Sleep allows the body and mind to effectively cope with life’s stresses, probably by allowing the brain to manufacture brain chemicals and making it possible to store and make sense of memories. The amount of sleep needed varies widely, but generally people need between 4 and 10 hours of sleep nightly, averaging 7-8 hours. Elderly people need less sleep, and often erroneously feel they need more than they are getting.

Studies have shown that most people who feel they "haven’t slept at all" have actually slept a lot more than they think. Missed sleep usually gets "caught up" the next night - rarely are many extra hours of sleep needed, although missing sleep can make you feel ill for a few days. Any physical or mental illness can cause insomnia. Chronic insomnia can cause illness. Sleep deprivation is so harmful it is considered a form of torture.

Problems falling asleep:

This most common type of insomnia is usually caused by stress. When one feels afraid, nervous or anxious, the body is constantly ready to "fight" or "run." When the stress goes away, or new coping skills are learned, this form of insomnia goes away. Medications frequently cause insomnia - especially caffeine, decongestant (in many cold medicines), and diet pills. The fear of not falling asleep is a common cause of insomnia. Napping can harm the body’s sleep/wakefulness cycle and result in a pattern of not sleeping and "catching up" with naps.

Problems staying asleep:

Many people wake up during the night, often unable to go back to sleep. Physical illnesses such as heart failure, prostate enlargement, and breathing problems can result in an inadequate night’s sleep. When an inability to stay asleep persists, especially when accompanied by chronic fatigue, the most common cause is depression. Many people who wake up from depression will cough or urinate while they’re awake, and incorrectly assume it is a problem with their urine or lungs that keeps them from sleeping.

Medications for insomnia:

The most commonly prescribed class of sleeping pills are called "benzodiazepines" (such as Valium, Dalmane, Restoril, Xanax, Halcion, etc.). While there are differences between these medicines, they all prevent the deepest stages of sleep, especially the crucial "REM" sleep, where dreaming takes place. These medicines keep you from being awake, but do not result in a good night’s sleep - often making you tired and uncoordinated the next day.

Over the counter antihistamines such as Benadryl and Dramamine can make you very sleepy, but can cause constipation, trouble urinating, and vision problems. Antidepressants in low doses (especially "trazodone") can give a good night’s sleep. Side effects can be a problem, but taking the medicine with a piece of fruit helps.

Insomnia treatment without medicines:

If you can’t fall asleep, don’t just lie there getting upset - get up and read something boring (not in bed!) until your body is ready to sleep. Often writing down your problems and possible solutions can put your mind at ease. Some foods make people sleepy - especially warm milk and sugary substances (but beware of overdoing it!). An excellent, thoroughly studied cure for chronic insomnia is Transcendental Meditation (T.M.).

Rotating shift work & re-establishing proper sleep cycles:

Rotating shifts are very stressful, causing physical illnesses, fatigue, and insomnia. The body responds better to postponing sleep, not going to sleep earlier. Shifts should always move forward - days to evenings, evenings to nights, and nights to days - to help the body cope with the stress of irregular sleep.

When a chronic insomniac can only fall asleep too late (such as 4 a.m.), postponing sleep by a few hours every day will restore an appropriate bedtime, often within a week. It is hard to do, however. For example, an insomniac who wants to go to bed at 10pm, but falls asleep at 4am, should go to sleep at 7am one day, 10am the next, then 1pm, 4pm, 7pm, then 10pm. The body will maintain this bedtime if a quiet nightly ritual is established - signaling the body that its time to sleep. Try to avoid sleeping in - keep the body’s biological clock ticking regularly with as little stress as possible.

October 22, 1999