Conservative estimates indicate that about 1 in 10 Americans experience trouble sleeping. Many of those who have trouble with sleep will experience chronic or episodic insomnia. Insomnia can be thought of as difficulty falling asleep, staying asleep, or waking earlier than you’d like for greater than a month, often resulting in difficulty functioning during the day. We often say unless you’ve experienced trouble sleeping, it is hard to imagine how sleep (or the lack thereof) can impact your waking life and create feelings of frustration, anxiety, and even panic. Patients with chronic insomnia often feel more irritable and depressed, have trouble concentrating, and find that much of their time is spent thinking about sleep. It becomes a pattern in which they live to sleep – or worry about sleep – rather than sleep to live! A study conducted by The National Sleep Foundation estimates that insomnia costs $100 billion annually in medical expenses, ramifications of accidents, reduced productivity, and impaired job performance.
So, where do these troubled sleepers turn for help? A quick Google search yields hundreds of tips on how to get a “good night’s sleep.” You’ll find suggestions for pillows, mattresses, room darkening tools, and temperature-control mechanisms. If you’re looking for advice on what to “do” or, rather, what to “give up” for good sleep, there are endless simple and seemingly “magical” solutions, from cutting caffeine out of your daily routine to never watching TV in bed and, God forbid, refraining from the use of any electronic devices within a few hours before bedtime. While these suggestions propose “easy” solutions for a blissful night of sleep, for those suffering with insomnia, adherence to rigid sleep rules can often hurt more than help.
As a case in point, I recently saw a patient who was experiencing an acute onset of insomnia that had lasted for several months. After the first few nights of difficulty falling asleep and then waking throughout the night, he began to worry. He had a very stressful job and felt he was not able to keep up with his workload; as a result he was sleeping only four hours per night. Prior to this rather sudden onset of insomnia, “John” was happily sleeping 8-9 hours per night and had never given his sleep much thought other than to look forward to getting into bed and drifting off to sleep after a long day at work.
After a week of sleeping 4-6 hours per night, John began to look for solutions. He started with an online inquiry and quickly learned that he needed a new pillow and mattress. Aside from costing a pretty penny, these purchases did nothing for his sleep. Next, he cut all caffeine and alcohol out of his diet. He had read somewhere that both were bad for sleep. John was feeling a little more irritable and exhausted but, unfortunately, his sleep still did not improve. John decided he would wear an eye mask and earplugs, get rid of the TV that he used to enjoy watching, and stop eating anything after 6 p.m. His sleep still did not improve, and John began to panic.
Every single night, the bed became a terror zone. He explained that he felt it was like playing Russian roulette: He did not know if he would be able to fall asleep or if he would spend hours tossing and turning. He could not understand what was wrong; after all, he was doing all the “right” things. By the time John decided to talk to his doctor, he had eliminated evening social engagements and was spending up to 10 hours in bed at night hoping that, if he tried hard enough, he would be able to get to sleep. John’s doctor suggested several medications that may help with sleep, but given his concern about side effects and not wanting to run the risk of becoming dependent on the medication, John decided to come in for non-pharmacological treatment.
Cognitive Behavioral Therapy for Insomnia (CBTI) is a very effective non-pharmocological treatment for insomnia. Using CBTI, we worked with John to help decrease the sleep anxiety that had developed over the past few months. We discussed the factors that control sleep and explored how sleep responds negatively to “performance pressure.” We worked with John’s beliefs about sleep and gave him specific techniques to help improve his sleep. Gradually, John began to stop placing so much attention on the sleep and re-engaged with his life. Over the course of five sessions, John was able to fall asleep within 10-30 minutes and stay asleep for 7-8 hours.
Although treatment is effective, the majority of patients with insomnia or other sleep problems do not seek professional help. Maybe they are worried about taking sleep medications or fear that their doctor is too busy to help. Insomnia is a common problem and there are effective treatment options available. If you are having trouble sleeping, we encourage you to tell your doctor or make an appointment with a sleep specialist so you can get to sleep and get back to your life. You may also consider finding a certified behavioral sleep medicine provider in your area.
Britney Blair, Psy.D. is a postdoctoral fellow at the Insomnia and Behavioral Sleep Medicine Program at the Stanford Center for Sleep Sciences and Medicine. This Center is the birthplace of sleep medicine and includes research, clinical, and educational programs that have advanced the field and improved patient care for decades. Her clinical and research focus is in behavioral medicine with specialization in sleep and sexual health. She received her doctoral degree in Clinical Psychology from the PGSP-Stanford Psy.D. Consortium in 2012. To learn more, visit us at: http://sleep.stanford.edu/.
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