Why Can't I Sleep?
Insomnia: A Daytime Problem with Night Time Consequences
Trouble sleeping? You are not alone! Occasional insomnia affects most of us at one time or another. Ten percent of the U.S. population suffers from chronic insomnia, lasting 6 months or more.
Clinically significant insomnia is defined as insufficient sleep on 3 or more nights per week. Adults need 7.5-8 hours of sleep, while children and adolescents require 9-10 hours.
However, recent sleep research has demonstrated loss of as little as 16 minutes of sleep can result in measurable impairment, and being awake all night results in functioning the next day as though being above the legal intoxication of alcohol.
Three Types of Insomnia
Transient ~ precipitated by life stress. Usually situational and lasts less than one month.
Sub-Acute ~ persists 1-6 months. It can be caused by stress and / or physical conditions such as sleep apnea, Parkinson’s disease, hot flashes, medication side effects, hormonal transitions, and restless leg syndrome.
Chronic ~ lasts 6 months or more. It can be caused by stress, physical conditions, genetics (familial insomnia syndrome).
“Most insomnia is not just a disorder of sleep — it has its roots in daytime stress.”
Let’s take a closer look at the type of insomnia most of us experience — stress-related insomnia. The stress we experience throughout the day, and how we perceive and manage that stress, can create or perpetuate insomnia.
How this works:
Stress activates the body’s emergency system, housed in our brain, adrenal glands, and nervous system — and triggers our stress-management cascade:
Adrenaline and Cortisol Activate the Body's Nerve and Metabolic Systems
The adrenaline and cortisol “activate” the body’s nerve and metabolic systems, which:
increases your heart rate
increases your blood vessel constriction producing high blood pressure
increases your body temperature
increases your body movements before the onset of sleep, leading to physical agitation, such as “restless leg” syndrome
changes your metabolism to increase fat deposits around your middle
These physical changes caused by stress during the daytime cause excess arousal, an energy that manifests itself as:
delayed onset of sleep
frequent awakenings
poor sleep quality
Long-term sleep deprivation has wide-reaching consequences
Weight gain*
High blood pressure
Anxiety
Depression
Altered perception of the world, even psychosis
*Sleep deprivation turns on our appetite centers in the brain, and we crave carbohydrates. In ramping up our stress hormones, it contributes to even more weight gain.
Insomnia Produces Fatigue, Not Sleepiness
Ironically, insomnia causes daytime “fatigue,” which may actually inhibit “sleepiness.”
Sleepiness is a feeling of physical and mental tiredness associated with a desire and ability to sleep.
Fatigue, on the other hand, is a feeling of physical and mental tiredness not associated with increased tendency to sleep. Instead, fatigue can produce a sensation of agitated wakefulness, in which our heart rate is elevated, our muscles are tense, and we feel emotionally hyper-vigilant.
Insomnia increases our body’s inflammatory response. Normally our “inflammation molecules” peak shortly after onset of sleep. However, with insomnia our inflammation molecules peak in the early evening and remain sustained throughout the night and day, contributing to a sensation of restlessness and fatigue.
Once insomnia is established, it induces physical changes in our bodies that make it self-perpetuating.
Life Transitions Increase Our Vulnerability to Insomnia
Dramatic hormonal transitions such as peri-menopause and post-partum are associated with insomnia.
As we get older our body becomes more “reactive” to similar amounts of stress because we grow more physically sensitive to the stress-modulating hormones.
A Word on Sleep Aids
Sleep aids such as Zolpidem (Ambien) are often prescribed to treat insomnia. Medication can help in the short term to get you over a rough patch. But in the long term it causes problems. First, these drugs can create dependency, in which you require medication in order to sleep. Second, the kind of sleep you get with a sleep aid is not a natural sleep. As a result, sleep aids can cause forgetfulness, bizarre behavior such as sleep-walking, middle-of-the-night refrigerator raids, and sluggishness because you are basically sedated persistently throughout the day. Not a great solution!
Many of us also try to self-medicate for insomnia, for example with alcohol or other chemicals. But in the long run these substances worsen insomnia.
“To get lasting relief from your insomnia, you need to address both the physical and mental or emotional factors contributing to your insomnia.”
We’ve explored the causes of insomnia, from daytime stresses and life transitions, and seen how insomnia can cause weight gain, high blood pressure, anxiety, depression, and even an altered perception of the world.
Now let's explore how to treat your insomnia and wake up feeling like a million bucks!!
Physical Causes of Insomnia
First, consider whether you have physical factors creating insomnia, such as sleep apnea, restless leg, or a neurologic conditions such as Parkinson’s.
Sleep apnea can be addressed by weight loss, use of oxygen at night, and through consultation with a sleep specialist.
Restless leg can be addressed with medication, but it also improves with stress management and exercise.
Physical illnesses such as Parkinson’s need to be treated by a specialist, such as a neurologist.
Hormonal transitions such as menopause and post partum are often associated with sleep disturbances in women. Often, hormone supplements can resolve sleep-disturbing night sweats.
Emotional and Mental Causes of Insomnia
Most of us at some point in time have insomnia related to stress or anxiety. To manage our insomnia we need to modify our physical and emotional response to stress.
We can reduce all these physical effects through a few measures to quiet our daytime stress response:
Regular daily exercise. Physical exercise such as walking reduces blood pressure, heart rate, and stress-metabolic by-products. It’s best not to exercise immediately before bedtime, as it may increase your level of physical arousal just as you’re about to try to sleep.
Meditation. Deep breathing can be done throughout the day in brief (e.g. 2-5 minute) episodes to mitigate daily stress, reduce both heart rate and blood pressure, and create calmness and mental well-being.
Yoga. Very effective at reducing heart rate, breathing rate and silencing "the chattering monkey" of the mind, yoga is a great way to reduce the metabolic by-products of stress.
These suggested activities provide outlets to quiet the body physically.
Cognitive Behavioral Therapy (CBT) is a very effective way to reduce our mental and emotional arousal. CBT consists of using the mind to redirect worry, automatic negative thoughts, and rumination. Elements of CBT include:
being mindful of your emotional state
consciously interrupting "runaway" anxiety, rumination, worry, negative thoughts and replacing them with neutral or positive thoughts such as affirmations
incorporating physical relaxation with the conscious process of slowing down the mind
Recent evidence shows severe insomnia responds best to cognitive behavioral therapy.
Improve Your Sleep Hygiene
We think of hygiene when it comes to our teeth, feet, or skin. But did you know that sleep also requires hygienic habits and practices if we want to sleep well on a regular basis? They say “Sleep hygiene is the key to sweet dreams.” Here are some suggestions to improve your sleep patterns:
Establish a routine for waking and sleeping.
Set your alarm to wake up the same time every day, even on weekends. Creating a routine for arising and retiring to bed trains your body to expect to sleep at a certain time every day.
Relax to prepare for bed.
Try to read, listen to soft music, take a warm bath, do relaxation exercises, practice deep breathing, or meditate to slow down and guide your body towards sleep.
Lay in bed only when you’re sleepy, especially if you wake up in the middle of the night.
Try to read, listen to soft music, take a warm bath, do relaxation exercises, practice deep breathing, or meditate to slow down and guide your body towards sleep.
Turn off the screen.
A preponderance of evidence has shown that the blue light of TV, computer and phone screens tricks our brains into thinking it's daytime, and suppresses melatonin production, an essential hormone for sleep. A recent study compared subjects who read a book in the hours leading up to bedtime versus those who used watched screens, and found that those who read a book fell asleep much more easily than those who watched screens.
Avoid caffeine after noon.
Drink that double latté in the morning and switch to decaf by lunch. Caffeine can increase your state of arousal through the evening and keep you awake or disturb your sleep.
Avoid alcohol.
Lots of people drink alcohol with the belief that it relaxes them. But in fact, alcohol can increase stomach acid reflux, which in turn causes episodic awakening.
To summarize, we’ve seen that sustained management of insomnia requires:
addressing the physical causes of insomnia,
establishing good sleep hygiene,
reducing our level of physical arousal during the daytime, and
making use of cognitive behavioral techniques (CBT) to manage worry and rumination.
What’s your experience?
Do you suffer from insomnia? If so, how long has it been going on?What long-term strategies have you found to successfully reduce your insomnia?
