Why Do I Sleep So Poorly?
Sleep is a natural and essential part of our existence. Yet, by conservative estimates the problem of sleep disturbances is one that afflicts more than 30% of the Canadian population, and evidences profound physical, emotional and social impact. Sleep deprivation has been cited as a primary or secondary cause of numerous industrial and motor vehicle accidents. People with sleep problems tend to work inefficiently or miss work altogether. Others have unexplained sleepiness in the daytime that become extremely disruptive and dangerous. Even stable marriages have suffered from loud and unabated snoring, sleep walking, sleep talking, and tooth grinding.
We know that numerous psychiatric and emotional problems are also associated with sleep disturbances: depression and anxiety both produce drastic changes in sleep patterns; schizophrenia and mania in manic or bipolar depression produces reduced need for sleep; children with Attention Deficit Hyperactive Disorder (ADHD) cannot seem to sleep at night, and then become overly tired in the day. One sleep researcher calls sleep "the window of mental health", and the examination and treatment of sleep problems can be a first step in helping depressed and anxious people.
How Much Sleep Is Normal?
The amount of sleep required varies with each individual, with the average being 7.2 hours. Some extremes have been recorded of people requiring no more than 4 to 6 hours of sleep (Thomas Edison is one), while others have been known to require 8 to 10 hours (such as Albert Einstein). Newborn infants sleep an average of 16.2 hours and by 6 months usually average about 14 hours. At age 2, the average is 12.2 hours in total (including naps) and by age 6, most children no longer need naps and require an average of 11 hours. By ages 15-19, we begin to establish our lifetime average. The amount of sleep required stabilizes once one reaches adulthood. Among the elderly, the amount of sleep required remains the same, but the quality of sleep may deteriorate, with sleep becoming less efficient, lighter and less restful.
The best way to establish your individual sleep requirements is to keep careful track of the amount of sleep you get over one month. Your "Sleep Log" should reflect
- (a) the total number of hours of sleep you get each day, distinguishing between naps and night-time sleep,
- (b) the total number of night awakenings,
- (c) lights-out and get-out-of-bed times,
- (d) the amount of time required to fall asleep, and
- (e) the use of medication to aid in sleep or relaxation.
If you know you have sleep disturbances, use these five points to log your sleep needs, and consult a counsellor familiar with sleep disturbances for further help.
Problems With My Biological Clock
One of the functions of the Sleep Log is to allow you to track your biological clock that helps to determine your sleep-wake schedules. There are actually two biological clocks, one that responds to light and activity, and the other that responds to the production and breakdown of chemicals in your body. From about the 6th to 14th month of life, our built in "clocks" are activated. These clocks run very close to a 24 hour cycle. Thus, children get up easily most mornings and fall asleep at about the same time each night.
Then sometime in the teen years, the clock slows down so that it is always slower than the actual time, actually on a 26 to 30 hour cycle for clocks one and two, respectively. Consequently, adolescents have trouble going to sleep at night since their clock says, "It's only 9 pm" when your watch says it's 11 pm. Similarly, they find it hard to get up at 7 am since their internal clock registers only 4 am! For about 10 years, adolescents and young adults endure the constant and biologically imposed struggle of getting out of bed and going to sleep in time. Thankfully, the clock speeds up again when we reach our early 30s, allowing us to live more comfortably on a 24- hour cycle.
Insomnia: Why Can't I Just Go To Sleep?
At times, the biological clock seems to suffer a breakdown. You lie down but cannot sleep, or you sleep but wake up far too early, or have multiple awakenings at night so that you wake up tired and unrefreshed. Why do people suffer from insomnia?
1. Medical reasons. Allergies, congestion, coughing, arthritis, back pain or other pain, and even indigestion can initiate insomnia. At times, the medications prescribed for other ailments may contain caffeine, ephedrine or amphetamines that interfere with sleep. Alcohol and drug addictions have been shown to be a primary cause of insomnia. Even sleeping pills may cause sleeplessness. Consider that the sleeping pills may be interacting with other medication prescribed to you. Such pills can also lose their beneficial effect and you may have had to increase your dosage to feel any drowsiness. Even worrying that your physician might refuse to renew your prescription for sleeping pills can keep you awake! One danger sign is finding yourself unable to sleep at all for a night or two when you take yourself off your sleeping pills. Certain medications such as corticosteriods actually disrupt sleep architecture. Other medical conditions such as obesity, muscle convulsions while sleeping, snoring and sleep apnea also disrupt sleep patterns.
2. Emotional Causes. Depression and anxiety are major causes of insomnia. Examine the thoughts that seem to persist when you are unable to sleep. Depressive thoughts or excessive worrying seem to occupy a great deal of those wee hours of the night. Even worrying about being unable to get enough sleep to handle the next day contributes to the emotional tension. Often, anxiety can express itself by dreams and nightmares. Typically anxiety dreams include being chased, running but not escaping, being trapped, losing one's way. Sometimes nightmares are specific to an accident or a traumatic event. The dreamer awakes in a cold sweat. This is a condition called Post Traumatic Stress Disorder, and requires immediate help from a psychotherapist.
3. Lifestyle Causes. Stress at work or at home, smoking, drinking coffee, tea or colas in the afternoon or evening, smoking, alcohol (two or more cocktails, beer or other alcoholic beverages a day), abusing narcotics, too much television, or even constant changes in shift work are potential causes of insomnia.
One difficulty is that insomnia does not usually confine itself to a single cause. For example, you may have experienced a lower back injury in a motor-vehicle accident. The resulting back pain reduces your sleep. As the injury persists, you worry about being unable to go back to work, about finances, and about your health in general. With depression setting in, you spend more time on your own watching TV till wee hours of the morning, and getting up at uncharacteristically late hours of the morning. The result is a conflation of reasons
What Can I Do?
Disrupted sleep patterns must be dealt with as soon as possible since the problem doesn't usually just go away. It usually gets worse.
1. Medications. Many people are suspicious of using medications to help with sleep, and rightly so. It really depends on what the medication does. Anti-depressants and anti-anxiety pills are usually prescribed to help with sleep, though they should not be used without psychotherapy. Muscle relaxants are often prescribed for people who experience kicking and excessive movements at night. Pain killers are used for people with chronic pain, though in these cases, the use of pain killers must be carefully monitored by a medical physician. For problems such as sleep apnea and snoring, measures such as weight reduction, reducing alcohol consumption, and changing sleep positions, and more drastic measures such as surgery or a nose mask device may be used. Do not simply use sleeping pills that may mask the underlying problem.
2. Resetting My Clock. We have discussed the existence of two internal clocks that determine our sleep schedule. Imagine that you are wearing two watches that are running at different speeds, and that they are both out of sync with real time! If the situation persisted even for three or four days, you would be totally confused about your sleep-wake schedules. Insomnia and other sleep disturbances actually compound the problem drastically. The only way you could hope to function normally is to reset the watches each morning, and let them run the course of the day. To reset your biological clock: (a) determine a regular wake up time. Even if you did not get a good night's sleep, drag yourself out of bed at a predetermined time each day. When evening arrives, allow yourself to go to bed earlier; (b) expose yourself to light and activity . Remember the first clock? Researchers have pinpointed this neurological clock located in the brain as a nucleus of nerve cells close to where the optic nerves come together. As a result, this clock is strongly influenced by the availability of light. When your body wants to sleep at a time you want to be up, going out into the sunlight and moving around can give you a very powerful stimulus that resets the clocks. You may also expose yourself to white, bright indoor lights such as halogen lamps at such times. (Phototherapy uses this principle.)
3. Lifestyle Change If you're suffering from sleep disturbances, it would definitely be necessary to re-examine your lifestyle. Reduce coffee intake; stop smoking; don't drink alcohol. Many heavy coffee drinkers (more than 5 cups a day) claim that they can sleep even after drinking massive amounts of coffee. This may be so, but the restfulness of the sleep and the types of dreams are severely affected. Furthermore, other mitigating factors that affect sleep would be compounded by high coffee consumption. If you are constantly on shift work, try a major resetting of your sleep clock on the first day off an old shift. If you are a workaholic, plan in your sleep hours. Read up on relaxation therapy, or seek the help of a qualified counsellor.
Sleep disturbances are terribly disconcerting afflictions. Though we may not know all there is to know about the mechanism of sleep, there is usually help available for the sufferer. Don't be afraid to look for it.
Reading Materials You May Be Interested in: Dr. Peter Hauri & Dr. Shirley Linde (1991), No More Sleepless Nights John Wiley & Sons, Inc: New York. ISBN 0471-54796-4
"God grants sleep to those He loves." Psalm 127:2b
Author: T. Quek
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The effects of chronic pain
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Copyright © 2002 Timothy Quek, Ph.D.