimonials from patients he’s helped. But if you’re open to experimenting, $4.99 is not a lot to lose. For more information about the app, visit the SleepQ website.

A Sleep-Friendly Diet, Part II

You wouldn’t think dietary choices would differentiate people who have trouble falling asleep from people who have trouble staying asleep. But apparently they do.

This is the conclusion of researchers at the University of Pennsylvania, who looked at data collected from over 4,500 participants in a national health survey. The diet of people with sleep-onset insomnia is different from the diet of people with sleep-maintenance insomnia, and both groups make different dietary choices than people who sleep well. It’s possible that making changes to your diet will improve your sleep.

Drinking coconut milkYou wouldn’t think dietary choices would differentiate people who have trouble falling asleep from people who have trouble staying asleep. But apparently they do.

This is the conclusion of researchers at the University of Pennsylvania, who looked at data collected from over 4,500 participants in a national health survey. The diet of people with sleep-onset insomnia is different from the diet of people with sleep-maintenance insomnia, and both groups make different dietary choices than people who sleep well. It’s possible that making changes to your diet will improve your sleep.

A Common Finding

Both types of insomnia sufferers have diets low in dodecanoic acid. This saturated fatty acid (a.k.a. lauric acid) is abundant in coconuts and coconut oil. Added to the diet, lauric acid increases high-density lipoprotein cholesterol (HDL) without affecting levels of low-density lipoprotein (LDL). Not only is cooking with coconut oil a wise choice when it comes to protecting your heart; it may also improve your sleep. Palm kernel oil (not regular palm oil) is also high in lauric acid.

If You Have Trouble Falling Asleep

Insomnia at the beginning of the night is associated with eating fewer foods containing alpha carotene, selenium, and calcium. The U-Penn study doesn’t show that eating more of these nutrients will necessarily improve your sleep—but neither does it rule out the possibility. So if you’re prone to tossing and turning when you go to bed, try eating more of these foods:

  • Carrots, pumpkin, and squash. These orange vegetables contain lots of alpha carotene.
  • Fish and seafood, meat, Brazil nuts, and sunflower seeds. These foods are high in selenium, which enhances immune function, lowers the risk of chronic inflammation, and is likely beneficial to sleep.
  • Dairy products, dark leafy greens, and calcium-fortified cereals and beverages. These foods contain lots of calcium, which tends to lower blood pressure and may also improve sleep.

If You Have Trouble Staying Asleep

On average, according to this study, the diet of people who experience middle-of-the night awakenings is high in salt. If you’re aiming for fewer wake-ups, try cutting down on salt. A low sodium diet also helps prevent high blood pressure.

Middle-of-the-night awakenings are also associated with diets low in butyric acid, vitamin D, and lycopene, nutrients you can obtain by eating these foods:

  • Whole fruits and vegetables and whole grains. Eating these foods leads to increased production of butyric acid in the gut and guards against inflammation of the digestive tract and cancer.
  • Fish and vitamin D-fortified cereals and soy products. Your body also produces vitamin D when you’re exposed to sunlight.
  • Tomatoes, guava, watermelon, papaya, and grapefruit. These foods are high in lycopene. Low levels of lycopene are also associated with very short sleep (less than 5 hours a night).

These foods are nutritious and healthful for many reasons. Will eating more of them improve your sleep? You’ll never know unless you try them out.

(Part I of this two-part series was published on May 5.)