If you awoke this morning feeling drained and exhausted after a poor night's sleep, read on!
What we're about to explore just might make a major difference in the quality of your life if you’re
having difficulty sleeping on a regular basis.
While issues of sleep apnea (breathing cessation) due to a host of respiratory and central nervous
system causes has been discussed in a prior column, we’re about to focus on insomnia from a rather
Rather than dwelling on well-established causes such as medication side effects, exercise,
eating/drinking/smoking prior to sleep, noise, jet lag, or extreme temperatures, let's take a closer
look at an issue that is far more commonplace.
It's a fact many people in our society simply suffer from insomnia for no apparent cause. This is
especially apparent for seniors, yet individuals of all ages experience this as well. While the issue
of daytime fatigue associated with disordered sleep is well recognized, many other symptoms remain
relatively obscure. Some of these include headaches, muscle tension, irritability, frustration and
diminished mental/physical performance. The list is rather extensive when one considers the fact that
adequate sleep is necessary for appropriate neurological, endocrine and immune function.
It is not surprising that the most common treatment for insomnia unassociated with sleep apnea (even
in the absence of a bona fide cause) is a prescription for sleeping pills. Unfortunately, side
effects vary considerably and effectiveness tends to diminish over time. Most people do not even
consider another approach.
A recent study published in the Journal of the American Medical Association (JAMA, April 11, 2001) is
shedding new light on insomnia from a rather unique treatment perspective. It has nothing to do with
the latest pharmaceutical breakthrough, the most commonly touted supplement, or counting sheep.
Researchers at Duke University Medical Center studied 75 men and women (average age 55.3 years) with
sleep maintenance insomnia, a condition characterized by more than 30 minutes of awake time in the
middle of the night. These people did not experience transient sleep problemsæ subjects on average
noted 13.6 years of insomnia. Participants were randomly divided into 3 6-week interventions which
included cognitive behavioral therapy including sleep education, stimulus control, and time-in-bed
restrictions, relaxation training or placebo therapy.
The investigators used polysomnography (sleep studies) to determine outcomes. The most favorable
effects were found in cognitive behavioral group participants who manifested a 54% reduction in wake
time after sleep onset even through 6 months of follow-up. Those in the relaxation group and the
placebo group averaged 16% and 12% reductions respectively. Sleep efficiency (the amount of time
asleep compared to the total time in bed) was 85% for the cognitive behavioral group compared with
78.8% in the relaxation group.
The Duke researchers also identified 2 common misconceptions about sleep. The first belief is that
everyone needs 8 hours of sleep a night in order to remain healthy. The second is that the elderly
can and should sleep as much as much as they want even if it means remaining in bed in the morning to
catch up on a poor night's sleep. Both of these assumptions are clearly erroneous.
The bottom line - reestablishing a healthy sleep-wake cycle requires a 3-fold strategy:
- Eliminate excessive naps during the day as well as the triggering causes noted previously.
- Follow a consistent schedule for going to bed and getting out of bed in the morning.
- Develop appropriate expectations for the amount of sleep time your body needs. Healthy sleep time
varies considerably - learn to listen to your body.
While these suggestions seem elementary on the surface, they have been scientifically shown to
substantially improve sleep. As a physician, I believe it is much more sensible to offer these
insights to anyone in need rather than simply prescribing sleeping pills.
On a final note (this is no time for yawning), here’s a personal suggestion I'd like to add. Consider
avoiding our planet's greatest recount of violence (the World News) prior to sleep. A healthy dose of
laughter instead just might create the stuff pleasant dreams are made of - Mind Over Matter!
© 2001 Barry Bittman,
MD all rights reserved