Difficulty Sleeping

Sleep, and lack of sleep, affects our daily functioning and our physical and mental health in many ways that medicine and psychology are just beginning to understand. Sleep problems include difficulty in getting to sleep, problems staying asleep, waking up too early and not being able to fall back to sleep, as well as more severe problems such as Sleep Apnea, Restless Legs Syndrome, and Narcolepsy.

Almost everyone has nights when you can not fall asleep or when your sleep is fitful.  However, in the U.S. sleep deprivation and fatigue are major health issues.  A recent survey found that over 40 million Americans each year suffer from chronic, long-term sleep disorders and over 20 million more experience occasional sleep problems. Estimates are that between 25%-50% of Americans have difficulty with sleep.

The amount of sleep you need depends on several factors including your age and health condition. In general, infants need about 16 hours a day, teens need about 9 hours on average, and most adults need 7- 8 hours sleep a night. People tend to sleep more lightly and for shorter time spans as they get older, although they generally need about the same amount of sleep as they needed in early adulthood.

Sleep deprivation interferes with work, driving, social activities, and our personal lives. It accounts for an estimated $16 billion in medical costs each year, plus much more due to lost productivity and other factors related to fatigue and sleep deprivation.  Doctors have described more than 70 sleep disorders, most of which can be managed effectively once they are correctly diagnosed. The most common sleep disorders include insomnia, sleep apnea, restless legs syndrome, and narcolepsy.

The following is a brief summary of the major types of sleep problems:

Insomnia

Three types of insomnia include: difficulty falling asleep; no problem falling asleep but difficulty staying asleep; and waking up too early.  Insomnia typically results from stress, environmental noise, extreme temperatures, shift work or other nighttime activity schedules, the side effects of medication, jet lag, diet, as well as physical problems, medical problems, depression and other mental health problems. Insomnia tends to increase with age and affects men a little less commonly than women.

Insomnia can affect not only your energy level and mood, but also your mental and physical health.  It leads to diminished mental alertness and concentration.  The following behaviors have been shown to cause or perpetuate insomnia:

* poor sleep habits like watching T. V. in bed or napping in the afternoon or evening
* consuming stimulants such as caffeine or chocolate
* drinking alcohol before bedtime
* smoking cigarettes before bedtime (nicotine is a stimulant)
* taking some medications and herbs
* physical problems such as pain
* stress, depression, and anxiety
* lack of exercise
* long-term use of sleep medications
* eating significant amounts late in the evening

Sleep Apnea

Sleep apnea is a disorder of interrupted breathing during sleep. If you have sleep apnea (the majority of sleep apnea cases are undiagnosed) the frequent awakenings that result from sleep apnea will leave you continually sleepy and may lead to irritability or depression. In addition, since sleep apnea deprives you of oxygen, you may experience morning headaches, a loss of interest in sex, a decline in mental functioning, high blood pressure and irregular heartbeats.

Restless legs syndrome

Restless legs syndrome is an unpleasant crawling, prickling, or tingling sensations in the legs and feet and an urge to move them for relief. This disorder, which affects as many as 12 million Americans, leads to constant leg movement during the day and insomnia at night.

Narcolepsy

The main characteristic of narcolepsy is excessive daytime sleepiness, even after adequate night time sleep. Daytime sleeping ("sleep attacks" or naps) can be physically irresistible, can occur without warning at inappropriate times and places, and they can occur several times a day. These attacks last from several seconds to more than 30 minutes. 

Treatment of sleep problems is either medical, psychological or some combination of these. Like most mental health professionals, if I have a client suffering from sleep apnea, restless legs syndrome or narcolepsy, I refer them to an appropriate physician or sleep clinic since these problems are best treated with medication or other types of medical intervention.

The treatment of insomnia is a difference story.  For short-term insomnia, doctors may prescribe sleeping pills, but studies have found that after several week the sleeping pills become less effective and they frequently lead to daytime drowsiness and fatigue.  Accordingly, many of my clients choose psychological therapy to help prevent or overcome insomnia.  I have found that therapeutic approaches such as traditional psychotherapy, behavioral therapy, and relaxation techniques can help clients to develop good sleep habits and overcome insomnia. Reconditioning and "sleep restriction" can also be helpful.

Reconditioning means not using your bed for any activities other than sleep and sex (some experts even exclude sex).  You only use your bed when you are sleepy and, if you are not able to fall asleep, you get up and stay up until you become sleepy, and then you return to bed. Sleep restriction is based on the idea that you may be spending too much time in bed unsuccessfully trying to sleep and may benefit from a program that at first allows only a few hours of sleep during the night. Gradually the time is increased until a more normal night's sleep is achieved.

While medication can be used (in 2007 over 24 million prescriptions were written for the top 4 sleep medications and the top 2 sleeping medication advertisers spent over $500 million in advertising) my clients generally prefer not to use them.  A recent study by Consumer Reports found that for many people sound machines, cognitive-behavioral techniques, and modified sleep routines were just about as effective as sleeping pills and without the side effects.

If you suffer from one of the 3 types of insomnia (difficulty falling asleep, difficulty staying asleep, and waking up too early) a psychologist or other mental health expert can help.

For more information about insomnia and other sleep disorders, please click on the linked websites listed below.

"If you really want help dealing with your feelings and emotions, changing your behavior, and improving your life, I will be happy to help you.  I am available almost any time and any place.  You can call me directly and there is no cost or obligation for the initial telephone consultation.  Or you can reach me by email.  I look forward to the possibility of helping you to improve your life."   Dr. Vince Berger