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I see many patients whose primary complaint is of poor sleep. Some wake up repeatedly during the night and too early in the morning over and over again. Such a sleep pattern is characteristic of an underlying depression. This sort of depression is best viewed as an illness. This pattern of sleeping appears and disappears in conjunction with other symptoms of the illness, which is characteristically relapsing and remitting. Treatment often relies on medication and can be effective in certain cases.
There are other causes of poor sleep. The most common is pain. Sleep can be interrupted in an arthritic patient simply by rolling over in bed, but is likely to return in between bouts of discomfort. Similarly, both men and women can develop prostate or bladder problems which may wake them up during the night to urinate. Usually, they go back to sleep without difficulty.
However, most people who complain of insomnia have trouble falling asleep. This sort of sleep disturbance is usually based on what may be referred to as poor “sleep hygiene,” a set of bad sleep habits. Among these are lying in bed when not asleep, usually watching television. Bed should be associated strictly with sleeping. Staring at a clock during the night, as many do, tends to upset them and prevent them from returning to sleep. Some are in the habit of drinking coffee too late in the day. A principal underlying cause of this sort of sleeplessness is a set of incorrect ideas about the absolute necessity of getting a good night’s sleep. It is important over a long period of time to get enough sleep, but it is not necessary to sleep well, or at all, for that matter, every night. Feeling desperate to fall asleep right away, many people become anxious and, therefore, less likely to fall asleep.
The constant use of sleeping medication leads inevitably to an inability to sleep without it. Nevertheless, chronic insomniacs find the use of drugs more appealing than trying to change life-long habits. These medicines make the underlying problem worse. If patients feel they must take them, I encourage them to skip a dose every third or fourth night to prevent the development of tolerance.
As men and women grow older their pattern of sleep changes in predictable ways. They fall asleep earlier and get up earlier. When they are old, sleep becomes chaotic. They wake up repeatedly during the night and nap once or twice during the day. This pattern is only a problem if the elderly person sees it that way. I know an 80-year-old man who is still employed in his family business and feels comfortable doing paper work at night when everyone else is sleeping. Except his wife, who is also 80 years old.
It should be noted, also, that some people are more inclined to wake up later in the morning than others. This seems to be innate, although improved or worsened to some extent by habit. It is this group of individuals that who are likely to fall into the habit of using the snooze alarm, sometimes three or four times every morning.
Two reasons for never using the snooze alarm:
There are different stages of sleep traversed every night by the sleeper. Certain of these stages constitute deep sleep and are especially important. When an individual is awakened from deep sleep by an alarm and returns to sleep, it is likely to be into a lighter stage. Consequently, there is less benefit to that sleep than had the patient slept uninterruptedly during that time. If the snooze alarm is used repeatedly, the sleeper can lose a half hour or so of sound sleep.
Secondly, and perhaps more important, when the alarm goes off, the sleeper has to go through the process of deciding whether this is the time he, or she, really has to get up or whether it is okay to use the snooze alarm one more time. There is, therefore, no clear signal about getting up and getting out of bed. Ordinarily, the routine of getting up in the morning is effortless precisely because it is routine. When an intellectual process is required to figure out whether it is really time to get up, the whole process becomes annoying and tiring.
How to use the alarm:
Set the alarm click for as late as possible, allowing just enough time to get ready for work. Put the clock across the room so that you must get up in order to turn it off. Go at once into the bathroom and brush your teeth, whatever. You will find yourself getting up effortlessly.
