Sleep Basics - 101 Questions About Sleep and Dreams

Chapter 6 - Poor Sleep (Too Little or Too Much)

48. How many Americans have trouble falling asleep or other complaints of insomnia?
49. I have always been a light sleeper. Lately, though, things are really bad. The smallest noise awakens me and I cannot get back to sleep. My friend has told me to get out of bed when I cannot sleep and exercise until I am so tired I will have to sleep. I am exhausted already. When I get home from work, I fall asleep in my easy chair. What should I do?
50. We have moved near a major airport. The noise of the jets is really loud. I seem to be able to sleep all right, but my wife is miserable at night with insomnia. What should we do?
51. Will it help to take a hot bath or read a dull book before going to bed?
52. My friend bought a record of sounds and special music that is supposed to help beat insomnia. Do such records really work?
53. What about the old axiom, 'early to bed, early to rise'?
54. I have always heard that 1 hour of sleep before midnight is worth 2 hours of sleep after midnight. What is the basis of this old adage?
55. My wife has arthritis and can manage pretty well during the day, but she is so miserable at night because she cannot sleep. Is there anything that can be done?
56. I have been on rotating shift work for ten years and never had problems with my sleep. Lately, though, the graveyard shift is just murder for me and I cannot seem to sleep during the day. Where have I gone wrong?
57. I make frequent short trips to the East Coast from the West Coast. Is it best to try to stay on West Coast time, or to adapt to East Coast time?
58. My husband and I have a cabin in the mountains. We have been enjoying vacations there for years. Now my husband finds that he cannot sleep in the cabin and has grown to hate the place. He wants to sell. How can he break his insomnia, so we can again enjoy our second home?
59. Is it good to exercise just before going to bed?
60. My husband is always falling asleep around the house. He seems to get a lot of sleep at night. How can I get him to be more alert and pay more attention to me and the family?
61. I feel as though I have not slept a wink for days. I drag through the day without any energy. If I do not get some sleep tonight, I am going to go crazy. What can I do?
62. I fall asleep quickly, but I wake-up at 3 or 4 in the morning and cannot get back to sleep. I am exhausted by 6 o'clock and fall asleep just in time to be awakened by my alarm for work. What do I do?
63. We just had a death in the family and a lot of the problems have been left for me to solve. I have not been sleeping well and the doctor prescribed some sleeping pills. Do these things work? Will I get 'hooked' on them?
64. My husband wants to buy a new water bed because he read that people sleep best on this type of surface. Is this really true?
65. I think I have insomnia, but it is only on Sunday night. Why is this?
66. Are we really more likely to get sick if we do not sleep enough?
67. What are the signs indicating that someone is not getting enough sleep?

48. Q: How many Americans have trouble falling asleep or other complaints of insomnia?

A 1991 Gallup poll found that 36% of American adults have some type of insomnia and 9% have chronic sleep difficulty. For the 36% with insomnia, 72% complain of waking up in the morning feeling drowsy or tired. Other common complaints include waking up during the night, difficulty getting back to sleep and difficulty falling asleep. In addition to this 36%, almost everyone experiences difficulties with poor sleep from time to time when facing problems such as a family crisis, death of a loved one or loss of a job. These are situations in which it is quite common -- maybe even normal -- to have difficulty with sleep.

It is only recently that physicians and other health care workers have begun to take the complaint of insomnia seriously. This change in attitude has come about because of the vast numbers of people with sleep problems and the fact that people with chronic insomnia report significantly more problems meeting their work and family responsibilities and have over twice as many auto accidents as people without sleep problems.

49. Q: I have always been a light sleeper. Lately, though, things are really bad. The smallest noise awakens me and I cannot get back to sleep. My friend has told me to get out of bed when I cannot sleep and exercise until I am so tired I will have to sleep. I am exhausted already. When I get home from work, I fall asleep in my easy chair. What should I do?

Sleep experts tell us that the first thing people with this problem should do is develop a regular schedule of sleep and wakefulness so as to maximize the natural tendency to sleep during the night. Get up at the same time every day, 7 days a week. Try to sleep only at night -- no naps. Do not worry about one or two bad nights. Eventually, you will be sleepy enough to sleep at the appropriate time and feel rested when you wake up. Avoid stimulating foods and drinks, particularly after dinner. Do not use alcohol for sleep -- alcohol is a very poor sleep aid because, while it may help you feel drowsy, it wears off in 2 - 4 hours and actually wakes you up once it has been partially eliminated by the body's metabolic processes. Alcohol is the leading cause of waking up too early and being unable to get back to sleep.

If you do wake up at three in the morning and cannot get back to sleep, try to do something quiet and, preferably, in the dark so as not to disrupt your body's clock. Listening to relaxing music is a sensible choice. Avoid exercise and other stimulating activities at these hours so that, even if your 24-hour wakefulness-sleep cycle is disturbed, your activity-inactivity cycle is preserved. If insomnia persists after schedule regularization, get professional help.

50. Q: We have moved near a major airport. The noise of the jets is really loud. I seem to be able to sleep all right, but my wife is miserable at night with insomnia. What should we do?

Loud noises during sleep such as the noises from an airport have been shown to disrupt sleep to some extent even in people who say that the noises do not keep them awake. This is because the normal brain always reacts to stimuli such as sounds or touches even during sleep. However, it is obviously true that people have lived near airports for years with few measurable problems. If your wife's problem persists after a couple of months, the logical thing to do is to improve your sound insulation by insulating the bedroom, using ear plugs, or both. If your wife still cannot acclimate to your new location even with these measures, you had better think about moving. There is really no long-term remedy that would be preferable to finding a quieter location.

51. Q: Will it help to take a hot bath or read a dull book before going to bed?

For those who have occasional difficulty falling asleep, the best advice is to do whatever helps and avoid whatever makes matters worse. There are many reasons why someone may have trouble falling asleep ranging from 'nerves', to trying to sleep at the wrong time in the body's daily wakefulness-sleep cycle. So, sleep aids that work for one person may do nothing at all for someone else. Many people use warm baths. Quiet soporific tasks are also common -- like counting sheep. On the other hand, it is probably not a good idea to engage in exciting activity or intense physical exercise (other than sexual activity) before bed.

52. Q: My friend bought a record of sounds and special music that is supposed to help beat insomnia. Do such records really work?

There is really no way to answer in general. If the record works for you, then use it. Almost all scientific information about things that help sleep, comes from studies of drugs. Scientifically valid laboratory research has identified many drugs that help people sleep. Drug companies must do this type of research before they can market a drug that they claim to be an effective treatment for insomnia. However, this kind of work takes years to complete and the evaluation of a typical sleeping pill may cost several million dollars. For obvious reasons, such laboratory research has rarely been conducted on self-help remedies such as audio recordings. This does not mean that such remedies do not work. Rather, it means that our consumer protection and economic systems have led to proper sleep laboratory evaluation only of drugs that are manufactured and sold for the complaint of insomnia.

53. Q: What about the old axiom, 'early to bed, early to rise'?

Sleep specialists would revise this old advice from Benjamin Franklin. A better rule is 'consistently to bed and consistently to rise makes one healthy, wealthy and wise.' Some individuals claim to be 'night people' and others 'morning people'. But if both types are free to sleep undisturbed, night people sleep about the same as morning people -- only at different hours. The night person sleeps beautifully after falling asleep at 2 AM, while the day person does quite well retiring at 10 PM.

54. Q: I have always heard that 1 hour of sleep before midnight is worth 2 hours of sleep after midnight. What is the basis of this old adage?

Sleep is an active, highly organized sequence of events and physiological conditions. Sleep is actually made-up of two separate and distinctly different states: 'non-rapid eye movement sleep' (NREM sleep) and 'rapid eye movement sleep' (REM sleep) or dreaming sleep. NREM sleep is further divided into stages 1 - 4 based on the size and speed of the brain waves generated by the sleeper. Stages 3 and 4 NREM sleep have the biggest and slowest brain waves and it is hard to wake people up from Stages 3 and 4 sleep. Large spurts of growth hormone are secreted during stages 3 and 4 NREM sleep. Because of these and other characteristics of stages 3 and 4 of NREM sleep, this type of sleep is thought to be particularly restful. If we go to bed at, say, 10 or 11 PM, we will perceive that our most restful sleep occurs before midnight. However, the main point is that the type of sleep that we believe is most restful occurs in the first few hours of sleep -- whatever the clocktime of the sleep might be.

55. Q: My wife has arthritis and can manage pretty well during the day, but she is so miserable at night because she cannot sleep. Is there anything that can be done?

Your wife's problem is very common and will become more common as our population continues to age. There are a number of medications that help with pain and acceptance of pain. Some of these interfere with sleep more than others. It may be helpful to ask a sleep specialist to review your wife's medications to see if changes can be made to minimize the unavoidable sleep disturbances caused by her pain.

56. Q: I have been on rotating shift work for ten years and never had problems with my sleep. Lately, though, the graveyard shift is just murder for me and I cannot seem to sleep during the day. Where have I gone wrong?

Chances are that you have not gone wrong -- you have just gotten older. People are very different in the way they handle irregularities in their work and sleep schedules. Some people can never stand swing or graveyard shifts. Others manage reasonably well on the night shift for years. The newest studies show that humans can never completely adapt to working nights and sleeping days. The best we can do is get through periods of night work with a minimum of sleep loss. Besides individual differences, age is the most important factor in tolerating night work. Statistically, the older you are, the tougher it is to handle any deviation from a day work - night sleep schedule.

Because we are all biologically night sleepers, a number of industries that operate around the clock are experimenting with bright illumination of the work environment at night in order to help push the nighttime sleep tendency to another clocktime. While this approach is promising and has helped NASA astronauts prepare for early morning launches, it can be prohibitively expensive in many industries and impossible in others. Until a general method is found to fool our sleep clock into letting us be alert all night, shift workers will have to find individual solutions. Examine your schedule and activities. If you cannot explain the sudden inability to handle the graveyard shift in other ways, then you should think about arrangements to work only the day shift.

57. Q: I make frequent short trips to the East Coast from the West Coast. Is it best to try to stay on West Coast time, or to adapt to East Coast time?

If the trips are short and you can schedule your business during normal West Coast business hours, do not try to adapt to East Coast time. Adaptation would take longer than the duration of your trip. There are other strategies that you may consider as well. For example, if you know of an important East Coast meeting at, say, 7:00 AM -- which corresponds to 4 AM in your West Coast body, plan to go east several days before the meeting to adapt. Alternatively, try to use East Coast time at your home for a few days before traveling east.

58. Q: My husband and I have a cabin in the mountains. We have been enjoying vacations there for years. Now my husband finds that he cannot sleep in the cabin and has grown to hate the place. He wants to sell. How can he break his insomnia, so we can again enjoy our second home?

If your husband sleeps all right at home, you should take your husband's cabin insomnia seriously. The first thing to check is his breathing when he sleeps in the cabin. Check to see if his breathing is smooth and regular when he sleeps. If his breathing is irregular with alternation between shallow breaths and deep gasps, his insomnia is probably related to periodic breathing during sleep and a physician should be consulted. Because the oxygen level in the air is reduced as altitude increases, breathing problems of this kind develop in all individuals at altitudes above 10,000 feet or so. However, people with respiratory disorders such as emphysema or shortness of breath related to obesity can develop such sleep-related breathing problems when they go from sea level to as low as 4000 - 5000 feet. For mild cases, doctors prescribe respiratory stimulants until people acclimate to altitude. For serious cases, high altitudes should be avoided.

59. Q: Is it good to exercise just before going to bed?

No, probably not. For all humans there is a physiological tendency to have a major sleep bout once every 24 hours. Most of us begin this sleep bout between 10 PM and 1 AM. Any behavior that alerts us, such as vigorous exercise or intense intellectual and emotional activity, will act to delay the sleep bout. People who never have trouble falling asleep are probably oblivious to this effect. However, for those who are frequently troubled by difficulty falling asleep, it is wise to avoid any bedtime activity that leaves one physiologically or mentally aroused.

60. Q: My husband is always falling asleep around the house. He seems to get a lot of sleep at night. How can I get him to be more alert and pay more attention to me and the family?

Falling asleep at times when one should not fall asleep is a dangerous symptom. If nighttime sleep is really sufficient, unintended bouts of sleep in the day should not occur. The two most common reasons for falling asleep inappropriately are sleep apnea and narcolepsy. Both of these conditions can be successfully treated once a doctor has made the diagnosis. If someone in your family falls asleep inappropriately, get them to a doctor. If untreated, this kind of problem can lead to car accidents, loss of job and ruined marriages.

61. Q: I feel as though I have not slept a wink for days. I drag through the day without any energy. If I do not get some sleep tonight, I am going to go crazy. What can I do?

This type of sleep problem can be caused by many different things going on in your body or in your life. Trouble getting to sleep is very common after a crisis such as losing a loved one or a job. This kind of insomnia may also stem from alerting compounds in your diet such as too much, or increased sensitivity to, caffeine. Increased sensitivity or excessive use of tobacco has also been implicated as a reason for the symptom of insomnia. Many medicines prescribed for medical conditions such as arthritis, asthma and heart disease can cause insomnia. If the problem persists, see your doctor. Physicians are taking the complaint of insomnia more seriously these days because people with insomnia have an increased rate of problems at work and an increased rate of accidents on the road. Find out what is keeping you awake.

62. Q: I fall asleep quickly, but I wake-up at 3 or 4 in the morning and cannot get back to sleep. I am exhausted by 6 o'clock and fall asleep just in time to be awakened by my alarm for work. What do I do?

The two most common reasons for this type of insomnia, called sleep maintenance insomnia, are depression and too much alcohol before bed. People who are depressed may not recognize any other problem except early morning awakening. Most doctors can diagnose depression and begin therapy after one or two visits. The most widely accepted theory about depression is that it is a biological imbalance among the brain chemicals, called neurotransmitters, that are used by brain cells to signal one another. Imbalances in these chemicals almost always affect sleep as well as mood. When the depression is controlled, the sleep problem usually goes away. If the early morning awakenings are due to too much alcohol before bed, the best first approach is to stop drinking.

63. Q: We just had a death in the family and a lot of the problems have been left for me to solve. I have not been sleeping well and the doctor prescribed some sleeping pills. Do these things work? Will I get 'hooked' on them?

Sleep problems at the time of a personal crisis are very common and may be even considered a normal part of the grief process. Modern sleeping pills of the benzodiazepine or imidazopyridine type are often used in such 'situational insomnia'. These kinds of drugs are safe and effective when used as directed. In fact, short-term use during a crisis may prevent a chronic insomnia problem from developing.

64. Q: My husband wants to buy a new water bed because he read that people sleep best on this type of surface. Is this really true?

In general, people sleep best on the surface that feels most comfortable to them. However, the best sleep research available shows that, after a night or two of adaptation, most people can sleep as well on a thin pad over a concrete floor as they can on the most elaborate mattress available. Of course, this is only true for people who do not have muscle or skeleton problems that require particularly soft or particularly firm surfaces to avoid discomfort.

While research has not shown that the cost or physical properties of sleeping surfaces are major factors determining sleep quality, other psychological factors will influence what people believe about sleeping surfaces. For example, the more money and time invested in a particular mattress and/or bed, the stronger will be the belief in the superiority of this particular sleeping surface.

65. Q: I think I have insomnia, but it is only on Sunday night. Why is this?

The first thing to consider in this situation is your weekend schedule of sleep and activity. If you are staying up later to play and party and sleeping late on Saturday and Sunday mornings, you are setting up perfect conditions for Sunday night insomnia. Try to go to bed at the same time every night, seven nights a week. The body clock controls when we are ready to sleep and when we are ready to be active. For most of us, it is easy to delay sleep and the next day's activity. However, our clocks are hard to set forward again so that we feel like going to sleep earlier, say, on Sunday night. If schedule irregularity is not to blame, the next thing to consider is whether you have some apprehension about Monday's activities.

66. Q: Are we really more likely to get sick if we do not sleep enough?

There are more and more studies coming out on the relationship between sleep and disease. Some studies indicate that our body's defenses against viral and bacterial infection are increased during sleep. Studies have shown that, after a period of experimental sleep deprivation, some components of the body's immune system become overactive and then return to normal after recovery from sleep deprivation. Other studies have shown that the cells and chemicals of our immune system, released as our body fights off invading germs, actually do make us sleepy. So there may be some truth to this old adage.

67. Q: What are the signs indicating that someone is not getting enough sleep?

Sleep deprivation studies have shown repeatedly that the early signs of not getting enough sleep are progressive slowing of reactions and increased numbers of brief attention lapses. If you have been cutting back on sleep for a day or two or if you are trying to stay up for a whole night, you are likely to miss the early signs of not getting enough sleep. However, when you do something sedentary for more than 10 minutes or so, particularly something that demands sustained attention, you are likely to perform poorly.

The effects of too little sleep increase relentlessly from the time you last slept. Brain imaging studies of volunteers who have lost about one night's sleep show significant reductions in basal activity especially in the frontal areas. However, other studies have found that when sleep deprived subjects are engaged in mental work, such as trying to recall a previously memorized list of words, the frontal and parietal brain areas become more active than during comparable mental work when the subjects are normally rested. This increased activity during work indicates that the brain is able to compensate to some extent for the deleterious effects of sleep loss. But, the compensation is certainly not perfect. One study compared the effects of sleep deprivation with the effects of drinking alcohol. After 17 hours of continued wakefulness, a person's performance lapses become as frequent as they are for a person who has a blood alcohol level of 0.08 percent -- i.e. someone who is legally drunk.

If you are sleep deprived night after night, the main tip-off is overwhelming daytime sleepiness and inability to function effectively. At sleep disorders centers, this is the first thing doctors look for: Is the person impaired during the daytime? That is the basis for deciding whether or not to intervene with drugs and other therapy. With extreme sleep deprivation, you have frequent loss of attention, frequent lapses in performance and accidents. Many people experience a burning of the eyes and increased irritability. In extreme cases, sleep during the day becomes unavoidable and people experience sleep attacks. When they merely sit down, they fall asleep. Such patients must force themselves to be active in order to stay awake.

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