How To Deal With Insomnia

How to Deal With Insomnia

My experience:

Sleep wasn’t always something I dreaded, not that long ago I didn’t think of sleep really at all. It wasn’t a chore or an internal battle that I wondered if I would ever overcome. But there I was again, laying in bed and glancing at the clock as it ticked away and passed the time in my head that I knew I needed to get to bed by.

This was a common pattern, many nights I would go several days without sleep. My brain would be foggy, I struggled to recall things, everything felt like a blur and I was much more sensitive to anything people said. I didn’t have the luxury of missing work so I had no choice but to go in and the problem were worsened because on those nights I did miss work I became more anxious wondering if I had made a mistake. Sound familiar?

The vicious cycle:

Anxiously worry during the day if I was going to sleep that night > lay in bed and try to focus on different things to quiet my racing mind > listen to an audible book, watch a movie, read a book, think about a peaceful place, a blank sheet of paper > I can feel my heart beating faster now, I try and tell myself, “It’s alright, you’ll be okay” “Remember, sleep is great, you love sleep” > I look at the clock and its past the time I want to sleep > I try the same distractions again with no such luck > I get up and use the restroom > I frustratingly wonder what’s wrong with me, why do I have to suffer like this, how awful my day will be with no sleep > I ruminate even more thinking of another work day of suffering > as I stare at the ceiling I try to take deep breaths > I look at the clock and it’s already 4:00am > I hear some people’s cars start up as the early birds are off to start their work day > I get more anxious > I tell myself I still have 2 hours left and that’ better than nothing > It’s 5:15am and I wonder if I should just get up now and grab some energy shots to help me survive > finally I resign to the fact that I went another night without sleeping > I go to work groggy, feeling awful and praying I don’t make a mistake > I finally make it through work, exhausted I get home and lay in bed > I’m able to get to sleep on this night “making up for it” but then the cycle repeats itself the following night.

The Alarming Statistics:

So I imagine that many of you have also experienced a similar experience, some worse than mine and others perhaps a little better. The alarming statistics in the US are that people are sleeping less and less. According to the CDC, 30-35% of adults have brief symptoms of insomnia, 15-20% have an insomnia disorder lasting less than 3 months, 10% have chronic insomnia lasting more than 3 months.

You can see in the map below how the number of hours people are sleeping vary considerably by geographic location.

Figure 1. Age-Adjusted Prevalence of Short Sleep Duration (<7 hours) Among Adults Aged ≥18 Years, by State, United States, 2014

According to a 2002 “Sleep in America Poll,” Women appear to suffer from insomnia more than men and almost 1/4 of Americans sleep less than 6 hours per night on average.

If you are interested in learning more about just how important sleep is to your health, check out Dr. Peter Attia and Dr. Matthew Walker’s discussion about it here.

Note, I didn’t go into details about the dangers of sleep deprivation because it can often make those of us who are worry warts even more fearful. However, I do think it’s important though to be aware of just how important sleep is and by reframing our thought process to prioritize sleep we can make long-lasting changes that benefit our health.

Practical tips that worked for me:

  • When you think of all of the catastrophizing thoughts (see below of common ones), ask yourself how many times it actually occurred. What you’ll realize is that the probability of its occurrence in the course of a year is overall very low.
  • Understand that it’s often the discomfort of not getting sleep that is the very thing we are worried about and not the potential outcome of it, which we discussed above is rare.
  • Only use the bed for sleep and sex. This sounds almost elementary but it was one of the most powerful things I did. When you do anything in bed other than sleep, you are in fact conditioning yourself to associate the bed with other wakeful promoting activities. I will go as far as setting my phone alarm before I enter the bedroom and then flipping it over once I enter the bedroom refusing to check it or my computer at anytime I’m there.
  • Never stay in bed awake for more than 15 minutes. The moment you feel upset, more alert, worried, frustrated, get up immediately and leave the bedroom.
  • Don’t nap, go to bed early, or stay in bed later. According to a sleep specialist at the Ross Center for Anxiety, each one of us has a sleep homestat in the same way you have a thermostat in your house that regulates your temperature. The idea here is that to initiate sleep you need to build up a “pressure” if you will where you feel tired. Napping, going to bed too early or staying in bed later than normal “relieves that pressure” and now your ability to feel tired is reduced, making it harder to initiate sleep. This is one of the reasons why people get in a vicious cycle of getting no sleep, then sleeping 12 hours the following night to make up. The 12 hours of sleep alters the sleep homestat “relieving the pressure” so that the following night is difficult again. This brings me to my next point.
  • Keep a regular sleep schedule. While this isn’t always easy especially on weekends where its common to sleep in more. The reason being is similar to the previous tips I mentioned above related to sleep homeostasis and classical conditioning. Check out the National Institute of Neurological Disorders and Stroke for more information on sleep here.
  • Think of your bedroom like a cave, cold/quiet/dark. According to the Cleveland Clinic, the ideal sleeping temperature is between 60-67 degrees Fahrenheit. Interestingly, your body’s ability to regulate temperature is diminished in REM stages which they think is related to the most primitive part of our brains.
  • Avoid and/or reduce alcohol and nicotine as much as possible. According to the NIH, besides all of the other health issues, nicotine is a known stimulant which disrupts sleep. Alcohol on the other hand is a problem because it inhibits vasopressin, a hormone that allows your kidneys to reabsorb water. As a result, you end up urinating more frequently forcing your body to get up in the middle of the night. Furthermore, alcohol is similar to a lot of CNS depressants in that it paralyzes your cortex effectively “knocking you out” but based on EEG studies, it doesn’t replicate natural sleep at all (decreased quality, fragmented sleep).
  • Think of sleep medications as a crutch to help you walk again. The idea here is that the role of sleep medications is to assist you but not replace your ability to walk again. For most people, cognitive behavioral therapy provides an effective long-term solution to insomnia without the need for long-term use of sleep medications.
  • When you’re feeling anxious, allow yourself to feel. I have a tendency to block out my emotions and the problem with that is it only fuels the anxiety. Over time, we become more sensitive to the anxious feelings because we never actually deal with them. The only way to correctly handle them and relieve the pressure is by feeling your emotions. Check out this 2-part series where I discuss the importance of emotions here.
  • Discuss with a healthcare professional your concerns, in some cases your underlying insomnia may be secondary to a medical condition.

In closing, some of the tips I mentioned above will sound extreme to you, they certainly felt drastic initially and the first couple weeks were not easy. This is in essence though the foundation of cognitive behavioral therapy for insomnia and that things will likely get worse before they get better. Keep in mind, you are trading off a short-term problem for a long-term solution without the potential side effects of sleep medications. I would encourage you to give it a shot and don’t be discouraged initially. Remember,

God’s peace is not the calm after the storm. It’s the steadfastness during it.

 

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