Posted tagged ‘insomnia’

“Can’t sleep and don’t want to take drugs”

January 9, 2017

Q:  I’m in my late 20s, with occasional insomnia.  It usually takes me awhile to fall asleep, then I don’t feel rested in the morning when I have to get up for work.  I try to lead a healthy lifestyle with exercise and a good diet, so I suspect this may be psychological.  I don’t want to take drugs, so what else can I do to help myself sleep better?

A:  You are right there probably is a psychological component, but there also likely is a significant circadian component as well.

By way of background, the two most important internal systems controlling sleep are circadian rhythm and homeostatic sleep drive. The two components, when synchronized and working well together, can make sleep when you want practically irresistible.

Consistency helps the two systems work better together.  For most of us that means setting and keeping the same wake up time each morning, 7 days a week.  It also means keeping a consistent bed time each night as well.

If you are not drowsy when you normally go to bed, you might try setting a later bed time, while keeping your wake time consistent.  In other words, see what happens if you reduce the amount of time you allow in bed.  This may have the effect of ramping up your sleep drive to produce faster sleep onset.

If you are otherwise healthy, doing something as simple as reducing from 8 to 7 hours in bed per night may be all you need to restore sleep to where you want it.  And as your sleep improves, you may be able to incrementally add in more time in bed.  However, be cautious about reducing to less than 7 hours  in bed, which is at the lower end of the normal range for most adults.

Of course watching any caffeine intake, getting daily exercise, minimizing stress before bed, and so forth, are also important.

If this continues to bother you, then a check up with your doctor is important to either treat or rule out an underlying medical issue.

As for the psychological part, you are right in that recurring negative thoughts about sleep are a potent fuel for insomnia.  For solutions, check out adult sleep training methods based on CBT — cognitive behavioral therapy. There are many powerful tools you can use to get your thoughts under control and help restore normal sleep.

Fixing insomnia caused by “no sleep pattern”

June 30, 2015

Q:  My sleep schedule is all over the board.  On a good night I sleep only about 4 or 5 hours.  I go to bed late and get up early, awaken exhausted, then typically nap for a couple of hours in the afternoon.  Now I’m worried because I read all the coverage in the media about how bad insomnia is for health.  How do I fix this?

A:   Sounds like you may have a circadian rhythm issue, possibly not dissimilar to jet lag.

Consistency in your sleep schedule should help.  Start with deciding what hours you want to sleep, and what hours you want to be active and awake, keeping in mind the normal recommended range of 7 to 9 hours for most adults.  Then set and keep a consistent sleep-wake schedule 7 days a week to allow your circadian rhythm and sleep drive to adjust.

When setting your schedule, also consider that the physiology of the human mind-body system has evolved over the millennia to be active during the day, and sleep at night.  That’s how our physiology is designed to work, on many different levels.

It may take a few weeks to fully adjust to your new schedule, depending on how different it is from your previous schedule.  But be patient.  If you haven’t previously had insomnia, you should be able to adjust and restore better sleep as your homeostatic sleep drive and circadian rhythm synchronize.   These two internal processes largely control sleep.

This process of re-establishing a normal circadian rhythm is very similar to what travelers do when recovering from jet lag.  Generally, most people take about a day to adjust to each hour of time difference.  So if you were to cross 7 time zones, it would take on average about a week to more fully adjust to your new time.  And of course such adjustments are made successfully by literally thousands of travelers every day around the globe.

You might also reconsider your idea of napping.  It is very difficult for most people to sleep soundly through the night when taking long daytime naps.  To protect your prior wakefulness, which is helpful for ensuring robust sleep through the night, try to limit yourself to no more than about a 20 minute nap, and at least 5 or more hours prior to your usual bedtime.

In the meantime, try to let go the worry, which only tends to fuel insomnia.

And you sure are right about the one-sided media coverage about insomnia.  We are constantly bombarded with bad news about how awful insomnia is, even though the reality is most of us are quite capable of adjusting to sleep deprivation, at least over the short term.  This is not meant to minimize the importance of establishing a lifestyle supportive of good sleep, just to help put things in a more realistic perspective.

Be confident you can fix this, and in so doing you’ll probably be able to function just fine.

Constantly obsessing about sleep

May 21, 2015

Q:  I obsess over whether or not I will sleep.  I toss and turn for hours worrying about how insomnia is hurting my mind and body.  For me this is not so much a sleep issue as it is a worry issue.  I hate feeling like this and feel like nobody understands what what torture this is for me.  How can I stop worrying so much and sleep better?

A:  What you are describing sounds like a form of psychophysiologic insomia, one of the most common types.  While survey data is limited, the Institute of Medicine estimates there are likely tens of millions of people in the U.S. alone who have some form of what you are going through.  So if it’s any solace, you are hardly alone.

This may not necessarily be what you have — or all that you have — that’s responsible for disrupting your sleep, so it’s important to see your doctor to either treat or rule out any underlying medical or psychiatric conditions.  But don’t be surprised if your doctor can find none.  No true underlying medical conditions is another of the hallmarks of psychophysiologic insomnia.

If that’s the case with you, then you are probably right about this being is more of a worry issue.

To treat this, look at solutions to address the nonmedical root sources of your insomnia.  These root sources typically are more than just worry, however.  That’s only one part of it.  The other part is bad sleep habits, actions, and behaviors which many people do inadvertently.  Like take 3 hour naps during the day and expect to sleep well that night.

The problem with taking sleeping pills for psychophysiologic insomnia is drugs do not get at the true root sources, only the symptom.  With this condition, you’ve got to get beyond the symptom to get at the true underlying issues, which are likely some combination of excessive worry about the idea of sleep, and bad sleep habits.

Fortunately, there are proven solutions to treat psychophysiologic insomnia.

Cognitive behavioral therapy specifically designed for insomnia (CBT) is the gold standard to treat psychophysiologic insomnia.  It is a permanent solution that is completely drug free.

CBT includes two parts, as you would expect, the cognitive and the behavioral.

Cognitions refer to the thoughts, ideas, beliefs, and attitudes you hold about the idea of sleep.  The cognitive component enables you to manage and reduce the worry, so it is less likely to fuel your insomnia.

CBT’s behavioral components address all the actions you take — or in some cases actions you don’t take — that either support or undermine good sleeping.

These two components work synergistically together, and are a potent nondrug method to permanently improve sleep.

So have hope.  Check out CBT for sleep, either through your doctor or other healthcare professional, or use one of many good online resources if you are the self-help type.

Waking up at the same times each night

May 15, 2015

Q:  For the past few nights I have been awakening at very close to the same times each night, about 1:30 a.m., 3:00 a.m., and 4:30 a.m.  Now I’m beginning to worry I’m getting locked into this pattern.  Is this kind of thing normal?

A:  Awakening at the exact same time for multiple nights is unusual, and likely coincidental.

However, if you keep a consistent sleep schedule, it might not be all that surprising to awaken at similar times each night.  That’s because our mind-body system generally works in roughly 90 minute sleep cycles, with 4 or 5 such cycles typically per night.  Each cycle consists of several predictable sleep phases, including deep or slow wave sleep, and REM (rapid eye movement), also known as dream sleep.  Each cycle normally ends with a REM dream phase, and that’s when sleep typically is lightest.

Even the best sleepers will awaken to some degree during the transition from one cycle to the next.  However, good sleepers usually fall right back asleep and by morning do not remember these transient awakenings.

Those with insomnia — who are often lighter sleepers anyway — tend to be awake longer during these sleep cycle transitions, and that’s when conditioned negative sleep thoughts and anxiety or stress from the previous day can hit hard.  Then it can understandably take longer than a few minutes to fall back asleep.

In the Sleep Training System, we counter this by using specific in-bed relaxation methods that can help you move naturally back to a drowsy state more conducive to falling  asleep.

As we age, we also tend to spend less time in the deepest sleep phases, and more time in what’s known as stage 2 sleep.  Stage 2 is true sleep, but lighter than the slow wave sleep phases.  Also, the elderly may reach a REM dream phase much faster than younger persons, sometimes entirely skipping preliminary phases.  These are just a couple of changes that often occur as we age.

So if you awaken in the night and can recall a vivid dream, it’s likely you’ve just completed one of these typical sleep cycles.  This kind of awakening is therefore normal, and by itself nothing to worry about.

You might benefit by becoming less of a clock watcher.  Some of us can become somewhat obsessed with checking the time when awakened in the night, but if that only works to remind you of how much sleep you’re losing, then your clock can become yet another conditioned cue that reinforces insomnia.

By using proven cognitive and behavioral methods for better sleep, you can help naturally strengthen your inherent sleep system to the point where these middle-of-the-night awakenings, while common and normal, are no longer bothersome.

Temporary setbacks common with sleep improvement programs

April 8, 2015

Q:  After struggling with insomnia for several years, I have been using the Sleep Training System with excellent results (over 90% sleep efficiency) until recently.  After I returned from a cross-country trip, jet lag seems to have totally thrown me for a loop.  Now I have regressed back to tossing and turning for what seems like hours.  Is it unusual for jet lag to cause such issues?  What can I do to prevent this in the future?

A:  First, excellent news on your progress.  And yes, you are right about jet lag causing issues for many people.  You are not alone in this regard.  Even the one hour switching to or from daylight savings time can be disruptive for some.

Jet lag and DST issues involve changes to our circadian rhythms, one of the key internal components controlling sleep.  For most people making such adjustments is usually a fairly straightforward process, but it can be more challenging if you are prone to insomnia.

Generally, most people take about a day to adjust to each hour of time difference.  So if you were to cross 7 time zones, it would take on average about a week to more fully adjust to your new time.  And of course such adjustments are made successfully by literally thousands of travelers every day around the globe.

To help re-calibrate or entrain your circadian rhythm, it’s important to stay with your usual schedule in the new time.  Especially important is a consistent wake time, because this is your fixed point each day to both reset your circadian rhythm and synchronize it to your homeostatic sleep drive.

Also important is to expose yourself to bright light first thing upon awakening.  Natural sunlight is best for this purpose, but normally any bright lighting will work.  Then, as your bedtime approaches, try to reduce or modulate your exposure to bright light.  This will have the effect of stimulating the natural production of melatonin, which helps support better sleep.

In addition, before bed use a relaxing routine to help transition yourself to a calm and restful state conducive to falling asleep.

Some people try to phase such time adjustments in advance, by changing their sleep schedule in 15 minute increments starting about a week before the change.

But in your case, perhaps most important is to be confident you have proven to yourself that the methods in the STS work, and you have proven to yourself that you can in fact sleep well.  90% sleep efficiency is strong evidence!  So when those negative sleep thoughts come, choose to let them go and instead dwell on these proven facts.  By cutting off insomnia’s negative fuel, sleep tends to improve naturally.

Temporary setbacks in sleep improvement for a myriad of reasons are actually common and normal.  If it’s not jet lag, it could be DST or some stressful event.  These kinds of things happen to us all, including normal sleepers.  The key is to stay with the program, and continue using the methods.  Make them part of your normal, everyday lifestyle.

When temporary sleep setbacks occur, we adjust.  We let go the stress and anxiety, and better sleep inevitably returns.  It will for you too.

How negative thoughts feed insomnia

March 18, 2015

One of the great accomplishments in cognitive psychology over the past several decades is arguably the defining of recognizable categories of thought distortions by psychiatrists Aaron Beck and David Burns.  Distortions of rational thought are often at the root of many psychiatric disorders like depression and generalized anxiety disorder.  Similarly, negative and often inaccurate thoughts specifically about sleep also tend to fuel and perpetuate insomnia.

In his book “Feeling good:  New mood therapy” (one of the top self-help books ever published), Dr. Burns lists 10 of these very common categories of thought distortions.  And it’s probably safe to say nearly all of us have succumbed to one or more of them at one time or another.

As one example, consider “disqualifying the positive”.  This occurs when you only see the negative aspects of a certain situation you are in, and completely overlook any positives as if they don’t count.  It’s not a valid or accurate representation of what’s truly there, and such distortion tends to feed worry and anxiety — sometimes to the point of being debilitating.

Moreover, seeing the situation more accurately can work to almost immediately lift one’s spirits and reduce depression.  Dr. Burns cites clinical evidence showing more rational understanding actually works better than drug therapy.

Specifically for sleep, insomniacs are prone to many common but inaccurate distortions of thought that tend to feed insomnia.  Such as, “I must fall asleep RIGHT NOW because I’ve got this very important (presentation, job, assignment, exam, project due, etc.) tomorrow, and if I don’t get a solid 8 hours I’ll be a complete wreck tomorrow!”

Which of course makes it nearly impossible to sleep at that point.

Interestingly, empirical studies have found that particular negative belief about insomnia is simply not true.  In reality, we adapt and usually perform well even when sleep deprived; and this is true both in terms of physical performance and cognitive performance —  Insomniacs tend to perform just as well as good sleepers.

But for insomniacs, it typically doesn’t feel that way. Studies also confirm that insomniacs tend to feel like they don’t perform well, even when they do.

So the real difference is in mood and perception, not performance.

You typically don’t hear much about this side of insomnia, because the media tends to be so one-sided.  What we do hear about more or less constantly is how awful sleep deprivation is and how much damage it causes.  Worry and fear can sell a lot of sleeping pills and herbal sleep supplements.

But knowing the negative consequences of a bad night are typically limited mostly to mood and perception, and not necessarily to performance, helps to reduce anxiety about sleep.  And the corresponding reduction in worry often results in better sleep.

By reducing the pressure we put on ourselves about sleep, we can relax more easily, let go, and fall asleep easier.  And learning how to do this consistently and when you want is a permanent tool you can use for the rest of your life.

Better yet, this method of cognitive restructuring is completely drug free.

So if you are subject to sometimes sleepless nights and don’t have an underlying medical issue causing insomnia, consider using these clinically proven non-pharmacological methods for sleep improvement.  Doing so will help you understand how some of your thoughts — especially about sleep — are distorted and inaccurate.  By learning to safely let these negative thoughts go, you can help yourself sleep better.

Taking an anti-psychotic drug to treat insomnia

February 27, 2015

Q:  I am battling chronic insomnia, and have for many years.  Some nights I lie in bed for what seems like hours, and each day is difficult.  My doctor prescribes seroquel, but it’s not helping much.  I am fighting to beat this disease, but am running out of hope.  What can I do?

A:  First, it’s important to understand that insomnia is a symptom, not a disease.  Sleeplessness is only a symptom of something else going on deeper causing the problem.

Seroquel is an anti-psychotic drug approved for treating psychiatric disorders, primarily schizophrenia and bipolar disorder.  Without knowing the specifics of your situation, it’s possible whatever underlying condition you have is also causing insomnia.

Doctors sometimes prescribe seroquel off-label to treat insomnia, and this may be the case with you.  It would be a good idea to find out for sure by talking to your doctor about your situation.  Try to identify why s/he prescribed this drug, and discuss any underlying medical or psychiatric issues causing your insomnia.

If your doctor cannot identify any underlying medical or psychiatric issues, then you are basically using a powerful anti-psychotic drug as a sleeping pill.

Many sleep experts take the position that the use of drugs to unnaturally force sleep in the absence of an underlying medical or psychiatric condition can actually do more harm than good.  That’s because the use of drugs tends to reinforce the idea that the solution to insomnia is external and resides out of your self-control.  Drug takers also risk dependency, both physical and psychological, and the true underlying cause unfortunately remains untreated.

By attempting to identify and treat the true underlying roots of your insomnia, your sleep stands to improve.  If you have no medical or psychiatric issues, then you have what’s known as primary insomnia, which is often caused by some non-medical combination of bad sleep habits and excessive worry about the idea of sleep.

The good news is that the non-medical roots of primary insomnia can be successfully treated.  Cognitive behavioral therapy specifically designed for sleep (CBT-I) is the standard of care for primary insomnia, and helps most people who try it.

CBT-I methods will help you counter the negative sleep thoughts that often fuel and perpetuate insomnia, as well as address behaviors and environmental factors you can control to improve sleep.

So start with your doctor, as this person has examined you and knows your unique medical history.  But rest assured you have a number of proven, effective tools at your disposal to help naturally restore better sleep without drugs.