Question:
I was looking through the FAQ, and kept seeing things like "3 minutes,
or until you fall asleep." Does this mean to say that 3 minutes is a
normal time to fall asleep? I've never fallen asleep that fast in my
life! 20 minutes on the inside is how long it would take. Sometimes 45
minutes or an hour. Even when I am _dead_ tired, I'll lay there for 15
minutes or so, my thoughts blank, with perhaps some music going through
my head before I zonk out. Of course, I've always felt better rested
after a night of waking up every hour or so rather than sleeping 7 hours
straight. It makes the night seem longer or something. Any ideas or
comments?
Answer:
Your experience falls within the outer limits of what's called
"normal" for falling asleep. There's a good chance you're spending
more time in light, Stage 1 sleep than you think. As long as you wake
up rested, that's the most important part. If you consistently wake up
feeling groggy all day, that's the time to start considering taking it
to a doctor...otherwise, you're cool.
It takes me nearly that long to fall asleep when I'm lying on my back. But when
I try other positions I find it sometimes only takes a couple minutes... or
less
Just what can cause insomnia?
Any one of some 40 different conditions have been
identified. The most
common is a psychological or psychiatric
abnormality. That is true of about
half the insomniacs who come to sleep disorders
centers. The other half are
people with more specific medical abnormalities.
Here are some of the
most common:
breathing difficulty during sleep such as
sleep apnea
periodic twitching of the legs and arms that
disturbs sleep
overuse of sedatives or alcohol that disrupts
sleep
stomach problems such as reflux or indigestion
physical pain such as with arthritis or
rheumatism
69.
What are the best ways to treat these problems?
Once a specific diagnosis is made, proper treatment
is aimed at the cause
of the insomnia. For example, people with insomnia
secondary to
respiratory difficulty may take drugs to improve
respiration during sleep.
People who have insomnia associated with overuse or
abuse of alcohol
must stop drinking, and so on. Sleeping pills are
best reserved for patients
who have insomnia as a reaction to some crisis.
Sleeping pills should be of
the prescription variety, not the over-the-counter
kind, because there are no
good studies to show that non-prescription sleeping
pills work as
advertised. This is true, in part, because
over-the-counter medications are
not subject to the strict requirements that the
U.S. Food and Drug
Administration sets up for prescription drugs.
Sleeping pills should be taken
over not more than a three-week period -- and
preferably not every night.
Furthermore, the use of sleeping pills should be
supplemented with
othertechniques to promote sleep, such as a regular
wake-sleep schedule,
regular activity after getting up in the morning
and abstinence from
caffeine-containing drink and food. The caffeine in
coffee, tea or even
several pieces of chocolate after dinner can be
sufficient to keep a
sensitive person awake for hours.
70.
Can sleeping pills make matters worse?
Absolutely. There is no question that abuse of
sleeping pills leads to
destruction of normal sleep and increased insomnia.
For example, a
barbiturate taken for too long can eventually make
sleep much worse than it
was during the period of insomnia that prompted
taking the drug in the first
place.
Furthermore, when the patient discontinues the
medication or runs out of it,
terrible insomnia follows. The person cannot sleep
at all for days, and after
finally falling asleep may have terrible
nightmares. This predisposes the
patient to return to the barbiturate and you have a
vicious cycle of
dependency and withdrawal. Still, if it is a matter
of getting a good night's
sleep before a difficult examination or during a
brief family crisis, a good
sleeping pill may be very useful.
71.
How soon will it be before science develops a
natural,
non-addictive sleeping pill that acts like the
natural
sleep-producing chemicals in the brain?
This is an area of intense investigation, but it is
too early to tell what the
results will be. Scientists are somewhat less
optimistic about a super
sleeping pill than they used to be. Sleep and
wakefulness are
complementary periods in a natural 24-hour cycle
that cannot be
manipulated on the spur of the moment. When we fly
across the Atlantic
from New York to Paris, our sleep structure as well
as our work productivity
adjust slowly, over several days, to this time
shift. So, it is unlikely that taking
a single pill could quickly reschedule all aspects
of our natural body rhythms.
One disappointing ‘natural’ approach for insomnia
and other problems
related to jet-lag has been the specially timed use
of melatonin, a natural
chemical manufactured by certain brain cells.
Melatonin is thought to be
involved in regulating our body clock. Experiments
giving melatonin to
people at specific times each day for several days
prior and after a long
flight east or west have failed to show any
improvement.
Another approach to sleep rescheduling is exposure
to bright light at a
particular time. The light should be in the form of
regular sunlight or special
artificial light with an intensity of about 2500
lux (the intensity of daylight just
after dawn). Research indicates that people who
need to sleep at a time
later than their habitual time -- either because
some disorder has shifted
their schedule or because they must work on a new
schedule -- can shift by
sitting in bright light for several hours before
they would normally go to bed.
On the other hand, if one wants to shift their
sleep to an earlier time, light
exposure should occur just after awakening. The
light is thought to reset the
biological clock. Bright light's shifting effect
requires at least 2 hours of
properly scheduled exposure to a light source that
is as least as bright as
dawn sunlight for 2 or 3 consecutive days.
SEE RELATED material in Chapter 5, Question number
40.
72.
Can behavior modification cure insomnia?
It is important to remember that there are many
causes for the symptom of
insomnia. Behavioral approaches are unlikely to
work if the cause of
insomnia is, for example, sleep apnea or
respiratory irregularity associated
with altitude. Behavioral techniques, particularly
of the self-help variety, can
be dangerous when they delay proper diagnosis and
treatment. Do not be
too quick to 'psychologize' your sleep problem --
it could be a treatable
physical condition.
However, if medical problems are ruled out and the
sleep problem is
chronic and psychophysiological, behavior
modification often is the best
choice. There are many approaches: relaxation
therapy, biofeedback,
meditation, improvement of sleep habits. A patient
who does not respond to
one approach may respond to another one, so sleep
experts advise
patients to continue trying until they find the
technique that works best for
them, rather than to rely exclusively on pills.
SEE RELATED material in Chapter 1, Question number
9.
73.
Is exercise helpful?
Yes, if it is done consistently. One day a week of
exercise is likely to disturb
rather than promote sleep during the following
night. But consistent, daily
exercise, preferably in the morning or at least
well before dinner, helps
promote a regular wake-sleep cycle and improves
chances for a good
night's sleep.
If one has trouble falling asleep, is it better to get up or stay in
bed and ‘count sheep’?
That depends on the individual, which is why the decision as to what
to do should be guided by a professional. One approach is to behave
exactly as you would normally behave during sleeping hours -- lie in
bed and try to relax. Do not get up and do push-ups. But, if by
remaining in bed you only create a great deal of anxiety and misery
for yourself, then you should get up and try to engage in some
activity to reduce anxiety and tension. However, there is always the
risk that in getting up you may further disturb the natura 24-hour
cycle of activity and rest that is necessary for good sleep.
