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No More Sleepless Nights

Dov Finkelstein, LCSW

Insomnia steals the sleep of 40 million Americans. Learn how to use C.B.T. methods to vanquish it — a method proven faster, more effective, and safer than sleeping pills.

Wednesday, March 21, 2012

bedside tableForty million Americans toss and turn all night, sleep elusive. This difficulty sleeping — insomnia — is a common disorder, affecting twice as many women as men. True insomnia presents in several ways, with symptoms lasting at least one month: the insomniac may have trouble initially falling asleep or will wake in the middle of the night or in the early morning hours and be unable to fall back asleep.

Situational stressors are the most common reason people can’t sleep. Constant tension weighs down on the individual, triggering related thoughts, heightening emotions, and quickening his heartbeat. This hyper-aroused state makes it hard for the person to unwind at night and allow drowsiness and sleep to set in.

Unfortunately, many people continue to struggle with insomnia even after the original source of anxiety is resolved. In Sarah’s case, her insomnia began as a job-related stress, but persisted even though she is happy in her present situation and not feeling strained. This occurs because after several days of difficulty sleeping, the insomnia takes on a life of its own —it consumes the sufferer’s mind. She spends her waking hours perseverating over the quality of her sleep the previous night. Every conversation starts with a remark about last night’s sleep. In the afternoon, she checks in with herself to see how her lack of sleep is affecting her daily life. All day long, she can’t stop worrying: “How long will this last?” “Will I ever be able to fall asleep again?” “I hate walking around tired.” At night, instead of relaxing in bed and allowing sleep to come, she tries harder to fall asleep, which only makes it more difficult.

In addition to the stress of not being able to sleep, the insomniac introduces new behaviors to his routine to cope with his perpetual fatigue. For instance, he may spend more time in bed or take daytime naps to obtain his “required” amount of sleep. Although these strategies work in the short term, providing temporary relief from exhaustion, in the long term they backfire because they upset the brain’s internal clock, the circadian rhythm.

The circadian rhythm controls the body’s sleep-wake cycle: the natural rhythm of feeling tired after being awake roughly 16 hours, and feeling rested after sleeping about eight hours. (Younger adults may have 25-hour cycles or longer, while older adults have considerably shorter cycles.) For this clock to run smoothly — and for you to feel most rested — it should be synchronized, that is set, with consistent behaviors. For example, you should go to bed around the same time at night and wake up around the same time each morning. Excessive time in bed, going to sleep and arising at atypical times, or taking a daytime nap interfere with the body’s sleep-wake rhythm. That’s why taking a late afternoon nap or one that lasts more than an hour makes it more challenging to fall asleep that evening.

Each of these factors combine to create a vicious cycle. The more time passes, the more difficult it becomes to get a good night’s sleep. Many people are desperate by the time they come in for treatment.


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