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

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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.

Can’t sleep with a big event the next day

Posted August 15, 2019 by stephan
Categories: anxiety, Insomnia, sleep, stress

Tags: , , , ,

Q:  When I have something important the next day like a job interview, seems I toss and turn for hours.  But if I have nothing going on I sleep like a rock.  This has caused me to miss some good opportunities, so how do I deal with it?

A: It’s common and normal to feel some general anxiety and increased stress levels in advance of a job interview, or a test, or an important upcoming assignment.  Such stress increases, providing they’re not excessive, can help improve one’s ability to perform, and so can actually be desirable.

But in terms of sleep, you are right.  The increased stress and anxiety does commonly affect sleep.

Maybe it would help you to know that sleep is happening, you probably just don’t realize it.  Sleep state misperception is very common.  It may not feel like it, but if you allow yourself to just rest comfortably in bed with your eyes closed you will in all likelihood drift off and benefit.

Perhaps more importantly, a significant body of evidence shows even if we don’t feel like our best because of a restless night, our performance does not necessarily suffer.  This is true both cognitively and physically.  Pretty much every starting pitcher in game 7 of the World Series can tell you that!

If you ever feel overwhelmed by stress or anxiety, or if it becomes excessive and unremitting, then counseling can go a long way to help you get it back under control.

But if you are experiencing normal levels, then know it’s OK to let go the worry and be confident you will be just fine, even if it doesn’t feel that way.  The difference is largely in perception, not performance.

Negative thoughts prior to some big event are just one example of the many worrisome issues that can disrupt sleep.  For more help, consider using cognitive restructuring, one of the core methods in CBT sleep training.

What should I think about to fall asleep fastest?

Posted June 24, 2019 by stephan
Categories: Insomnia, sleep, stress

Tags: , , , , ,

Q:  What type of thoughts are recommended to fall asleep the fastest?

A: Great question. This actually has been studied. The conclusion:  Nothing.

That doesn’t mean not think, which isn’t possible. It does mean thinking about “nothing in particular”.

While it’s normal for all of us to replay our day to some extent before falling asleep, insomniacs tend to fret and worry about events that have already passed, and these thoughts tend to be negative and stressful.  This then typically results in a faster heartbeat, increased respiration, and a higher body temperature — the opposite direction you want to go to fall asleep.

Another variation is to excessively focus on one thing or another, which is a form of the occupying thought.  It may be listening to the slightest sounds in your bedroom, or replaying a tune over and over in your mind.  In either case, this kind of thinking is not conducive to falling asleep.

What the research has found is letting your thoughts wander pleasantly without any force or direction is associated with faster sleep onset.  This might be simply described as just letting go.

We suggest that’s a good way to conceptualize sleep:  a process of letting go.

So for faster sleep onset, find a place in your mind where your thoughts can just meander pleasantly and then just go with it.  When you begin recognize this, you can return to it again and again to help yourself fall asleep.

To enhance this process there’s many additional supportive actions and behaviors you can use.  Of particular importance is consistency in your circadian rhythm.

For a comprehensive, substance-free, and permanent solution that includes all these methods, check out CBT sleep training programs.

Sleep and the EEG

Posted April 16, 2019 by stephan
Categories: Insomnia, sleep

Tags: , , , , , ,

When the EEG, or electroencephalogram, was invented, a whole new world opened for  exploration — the previously unknown world we all enter when we fall asleep.

Before the EEG, sleep was often thought of as a death-like experience, wherein one loses consciousness each night, hopefully to return in the morning.  Our remembered dreams gave us glimpses of this other world, often comprised of bizarre fantasies and sometimes disturbing nightmares, but no one knew for sure what was going on.

By measuring electrical activity in the brain, the EEG gave us a much better understanding of this unknown world.  The brain — powered by billions of neurons, or brain cells — produces measurable waves of electricity the EEG can record.  The first recording EEG machine was invented by German physiologist and psychiatrist Hans Berger in 1924.

Yet it would be almost 30 years later before scientists got the bright idea of attaching one of those devices to someone while asleep.  In 1953, two researchers at the University of Chicago, Eugene Aserinsky and Nathaniel Kleitman, first measured the alternating periods of REM (rapid eye movement) and NREM (sometimes called slow wave sleep) during all-night EEG recordings, launching the era of modern sleep research.

More than 60 years later the EEG remains the primary tool for laboratory sleep evaluation, and what researchers find looks something like this:


EEG recordings for various stages of sleep.  Notice the similarity between REM sleep (bottom) and an awakened state (top), and the striking difference between that and the slow deep rhythmic waves of Stages 3 and 4, the deepest forms of sleep.

When we fall asleep we transition through various stages, starting with a relaxed state, which leads to drowsiness, or Stage 1.  True sleep starts in Stage 2 with the appearance of the sleep spindles and K complexes, and the deepest form of sleep shows rhythmic waves of electrical activity slowly sweeping across the brain.

The transition of sleep stages usually ends with something that appears very close to an awakened state — the REM dream stage.  A complete cycle of NREM and REM usually takes about 90 minutes, and we typically experience 4 to 6 complete cycles of sleep each night.

Research has shown during these deepest slow wave sleep stages the brain clears itself of toxins and replenishes its energy supply for a new day.  It is thought these slow cycles of electricity literally draw cerebrospinal fluid into and through the brain to facilitate this renewal process.

If awakened during a deep NREM stage, we usually remember little about our dreams and are typically extremely groggy.  In complete contrast the REM dream stage is much closer to a fully awakened state.  In REM our dreams are vivid, and by completing one’s final REM stage of the night one likely feels better rested and more emotionally restored for a new day.

Use of the EEG opened a much broader understanding of sleep, with intense research still ongoing today.  There is still much more that we don’t know than we know about this hidden world we enter each night.

Easily fall asleep with TV on — but turn it off and bam! — wide awake

Posted January 22, 2019 by stephan
Categories: Insomnia, sleep

Tags: , , , , , , ,

Q:  I can’t keep my eyes open in bed if I watch TV, but as soon as I turn it off I’m wide awake.  So frustrating, how can I fix this?

A:  You likely have what’s known as conditioned insomnia.  And this is not unusual, many insomniacs experience something similar.

Conditioned insomnia typically results from tossing and turning in bed for hours at a time, which of course is very negative and frustrating.  So a negative association is inadvertently created with your bed, bedroom, and the idea of sleeping.  This is why many insomniacs can’t sleep in bed, but easily fall asleep on the couch, in a tent, in a motel room, sometimes anywhere besides their own bed.

In your case, watching TV temporarily distracts you from the negative conditioning.  But once you turn off the TV and roll over to sleep — wham!  All those negative, stressful associations return and act like a shot of caffeine.

You can effectively counter this by not watching TV in bed, or doing anything else in bed besides sleep.  You can also help this process by not allowing yourself to sleep anywhere else besides your own bed.  Over time, and with consistent discipline, the negative association weakens and is replaced by increasing confidence in your ability to sleep when and where you want.

To help break the old, negative associations, you might consider something as simple as a new blanket or bedspread or pillow.  Taking control of your sleep behaviors and bedroom environment is part of the stimulus control method of improving sleep.

In addition, there’s probably more going on that initially led to your inability to sleep in the first place.  Fortunately, there are a number of ways you can improve, restore, and strengthen better sleep.

For overall sleep improvement, CBT sleep training methods are the gold standard.  These methods are comprehensive, simple, and common sense.  They include stimulus control and much more, are completely substance free, and have no adverse side effects.

Be confident that by taking some healthy sleep supportive actions you can fix this and sleep when and where you want.