Insomnia

The Struggle of Insomnia

Insomnia is terrible. It is a painless pain. Insomnia is a disorder that afflicts close to 10% of Americans. It is one of the most common sleep problem.  Everyone has suffered a bid of sleep difficulty now and then but chronic insomnia brings lots of suffering and is a harbinger of health problems. Insomnia is not a benign problem.

Insomnia can affect your thinking and daytime functioning. A 2011 study from Canada which was published in the May issue of Sleep Medicine Reviews looked at a total of 24 studies and concluded that insomnia is associated with mild to moderate degree of memory and executive function. Executive function is crucial for your success in life. For example, it helps you organize your thoughts and lay out a task that requires a sequence of actions: decide who to marry, plan a trip, manage your time and succeed at your job. Insomnia also causes fatigue, headaches, low motivation, irritability and depressed mood.

Insomnia is not a one-problem disorder. To treat insomnia, it is important to go after the root of the problem; it is like pulling weed.

Here are few disorders and problems that lead to insomnia: Hyper-aroused personality, depression, anxiety, medication effect, environment (noise), hormonal changes, aging, pain, circadian rhythm disorders (night owl, shift work), poor sleep habits, caffeine, alcohol, medical conditions (stroke, heart and lung disease, frequent urination, gastric reflux), sleep disorder (obstructive sleep apnea,  restless legs syndrome) and genetic predisposition.

It is prudent to consult with your physician and possibly a sleep specialist if you think you have one of the above disorders. It is important to remember that stress and anxiety are not the only causes for insomnia.

Stress, worry, and overworking, with no breaks and no fun, are common causes for insomnia and fatigue.  They cause burnouts. A recent 2011 study from Italy showed that individuals with insomnia have faster heart rate in the evening compared to the non-insomnia group. This means that insomnia sufferers are in a hyper-arousal state, which makes winding down a challenge and therefore falling asleep difficult. This study was published in the April issue of International Journal of Psychophysiology.

Many people are surprised to find out that thoughts have power. This is especially true of the effect on stress and sleep. Close your eyes and imagine yourself in a kitchen slicing a lime; then imagine taking chewing on a slice. You begin to salivate. So how is it that simply a thought (lime) become a physical thing (saliva) ? Amazing! The same is true if you just imagine that you are being chased by someone in a dark alley. You feel scared, your heart is beating fast and your palms are sweating. How does all this relate to sleep? Well, if you are anxious and stressed in late evenings (work, family, finances), then your body sends stress hormones, which are incompatible with a good night sleep. We sleep when we feel safe.

So what happens if you try the opposite? Think of pleasant thoughts and sweet images? You begin to feel calm. Try it !

Keep this in mind if you are stressing or having racing thoughts. You might have a story that runs in your head that wouldn’t shut even till midnight. Be mindful of your thoughts, not only prior to bedtime, but during the day. Pay attention to your stress level throughout the day. Avoid negative, hurtful thoughts. Talk to yourself gently (not loud). Focus on happy thoughts, maybe a puppy, your or family’s good health and so on.  Repeat a mantra like “kindness, love, kindness, love” when you feel stressed- you see how it eases your stress. Learn to breathe through your abdomen.

Tips on managing your insomnia:

1.  Imagine your thoughts as a train traveling though the countryside. As it approaches the city center, it needs to slow down from 100 to 90 until 10, 5 and 0. It cannot go from 100 to 0 within 15 minutes. The same goes with your thoughts. You cannot sleep when your thoughts are running at 100 miles/hour. So…

  • The first step is to have awareness of your thoughts. Be mindful of your thought. Remember, these thoughts are not you. So, try to separate them from your presence. Give them a name. Call them “Buba” or some funny name. Observe them and tell Buba to move on. Observe your environment without these thoughts.

2.  During evening hours and before bedtime, adopt the right rituals. Try this in the evening: take a warm shower or foot bath, then watch a little TV, if you wish; do some stretching. Turn all electronics off 1 hour before bedtime. Instead, listen to soft music (perhaps classical, soft Jazz, spirituals) and read something light and uplifting. You can also enjoy the long lost art of conversing with family in the evenings.

3.  During the day, aim to keep your mind and body calm. Easy said, but it has to be done.

  • Exercise during the day is a great way to reduce stress and directly improve your sleep quality.  Avoid exercising close to bedtime (3 hours). Evening exercise is fine in folks who are prone to anxiety- it reduces their muscle tension and helps them relax.
  • Be mindful of your stress level during the day. What are you doing to reduce that stress? Remember, how you think about yourself and the world the very minute you open your eyes in the morning will affect your stress and will affect your sleep. Some form of stress will likely be there every now and then for the rest of your life. You need good coping mechanisms to deal with it.  What are you doing to enjoy life? How about long hikes on weekends with your loved ones? Fishing, yoga, traveling, reading, gardening, music, praying are samples of how you can add spice to your life to combat stress.
  • Make play time. Play is not just for children. Children and animals do it because nature has it in all of us to play.  If you spend your days running chores with no time for yourself, insomnia will catch up with you. Other diseases that will also catch up with you could be headaches and joint pains.
  • Cognitive behavioral therapy (CBT) is helpful if your stress is excessive and need extra help. This requires a licensed professional. Look for someone in your area.

4.  Pay attention to what you give your body

  • Stop smoking or using tobacco. It is a stimulant and makes your sleep worse. It also causes cancer, stroke, dementia and heart disease.
  • Cut down on alcohol. Alcohol may help you fall asleep. But alcohol is tricky becauseit makes your sleep fragmented (disrupted) so you wake up unrefreshed and with a hangover.
  • Cut down on caffeine after 12 pm.
  • Eat healthy. Avoid high fat and high carbohydrate food. Eat  fruits, vegetables, grains and lean meats. Drink plenty of water.

5.  Those who are “night owls” have what is called “delayed sleep phase syndrome” which occurs most commonly in teenagers but also in adults. Those folks don’t get sleepy till about 2 or 3 am and wake up early afternoon. Their sleep clock is shifter later. What helps them is light therapy and melatonin.

  • You can purchase a “light box” on-line. Use it early in the morning for 15-20 minutes to shift your rhythm earlier. Avoid direct eye contact.
  • Take melatonin 1-3 mg, 4-6 hours before desired bedtime and again at bedtime for 2-3 weeks and then stop. So if you wish to fall asleep at 10 pm, you take melatonin at around 5 pm and again at 10 pm. You can continue with the light therapy.

6.  If depression and anxiety are significant, seek counseling or psychiatric help to address the treatment. This is a chicken and egg situation.  Insomnia can cause mood disorders and vice versa. Either way, you want to treat the insomnia and mood disorder together. Don’t assume that if you treat one, the other will get better on its own.
 
7.  A sleeping pill is helpful, but it should NOT be the first or only option. It is often not the only solution.

8.  Find out the cause of insomnia: it will put emphasize on the right solution. Sleep apnea can cause people to wake up frequently. Restless legs can make it difficult to fall asleep.
 
9.  Talk to you doctor. If you feel your problem is complex, get evaluated by a sleep medicine specialist who can narrow the cause of the insomnia and tailor the treatment. Maybe other sleep disorders such as sleep apnea, restless legs are causing your insomnia.

 

Good Luck!