For almost as long as I can remember, bedtime was the time of day when I felt the least sleepy. As a small child, I would read by flashlight or listen to my transistor radio until the small hours of the morning. As a college student, I would stay up all night several times a week.
Needless to say, this became a problem for me when I grew up and had to work 9 to 5. Over-the-counter sleep aids made me wired at night and groggy in the morning; supplements like melatonin only helped the first time I took them. When it got to the point that I was nodding off in meetings, I sought medical help. Prescription benzodiazepines like Restoril and Valium helped, but only for a night or two. Ambien did nothing at all.
Every doctor I saw recommended that I cut back on coffee, but how could I do that and get through a day at the office? Exercise made a small difference, but it didn’t provide anything like a cure. One psychiatrist prescribed a low dose of an anti-psychotic medication. It made a significant difference for the first few nights, but after a week or so I started to feel weirdly estranged from myself.
Maybe my problem was in the wiring of my brain’s switches. A study published in August 2013 used brain imaging to discover that insomnia subjects “did not properly turn on brain regions critical to a working memory task and did not turn off ‘mind-wandering’ brain regions irrelevant to the task.”
“The data help us understand that people with insomnia not only have trouble sleeping at night, but their brains are not functioning as efficiently during the day,” said the study’s leader, Sean P.A. Drummond of the University of California, San Diego.
A study led by Rachel E. Salas at Johns Hopkins University found that insomniacs have more plasticity in the parts of their brains that control movement. “Insomnia is not a nighttime disorder,” she remarked. “It’s a 24-hour brain condition, like a light switch that is always on.”
“You have an ‘agitated depression,’” another doctor told me, “and that’s not a problem that medication can effectively address.” He recommended talking therapy, along with a program of behavioral modification, which amounted essentially to avoiding napping, going to bed at the same time every night, and reserving the bed for just two activities: sleep and sex. In other words, no reading in bed, no watching television or listening to the radio, and not even any tossing and turning. If you’re not sleeping, he said, then get out of bed and occupy yourself in another room until you feel drowsy. This will break the association between “bed” and “sleeplessness.”
Wilfred Pigeon, Ph.D., co-author of the book Sleep Manual: Training Your Mind and Body to Achieve the Perfect Night’s Sleep and director of the Sleep and Neurophysiology Lab at the University of Rochester Medical Center, recommends those measures as well, but as a strategy that can lead to an eventual cure. As he explained in an interview in The New York Times, “sleep restriction” consolidates a “person’s ability to sleep in one large chunk as opposed to in several fragmented chunks of sleep. This technique is thought to recalibrate a sleep ‘thermostat’ that we believe gets out of kilter in prolonged insomnia.”
Dr. Pigeon’s patients fill out sleep questionnaires to establish how much of the time they spend in bed is devoted to sleeping as opposed to tossing and turning. If they only sleep five hours on average, he tells them to go to bed at 1 a.m. and set their alarm clock for 6 a.m. Things may get worse in the short term, but “eventually they’ll have a night where they go upstairs, turn off the light, go to sleep, and sleep through the night,” Dr. Pigeon says. Once they are sleeping 90 percent of the time they spend in bed, they are rewarded with an extra 15 minutes of sleep, and then a week later with another 15 minutes. “After two months of such weekly adjustments,” he says, “a person may gradually add as much as two additional hours to the average nightly sleep time.”
A year or two ago, my wife began to worry that I had sleep apnea. On the rare occasions that I fell asleep before her, she told me, she would hear me stop breathing at intervals, sometimes for an alarmingly long time, after which I would wake up gasping. She urged me to go to a sleep lab like the one Dr. Pigeon runs, but then my circumstances abruptly changed last spring when I was diagnosed with Type 2 diabetes.
The medical regimen and lifestyle changes I began in order to address my diabetes appear to have addressed my insomnia as well. Or maybe my blood sugar and my sleep disturbances were connected all along. A 2011 study carried out by the American Diabetes Association, “Cross-Sectional Associations Between Measures of Sleep and Markers of Glucose Metabolism Among Subjects With and Without Diabetes,” found an association between “poor sleep quality and higher glucose, insulin, and estimated insulin resistance among subjects with diabetes.”
5 Tips for Better Sleep
1. Consider a new mattress. Insomnia’s causes run deeper than a lumpy or sagging mattress, but why make things harder for yourself?
2. Lose weight if you need to. There are clear associations between sleeplessness and obesity, which may well run both ways. Sleep apnea, for example, is exacerbated by excess weight—and chronic exhaustion causes people to eat more. It’s a vicious circle, but being mindful about what you eat and exercising regularly will make a difference.
3. Meditate if you can. If you’re not a meditator, try to still the chatter in your head by simply counting your breaths.
4. Enjoy a tea ritual. Peppermint, chamomile, and valerian tea are all recognized sleep aids; drinking a little at the same time every night will help condition your body to regulate its “sleep timer.”
5. Use white noise. Buy a white noise machine, or turn on a fan. Filling the room with one steady sound blocks abrupt distracting sounds (barking dogs, shouts from the street). And it’s soothing, as a large body of neurological research confirms.
Very informative article. I like how it addresses insomnia from a number of vantage points. A valuable read for insomniacs of all types.