Can’t sleep? What to do

One of the activities that we recommend in the Can’t Sleep Café is to get up from bed if you cannot sleep. This is to avoid the frustration of lying in bed, tossing and turning, worrying about tomorrow, and just being upset by the fact that you are awake at night--again.

But what to do? Well, even if you are going to be frustrated by being awake, and even if you will be worrying about performing tomorrow, and even if you are angry about being awake again, it is better to have these feelings while sitting up than while lying in your comfortable bed. This is to prevent the negative associations that can develop between “trying to fall asleep” and “the bed.” It is vitally important, and a long term issue, that your bed be a place of pleasantness, if not happiness and calmness. Being tortured in bed by insomnia just sets up your brain to be in that habit--not good for falling asleep.

The usual advice is to get up, go sit in a comfortable place in another room, and doing something relaxing. For example, I advise against vacuuming or paying the bills. Reading and having a hot tea is good, or just sitting and having a hot tea. This is a good time to meditate or to pray so that your mind is focused on something besides your sleep problem. Also, such an internal activity makes you independent—you don’t need that book, CD, or TV to distract you—you can do it yourself. Remember, however, that meditation, prayer, or a relaxation technique are not methods to actually put you to sleep; rather, they are general stress reducers that allow you to occupy your brain when you are forced to be awake.

They help sleep indirectly in several ways. Other good activities would probably include listening to relaxing music, but not dancing to it. Maybe TV, although the brighness and commercials are generally stimulating, so I don’t recommend it. A computer is fine, especially if you are reading boring political analysis for example, not surfing websites that are stimulating. A lot of people ask me if sex helps sleep. I’m not sure, but this is usually a short-lived activity that gets your mind off your problems, after which sleep might come easier; so give it a try too.

If you are going to worry, it is still better to do this in another room than your bed, if possible. If not possible, at least sit up, turn on a DIM light, and then worry. Make a list of things you are troubled by or need to get done this week. Many times, life seems worse in the night, and better in the morning. Although it is not technically true, in some ways, “the darkest hour is just before the dawn.”

I found a web site with some good suggestions for things to do in the night, and I have added it to my blog roll, isleepless.com.

This site is for people with insomnia, and it appears to be run by a person with insomnia. There are several good reads on this site, including a long list of things to do in the night, although I have not been to all of the site. Take a look some night when you can’t sleep; it will be one way to help yourself and your sleep.

Insomnia blog

Hello from insomnia land. A google alert flashed across my computer screen today, and I went to sleepstarved.org. This is a site started by a woman with insomnia by and for people with insomnia. It reminded me a lot of our own Can’t Sleep Café. Clearly, there are people with insomnia who want to talk about the problem, support other people with the problem, and be supported by others. This is really important for a condition that is often long-term, poorly understood, has limited treatment, and affects our sense of well-being so much.

But a lot of people with insomnia ignore it. They think that it is just part of life, part of the result of stress. Most people with insomnia never go to the doctor, although the direct-to-consumer advertising from the sleeping pill manufactures might have changed that. In fact, I almost think that people with insomnia don’t want to talk about it. So I am pleased to call your attention today to the Can’t Sleep Café and the insomnia site.

A lot of the information about poor sleep comes from sources who have a particular interest in the condition. Obviously, for example, those who make and sell sleeping pills want you to be concerned about insomnia and to ask your doctor about it. Others might be biased toward doing sleep tests on everyone with insomnia, or perhaps being opposed to the use of sleeping pills believing that they are harmful. Others might be particularly enamored with certain remedies like herbal supplements.

I can tell you that everyone with insomnia is different, and that some people benefit from each and every treatment out there, including sleeping pills. The most important aspects of understanding insomnia are to try and understand the cause, not to become anxious about the insomnia itself, and to use behavioral and relaxation techniques in combination with medications. I think that another aspect of treating insomnia is to talk to other people who have dealt with it, coped with it, and found their own way to improve it or to accept it.

You can start your own discussion of insomnia here, and then you might even better enjoy your sleep.

Sleep, marriage, and arguments

Mira Kirshenbaum has a great blog about getting along with your life partner, called Healthy Relationships. Recently she talked about the problem of getting sleep when you are having a rough spot in your relationship, or after a big fight. All of her advice is excellent. I want to talk a little bit about her first of five rules for getting good sleep while under this kind of stress: "You CAN go to bed angry." Well, yes and no.

Mira's point is that you can't keep arguing all night—you need some sleep in order to function the next day. This is true and important. However, NEVER actually go to bed angry. You might not be able to finish or resolve the problem, but don't be angry while you are lying in bed trying to sleep. Those of you who are familiar with my blog and the concept behind learned insomnia know that being angry, frustrated, anxious, or stressed out while lying in bed is one of the main reasons that people develop long-term insomnia.

At some point you need to quit arguing or otherwise let your anger pass. If you have stopped fighting and are still keyed up, I would recommend sitting in the dark or making a hot tea. Don't try to sleep when you know that you cannot. After a while, you might feel sleepy and then you can get into bed and try to sleep. Until then, lying in bed angry or stressed sets the stage for future sleep problems. You'll just have to get by the next day on less sleep—you have to anyway—so sit up if you cannot sleep.

"Don't' go to bed angry" does not mean that you have to keep fighting all night. During periods of stress you will sleep less. This is normal. Keep healthy sleep habits even during these times. Don't booze it up, sleep with the TV on, or be angry in bed. Also, sleeping pills are perfect for this situation—short-term stresses.

Sometimes it is the only way to get some sleep. Use them and follow the advice on sleep habits as well, and use them only for a week or two. And remember, no matter what, enjoy your sleep.

Patterns of insomnia

One of our Can't Sleep Cafe group members says that she is sleeping a lot better after starting CPAP therapy for sleep apnea.

We don't usually think about insomnia and sleep apnea in the same person, so I wanted to tell all what the pattern of your insomnia might suggest is the cause of your insomnia. These are general rules, not absolutely true all the time.

The first pattern is called sleep-onset insomnia. This is difficulty falling asleep in the beginning of the night, but sleeping pretty well through the night. This pattern of insomnia can be typical of anxiety, restless legs syndrome, or delayed sleep phase syndrome (typical in teenagers). In addition, so called "primary insomnia," which is sometimes called conditioned insomnia, learned insomnia, or psychophysiologic insomnia, usually causes difficulty falling asleep at the beginning of the night.

A second pattern of insomnia is sleep-offset insomnia, also called "end of night awakening," or terminal insomnia. This is the problem of falling asleep easily at the start of the night, but waking up too early and being unable to fall back to sleep, say at 3 am. This pattern of insomnia is famous as a symptom of depression, but can be caused by any type of stress as well, and our sleep is lighter in the last half of the night so thoughts can more easily intrude. It is also typical of advanced sleep phase syndrome, in which the body clock is running early, so the person gets sleepy in the evening but then is awake too early. This pattern of insomnia is more common in older people. A similar pattern is to wake up for a few hours in the night and then fall back to sleep just in time for the alarm—stress or alcohol intake are typical causes.

Lastly, sleep-maintenance insomnia is when you keep waking up in the night but falling back to sleep. Needing to get up to urinate 4 times in an older man is an example. However, for others, frequent awakenings are a sign that something physical is happening in the night that awakens you. Breathing disturbances, pain, or leg jerks are perhaps the most common. It is this pattern of insomnia that is more likely to cause daytime sleepiness, and it is this pattern of insomnia that should definitely make you see a doctor and get a sleep study.