When you’re awake in the middle of the night tossing and turning — or staring at the inside of your eyelids for hours — you probably feel as if you’re alone in the world. You’re not.
One in three people don’t have an occasional bad night’s rest. Instead, they have insomnia. Insomnia is a disorder that makes it hard to fall or stay asleep. The results range from the expected — fatigue, lack of energy, inability to focus — to poor job performance, overreacting to stress, and a higher risk for developing certain diseases.
According to Dr. Camilo A. Ruiz, the medical director of Choice Physicians Sleep Center in Florida, insomnia sufferers have ample opportunity to sleep, but are unable to fall and/or stay asleep. He says obstacles to achieving refreshing, restorative sleep include “environmental, psychosocial, stress, mood disorders, and shift work.”
Mild to severe insomnia can also be triggered by medications prescribed for conditions such as depression, asthma, and high blood pressure, as well as treatments following painful accidents or surgeries. Aging, divorce, anxiety, cigarettes, and grinding teeth also interfere with sleep, as do
“obstructive sleep apnea, hormonal changes such as those seen in menopause, mood disorders, and recent stressful life events such as a loved one’s passing,” per Dr. Ruiz.
Once sleep becomes unsettled, the doctor says worrying about its absence creates even more anxiety. “A lack of sleep and the stress it produces in turn creates poor sleep habits that become ingrained and hard to break.
Humans are programmed to spend about one-third of their lives sleeping, but two-thirds of an insomniac’s life may be consumed by missing sleep. That lack of sleep is a true nightmare for many insomniacs. Charles G. Hill shares, “There are going to be nights when every other fear in the catalog is going to be bidding for space in my brain, and behaving sensibly is completely out of the question.”
Eddie (last name withheld) never gets enough shuteye because his partner snores. “I can’t sleep and then I worry about what’s going to happen to me because I can’t sleep,” he complains. “Maybe I’ll have a car accident because I’m so sleepy, or maybe I’ll hurt myself or someone else at work because it’s so hard to concentrate. I am never at my best anymore.”
Eddie’s fears of making a mistake or being unable to avoid an accident aren’t unfounded. According to the American Academy of Sleep Medicine, “Research suggests that insomnia is a major contributor to deaths caused by motor vehicle crashes and other unintentional fatal injuries.” [Boaters take note: according to U.S. Coast Guard statistics, operator inattention was one of the top five primary contributing factors in maritime accidents.]
While Dr. Ruiz stresses that insomnia “rarely becomes life threatening,” he notes that it can “impair a patient’s quality of life and potential to live a fulfilling one at that. When a patient finds that their mood, work performance, energy levels, and general wellness are suffering, then it is time to seek professional help.”
Cognitive behavioral therapy (CBT) is a core treatment for insomnia provided by board certified sleep specialists specially trained to evaluate, treat, and manage all sleep disorders. Dr. Ruiz, board certified in internal and sleep medicine and a clinical assistant professor, explains that CBT involves altering “primarily habitual behaviors that lead the patient towards a more restful and consolidated sleep state. These include bright light therapy in the morning hours, avoiding bright light in the evening, and maintaining the same bedtime and rise times.
“CBT also develops positive associations with our physical sleep environment (i.e. bed) by only sleeping and having sexual intimacy in bed and not doing paperwork or watching TV.”
Sleeping pills are not the first choice of treatment by specialists, says Dr. Ruiz, who usually combines CBT with low dose melatonin three hours prior to bedtime. He says the supplements “can help prepare our bodily organs for sleep as well.”
Sometimes medication is added to treatment if deemed warranted by the physician. “There are prescription medications available to treat insomnia, but these medications have the potential for abuse or misuse and must be monitored. Furthermore, they carry a potential for dependency and other side effects such as falls and memory loss,” counsels Dr. Ruiz.
Eddie says, “I know it’s a cliché, but insomnia is going to drive me to drink!” While some people claim that drinking alcohol is a sleep inducer, Dr. Ruiz nixes that notion. “Substances such as alcohol can intensify a patient’s insomnia and can lead from an acute condition to a largely chronic disease state.”
This article is not a substitute for medical treatment. For further information on insomnia and locating a qualified sleep specialist, visit https://aasm.org/ and www.sleepeducation.org.
