This article was written by: M. Maran, Carleton University Journalism Student, 2001.
The first long night I can remember was when I was fourteen, sitting at the
kitchen table at four in the morning, glass of milk in hand, listening to the buzz of the refrigerator. How could I be so awake when everyone else is asleep?
If you’re anything like me, and an estimated one in ten Canadians, this is a familiar tale. Insomnia is one of the most common disorders, and it can have serious side-effects. Researchers in Australia and New Zealand have found that sleep deprivation can impair the mind just as much as alcohol can. Yet while most people recognize the potential dangers of alcohol, few realize the impact of a sleepless night. And for insomniacs, these long nights are a fact of life.
My sleepless nights subsided until the next spring, when two cheerleaders at my school were killed by a freight train on tracks just around the corner from the student parking lot. It happened at lunch hour, and everyone was outside because it was such a beautiful day. I didn’t cry; I couldn’t. But for the next few months, the vision and sound of the train haunted my nights and scared away the sandman.
I was prescribed sleeping pills, which had little effect. Then one night my younger brother Dave, said something that would prove more effective than any pill: “What’s the big deal? It’s just sleeping. It’s easy. Just lie down in bed and close your eyes.” It worked.
The insomnia bounced back a few times during high school, lasting anywhere from a week to a month. But throughout most of university, it remained dormant. Last fall, it returned with a vengeance. I don’t know if it was September 11 that set it off, or the stress of a final year at school, but all of a sudden I was awake again. For six straight days. By day three, I was losing my mind.
I saw a vampire in the grocery store, shadows of people in an empty hall, words in books that just weren’t there. And I felt things too. One night I was so convinced that I broke my jaw on a piece of pizza, that I woke my boyfriend to ask him to drive me to the hospital. I was constantly falling and hurting myself. There were shivers, headaches and nausea. I couldn’t finish a sentence or a complete thought, so I stopped answering the phone and going to school. And for the first time ever, life was a chore.
According to sleep experts, my experience was the result of too much wear, and not enough repair, on my body and mind. Sleep regulates body chemicals, improves memory, fights infection, controls temperature and repairs tissue. Without this nightly rejuvenation, I was a mess. Different sleep stages also have different roles in maintaining the body. Deep sleep is needed for the body to repair itself, though it’s not clear exactly how it does this. REM sleep (rapid eye movement) has been credited as the stage for remembering, forgetting and dreaming, among other cognitive activities.
Sleep deprivation can cause mental problems because of sleep’s role in regulating and restoring the chemicals in our brain. Throughout the day, serotonin, a chemical partly responsible for regulating mood and perception, builds up in our brain, making us feel tired. As we sleep, the chemical is released and balance is restored, leaving us feeling refreshed the next day. Without sleep, there is an imbalance of serotonin and other neurotransmitters that control vital bodily functions. This chemical imbalance could be the explanation for my frightening hallucinations after three days of no sleep, says Clinton Marquardt, MA, RPSGT, one of only a handful of Professional Sleep Coaches. “My own hypothesis for those interesting experiences that can happen when you’re sleep deprived is that because serotonin has a similar structure to LSD, too much of it can cause very similar experiences.” Well, it was a strange trip, but thankfully not a long one. My doctor prescribed me some pills, saying they would “break the cycle.” Though I finally had some rest, the cycle was far from over. I am still taking them.
However, all cycles have a beginning, and for insomnia, understanding the cause may lead to a personal cure. For some people, irregular work hours or jet lag may trigger insomnia. For others, caffeine sensitivity, nicotine, illness, lifestyle or medications could play a role. And demographically, more women than men feel they are sleep deprived. A recent poll commissioned by the Canadian Press suggested that one in four Canadian women cannot get a good night’s sleep, compared to one in five men. Sleep specialists say more women than men report insomnia, though whether this is due to social reasons or a real propensity is unclear.
PMS can cause insomnia, as can pregnancy and breastfeeding. In a 2001 Statistics Canada survey, 61 per cent of women reported feeling stressed from trying to balance family life with their jobs, compared to 39 per cent of men. And while the passage of time can ease some of these demands, aging presents some new obstacles for women. The hot flashes of menopause can make it hard to fall asleep, and frequent awakenings can interrupt a refreshing, deep sleep. A common cause of insomnia is the body’s response to stress – both physical and mental. “When the initial stress is gone, the problem remains because your mind and body have learned a new pattern.”
Clinton, the Sleep Coach, says this pattern is a state of “conditioned arousal” that occurs after a couple bad nights when the mind begins to associate the bed with being awake, despite having resolved the initial worry. “Not to sound simplistic, but it’s like Pavlov’s dogs. The same thing can happen in humans. If you pair the bed with mental arousal, especially when you add in that negative emotion that comes from not sleeping, your brain thinks; ‘Hey, I should be awake now.’”
And so the cycle begins. Clinton says the brain could then go into a chronically aroused state, paired with physical problems. “Once insomnia really kicks in, the physical problems can cause more stress. Things like gastrointestinal problems, and all the performance-related issues…”
This clear mind-body connection is perhaps what makes insomnia such an ambiguous disorder. While a common trigger may be mental stress, the problem soon becomes physical, presenting a new reason to lie awake worrying at night. The people who suffer the most seem to be suffering in silence. They don’t feel comfortable talking about it. The burden is lighter when they can talk about it. Some are talking about it in cyberspace, on insomnia chat rooms and message boards. Most entries are time-stamped in the early morning hours, with desperate cries of: “How do I stop this thing?… I thought I had spiders in my hair!… How can I get off these pills?… Today was rough….No sleep all week…I had to quit my job…Why is this happening to me?”
I wish there was Internet access in the house when I was 16 and sleepless. When the night boredom became irresistible, I would call up sleeping friends, or as a last resort, make a noise to wake up my family. Not even for conversation, but just to hear a squeak or shuffle before they fell back to sleep. I wanted to find other night owls, but except for my yowling cat, there were none to be found.
A poll conducted by the American National Sleep Foundation in 2000 found that 27 per cent of the respondents felt sleepy at least two days out of the work week. And of those people, 68 per cent said this affected their ability to perform on the job. “Many people who are lying in bed awake will say to themselves; ‘I won’t be able to cope tomorrow at work’ and they keep looking at their clock,” say the sleep specialists. This performance anxiety can perpetuate the insomnia, and continue the spiral.
This pattern is what Sleep Coaches like Clinton try to break. After ruling out physical causes using polysomnograph monitoring (hooking people up to wires and observing their brain waves during sleep), or using an electronic questionnaire like the Sleep Advisor, they focus on re-training the person to sleep through behavioural and lifestyle changes. “There’s nothing magical or weird about it. People have been sleeping for millennia,” says Clinton. Which is perhaps why my brother’s advice to ‘just do it’ was so effective. As long as I was thinking about my difficulty sleeping, or how to sleep, it never came.
Teaching people how to relax can take time, which is why behavioural therapy lasts for at least a month. But for some insomniacs, behavioural changes take too long to show results. For these people, sleep medications may be the only help in sight. An estimated ten per cent of Canadians use pills to fall asleep and Clinton says that at most sleep clinics, pills are the only help offered to insomniacs, when they can be used very effectively in conjunction with behavioural therapy.
Experts agree that most older tranquilizers can cause rebound insomnia, where stopping the drug makes the problem worse. This means a person must continue taking them, or face the effects of withdrawal. Many older generation sleep aids also cause a hangover feeling the next day says Clinton. “These pills don’t give you a normal sleep. They act as major depressants on the entire brain and can interfere with deep sleep.” Clinton also goes on to say that the newer sleep medications like Starnoc (Zaleplon) are very effective when used properly and are combined with behavioural therapy, “Starnoc does not interfere with deep sleep, it does not cause rebound effects or withdrawal, and it can be used for extended periods of time without developing tolerance.”
Sleep-deprivation due to sleep disorders like insomnia is gradually gaining more recognition and understanding, partly due to extensive coverage of fatigue-related tragedies, such as the Exxon Valdez oil spill, the destruction of the space shuttle Challenger, the nuclear accident at Chernobyl, and long-haul trucking accidents. “There’s much more awareness [of sleep deprivation] now because of all the information technology that’s out there, like the Internet,” say sleep experts. “The sheer number of sleep labs springing up all over the place shows we’re becoming more aware. Consumers are demanding better treatment.”
In Ottawa, Canada, there are six sleep clinics. The Canadian Sleep Society lists close to 100 for the entire country. Most provincial health insurance plans cover sleep clinics, and some workplaces are even promoting napping as a way to relieve fatigue. In the last few years, sleep clinics have seen an increase in the number of patients they see who report insomnia. Whether this represents new cases, or just a new awareness of the problem, it means that more people are realizing the importance of sleep, and their right to have it.
My journey with insomnia is not over yet. I’m still on the meds, and while many nights are good – some are bad. Yoga has been helpful, and visualizing a sun-dappled forest trail, though boring, has seemed to calm me down. Tonight I might try sniffing an onion before bed, a remedy I found on the Internet.
But for all its drawbacks, insomnia is a part of who I am. Without it, there would have been less time to read books, draw pictures, watch infomercials and ponder the mysteries of life. When I sleep well, I actually miss the long quiet night, and the vacation it can offer from a hurried life. But too much of anything can drive a person crazy.
As dusk falls, that voice in my head chides; You won’t sleep tonight. And you’ll feel horrible tomorrow. Don’t even try. Maybe the voice is right. But I control my own destiny, and it’s time to take back the night. I respond to the voice: I will sleep, and it’s about time you did too! Sweet dreams.
M. Maran, Carleton University Journalism Student, 2001.