Insomnia

I know I am not alone in saying that I have experienced insomnia all of my adult life and throughout most of my childhood.  But what does that mean? Sleep is complex, so little is known about it and our experience of it is subjective.  Scientists are certain about one thing concerning sleep - it is important.  Lack of adequate sleep (subjective) can lead to heart disease and diabetes.  Insomnia impacts memory and may contribute to the onset of dementia.  The problem is no one can agree on what is an adequate amount.  The recommendation is six to eight hours for an adult but kids and teens need more and the elderly don't get enough (and should get more).

The problem with these conclusions as in many aspects of life is that they contain a lot of "shoulds".  We know that looking at the short wave light produced by our computer screens suppresses the production of melatonin which regulates sleep.  We know that a crucial element of sleep hygiene is that your bed should be used for only two things - sleep and sex, but many of us find it difficult to abide by this rigid paradigm.  Besides there are many other places to have sex.  We should go to sleep at the same time every night and wake at the same hour every day, we should not drink too much caffeine and alcohol and we should do everything we can to reduce stress.  The problem is that since the industrial revolution, the invention of the electric light bulb, the dawn of the tech-netronic age,  the great recession and my neighbors who like to set off fireworks at 2AM on any given Friday or Saturday night it is hard to do what you should to get what you need.

Whenever I read a new study concerning sleep it makes me anxious because according to the results I should be dead.  Millions of people in this country are considered sleep deprived and a substantial number of car accidents and work related injuries cost the nation's economy millions of dollars and thousands of lives.  All of this information, however, does not improve your sleep and as a matter of fact it makes it worse because sleep is another biochemical mystery regulated by the good old hypothalamus which we can't control.  You can help the brain decide to secrete GABA, an inhibitory neurotransmitter necessary to quiet the mind and the lymbic system but you can't tell it to go to sleep and attempting to do so will have the opposite effect because stressors cause the release of cortisol which keeps you alert.  One of the reasons sleep is so important is that we secrete growth-hormone-releasing-hormone (GHRH) in deep sleep, so if we aren't sleeping the body is not healing properly after a day of work and exercise (stress).   And if you are not sleeping well your body becomes less resilient to the slings and arrows that life tosses your way.  Are you getting nervous?  I hope you aren't reading this in bed.

Benzodiazepines,  Ambien (slightly different from BDZs and can be problematic), SSRIs (Prozac), exercise, yoga, weight loss, massage, acupuncture, diet, limiting caffeine and alcohol intake (and time of ingestion) can all be helpful but there is no silver bullet.  After sleep apnea and other physical causes of sleep deficiency have been ruled out, the next step is to assess all of the factors above and start experimenting with what works.  You might find that none of these do and that in itself is beneficial.  Acceptance of the way your body functions on all levels is half the battle.

What does work is stress reduction.  Even if you don't sleep well reducing anxiety will help curb the resulting dread and paranoia associated with insomnia which will eventually lead to better Zs.  I have given up on conventional approaches to insomnia because none of them worked over the long haul except for stress reduction through meditation and working with my natural cycle instead of fighting it.  The best sleep I experience is during naps.  A sleep specialist at Cornell Medical Center told me not to nap because it would screw up my sleep cycle at night, but since that cycle was already a shambles I disregarded his admonition after unsuccessfully attempting to abide by it.  Now I nap whenever I can.  I sleep in chunks lasting from forty-five minutes to three hours, two to three times within a twenty four hour period and that generally works for me.  I am more awake at 3AM than I am at 8AM, so I get up, go to another room and read or write until I doze off again.

Fighting your natural cycle doesn't work.  First you have to figure out what your cycle is and then you have to work with it.  If you currently reside in the deep dark hole of insomnia remember that you will eventually sleep.  Conversely, if you are an insomniac who is currently feeling rested remember that this is a temporary state of affairs.  Eventually you will experience sleepless nights, so don't be furious with yourself when that occurs.   If your life is a wreck right now and you can't sleep identify what you can change to mitigate stress, set goals and speak with your health care provider about sleep aids.  With society being the complicated mess that it is there is no shame in using pharmeceuticals to get you through a rough patch.  Use them with caution and without guilt. 

Care keeps his watch in every old man's eye,
And where care lodges,
Sleep will never lie;
But where unbruised youth with unstuff'd brain
Doth couch his limbs, there golden sleep doth reign.
Romeo and Juliet - William Shakespeare

And to all a good night!