Wasn’t the grass greener? Sleep.

Once upon a time (if memory serves me right) sleeping was simple thing. You went to bed when you were tired or you went to bed when you thought you should. Sometimes you read a little, something not too lofty, to assist with falling asleep. Thems that couldn’t sleep shrugged their shoulders and went out into the living room to do something until they felt sleepy. The next day they dragged a bit, but if asked they told co-workers they didn’t sleep well last night and where’s the coffee?

“I can’t sleep!” is one of the most frequent presenting factors of a new patient. This is usually said with a high level of anxiety, a sensation if they don’t get enough sleep at the time they feel they ought to, they will go to pieces and life will be ruined. Mind! Not getting enough sleep is a serious problem and nothing to be dismissed. However so many do things that thwart a good night’s sleep and many have poor solutions what to do about it.

Getting enough sleep is sacrificed for other things. We stay up late: we take the TV/the phone/the laptop to bed with us. Ironically many of these technie toys have apps and to monitor their sleep, which often paradoxically worsen sleep: people wake up to look at these things to see if they are getting enough.

Alas, Babylon! Despite our 21st century lives our brains are still wired for the 19th century, when daylight (or lack thereof) guided our circadian rhythms to go to sleep and when to wake. Modern folks think the brain is like a computer: when done for the day you press the ‘off’ button. The brain is more like a plane that needs to descend slowly to arrive at The Land of Nod airport.

The main treatment for insomnia doing all you can to accommodate its needs and not the other way around. These matters are lumped into what is called sleep hygiene. Common sense things (common to our grandparents anyway) is to slowly turn down the activities and lights in the evening, get off the techie toys, avoid caffeine and alcohol (and curried snacks), and make the bedroom as sleeping-friendly as possible: cool, dark, and devoid of distractions – like my men.

There is a need to get the insomniac patient to stop thinking or freaking out over not falling asleep at the time they feel is right. In cognitive behavioral therapy for insomnia patients are sometimes asked to not force sleep at their ‘should time’ but let the brain fall asleep when it will, combined with a set wake up time every day including weekends. These non-pharmaceutical interventions take time to practice and work – and they go over like a lead balloon. Patients (the ones I see) want ‘something for sleep’ meaning a sleeping pill to go and stay asleep. Sleeping pills sort of work like hitting a large hammer on the head in a Bugs Bunny cartoon. They work OK for a while but often stop working. Some patients become psychologically and physiologically dependent on sleeping pills “I can’t sleep without my Ambien!” They show as evidence they have to have them if they skip a dose they have anxious insomnia, when this is mostly withdrawal or anxiety about not sleeping without medication.*

Sleeping ought to a good thing, not something to fight or struggle with.

On the whole we work too much, worry more, ruin our nights and it all leads to lousy sleep.

Do you have troubles with sleep?

*A very hard sell is convincing long-time users of hypnotics Rx they may not need them anymore. It is like convincing Dumbo he can fly without his magic feather. Yes, they won’t sleep well for a while in the process, but in time the vast majority start sleeping OK/enough, as if they were never on sleeping pills. It’s a rare patient willing to try this.