What causes insomnia?

Posted September 26, 2022 by stephan
Categories: Health, Insomnia, sleep

Tags: , , , , ,

Q: What usually causes insomnia? I was a normal sleeper then suddenly got it. Does it ever go away?

A: Commonly, a stressful event. Typical examples are loss of a job, the end of a romantic relationship, death of a loved one, a catastrophe like a house fire.

Such stressful events often cause a temporary loss of sleep. Usually insomnia fades away within a few weeks as we either adapt to the stressful event in some way or the underlying cause is resolved.

Short term sleep issues typically result acute insomnia, which often resolves on its own spontaneously in under a month.

Acute insomnia can also be fueled by numerous medical issues such as sickness, fever, and seasonal allergies. These sorts of temporary sleep disruption issues also tend to resolve relatively fast.

In some cases, stress — and often anxiety — build slowly, insidiously, and somewhat below the level of conscious awareness. If stress and/or anxiety become excessive and unremitting, sleep disturbances often follow. This can cause chronic insomnia that can last for years — or even decades if the underlying stress and anxiety aren’t adequately managed.

Long term insomnia can also be caused by chronic medical conditions such as arthritis, pain, asthma, and a host of psychiatric problems such as clinical depression and PTSD.

With many if not most chronic insomniacs, however, there are no underlying medical or psychiatric issues. Instead, sleep disruption is persistently fueled by some combination of excessive worry about the idea of sleep and bad sleep habits. Sleep disturbances lacking an identifiable medical basis are usually called primary insomnia.

This is why it’s important to see a doctor about chronic insomnia. To fix it, you need to identify and address the underlying cause. If nothing medical, then the use of sleeping pills and other substances that artificially force sleep only treat the symptom, leaving the true underlying basis unaddressed.

For primary insomnia, the evidence-based standard of care is use of a CBT sleep training system. These methods are permanent, substance free, and enable you to effectively address the underlying nonmedical root causes.

How long does it take to recover from insomnia?

Posted July 13, 2022 by stephan
Categories: Health, Insomnia, sleep

Tags: , , , , ,

Q: If I start a CBT sleep training program, about how long will it take before I recover normal sleep?

A: Depends on the underlying causes for the sleep disruption. Many factors unique to your situation come into play here.

From a strictly sleep timing standpoint, your body clock can typically adjust about an hour a day. So for those with insomnia resulting from say jet lag, recovery to normal sleep can be relatively fast.

But if you’re working on underlying conditioned behaviors or psychological issues like negative expectations that disrupt sleep, those are not so straightforward and could take considerably longer to address. So the answer in that case is basically as long as it takes to undo the negative conditioning and replace dysfunctional sleep thoughts with better, more accurate ones.

When working with underlying thoughts and behaviors that disrupt sleep, some people experience fairly rapid improvement, sometimes in a matter of a few weeks. For others, it can take longer.

Most CBT sleep training programs like the Sleep Training System typically involve a few weeks to establish the methods. But then the methods need to be actually worked, and continually, to be effective.

Stress management is a good example. You don’t just learn how to manage stress and then stop doing it. Stress is a normal part of everyday life and needs to be continuously managed. So this is something to do for the rest of your life. That’s normal and to be expected.

Ideally, using CBT sleep training methods, you’ll see steady if not rapid improvement. Some setbacks are normal. But in general you can expect to see enough ongoing progress and benefit to keep you going long term.

After all, the payoff — a permanent substance-free solution to insomnia — is priceless.

Why does awakening from a dream feel more refreshing?

Posted January 26, 2022 by stephan
Categories: Health, Insomnia, sleep

Tags: , , , , ,

Q: Sometimes I awaken too early. If I fall back asleep and dream, I feel much more refreshed than if I don’t. What is the reason for that?

A: During the Rapid Eye Movement (REM) dream stage of sleep, the brain’s limbic system lights up.

The limbic system is largely in charge of emotions and emotional processing. Evidence isn’t entirely clear, but dreaming seems to have the effect of resetting our emotional balance — mood — for a new day.

The evidence for this comes from brain imaging and EEG studies of sleep stages. Although dreaming is thought to be a continuous process throughout all sleep stages, vivid dreaming is closely associated with REM.

During a typical night, we experience 4 to 6 complete cycles of sleep, each normally ending with a REM dream stage. In the first few sleep cycles of the night, our systems tend to prioritize the deeper NREM stages, indicating they are more important. But the later cycles preceding wake time normally have more REM.

So if REM has the effect of resetting our mood, reduced REM seems to have the opposite effect — leaving one more irritable and moodier.

Which is why for insomniacs getting in that last REM stage of the night is the holy grail.

Did people sleep longer in winter before electric lighting?

Posted November 30, 2021 by stephan
Categories: Insomnia, sleep

Tags: , , , ,

Q: Did our ancestors sleep longer during the winter with the much longer nights?

A: Yes and no. Although this is partly dependent on higher latitudes where there’s a greater extreme in duration of days and nights, the consensus is yes — prior to the advent of electric lighting people did spend more time in bed during the winter. But no, they didn’t necessarily sleep longer than now.

Instead, there were two periods of sleep during these longer nights, with an awakened time in between. The historical records sometimes refer to this as “first sleep, second sleep”.

Back then, when night lighting consisted mainly of relatively dim candles and lanterns, people might sleep for four solid hours, wake up for two or more hours, then fall back asleep again until morning.  The wakeful period in the middle of the night was called “the watch” or watchful sleep period.  This was generally described as a period of quiet and peacefulness, almost like a meditative state.

So if in the night, and especially during long winter nights, you sometimes find yourself awake between cycles of sleep, remember you are only a few generations removed from when this was more of the norm.

One way to counter the seasonal tendency for nighttime awakenings is to maintain a consistent sleep-wake schedule, which tends to optimize the body clock. There are a number of other substance-free methods to strengthen your sleep as well; the best are contained in a CBT sleep training system.

When should I be hospitalized for insomnia?

Posted September 16, 2021 by stephan
Categories: Health, Insomnia, sleep, stress

Tags: , , , , ,

Q: I haven’t slept for 5 nights now. I read that people should go to a hospital emergency room after a week of no sleep. If that happens, what could I expect?

A: This is of course a personal decision but there’s some questionable underlying premises you should consider first.

One is the idea that anyone really goes 5 nights with “no sleep”. Clinical sleep studies show even the worst insomniacs typically experience very rapid sleep onset after only about 24 hours of nonstop wakefulness. That suggests in all likelihood you are actually sleeping a lot more than you think. Sleep state misperception is very common.

It is a mistake to think sleep is anything less than a very elemental, overpowering force that at some point becomes irresistible for us all. The reality is we can’t not sleep.

That said, the same overwhelming desire for sleep can become literally maddening for some, who will go to great lengths to get some relief even if means unnaturally forcing sleep, or worse, anesthetizing themselves. But that’s the wrong approach and can have dangerous — even deadly — consequences, as Michael Jackson experienced.

Another questionable premise is that insomnia is some sort of disease that can be directly treated. It’s not. Instead, insomnia is just a complaint; a symptom of something else going on causing the sleep disruption.

Identifying the underlying causes would be the first questions you could expect if you went to a hospital emergency room unable to sleep, because those true root issues determine the right way to address them.

Certainly if one felt completely overwhelmed or considering self-harm then most definitely yes, one should reach out for help. But that may or may not mean a hospital. Help is there even if it means calling the national suicide hotline at 800-273-8255, and that’s available 24/7/365.

But the better approach is to start with your primary care doctor to either treat or rule out an underlying medical condition. If none, which is most common, that suggests self-induced insomnia — meaning you’re likely doing it to yourself with some nonmedical combination of bad sleep habits and excessive worry about sleep.

Pills and substances can mask the symptoms but not address these nonmedical root issues. For that the standard of care is use of a CBT sleep training system, which is a drug-free and permanent solution for most. These methods enable you to take the pressure off yourself, which can do wonders, while establishing a much healthier sleep supportive lifestyle.

Is cannabis for insomnia risk free if it doesn’t impact dream sleep?

Posted July 9, 2021 by stephan
Categories: Insomnia, sleep, stress

Tags: , , , , ,

Q: I use marijuana to help me sleep. I know that marijuana usually impacts REM dream sleep, but in my case I don’t have a problem dreaming. So if cannabis isn’t hurting my dreams are there any other risks?

A: Looking beyond the risk to the REM dream stage of sleep, this is a great question because the larger risks apply to any substance used to artificially induce sleep. Let’s start with how marijuana affects sleep, then come back to the question of risk.

There is no consistent evidence cannabis as a sleep aid is effective for chronic insomnia, largely because cannabinoid neurotransmitters aren’t directly involved with sleep onset or maintenance.

You are right, however, about marijuana’s negative impact on the REM dream stage of sleep. There is a considerable body of evidence cannabis use decreases REM sleep by increasing the amount of time spent in NREM sleep. That said, how one would know marijuana “isn’t hurting my dreams” is another question, because no home sleep tracking device without a legitimate electroencephalogram feature can accurately measure sleep stages.

So yes you can expect cannabis use to affect your sleep negatively, and particularly your dream sleep, based on the clinical evidence.

Beyond REM impacts, are there other risks?

Absolutely. And they apply to any substance used to artificially induce or force sleep.

These risks include creating an unhealthy physical and/or psychological dependency. Also the issue of treating only the symptom — sleep, or lack thereof — while leaving the true root issue(s) causing the sleep disruption unaddressed. And maybe most importantly, reinforcing the false belief that the ability to fix this is external and beyond your control.

For primary insomnia, there are better ways — particularly in targeting the true underlying root issues. Which is why use of a CBT sleep training system — a permanent, substance free solution without any of the problematic side effects — is the recognized standard of care.

Countering the ‘tired but wired’ syndrome

Posted April 21, 2021 by stephan
Categories: anxiety, Insomnia, sleep, stress

Tags: , , ,

Q: It’s not unusual for me to feel exhausted in bed but unable to sleep. Yet people keep telling me all I need to do is tire myself out enough and I’ll sleep. It’s very frustrating. What am I missing?

A: The feeling of “tired but wired” is one of the absolute worst aspects of insomnia. At one time or another it happens to many of us battling sleeplessness. But rest assured there are solutions.

First, the idea that sufficiently tiring yourself for better sleep has merit. The mind-body responds to sleep deprivation by ramping up the homeostatic sleep drive, one of the two most important core processes — along with circadian rhythm — that controls sleep. So the longer you go without sleep, the stronger the urge to sleep becomes. At some point, sleep becomes irresistible for us all, no matter how bad the insomnia. The key of course is managing this inevitable sleep process for optimal results.

If this has been ongoing for over a month, it’s a good idea to get a checkup to ensure there are no identifiable underlying medical conditions disrupting your sleep. If nothing medical, then you likely have primary insomnia, by far the most common type. With primary insomnia, the true underlying basis likely is nonmedical — usually some combination of bad sleep habits and excessive worry about the idea of sleep. Drugs and substances won’t address either of those.

Those battling the tired but wired syndrome are often hyperaroused, a condition typically caused by excessive stress and/or anxiety experienced during waking hours. For many insomniacs, just the idea of sleep itself is a potent source of stress fueling insomnia. Cumulatively over time, all these negative stressful thoughts can also cause the very uncomfortable jolting awake right at the moment of falling asleep, a closely related condition.

The standard of care to address all this is typically use of a CBT sleep training system. For most who try it, CBT tools provide a permanent, substance-free solution. CBT methods combine both behavioral and cognitive techniques to provide a comprehensive structure to improve sleep without drugs of any kind, and with no problematic side effects.

When tiring yourself out both physically and mentally isn’t enough, look to employing the tools in a CBT sleep training system. Be confident you’ll find a lasting solution.

How do I know if I’m beating insomnia?

Posted December 6, 2020 by stephan
Categories: Health, Insomnia, sleep, stress

Tags: , , ,

Q: I get stressed about falling asleep. I seem to fixate on wanting to know what’s normal to see right at sleep onset. How do you know that you are “successfully” beating insomnia?

A: What’s normal? No one knows exactly what’s normal to be thinking about in that twilight zone between drowsiness and actual sleep, although EEG recordings give us a clue.

Your description of stress about sleep gives us another clue about your situation in particular. Sleep is best understood as a process of just letting go, rather than dwelling on what we’re thinking about at the moment of falling asleep.

Specifically, studies have shown that thinking about “nothing in particular” is associated with faster sleep onset. So if you just let your thoughts wander pleasantly without any forcing or direction you’re likely to fall asleep faster.

As for “successfully” beating insomnia, you are the best judge of that. Normally it’s based on how you feel and perform during daytime hours. If you have enough energy to get through the day, mood is normal, don’t experience excessive drowsiness, all that suggests you’re getting enough sleep for your needs.

That’s a simple way of looking at it. In the Sleep Training System you’ll also learn how to measure your sleep objectively, so you can most efficiently make use of your time in bed.

That combination, your sleep efficiency plus your perceptions of daytime performance, is usually the best way to determine when you’ve reached your goals of better sleep naturally.

How to deal with middle-of-the-night wake ups

Posted December 17, 2019 by stephan
Categories: Health, Insomnia, sleep

Tags: , , , , , , ,

Q:  Seems most every night I awaken after about 4 hours of sleep.  Sometimes I can’t fall back asleep for a couple of hours, and it’s really starting to bother me.  What can I do to sleep more solidly through the night?

A:  What you’re experiencing is surprisingly common, and especially this time of year with the long nights and short days.  It’s sometimes called the “first sleep, second sleep” phenomenon, and was reportedly the norm prior to advent of electric lighting — when people might spend 11 or 12 hours a night in bed.

Fortunately, there’s a number of things you can do to help consolidate your sleep into one more or less unbroken block of time, although some wake ups are expected and normal for even the best sleepers.

One key is to keep a very consistent sleep-wake schedule.  Especially important is a consistent wake time every day.  This does two things — one is to regulate your circadian rhythm, and the second is synchronize it with your homeostatic sleep drive.  Circadian rhythm and sleep drive are the two most important internal components controlling sleep.

Avoid sleeping in or napping later in the day.  This helps preserve your prior wakefulness.

Schedule your bed time to allow enough time in bed for proper sleep, but no more.  This also helps consolidate your sleep.

Upon arising, immediately expose yourself to bright light.  This helps regulate your circadian rhythm, and your sleep drive begins tracking wakefulness.

When awakened in the night, again which is common and normal, do what good sleepers do — pay no mind.  By doing so you increase the chances of falling back asleep quickly.  What you don’t want to do is start fretting about it, which takes you more into a state of worried wakefulness.  Use in-bed relaxation methods to help fall back asleep, such as deep abdominal breathing combined with progressive muscle relaxation.

Note that none of these methods requires drugs or substances of any kind to work.  Just be conscientious about a healthy sleep supportive lifestyle and good sleep habits, and you will likely improve your sleep and your satisfaction with your sleep.

For more ideas like this, check out using a full CBT sleep training program.

Can’t wake up, sleep through multiple alarms — help!

Posted October 21, 2019 by stephan
Categories: Depression, Insomnia, sleep

Tags: , ,

Q:  I need several alarms to wake up.  Sometimes I sleep through them all or even turn them off, then go back to bed without knowing it.  Why can’t I wake up?

A:  Start with the idea that you “can’t wake up”.  Of course you can. 

Unless you’re Rip Van Winkle, at some point you do wake up.  Every day in fact, do you not?  So for you the keys are to both more accurately understand your experience and to better manage the sleep-wake process.

Presuming you have no underlying medical or psychiatric issues causing this (see a doctor if you aren’t sure), then you might look at a couple of likely factors.  One is sleep deprivation, and the second is motivation — or rather a lack of it.

Ideally — and if you plan a consistent wake time and schedule enough time for proper sleep —  you will awaken spontaneously and refreshed after the last of your sleep cycles completes, with no alarm clock at all.

For many people, keeping a very consistent sleep-wake schedule over time — especially important is a consistent wake time — results in awakening without the need for an alarm clock.  If you aren’t doing this now, it might be a good idea to start with as much regularity as you can.  Be sure to schedule enough time in bed for proper sleep, but be aware sleep duration is a moving target that changes as we age.

So you can expect to awaken when you’ve had enough sleep.  It’s as simple as that.  You won’t even need an alarm to get up because you won’t be sleep deprived.

And if you plan something you really want to do first thing in the morning, then you have good reason to get up and get going.

As for a good reason to get up and get out of bed, for most us work or school are sufficiently motivating.  But if you need more, try planning something you really want to do first thing so you have something to look forward to.

You are the best judge of this, but if you draw a blank on something to look forward to, then you might consider the possibility that your issue isn’t so much sleep as it is a healthy outlook on life.  In that case, counseling might help.

By better managing your sleep schedule, and by feeling more positively motivated about your day, there’s a very good chance you will permanently solve this problem.