Tag Archives: insomnia

Is it Insomnia or Delayed Sleep Phase?

Insomnia is an inability to fall asleep easily or stay asleep throughout the night. Delayed Sleep Phase is when a person is on a later schedule than the norm. The tricky thing is that Delayed Sleep Phase can masquerade as insomnia, because it can also cause difficulty falling asleep.

In Delayed Sleep Phase the circadian rhythm is pushed later, so the person doesn’t get sleepy until later than the norm. So if he tries to go to sleep at a normal time, he lies awake in bed, and experiences insomnia. However, if he goes to bed later when he feels sleepy he will have no sleep problem.

Recently I saw an adult woman who had delayed sleep phase, but who had been diagnosed with insomnia and treated with sleeping pills. One of the clues that she had Delayed Sleep Phase is that she said ” I am never sleepy at bedtime.” We shifted her circadian rhythm earlier, using light therapy and precisely timed melatonin.

Within 6 weeks she was sleeping well through the night, without the sleeping pill she’d previously taken.  Her last comment to me was “Now there’s nothing for me to do but keep on sleeping.”

To learn more about Naturopathic Sleep Medicine and Dr. Catherine Darley please go to www.naturalsleepmedicine.net.  Sleep Well, Naturally.

Sleep Promoting Thoughts

There’s a saying in the sleep community “the only people who try to sleep are insomniacs, everyone else just sleeps.”

Unfortunately, sleep can be one of those things that becomes more difficult the harder you try. Sometimes patients share that when it starts getting dark, they begin worrying whether they’ll be able to sleep well at bedtime. Other thoughts that can disrupt sleep include comparing your sleep to others, canceling fun activities due to your sleep, attributing your mood to your sleep.

So if you find yourself having negative sleep thoughts during the day: pause, and question “is this true, or is there another way of seeing this?” There may not be, but purposefully switching into sleep promoting thoughts when you can will help your sleep in the long run.

More about natural sleep medicine can be found at www.naturalsleepmedicine.net.

Positive Sleep Associations

Sleep is interesting in that it is a physiological process, which is strongly influenced by habit. When we work to have positive sleep associations with our bedroom, we can sleep better.

Remember Pavlov’s dogs? Whenever Pavlov fed the dogs, he would ring a bell. Eventually just ringing the bell would cause the dogs to start salivating, because they associated the bell with food.

People can also develop these type of associations. For instance, hard not to think about food when you’re standing in the kitchen. What associations have you developed about your bedroom?

Sometimes, when people spend a lot of time awake in their bed or bedroom, they start to associate it with being awake. This can feed into difficulty falling asleep or staying asleep.

To create a positive association of your bedroom as someplace to sleep, avoid being awake either in bed or in the bedroom.
– Choose to unwind before bed in another room.
– Don’t have a TV or computer in the bedroom, as those are waking activities.
– If you are awake more than 30 minutes at the beginning of the night, or 10 minutes in the middle of the night, get up and do something boring until you are sleepy enough to return to bed.

To learn more about Naturopathic Sleep Medicine go to www.naturalsleepmedicine.net.

Tryptophan for sleep: Truth or Turkey?

Many stories abound about how the tryptophan in turkey or a glass of milk before bed will help you sleep.  Is this true or not?  Let’s look at the information.

Tryptophan is an amino acid found in foods.  Many amino acids combine to make a protein.  These proteins are then digested and broken down into the amino acids.  Amino acids are carried by the blood throughout the body.  When we think about sleep, the important organ is the brain.  There is a “blood-brain barrier,”  which substances in the blood need to be transported across.  Tryptophan uses the same transporter as several other amino acids.  If those amino acids are in the blood at the same time, they will compete with tryptophan, so less tryptophan will cross into the brain.

Why is tryptophan relevant to sleep?

Several of the neurotransmitters (brain chemicals) of sleep rely on tryptophan for their production.  Among these are serotonin and melatonin.  Melatonin has been discussed in other blog posts here.  Increasing tryptophan by taking tryptophan supplements does help treat insomnia.  These supplements provide higher doses of tryptophan than can be found in food.  Cottage cheese has the most tryptophan per serving, at 400mg tryptophan in 1 cup.  A 3oz serving of turkey provides 283mg of trytophan, and 1 cup of milk 110mg.

Does the tryptophan in our Thanksgiving turkey help sleep?

Thinking about the tryptophan basics we first discussed above, the tryptophan in turkey probably doesn’t help you sleep.  This is because there are other amino acids in the turkey, some of which may compete with tryptophan to be taken into the brain.  That said, enjoy the sleepy reverie that often follows the Thanksgiving feast!

The Winter Holidays and Acute Insomnia

The winter holidays can be filled with fun activities, celebrations with friends and family, and snow sports.  But holidays can also be stressful as we both maintain our regular responsibilities and prepare for the additional activities.  This year many people are also concerned about the recent economic downturn.  The combination of the holidays and economic concerns can lead to acute insomnia, the topic for today.

What is Acute Insomnia?

Acute insomnia is the inability to fall asleep within 30 minutes, or spending more than 30 minutes awake in the middle of the night.  Acute insomnia is a completely normal response to life events, and something we will all experience periodically.  It becomes chronic when it has persisted for more than a month.  Although it is normal in times of extra activity or worry, there are still habits we can put in place to help us get the sleep we need to feel good.

Healthy Sleep Habits during the Holidays

Below are several ideas to keep you sleeping well during the holidays.  Remember the effects of insufficient sleep that we’ve talked about in other posts, such as having emotional ups and downs, difficulty concentrating, poor manual dexterity, and fatigue.  Getting enough sleep allows us to really enjoy this season more fully.

– Plan a little time (20 to 40 minutes) to wind down before you get into bed.  This will allow you to fall asleep more quickly.  Spend this time doing something you enjoy that does not involve bright light like TV or computers.

– If your thoughts start to spin once you get into bed, start the habit of journaling.  The goal here is to put your thoughts to bed before you put yourself to bed.  Spend 10-15 minutes (no more) every day putting those thoughts down on paper a couple hours before bedtime.  Then if they arise during the night, tell yourself gently but firmly “I’ve thought about that already, and I’ll have time to think about that tomorrow.  Now is the time to rest.”  Although this sounds simple, it is amazingly effective.

– If you are going to stay up late for a party, plan to start the following day a little later, or slower.  Another option is to take an afternoon nap before your late night.  Don’t take a nap if you will be going to bed at your regular time, as it will make it more difficult to fall asleep.

– If there are regular tasks you do that can be suspended or rescheduled until after your holiday plans, consider doing it.  This will help preserve the time you need for sleep.

– Remember that drowsy driving can be as dangerous as drunk driving, so plan accordingly.

Progressive Muscle Relaxation for Sleep

Many people in my sleep clinic report lying in bed unable to sleep, having insomnia. This happens either at the beginning or middle of the night. For people who are thinking a lot, the Gratitude Meditation from last week can be helpful.

Another technique to help you fall asleep is called Progressive Muscle Relaxation. I recommend this for the people who report tossing and turning in bed. The benefit of Progressive Muscle Relaxation is that it both occupies the mind and relaxes the body. Below are the instructions, you can use this natural technique whatever time you are awake in bed.

  1. Starting with your toes, tighten a muscle group for a count of 8, then relax it fully, allowing those muscles to feel heavy and sink into the bed.
  2. Focus your mind on clenching your muscles and slowly counting. Gently turn away other thoughts.
  3. Next, slowly move up to the next muscle group, your calves. Repeat.
  4. Continue moving up your body through legs, abdomen, bottom, hands, arms, back, jaw, face.
  5. Be sure to continue breathing regularly during this practice.

People regularly find that they are asleep before they complete the entire sequence.

Behavioral Treatment for Insomnia

How does Insomnia develop?
Frequently there is an initial stressor that causes a person to not sleep as well. This could be either a happy event such as a wedding, or a stressor such as a job change. It is normal to have disrupted sleep for a short while. This is called acute insomnia.

Chronic insomnia is defined as lasting more than one month. In this case the person has frequently developed thoughts and habits that perpetuate the insomnia, even after the initial event is over.

What are treatment options?
The primary goal is to treat the underlying cause of the insomnia. There are both prescription drug treatments and behavioral treatments for insomnia. When insomnia is due to a medical or mental disorder the underlying disorder must also be treated.

Behavioral treatment for insomnia is a well-thought out approach that addresses several contributing factors in a systematic way. The therapeutic components include:
– Relaxation techniques. Example: Focusing only on the breath, breathe in slowly for a count of three, out for a count of three.
– Stimulus Control therapy. Example: Be in bedroom only when drowsy or asleep.
– Sleep Restriction therapy. Example: Limit time in bed just to the time spent asleep. In other words, no long periods of lying in bed trying to sleep.
– Education about sleep. Example: Waketime determines when you will get sleepy, so setting a consistent waketime will allow you to fall asleep easily at bedtime.

Research has shown that behavioral treatment for insomnia is more effective than prescription drug treatment, even two years after treatment.

Insomnia

There are many possible reasons to sleep poorly . . . stressful work, relationship conflict, pregnancy, moving, even summer heat. When your sleep is first disturbed, it can be helpful to keep in mind that everyone’s sleep is disturbed periodically for good reasons. If you’ve recovered from that initial event, but your sleep still remains poor after one month, then it is time to take steps to improve your sleep.
Insomnia is defined as spending more than 30 minutes at the beginning of the night to fall asleep, or awakening in the night for extended periods of time. When this happens most nights of the week for a month or more it is classified as “chronic insomnia.” It’s interesting to note that typically patients wait 7 years before they seek treatment for insomnia. In my clinic, the average duration of adult’s insomnia is closer to 20 years. As we’ll discuss in the future, insomnia has lots of daytime impact on mental, emotional and physical health.