Sleep patterns also shift during life. Believe it or not, "You don't want to sleep like a baby," says Michael L. Perlis, associate professor of psychiatry and psychology at New York's University of Rochester and director of the behavioral sleep medicine service there. "You want to sleep like an adolescent." Babies wake often; they are not yet able to consolidate sleep into one stretch. Adolescents sleep like there's no tomorrow.
For most people, it's downhill from there. Marriage means accommodating the sleep habits of another person, a biological minefield if a late-to-bed "owl" falls in love with an early-rising "lark" and tries to go to bed a couple of hours earlier than his body prefers. Childbirth brings, well, children, and women typically learn to be vigilant during sleep and never unlearn it; they become so fine-tuned to noise that the habit of waking easily stays with them the rest of their life. "Child rearing is the number-one precipitant of insomnia," says Perlis.
Insomnia typically starts innocently enough. Something gives you one bad night—or a few. You twist your knee and the pain torments you all night. You're jet-lagged. You fear your spouse is having an affair. Heartsick or anxious, you just can't fall back asleep.
The worst is yet to come. After one bad night, most people experience a great deal of frustration and anxiety about falling asleep and staying asleep. So you try to compensate. You nap in the afternoon or go to bed early. Or you sleep late the next morning, or you have a couple of drinks before bed. That only makes matters worse. You go to bed and, without the accumulated need for sleep, you stare at the ceiling half the night. Or—especially if you've had a few cocktails—you're wide awake at 4 a.m. Now you're even more tired and worried about the consequences of not sleeping than you were the day before—while you're at your greatest vulnerability to irrational thought. Is this, you worry, the beginning of decrepitude?
Pretty soon, this self-defeating cycle takes on a life of its own. Under the influence of anxiety, your brain learns very quickly, without your knowledge or consent, to associate the bedroom with wakefulness. You lie down to rest and your brain goes on high alert. "It has been shown that people who have difficulty falling asleep are supersensitive to bedroom-related stimuli," explains Perlis. "They become physiologically aroused in the bedroom environment"—their nervous system switches on just when they want it to calm down.
It's the psychophysiologic equivalent of the perfect storm, the sudden collision of mind, body and environment. The actual experience, though, is more demoralizing than dramatic: You fall asleep in front of the television. You get up out of the armchair at 1:30 a.m. and stumble into bed. Suddenly you're wide awake. There are now a million things to think about, including how much you need sleep to be at your productive best for tomorrow. Says Perlis, "Rumination and worry—cognitive elements—put gas on the fire."
No matter what sets off the sleeplessness in the first place, faced with bedtime, your brain kicks and screams like a 3-year-old. "The mind can get set in the default mode of wakefulness," says Spielman. "It gets stuck in the scared, dangerous, vigilant zone."
There's another variety of insomnia that results not from lack of sleep but from a misperception: Your brain thinks you are awake when you are asleep. Normally, during slumber the brain's information and sensory-processing equipment go offline. The unconsciousness of sleep also "bleeds" slightly into wakefulness, so that most of us can't remember falling asleep, and we are not fully alert when we wake up. That's why we don't remember waking up in the middle of the night—despite the fact that all of us normally wake up 5 to 10 times each night.
In some people, though, one part of the brain stays online while the rest is offline. Consciousness intrudes on sleep, and these people drag themselves out of bed in the morning, swearing, "It takes me a couple of hours to fall asleep," and "I'm awake most of the night." When they are hooked up to sleep monitors, though, they seem to be sleeping just fine.
Sleeping Off the Enemy
Where insomnia is concerned, we're our own worst enemies. No matter how sleeplessness starts, it easily gets locked in place by our own behavior. All of the tactics people usually resort to in order to feel better after a bad night—napping, sleeping in, going to bed early—tend to undermine the body's natural inclination to right itself after a short bout of insomnia.
As a result, the most powerful attack on the monster of insomnia is to do nothing at all. The first and best approach to sleeplessness is to let the sleep homeostat right itself, without making any attempt to compensate. It's also possible that the prompt use of a sleeping pill—say after a couple of sleepless nights, rather than after several wretched months—can get the natural mechanism back on track.
That's welcome news, given what's known about the destructive power of persistent insomnia. Chronic insomnia brings on irritability, headaches and muscle pain. It destroys concentration and mental well-being, it weakens coping skills and robs vitality. It undermines intimate relationships. On-the-job injury rates soar 400 percent for the sleep-deprived. Sixteen percent of absenteeism is associated with insomnia, adding up to $50 billion a year. "Presenteeism"—inability to focus on the job while there—brings the total cost to $150 billion. "Insomnia is the bastard cousin to everything," says Perlis.
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