A good night’s sleep is crucial for a healthy and productive day, not to mention a good and healthy life. A simple way to understand why we sleep is to think of what our bodies do when we exercise or even just go for a long walk.
After a time (shorter for some, longer for others), we get tired and have to rest our aching muscles. We may sit down, drink some water, or eat an apple. We feel rested and then resume our activities. We need to rest because we burn and use energy.
The brain works the same way. When we think, read, or speak, we use energy. There are biochemical waste products that build up even in our brains, and the brain needs to rest through sleeping. This allows the brain to get rid of those biochemical wastes and recoup that energy.
Our brain needs rest (in the form of sleep) in a similar way to how our muscles need rest after exercising.
CJ was a 42-year-old mother of two boys, ages 7 and 5. She was also a single mom who worked as a nurse. She had a great deal of trouble sleeping through the night. Her internist was prescribing her sleeping pills, which at first helped, but she realized she was addicted to them. My only advice for her was to help her realize that her sleep issues were obviously related to her stress levels, that she needed to address the stress, and not just take pills to cover them up.
Long story short, her solution was getting help from her mom, and reducing her stress levels, allowing her to get a full night’s sleep. Not every case of insomnia is so simple, most are not.
There are extreme cases of significant insomnia—so extreme that a person can die from lack of sleep. Fatal insomnia is very rare. These patients eventually lose basic brain and body function and will die 12 to 18 months after complete insomnia. There’s no known cure. The first reported case was of an Italian man who died with it in Venice in 1765.
The amount of sleep we need each night adjusts as we age. A newborn baby can sleep 14 to 17 hours a day, although most new parents will tell you they never sleep when you want them to. Teenagers require about eight to 10 hours a day, and an adult seven to nine hours.
There are several categories of insomnia. There’s sleep-onset insomnia, or difficulty falling asleep. There’s sleep-maintenance insomnia, or difficulty staying asleep. There’s also a mixed component of both problems.
It’s interesting how so many of us find that we have no problems sleeping when we’re on vacation. That tells us a great deal about the root of sleeplessness for many of us, though there are many risk factors and comorbidities for insomnia in adults.
Insomnia can be rooted in predisposing, precipitating, and perpetuating factors.
The predisposing factors increase the risk for insomnia and can be from childhood trauma, chronic health conditions, depression, or anxiety, to name a few. Erratic sleep patterns are also predisposing factors, such as erratic work hours or going to night shifts. Chronic pain conditions can also obviously affect sleep.
Precipitating events leading to sleep disruption can be a severe accident, injury, divorce, death of a family member or close friend, stress, and more.
Perpetuating factors are cognitive or behavioral actions that sustain poor sleep over a period of time. Examples are watching TV while trying to sleep, taking long naps during the day, and anxiety or worry.
To complicate insomnia even more, there are primary and secondary causes. Primary causes are obvious ones such as jet lag, loud noises, and stress.
Secondary causes can be obvious ones as well.
TC was a 28-year-old woman with no kids. She was a hard worker who happened to see me for an annual checkup. She had been complaining of insomnia for about 2 weeks. She had a big project due at work and also had a bad cold. She was using a nasal decongestant at night to keep her sinuses open as well as taking an over-the-counter decongestant before bed. She couldn’t fall asleep. I told her both medications she was taking were stimulants and can keep you up at night. The simple change in her medications solved her insomnia, although I have no idea how her project went.
For those with insomnia, simple things usually work. Have a regular sleep schedule: go to bed and get up at the same times each day. The body likes routine. Try to avoid long naps during the day. Limit alcohol near bedtime. Alcohol may initially be sedating, but as it’s metabolized, it negatively affects sleep patterns. Avoid caffeine after lunch. Caffeine can stay in your system for a long time and can affect sleep.
Exercising about four to six hours before bedtime can facilitate a good night’s sleep, but avoid strenuous exercise just before bed. There are plenty of over-the-counter medications and herbal remedies that can be tried. Prescription medications should be a last resort and only for a short period of time.
Being proactive about any sleep issues will keep your brain working its best and help you face the challenges of the day. So if you can’t sleep, take action.
After all, as F. Scott Fitzgerald said, “The worst thing in the world is to try to sleep and not to.”