For some people, bedtime is the most stressful time of the day. Rather than looking forward to restful slumber, they’re wondering if they’ll fall asleep at all, or what time it will be when they finally do. If it’s been several nights, or even weeks, since they had more than a few consecutive hours of sleep, they know they’re already running on fumes, and can’t imagine what tomorrow will be like if they lose even more sleep tonight. They know they should relax, but the exhaustion, and anxiety about the exhaustion, feed on each other, and make things worse.
These are the insomniacs, and they make up anywhere from 10 – 35% of the population. Maybe you’re even one of them.
Most people will battle some degree of insomnia at some point in their lives. About thirty-five percent of people deal with mild cases that resolve on their own. Another fifteen to twenty percent develop a short-term sleep disorder, lasting less than three months. But for ten percent of the population, insomnia is a chronic problem defined as difficulty with sleep at least three times per week, for at least three months. For some this can go on for years.
Those most at risk for developing insomnia symptoms are generally older, and in poor health. Women are twice as likely to have trouble sleeping at some point in their lives, and shift workers report higher than average rates of sleeplessness too.
Ironically, those who juggle work and family commitments, and work long hours, are at higher risk for insomnia too. Despite the obvious physical demands of their busy schedules, they are often too mentally “wired” to fall asleep easily at the end of the day. The sense that their day isn’t quite over, or that they didn’t accomplish as much as they wanted to, keeps them awake.
If you’ve ever had insomnia, you already know how lousy it can make you feel. Groggy and irritable describes how everyone feels after losing just one night of good sleep. Multiply the one night by three, and carry it over a few weeks, or months, and you can begin to imagine the cumulative effect of chronic insomnia.
Forgetfulness, difficulty concentrating, poor memory, lack of motivation, and daytime sleepiness, all take their toll. One study found that while insomniacs were no more likely to miss work than their better-rested peers, their productivity suffered dramatically. Even though they were at work, they were too tired to do their jobs well, which cost their employers an average of $2,280 per person. The study’s lead author, Ronald Kessler, Ph.D., a psychiatric epidemiologist at Harvard Medical School, even coined a name for their condition: “Presenteeism.”
CNN reported that another study estimated an employee with insomnia loses about eight days of work performance each year. Nationally, that adds up to $63 billion lost to insomnia each year.
Chronic insomnia can also cause more serious physical and mental health issues. Over time, sleep deprivation can lead to high blood pressure, and depression, and if mental health conditions predate insomnia, the lack of sleep can worsen symptoms. In fact, sleep is so important to mental health, treating sleep loss is one of the top mental health issues in America today.
As if all this isn’t bad enough, driving while drowsy is as bad as driving drunk – literally. Getting four to five hours in a single night is like driving legally drunk, and sleeping less than four hours leaves a person as impaired as if they’d had twice the legal limit of alcohol. In fact, missing just two to three hours of sleep in a 24-hour period more than quadruples the risk of crash, compared to drivers who get seven hours of sleep.
There’s no question about it, these are compelling reasons to lose sleep over sleep loss!
Pro: These are the tried-and-true options your pharmacist, or grandmother might suggest.
Con: They don’t work well for people with moderate to severe insomnia.
Melatonin: This is a hormone that helps regulate the sleep/wake cycle. Available over the counter at your local drugstore, Melatonin causes drowsiness, lowers body temperature, and acts like an internal pacemaker, creating a drive for sleep. Melatonin works best for those who have trouble falling asleep, not for those who struggle to stay asleep all night. Melatonin is still a hormone though, so it’s best to take it with a doctor’s supervision.
Magnesium: Research shows that even a slight magnesium deficiency can lead to sleepless nights. This is because magnesium helps the brain settle down at night. The best sources are green leafy vegetables, wheat germ, pumpkin seeds, and almonds. Magnesium supplements are also an option, but may interact with medications, so it’s always important to check with a doctor before taking them.
L-tryptophan: Naturally found in animal and plant proteins, L-tryptophan is considered an essential amino acid because our bodies can't make it. L-tryptophan converts in the body to 5-HTP (5-hyrdoxytryptophan), and then to serotonin, which transmits signals between nerve cells, and has a calming effect on mood. The reason people tend to feel sleepy after eating Thanksgiving dinner? Turkey has higher than average levels of L-tryptophan. While this remedy does help people fall asleep more easily, it’s not without risk. It has been linked to over 1500 reports of eosinophilia-myalgia syndrome (EMS) and 37 deaths due to a contaminated product so only buy reputable brands. Pregnant women in particular should never take L-Tryptophan.
Warm milk: Believe it or not, there’s a chemical reason grandma’s favorite remedy can work! Milk is an excellent source of calcium, which helps the brain make melatonin. Almond milk is a great stand-in for people who are allergic to dairy, because it’s high in calcium too. Warming it doesn’t really do anything other than spark pleasant memories of childhood, although there is something to be said for the fact that the body absorbs nutrients from foods and beverages closer to body temperature more easily.
Snacks: Speaking of food, there are snacks that can help too. Foods that combine carbohydrates and protein are best for inducing sleep. Banana, with some peanut butter, or a few crackers with cheese can help, but it’s best to try food at least thirty minutes before bed so you have time to digest it.
Lavender: Last but not least, research shows that taking a warm bath with lavender oil before bed can relax the mind and the body well enough for people with mild insomnia to fall asleep more easily.
Pro: Most people are able to fall asleep more easily using prescription medications.
Con: Prescription sleep aids have side effects, some can be serious, and many of these drugs are habit-forming. They can also be expensive, and require more frequent visits to the doctor to check for negative side effects, and to get prescriptions refilled.
For those whose insomnia doesn’t respond to natural remedies, prescription medications are usually the treatment of choice. This is because drugs solve the immediate problem: they help people fall asleep, and stay asleep long enough to reap the physical benefits of sleep.
Here’s a list of the most commonly prescribed sleep aids, their dosages, and risk of abuse:
The obvious downside to using these drugs is that the physical benefits of finally getting sleep can quickly be outweighed by some of the potential negative side effects. Obviously, every person responds differently to medication, but with possible side effects like the ones on this list, it’s important to consider whether or not the cure may be worse than the disease!
The most dangerous short term side effect of taking prescription sleep aids is accidental overdose. According to research by the Substance Abuse and Mental Health Services Administration, the number of emergency room visits involving overmedication of zolpidem—the active ingredient in some prescription sleeping pills—almost doubled between 2005 and 2010, increasing from 21,824 visits in a two-year period to 42,274.
Also sleeping pills hit women much harder than men, but many people, including some doctors, don’t know this. According to Carl Bazil, M.D., director of sleep and epilepsy at Columbia University, "Women tend to metabolize sleeping pills slower than men …. And when they take too high a dose, the effect is extra strong."
Prescription sleep aids do work, but they’re not a long-term solution, due to the major long term side effect, which is dependency and even addiction. Also, there are drug interactions that can cause negative side effects. And then there’s the financial cost of the frequent doctor visits, and the pills themselves.
Considering all the costs and potential negatives, it’s easy to understand why many patients would want to avoid medication, and find some other solution to their sleep problems.
Con: It is expensive and time-consuming, and it can be hard to find a therapist who specializes in treating insomnia.
The way CBT works is that it teaches patients better sleep habits. Typical treatment protocol involves several sessions (anywhere from 4 to 12) that last about 30 minutes with a qualified sleep professional. The CBT therapist doesn’t need to be a psychiatrist, or even a doctor. Nurse practitioners can provide this treatment, if they are properly trained in treating insomnia.
CBT teaches the insomniac better sleep hygiene, and helps them develop healthier attitudes towards sleep in general. This therapy is very structured, and patients have to do homework between sessions. Patients often keep a sleep diary, to keep track of the thoughts and expectations they have about sleep, and to document the length and quality of their sleep. Therapists encourage patients to use techniques for stress reduction, relaxation and sleep schedule management.
CBT is so effective, it’s become the gold standard for patients with moderate to severe insomnia who want to avoid medication.
As successful as cognitive therapy can be though, it’s not an option for many sufferers because they don’t live in an area where there are cognitive therapists who specialize in sleep disorders, or they can’t afford them when they do.
For years, doctors and therapists have cautioned patients with sleep disorders like insomnia to avoid the Internet at all costs at bedtime. LED light from devices blocks the body’s ability to tell day from night, and the content you find there tends to be more stimulating than sleep inducing. That’s all still true, but according to the Journal of the American Medical Association, daytime participation in a new Internet-based therapy called SHUTi (Sleep Healthy Using the Internet) may be the insomniac’s ticket to dreamland.
SHUTi allows the participant to get the same treatment they’d get from a qualified CBT therapist, but in the comfort of their own home. The treatment takes place entirely online, and many patients report significant improvements in their sleep in a matter of weeks, even those who have suffered for years with insomnia and feel they’ve tried everything.
The best part, other than the effectiveness of these programs, is that an entire program typically costs about the same as a single session with a CBT therapist.
Today, you can find dozens of options for SHUTi therapy online. All you have to do is Google SHUTi, and you’ll get pages of links to different programs, provided by doctors, universities, hospitals, and companies specializing in sleep related products and services. Of course, as with anything you find online, you’ll need to do your due diligence to make sure a particular program is right for you. Look for one designed and run by properly trained and qualified professionals in the field of Cognitive Behavioral Therapy, specifically for insomnia, and look for testimonials or reviews as well. The resources listed below can get you started with your research, but they do not reflect an endorsement of any particular program.
Sleep deprivation is a serious physical and mental health risk, so you should never just tough it out. Now that there’s an effective, affordable online solution, you don’t have to.