Insomnia: Breaking the Cycle

Written by Beth JoJack

Jay Walker has battled with insomnia his entire life.

While serving in the Army, Walker found himself going days at a time without any shut-eye. “The military doctors would actually order me to bed,” he recalls. “Sometimes that worked and sometimes it didn’t.”

Walker, who lives in Marlinton, WVa., went on to build a career as a cosmetologist and cosmetology instructor, but he quit working in the mid-1990s because he had difficulty functioning on so little sleep.

Over the years, Walker, 55, figures he’s tried most sleeping pills on the market.

“Now they have me on Seroquel, which kind of quiets the mind down,” Walker says. “It doesn’t actually make me sleep, but it kind of turns things off. That’s always been the issue. My mind goes constantly 24/7.”

It’s not unusual for individuals suffering from severe chronic insomnia to have this kind of brain excitability, experts say.

“The idea is that they have this hyperarousal,” explains Rachel Salas, an associate professor of neurology at Johns Hopkins University School of Medicine. “Just like the car that’s always running … they can’t really wind down.”

Too Many of us Aren’t Sleeping

The National Sleep Foundation estimates that 40 million Americans suffer from insomnia, defined as getting too little or poor-quality sleep. Ten percent of adults in the United States have chronic insomnia, meaning they have trouble falling or staying asleep at least three times a week for at least three months, according to the Centers for Disease Control and Prevention.

Individuals suffering from insomnia face the kind of effects familiar to anyone who’s ever pulled an all-nighter studying for an exam. “They’re tired,” Salas says. “They have memory concentration issues. Mood changes. Irritability. Poor quality of life.” 

Nearly everyone has sleepless nights, but sometimes, not sleeping can go beyond a few nights of not enough zzzzs and start to affect everyday life. Many people may experience short-term insomnia, especially if they’ve gone through a traumatic event or big stressor in their life, according to the Mayo Clinic. Insomnia can also become more common with age due to changes in activity, health, sleep patterns and increased medications.

Chronic insomnia can cause real problems. It can increase an individual’s risk of suffering from a whole slate of health problems including obesity, type 2 diabetes, high blood pressure and heart disease.

There’s also a societal toll. A 2011 study found an estimated $63 billion is lost in work performance due to insomnia each year. Research also indicates a significant link between insomnia and fatal car accidents.

The Right Kind of Help for Insomnia

With so much at stake, anyone who feels their sleep trouble is causing problems with daily life should call a doctor. There are a number of methods available to help.

About 25 percent of Americans take some type of medication to help them sleep, according to the National Sleep Foundation. Health professionals caution, however, that these sleep aids cause side effects and are intended for short-term use.

Cognitive behavioral therapy for insomnia, also known as CBT-I, is considered a better treatment. “That’s what’s been proven to have the best outcome,” Salas says. 

With CBT-I, an individual suffering from insomnia will work with a trained mental-health professional to replace thoughts and behaviors that make sleep problems worse with thoughts and behaviors that promote a good night’s rest.

Emily Fitton, a psychotherapist in New York, N.Y., began training in CBT-I after suffering with sleeping problems herself. When the techniques she learned solved her own insomnia, she began offering a six-week CBT-I program at her practice.

Individuals often begin struggling with chronic insomnia, Fitton explains, when they become overly fixated on not being able to sleep.

“Then the insomnia starts to feed on itself,” Fitton says. “People’s negative thoughts produce negative emotions that keep them awake and they start doing compensating behaviors. They start spending more time in bed. They start maybe having a drink to relax. They cut back on exercising or going out because they feel too tired. All of those behaviors paradoxically will actually make the insomnia worse.” 

As part of her program, Fitton teaches patients about the science of sleep. She talks about how it’s a myth that every person requires eight hours of sleep every night. “Everybody’s sleep needs are variable based on their own biology and genetics and also day-to-day depending on how active a person is,” she says.

Basic sleep hygiene is another part of the program. Fitton advises patients to keep their bedroom cool, not to drink alcohol and not to exercise within three hours of bedtime. Anything other than sleeping and sex, Fitton preaches over and over, should be done outside of the bed.

“Don’t play with your devices. Don’t pay your bills. Don’t have arguments with your partner,” she says. “The bed sort of becomes a shrine to sleep.”

Setting up a sleep schedule is another important component of CBT-I. That means sticking to an assigned time to go to sleep — usually a bedtime that’s later than the person is used to — and a time to wake up. “We’re sort of pushing them into a state of sleepiness,” Fitton explains.

The proof of the treatment is in the success rates. CBT-I has been shown to improve the symptoms of chronic insomnia for 80 percent of individuals who are treated, she says. “I am a believer because I’ve seen it work.”

About the author

Beth JoJack

Beth JoJack is a freelance writer who lives in Roanoke, Va., with her
husband, son, two cats and a pug named Nurse Beardsley. Since receiving
her master's in social work in 2011, she has specialized in writing about
relationships between animals and people, gender issues and mental health.

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