Unable to Get a Good Night's Sleep
"So, are you sleeping?" my gynecologist asked me at my annual exam last year. I had to laugh. That was funny. Not ha-ha funny. More wry, isn't-this-sad funny. Because I hadn't had a solid night of rest in years.
I'd always considered myself a good sleeper. But when I hit 40, everything changed. I suddenly had trouble falling asleep, and even when I did, I'd be wide-awake again hours later, working or puttering around the house. Not surprisingly, in the morning it was like slogging through muck just to brush my teeth and get dressed. I sometimes drank six cups of coffee to get through the a.m. hours, followed by an equal number of Diet Cokes in the afternoon.
At first I chalked it up to stress. A few years back my husband and I moved from Las Vegas to Orlando, Florida. We bought a house that I loved, but one that also made me worry that we'd overreached. Between concerns about the mortgage and saving for my son's college costs, I was popping out of bed every night like a jack-in-the-box. When weeks of not sleeping turned into months, I realized I'd become a card-carrying insomniac. Exacerbating matters was my husband, who snored more loudly than an entire construction crew. Many a night I weighed whether a jury of my peers—and by that I mean the 67% of American women who also have trouble sleeping—would understand my fatigue-fueled desire to smother him.
My doctor initially prescribed me a sleep aid. At first it seemed the ideal fix, but after a few weeks, one pill no longer lulled me to sleep. So I switched to Valium. Though not typically prescribed for insomnia, I knew from dental work that it could knock me out quite nicely. And just to hedge my bets, I often chased it with a cocktail. I knew that what I was doing wasn't smart, but I was desperate. It began to infuriate me that I had to be drugged to sleep in my own bed while my husband snored on, oblivious. To avoid nightly arguments, we started sleeping apart. Sex? Forget that. I was hardly in the mood. Suddenly my worries about getting shut-eye grew to concerns about my marriage and my overall physical health. I was miserable.
The Gender Divide
Research shows that when we don't sleep well we're at greater risk for accidents, weight gain, depression, diabetes, hypertension, heart disease, stroke, and overall premature mortality. While well more than half of all Americans have trouble sleeping, the effects of sleep loss hit women a lot harder than men. For instance, recent research suggests that when women lose sleep, they gain more weight than men. And there's more: Last year a British study found that sleep loss puts women at greater risk for hypertension than it does men. In a German study, sleeping five hours or less a night tripled women's risk for heart attacks, but not men's. And earlier this year researchers at Duke University in Durham, North Carolina, showed that women who took longer than 30 minutes to fall asleep had blood levels of C-reactive protein elevated enough to be associated with a high risk for heart disease. "It appears that sleep loss may be indicative of a disruption of the process by which the amino acid tryptophan is converted into serotonin and then into melatonin, a hormone that promotes sleep," says Edward C. Suarez, Ph.D., associate professor of psychiatry and behavioral sciences at Duke University Medical Center, who led the study. Women, it turns out, are far more sensitive than men to these disruptions, which then ripple out to influence appetite and weight, blood platelet stickiness and inflammation in the body (both which may affect the risk of heart attack and stroke), and mood. When men in the Duke research program didn't sleep well, they showed no signs of stress. The women? They got angry and depressed.
Fuming on the couch as my husband snored away in the bedroom, I would certainly attest to the rage. And I worried about depression, too, because it runs in my family: My sister, mother, and grandmother have all experienced the condition. Doctors used to believe that insomnia stemmed from depression, but now it's thought that it can work the other way, or that the two can go hand in hand. According to a recent University of Pittsburgh study that followed about 600 people for 20 years, up to 50% of those who had insomnia for more than two weeks experienced major depression later on. I had already gone through one terrible bout of depression about five years earlier, and I didn't want my insomnia to trigger another one.
A Search for Answers
I went to see William Kohler, M.D., director of the Florida Sleep Institute in Spring Hill, for an overnight observation to figure out why I wasn't sleeping—and what I could do.
Dr. Kohler's take was that I'd developed something called psycho-physiologic insomnia, or "learned insomnia." This can happen after some event or stressor triggers an initial episode of sleeplessness. For many, once they have a few difficult nights, the anxiety that builds up and the habits born of the desperation to fall asleep compound the problem. "Even after the stress gets better, the habits continue," Dr. Kohler explains. In other words, my husband's snoring aside, a big chunk of my problem was that I'd conditioned myself, like one of Pavlov's dogs, to associate going to bed with not sleeping.
Sadly, I'm hardly alone. As the Internet, BlackBerrys, and iPhones have made it possible to be on the job even when we're not in the office, we're all working more and sleeping less. "Partial sleep deprivation sneaks into our lives because we have more to do than hours in the day to do it," explains Craig Keebler, M.D., medical director of Medical Weight Management at Swedish Medical Center in Seattle. "Losing a few hours of sleep seems manageable. The problem is, once you've been working late for a couple of nights, it's harder to go to bed at 10 or 11," he says.
Working women may get hit the hardest, regularly pulling a second shift on the home front. Indeed, the National Sleep Foundation reports that 52% of women forfeit sleep when pressed for time. "Children's activities, family responsibilities, having time with your spouse—it all chips away at the time women really need to be sleeping," explains Qanta Ahmed, M.D., associate director of the Sleep Laboratory at the Medical University of South Carolina in Charleston.
That's certainly me to a T. Long after my son and husband have fallen asleep, I'm still plugging away—paying bills, answering e-mails, picking up, trying to get one more thing done.
A New Prescription
When the results from my night at the sleep clinic came in, Dr. Kohler phoned to discuss his findings. I braced myself for a stern lecture about my dependence on alcohol, sedatives, and caffeine. But surprisingly, Dr. Kohler offered a simple prescription. I didn't have to give up my morning French roast. (Of course, he thought my caffeine consumption was "really high," but figured that when I started sleeping better I wouldn't need as much.) Amazingly, I could hold onto my Valium too. It wasn't his first choice of sleep aids, but as long as I didn't feel foggy, experience memory loss, or increase my dose, I was okay for now. But he was adamant that I lay off the alcohol. A shot of vodka would help me fall sleep, he explained, but because alcohol metabolizes within five hours it would wake me up as it left my system. That certainly explained why I was prowling the house at 3 a.m. The other thing fueling my insomnia, he told me, was an inconsistent bedtime. The sleep log I'd filled out prior to my study showed that some nights I'd turn in at 9:30; others I'd be up past midnight. "The brain likes routine," he explained. "Stabilizing when we go to bed and when we get up helps with sleep quality."
To reacquaint my body with the idea that bed is a place for sleep, not stress, Dr. Kohler wanted me to get up and do something boring if I didn't doze off within 20 minutes of turning in. When I felt sleepy, then I could go back to bed and try again. And given that I'm a champion worrier, he suggested that before going to bed I write out a "worry list," noting all the things (like my fear of financial ruin) that get my mind spinning. And last but not least, he urged me to get my snoring husband to a sleep specialist. I wasn't arguing, though I was at a loss as to how. After all, we were already sleeping apart. If that wasn't motivation enough, I wasn't sure what would be.
So I focused on what I could do for myself first. I immediately ditched the alcohol and even the Valium (I'd fallen asleep without it at the clinic). Setting a bedtime was more challenging, as I still couldn't resist the urge to get one more thing done before bed. But each night I made an effort, aiming for lights-out between 11 p.m. and midnight. In the mornings, I cut down to three cups of coffee, and in the afternoons, I drank only caffeine-free beverages.
So how am I sleeping now? Much better, thank you. I no longer wake up at 3 a.m. and reach for my laptop. And since I've become more aware of when I should go to bed, I've noticed that I do get tired around 11, and if I can turn in then, I fall asleep faster and feel more rested in the morning than when I push myself to stay up.
Still more surprising, my husband and I have reached a detente of sorts in our sleep battles. I'm not sure if he got tired of sleeping apart or if my nagging ("You're going to die of a stroke or a heart attack if you don't stop snoring!") just reached critical mass. He recently went on his own to a sleep specialist, who promptly diagnosed him with borderline severe sleep apnea. That's a dangerous condition in which your airway collapses while you sleep, waking you frequently because you're not breathing. He did two overnight studies, and he got a prescription for a continuous positive airway pressure (CPAP) mask that will keep his airway open and stop the snoring.
Sure enough, he is no longer snoring. This may just save his life: A new study reveals that untreated severe sleep apnea quadruples the risk for dying of any cause. The diagnosis is also saving our marriage. The journal Chest reported that partners' quality of life improved tremendously after the people snoring next to them started using a CPAP mask. The machine does make a low whirring noise, but that's a small price to pay to once again sleep peacefully alongside my husband. Besides, I have plenty of earplugs.
7 Ways to Sleep Better Tonight
- Make your bedroom sleep-friendly. Not only should your mattress be comfortable and your room dark, quiet, and cool, you shouldn't do anything except sleep or make love in there: No eating, working, or watching TV. Light from screens signals your brain to stop producing the sleep hormone melatonin, so it takes longer to nod off.
- Hide the clock. Or at least turn it away while you're sleeping. Digital clocks are particularly bad because their precise readouts are constant reminders that the night is ticking away and you're still awake, says Daniel McNally, M.D., medical director of the University of Connecticut Sleep Disorders Center in Farmington.
- Spend less time in bed. "Most people spend more time in bed to try to increase their hours of shut-eye," says Bruce Rybarczyk, Ph.D., associate professor of clinical psychology at Virginia Commonwealth University in Richmond. But lying there awake breeds frustration. Instead, hit the pillow only for the hours that you are actually slumbering. This creates a greater desire for sleep so that when you finally do get in bed, you fall asleep faster and stay that way longer. As your sleep improves, you can gradually roll back your bedtime until you're sleeping for a full night.
- Don't eat late. Eating at night affects levels of ghrelin, a hormone that regulates hunger and sleep. Ghrelin levels naturally rise in the evening, readying us for bed. But if we nosh at night our ghrelin levels drop so we don't feel as sleepy. "One of the ways people keep themselves going until 1 a.m. is by eating late at night," explains Dr. Keebler.
- Avoid nicotine, caffeine, and alcohol. These are notorious sleep-stealers. Nicotine is a stimulant, plus cigarette cravings can wake you up at night. The effects of caffeine can last up to seven hours, so switch to decaf after 3 p.m. Alcohol's sneakier: It's sedating, but because it leaves your system quickly, that can wake you up and cause trouble getting back to sleep.
- Have a bedtime ritual. "You need a half-hour of unwinding time before bed," says Aparajitha Verma, M.D., medical director of the Methodist Sleep Disorder Center in Houston. "You can't be doing all these active things, then suddenly switch it off and expect to sleep. You have to prepare yourself. Read, meditate, listen to music, whatever calms you down before getting in bed."
- Clear your head. A steady diet of shock media will surely keep you up at night. So if you tend to ruminate on the world's ills, avoid material that will bother you, advises Ralph Pascualy, M.D., director of Sleep Medicine Associates in Seattle. "As people get tired, problems become much larger." One way to deal with worries that keep you up is to write down your concerns along with some possible solutions. Things don't look so dire when you see them on paper, notes Dr. Pascualy. This simple act allows your brain to let go of your fears so you can get some rest.
Is Insomnia Making You Fat?
It's possible. Research shows that sleep loss affects two hormones—ghrelin and leptin—that regulate hunger and satiety. When we don't get a full night's rest, ghrelin levels remain high, making us think we're hungry when we really are tired. At the same time, leptin levels plunge, so we can't tell when we're full. But there's more to the story. Not only does sleeping less make us hungry, but it causes us to yearn for junk food. When University of Chicago researchers reduced the hours their study participants were allowed to sleep, the volunteers were 23% hungrier and their cravings for sugary, starchy, and salty foods increased by as much as 45%.
Originally published in the December 2008 issue of Family Circle magazine.