Posted tagged ‘biological clock’

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

December 17, 2019

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.

Sleep and the EEG

April 16, 2019

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:

stages-of-sleep-eeg1

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.

Why can’t I sleep at night but can during the day?

April 21, 2016

Q:  I have been struggling with insomnia for a couple of years now, and find it very difficult to sleep at night.  But for some reason I have no problem napping during the day.  Why is this?  What can I do to sleep better at night?

A:  Your circadian rhythm is likely involved.  There can be many reasons why you can sleep during the day but have difficulty at night.  As always, it’s best to talk to your doctor to either treat or rule out an underlying medical basis — but here’s some general information that might help.

First, our mind-body systems have evolved over the eons specifically to sleep at night and be alert during the day.  The two most important internal systems controlling this process are known as the circadian rhythm and homeostatic sleep drive.

Circadian rhythms refer to the 24-hour cycle of day and night we all experience.  Your circadian rhythm sends out an alerting signal in the morning, and the cue it uses to determine this is light.  The circadian alerting signal diminishes in strength when night comes.

Our homeostatic sleep drive is a separate regulatory function in addition to the circadian rhythm.  Sleep drive is the biological pressure to sleep.  It builds up over the course of a day.

After about 16 hours of nonstop wakefulness, your sleep drive sends a signal reinforcing the lull in the circadian alerting system.  When the two systems are synchronized and working well together, sleep when you want it can become practically irresistible.

One way to strengthen these two processes and assist them in working well together is to have a consistent sleep-wake schedule.  Particularly important is a consistent wake time in the morning, followed by the immediate exposure to bright light.  This consistency helps to both regulate your circadian rhythm and synchronize it to your sleep drive.

Since you have been struggling with chronic insomnia for some time now, you may also be affected by a conditioned response to being awake at night, frustrated and tense, while trying to sleep.  In other words, you may have learned inadvertently over time to be awake and alert during the night as a result of your negative experience with insomnia.  This is actually common with insomniacs.

But just as it has been learned, it can be unlearned.  There are a number of methods known collectively as stimulus control you can use to counter this negative conditioning, and support better sleep.

The best overall strategy is to combine all these methods at once into one unified program for better sleep.  Taking a comprehensive approach enables you to address all the nonmedical issues that may be preventing you from getting a good night’s sleep.

Simple solutions for delayed sleep phase syndrome

March 14, 2013

Q:  After doing much research, it seems I have “Delayed Sleep Phase Disorder”.   I’m an otherwise healthy male in my mid 20s, and in graduate school.  Problem is I’m not performing well academically because I feel tired and sleepy during class.  Normally I go to bed around 2 or 3 a.m., and wake up around 11 a.m.  With my classes I now have to get up at 6 a.m.  When I wake up that early, I feel tired for the rest of the day unless I take a nap.  I typically nap between 3 to 5  p.m. and sleep 1 to 2 hours.  After a nap I feel better, but then can’t fall asleep until 2 or 3 a.m.  I’ve read about light therapy and melatonin supplements, do you think this will help me?

A:  What you are describing is actually common among adolescents and young adults, who often have a biological clock that runs a bit slow for a few years.  Light therapy and melatonin may help, but in your case we suggest you start with something more conservative and simple, because that’s all you may need.

First, your sleep schedule could probably be improved.  The key to help strengthen your internal sleep system is to have a consistent wake-up time.

That means the getting up at same time every day, consistently as much as possible, including weekends.  Use an alarm clock, and try to get out of bed at the same time every morning.  Let yourself sleep in one day, and you pay the price the next night.

Upon arising, immediately expose yourself to bright light.  Indirect sunlight, because of its full natural spectrum, is usually best. This helps re-set your biological clock for a new day, and resynchronizes it to your natural circadian rhythm, which largely controls sleep.

If you can’t get indirect sunlight for any reason, don’t worry about it.  Just go for whatever bright light is available.  Most people are fine with regular indoor lighting.  You may not need to go to the expense of buying specialized full spectrum lighting.  Try the simpler options first.

Napping is somewhat controversial among sleep experts. Some say it’s OK, others say no, it decreases your prior wakefulness and homeostatic sleep drive, therefore making it more difficult to fall asleep later.  That seems to be what you’re experiencing.

Sleep drive is a second major component, in addition to circadian rhythm, that largely controls sleep.

We suggest napping is OK, but less is better.  Limiting yourself to a maximum of 30 minutes and at least 6 or 7 hours before your normal bedtime should have a minimal effect on your sleep drive.  You may find that just 10 or 15 minutes of resting, if not sleep, leaves you feeling noticeably refreshed for the rest of the day.

Also try to have a consistent bed time. This should be determined by how much time you are allowing for sleep.  If for instance you normally schedule 8 hours and you are not sleeping well, try reducing to 7.5 hours for a couple of weeks and see what happens.  Make any scheduling adjustments to your bed time, and keep your wake-up time consistent.

Reducing the time allotted for sleep has the effect of increasing your sleep drive.  As your sleep starts to improve, you may be able to add time back in. But do this in small increments over a period of a couple weeks at a time.   Your sleep system thrives on this sort of regularity.

You also may be helped by scheduling a relaxing cool down routine before bed.  This can be getting your clothes ready for morning, making a to-do list, reading, taking a relaxing bath, and so forth.  This helps prepare your mind and body for the transition from wakefulness to sleep.

We also suggest avoiding or at least limiting any caffeine after about mid-day, in either drinks or food (there are many foods with caffeine, including chocolate).

All of these ideas and more are from CBT-based adult sleep training methods.  CBT, or cognitive behavioral therapy, is a simple and common sense solution for better sleep that works for most people.  The methods are completely drug-free, natural, and for many a permanent solution.

In your case, hopefully these simple suggestions may be all that you need to start sleeping better.

“My brain won’t let me sleep!”

November 8, 2012

Q:  “Ever since an intense bout of anxiety and stress a few weeks ago, I am having trouble sleeping.  Before that I was a good sleeper.  So now I wonder if something’s broken or wrong with me.  My doctor prescribed Xanax, and that’s helped, but I’m still only getting about 4 or 5 hours of sleep instead of my usual 8.  I want to sleep but feel like my brain won’t let me.  What’s wrong?”

First, it looks like you recognize the root causes for your insomnia, because you have stated it clearly: anxiety and stress.  Your inability to sleep at the moment is not some inherent defect.  You, like us all, have a built-in capacity to sleep well.  It’s just a matter of enabling it, and in your case, because you have history of being a good sleeper, re-enabling it.

From your description, it’s possible the Xanax worked not because it forced sleep but rather because it reduced the anxiety levels you are experiencing, thus enabling sleep.  So we suggest managing stress and anxiety you experience during waking hours, because these conditions can and will disrupt sleep.

It’s important to understand that sleeping pills (or supplements for that matter) do not directly address the root causes for insomnia caused by stress and anxiety.  But rest assured there are ways to effectively manage stress and anxiety that don’t involve drugs, and thereby help yourself sleep better permanently.

If you are not doing it now, we suggest setting and keeping a consistent bed time and wake-up time.  Your sleep system thrives on this sort of consistency.  Wake-up time in particular is important because that’s how you synchronize your biological clock to your natural circadian rhythm.

Then, upon arising, immediately expose yourself to bright light.  Light gets your system started in subtle but powerful ways.

Circadian rhythm, along with your homeostatic sleep drive, are the two most important internal components that control sleep.  You want these two systems working supportively together.  When they do, sleep is practically irresistible.

All these ideas about improving sleep come from CBT specifically designed for insomnia.  It’s a very effective and drug-free solution for improving sleep.  CBT is a conservative approach that enables you to directly address the root causes for insomnia, including stress and anxiety.

Since you are taking anti-anxiety medication, be sure to work closely with your doctor when making any adjustments.  But rest assured that by addressing the root causes, and by making healthy lifestyle choices, you will succeed and get the sleep you need.

Shift work and insomnia

August 29, 2012

Q:  “I work a swing shift, 4:30 to 1:00 a.m., and have had insomnia for several months now.  Nothing I try seems to be working.  I worry myself sick about not sleeping.  My bed time varies, but I always try to awaken at 10 a.m. consistently.   Now I’m scared I may have fatal familial insomnia.   What can I do?”

First, regarding fatal familial insomnia (FFI), this is very likely an inaccurate, overblown worry without basis.  FFI is genetic and extremely rare.  There is virtually no chance you have it unless you are a direct descendent of someone who has.  And you would undoubtedly know if you did.  So if you are not, then this is one worry you can legitimately cross off your list.

So presuming you have no medical or psychiatric issues causing insomnia — and it’s important to have a checkup to rule this out — then you might begin by looking at thoughts and behaviors.  That’s typically what causes insomnia when there’s no other identifiable basis.

At the very least, it sounds like you do have a lot of negative sleep thoughts. This, at a minimum, is helping to fuel your sleep problems.  In other words, worry about sleep is keeping you up.

Imagine if you could wave a magic wand and instantly get rid of all those negative thoughts, all that worry about FFI, and so on.  Poof, it goes away.  Just imagine the weight that would be lifted off your shoulders.

Now imagine you replaced all that worry with a positive view of sleep.  An expectation that you will sleep solidly and awaken refreshed, every day.

Unfortunately, there is no such thing as a magic wand.  But there are proven ways to do this.  You can reduce negative thinking and replace those thoughts with better, more accurate, and more supportive thoughts for better sleep.  It’s part of cognitive behavioral therapy (CBT) for insomnia.  And it works.

You may also have some behavioral and environmental issues that are keeping you up. These could range from too much caffeine to a snoring bed partner to a bedroom environment that’s too hot for good sleep.  CBT can help you assess all this as well.

Your consistent wake-up time is good.  You might help yourself further by establishing a consistent bed time as well.  It’s possible you’re not sleeping well because you’re allowing too much time in bed.

Most adults need between 7 and 9 hours of sleep.  You should only allow the minimum time you need.  Since you’re having trouble, you might start going to bed no later than 3 a.m. consistently, and awakening at 10 a.m. That gives you 7 hours in bed.  You might try that for a week or two and see what happens.

You can cut that back even further, but many sleep experts say do not go under 5.5 hours unless you are under the supervision of a health care professional who is knowledgeable about sleep.

The idea is to rev up your sleep drive. By only allowing yourself the minimum time in bed, you might produce more robust sleep.

A good CBT-based sleep training system will give you the tools you need, such as logs to accurately track each night’s sleep experience, to help you find your optimal sleep schedule.

Your shift work schedule also presents challenges — to your natural circadian rhythm. It’s important for you to try to mimic a more normal day-night pattern.  It’s a good idea to expose yourself to bright light immediately upon awakening, which should be easy at 10 a.m.  Then, for at least an hour before your bedtime, try to be in subdued lighting, and try to engage in some sort of a consistently relaxing pre-bed routine.  Not too relaxing, you don’t want to fall asleep before you actually get into bed at 3.  Doing all of this might help you.

For your best overall solution, we encourage you to first get a check up with your doctor.  You want to either treat or rule out any medical basis.  Then look into a CBT-based sleep training system.  It might just be a lasting solution for you, as it has been for many people.

How to take back control of your sleep

February 28, 2012

For those that suffer with insomnia, not being able to sleep is horrible at night.  And a lack of sleep negatively affects us during the day.  This is not news to insomniacs who must find ways to cope with this reality.

But what is striking about insomnia is how much of it we do to ourselves.  So much of our sleeping problems are self-imposed, usually from some combination of bad sleep habits and excessive worry. Many of us realize this, but seem powerless to do much about it.

So my message is this:  yes you can.

Yes, you can take back control of your sleep.  There are proven ways to do this.  You don’t have to needlessly suffer.

The interesting thing about sleep is that we can’t control it directly.  A frontal assault just doesn’t work.   Trying to force sleep usually pushes us the other way.  We tense up, we get frustrated and angry at our inability to sleep.  We just toss and turn for hours at a time with endless racing thoughts of worry.  We are unable to shut down and turn off our minds.

Rather than a frontal assault, what does work is an indirect approach to outflank insomnia.  We do this by creating conditions that support and enable sleep, rather than force sleep.  To do this, we in effect stack the deck in our favor during our waking hours to help us let go and sleep at night.  This approach works.

The first step in taking back control is really basic.  You make the decision.  You make the decision to no longer let your nights be ruled by insomnia.  When the choice is let insomnia control you or you control insomnia, that’s an easy decision to make.  And when you become determined, good things happen.

As you learn how to take back control, you will no doubt be consistently drawn toward the one method that has been proven to work consistently and especially well — cognitive behavioral therapy specifically designed for sleep.   CBT is actually a collection of common sense methods that, when combined and applied together, work remarkably well to restore sleep naturally, permanently, and without the use of drugs.

One of the first CBT steps is to set and keep a consistent and sensible sleep schedule to meet your unique needs.  This may be easier said than done.  It’s hard to force yourself to get up when you feel horribly sleep-deprived.  Yet your discipline in the morning pays off the next night with better sleep.  And better sleep the night after that, and after that again.  This is one way to begin to take back control.

There are many more common sense ideas in a good CBT sleep training program to help you strengthen your ability to sleep, including effective ways to finally take control over those racing thoughts.

So … do you feel powerless about your sleep?  What do you do to control it?