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Insomnia
Sleep is as essential to us as food, air and water. Sometime in your life you may have difficulty sleeping - many people do. Anyone can suffer from insomnia, although sleeping problems are more common among the ill, the elderly, smokers, alcoholics and women (especially menopausal). Sleep problems are also, however, surprisingly common among young people. While it is not an illness and is in no way life-threatening, insomnia can be very distressing, frustrating, exhausting, and at worst make you feel like you are going crazy.
Types of Insomnia
There are two broad categories of insomnia:
- Chronic insomnia--lasting for several weeks, months or even years
- Transient insomnia--lasting for a few nights or weeks only, usually connected to a stressful event e.g. an exam, bereavement.
Within these broad categories insomnia usually takes one or more of the following forms:
- Difficulty falling asleep- more common in young individuals
- Sleeping lightly and restlessly, waking often, lying awake in the middle of the night - more common in people over 40. In younger people it may be associated with depression.
- Waking early and being unable to get back to sleep - this is more common in older people and anyone worrying about something in particular.
Common Symptoms
If you ...
- Are tired during the day
- Have frequent headaches, are irritable or lack concentration
- Are tired and not refreshed upon waking
- Sleep better away from home
- Take longer than 30-40 minutes to fall asleep
- Wake repeatedly during the night
- Wake far too early and are unable to get back to sleep
- Only get to sleep with the aid of sleeping pills or alcohol
... then you are probably suffering from insomnia.
Main Causes
Insomnia is a condition that is caused by something else! Sometimes it won't be immediately obvious what the causes are in your case, but the following list might give clues:
- States of mind --anxiety, depression, worry, anger, grief, anticipating a difficult event
- Change--moving house/city, starting university
- Environment--noise, discomfort, time zone change
- Pain--one of the most common causes
- Medical conditions--heart, breathing, stomach, digestive, high blood pressure, arthritis, anorexia.
- Recreational drugs--including nicotine, caffeine, heroin, cocaine, amphetamines, LSD, cannabis
- Sleeping pills and tranquillizers--can actually cause sleep disturbance
- Other prescription drugs--including some contraceptives, diuretics, diet pills, beta-blockers, stimulants.
While some causes of insomnia can't be easily changed, most can.
What can you do about insomnia?
The good news about insomnia is that you can cure yourself in your own way, in your own time, and at your own pace. You may wish to enlist the support or help of your doctor, a nurse or a psychologist, but you may want to try some strategies first. However, keep in mind that you must be prepared to make some changes in your lifestyle in order to sleep better.
The rules your mother never taught you
Most of us don't realize that sleep is a natural cycle. It is one of our bodies many natural cycles know as circadian rhythms. Our bodies are always looking for some neutral point, or what the scientific world likes to call: Homeostasis. When we reach this point our body likes to remain there, however we, as humans, tend to do many things to set off these rhythms and to remove ourselves from this pleasant level of neutrality.
When our rhythms get off, our bodies attempt to return to this level of homeostasis, however we may not realize that is what it is doing and thwart it in its efforts. Or sometimes it's natural efforts to return to neutrality only produce more instability. This is what often happens with sleep. Good sleep comes when we have a well establish sleep cycle. The body doesn't like surprises, and therefore it likes to know when it's suppose to go to sleep, how long it is suppose to remain asleep, and where it will sleep. When we experience insomnia there is some disruption to the cycle, and this disruption only breeds more difficulties until we "reset" the sleep cycle.
People who suffer the worst from chronic insomnia are individual who have schedules that don't let them fall asleep at the same time day after day. Individual who do rotating shift work are at the most risk for this. If someone works two night shifts, then has a few days off and then works a few day shifts, the body never knows when it should be awake or when it should be asleep. Insomnia or hypersomnia (sleeping all the time) tends to be the result of this sort of problem.
The following are rules developed by sleep laboratories to help individuals reset their sleep cycle. In order to use them properly you must follow the first two without fail for at least 2 weeks, and then choose three more from the list that you believe would be most applicable to your particular situation (for example if you are a big user of caffeine then rule #11 would most likely be a good one to highlight). The sleep cycle takes time to return to normal, so don't be distressed if it does not get better immediately. However if followed the rules help 90% of individuals return to normal sleep within 1-2 weeks.
Sleep Rules:
- Do not take any naps during the day, regardless of how tired you are.
- Get up at the same time each morning, even if tired. This includes weekends.
- Do not try to go to sleep until you feel tired and ready to sleep. If you get into bed and are not asleep within 15 minutes, get out of bed, do something else and remain "up" until you feel ready to sleep again.
- Do not plan for tomorrow or review today while in bed.
- Choose a "quiet, unstressful" book and read 5-10 minutes before getting into bed.
- Do not watch the clock. If you have to, turn the face of the clock away from you so you are not focusing on how long it is taking you to fall asleep.
- Get cardio exercise, preferably in the late afternoon or early evening if you can.
- Do not continue to do work or any stress related activity up until bedtime. Quit approximately one hour prior to going to bed and use this time to wind down.
- If necessary, use a masking noise (e.g., fan, static from radio, white noise machine) to cover over distracting sounds while asleep. Use this only when sleeping.
- Use your bedroom only for sleep. Watch television, talk with others, do homework and other activities at other locations.
- Do not drink coffee, hot chocolate, tea or soft drinks with caffeine after 12:00 noon each day. Do not eat chocolate or products with high sugar content after 4:00pm.
Relaxation
Research suggests that people with sleeping difficulties tend to be more worried, depressed, unhappy and anxious than others, although apparently cheerful, calm and confident people can also suffer from insomnia. If you are stressed or anxious here are a few suggestions:
- Change or resolve the things causing you stress when possible
- Accept situations you can't change
- Keep your mind and body as relaxed as much as possible throughout the day
- Give yourself enough time to do the things you need to do including eating
- Don't take on too much and avoid unrealistic demands
- Live in the present, rather than worrying about the past or fearing the future
- Talk to your partner if there are problems in your relationship
- Have some relaxing, non-competitive activities--something you do just for pleasure and for fun
- Give yourself some 'quiet time' each day
- Practice a relaxation technique or breathing exercises regularly
There is a lot of help available. There are numerous books on relaxation. You may find that your college runs a relaxation group. At the University Counseling and Testing Center, we regularly run anxiety management groups for students.
Self Confidence
Research also suggests that people who suffer from insomnia tend to be less confident and have lower self-esteem than others. Therefore, anything that you can do to increase your confidence or improve your self-esteem is likely to help you sleep better. Once again, there are very many self-help books available, or you may prefer to consult a psychologist.
Depression
If you have been suffering from insomnia for some time, you may be depressed. Signs to look for are:
- Waking in the middle of the night or early morning and being unable to get back to sleep
- Loss of interest in activities, decrease in energy and appetite changes
- Aggression and anti-social behavior
- Aches and pains that have no physical explanation
If you are depressed, it makes sense to seek some help. Speak to a college nurse, see your doctor or make an appointment to see a psychologist.
Food and drink
There are some foods and drink which interfere with sleep, particularly if taken just before bed (e.g., very rich foods and alcohol). It is, therefore, wise to avoid or reduce these before sleeping. On the other hand, there are some foods that are thought to aid sleep. Here are some suggestions:
- If getting to sleep is the problem, eat a carbohydrate-high meal 2 hours before bedtime
- If staying asleep is the problem, have some bread and honey or a bowl of cereal at bedtime
- Have a warm milky drink at bedtime
- Some people find herbal teas soothing and helpful, especially chamomile
- hot water, lemon and honey or hot red grape juice are good alternative hot drinks
Sleeping Pills
If you are wondering about taking medication to help you sleep, speak to your doctor. It is also advisable to consult your doctor if you are already taking medication and are concerned about the side-effects or are thinking of stopping.
Alcohol and sleep
Alcohol is more disruptive to sleep than caffeine! Your body will produce adrenaline to compensate for the alcohol in your system. Alcohol also makes you thirsty. Both cause you to sleep fitfully or to wake. You don't have to give up alcohol altogether, but in the interest of solving the problem of sleeplessness and establishing a healthy sleeping pattern, why not think about cutting down, perhaps by not drinking late at night or by deciding to have a number of alcohol-free days a week.
If you are concerned about the amount you are drinking or think you might have an alcohol problem, speak to your doctor, a psychologist, or a counselor in the SMU Alcohol and Drug Abuse Prevention Office.
Anger and Sleep
'Bottled up' anger could be the underlying cause of your sleeplessness. If this is true for you:
- Figure out why you feel quite so angry
- Address or remove the cause of your anger
- Where there is nothing you can do about it, accept and understand your feelings
- Do some physical exercise which might help you get pent-up anger and frustration out of your system
- If you are depressed or grieving (anger can be a feature of both), make sure you get the support that will enable you to deal with your feelings.
Much of the above applies to other feelings, although anger can be particularly troublesome.
Mental games to help you sleep
There seem to be two schools of thought on this subject - those who believe that mental games can send you to sleep and those who believe that they stimulate your mind and keep you awake!
If you think they might help you, here are a few examples:
Word games
- Spell long words and sentences backwards
- Think of a poem or song then count how many a's or b's there are in it
- Work your way through the alphabet thinking of a four-letter word beginning with each letter
- Repeat long pieces of poetry or prose
Imagination games
- Recall in great detail a favorite painting, piece of music, place
- Imagine a storm raging outside while you are safe and warm in bed
- Visualize yourself sinking into your bed until you can't tell where your body ends and the bed begins
- Make your mind a complete blank then imagine a pleasant color and prevent it from taking any form.
And yes, if all else fails, you can always count sheep!
Getting additional help
The focus of this web-page has been self-help. You may, however, feel that you need some help in dealing with your sleeping problem. There are a number of people who can help you--a nurse, your doctor or a psychologist here at Ivy Tech Community College's Student Counseling Center. You need not feel bad about having to ask for help--insomnia is not a trivial matter. It can be debilitating and, once established, it can be difficult to shift. Professional help and encouragement may be just what you need.
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