Q. Sleeplessness

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Sleeplessness or insomnia is close and dear to many of us. We spend about a third of our lives sleeping and yet we know very little about sleep. For this article, I will focus on the causes of insomnia and its dire consequences and how to remedy the problem. We can have a conversation some other time on the mysteries of sleep.

Sleep is one of the three main pillars of health, the other two being nutrition and exercise.

There are many forms of sleeplessness. We can have difficulty in falling asleep, in staying asleep, waking up too early or unrefreshed when waking up. Since sleep is an integral part of our lives and a major player, we may need to approach it from a fresh perspective. For some reason, early morning routines such as taking a shower, shaving, hair grooming, putting on a make up, perhaps a bit of exercise or stretching and breakfast are a fixed routine and considered not only important but essential to get prepped for the day. And yet, going to bed usually doesn’t command our attention. We get tired, lie in bed and hope to fall asleep. No ritual or preparation takes place. There is no closure for the events of the day. We are about to enter into another realm of which very little is known about. In my opinion, going to sleep requires some amount of consciousness or savoir faire. We can’t expect to have a good nights rest (unless we are teenagers) after overeating and over drinking, as an example. Many other less dramatic instances causing poor sleep are a poor sleeping environment (bed, mattress, ambient noise, lighting, electromagnetic field, etc.); “busy mind” (anxiety, depression, excitement), dehydration (this is a big one, especially in Thailand); medications, drugs and of course jet lag.
You are not alone when it comes to insomnia. In the West, the majority suffer from some form of sleeplessness. Only 35% get 8 hours of sleep. When I was teaching in Seoul a few years ago, high school students averaged five hours of sleep daily, related to parental pressures to excel in their studies. Understandably, day time fatigue was rampant.

Closer to home (senior ex-pats), we lose about 80% of deep sleep once past the age of 50. That is, our sleep pattern gets lighter and lighter, preventing us from obtaining deep restful sleep. Hence the daytime naps so prevalent for seniors. Women suffer more than men given hormonal fluctuations.

What are the consequences? About 25% of auto accidents are related to sleep deprivation. Daytime fatigue obviously impairs ones function at work (remember the United flight last year where both the pilot and the copilot fell asleep)? Insomnia is not only depressing to oneself but also kills sex drive, which can add to ones depression. In addition, there are significant health consequences. Poor sleep causes stress hormones to rise. Increased stress hormones affects virtually every organ system in the body, deleteriously.

Neuro-peptides which suppress your appetite diminishes while peptides that inhence your appetite increases, therefore the obesity associated with sleep deprivation. Learning is impaired since memory and sleep are intimately related. Your skin ages prematurely while you dumb down (not a good combination). Heart disease, stroke, diabetes, lung disease, high blood pressure and cholesterol are all associated with poor sleep. Pain can cause poor sleep but poor sleep can also diminish your pain threshold thus begetting more pain.

OK, enough of the bad news. So how much sleep do we need? For us adults, it is between 7 and 9 hours. For teenagers, between 8.5 and 9.25 hours while for the younger school children, 10 to 11 hours. I know there are folks out there who feel that life is too short to be wasted on too much sleep. I recommend that you check in with your body and find out what the optimal amount of sleep is for you (where you feel refreshed and energized).
To be complete, we must also consider causes of insomnia, other than those created by ourselves. Some of these are, sleep apnea, unfortunately ubiquitous, and primarily seen in obese individuals, restless leg syndrome, narcolepsy (neurological disorder), sleepwalking, asthma, Parkinson’s and arthritis.

How do we get good sleep? I would suggest that you enter into your sleep cycle with some amount of forethought. Tell yourself that you are moving into another dimension which requires a little preparation and proper environment. Therefore use your bed only for sleep and sex. It should not be another office space, entertainment center or a library (reading yourself to sleep may induce a habituated pattern, which means no book = no sleep). Try to clear your mind before closing your eyes. If you just watched TV news (no way it can make you happy) or an exciting movie, briefly process what you have witnessed and clear it from your mind. The more “work” you take into your sleep, the more processing your mind needs to do. It’s like your office or house. The more debris you create during the day, the more cleaning up is required at night. Proper lighting, soothing music, fragrant aroma all help. Lying on the floor on your back with legs up against the wall ( at a 90 degree angle) can be extremely relaxing, if you are agile. Rewinding your clock, that is, remembering your thoughts and feelings of the day starting from the present moment and going backward to the early evening, then to the afternoon and gradually remembering the moment you awoke that morning can unload a huge amount of psychic burden on your mind. Obviously a light snack, preferably carbohydrates (makes you drowsy) is more conducive to sleep than a heavy fatty meal. Minimize caffeine and alcohol before bedtime, if at all. Try to avoid excessive day time naps, which can easily reverse your sleep cycle. Exercising in the late afternoon or early evening also helps you rest well at night. It is to be hoped that you will realize that you have much more control over the quality of your sleep than you might have thought. It is a sacred realm that we enter. It can be a profoundly relaxing, healthy and revealing experience. In my opinion sleep medications should only be used in dire circumstances (it can easily become habit forming and prevents normal sleep cycle). Natural sleep aides such as melatonin and valerian can be considered. Finally, do not obsess about your insomnia. If you find yourself awake in the middle of the night, just enjoy the quiet, dark space. No phone, no work, there is really nothing to do. Might even spend this time making a list of things you are grateful for. Just relax and before you know it, you will drift off. Rest easy.

Wishing you health and happiness,
Dr. Philip Bhark M.D., FACC