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When You Can't Sleep

Source: pamphlet from the National Sleep Foundation, 1993

Insomnia Quiz

Pick those statements that describe any symptoms you have had over the past year. Count the number of statements to which you answered "yes," then look at the explanation provided below.

  1. Falling asleep is hard for me.
  2. I have too much on my mind to go to sleep.
  3. When I wake up in the night, I can't go back to sleep.
  4. I can't relax because I have too many worries.
  5. Even when I sleep all night, I'm still tired in the morning.
  6. Sometimes I am afraid to close my eyes and go to sleep.
  7. I wake up too early.
  8. It takes me more than an hour or so to fall asleep.
  9. I am stiff and sore in the morning.
  10. I feel depressed when I can't sleep.

If you have said yes to: 

1 to 3 statements - You may not have a problem. Be assured that it is not unusual to have trouble sleeping at some point in your life.

4 to 6 statements - You may have a problem. Making the changes recommended in this booklet may help improve your sleep habits. If you still need help, talk with your doctor.

7 to 10 statements - Chances are, you have a sleep problem that requires medical attention.

*Even if you have picked only one statement, you may want to consult your doctor if you are concerned about this problem.

Why Do You Need Sleep?

Every 24 hours or so every person feels an unavoidable need to sleep. Sleep is not merely a "time out" from daily life, it is essential to health and longevity. But why? There are several theories about the "why" of sleep. Most suggest that sleep is the time for the body to recover. Getting enough sleep is thought by most people to be important to good health and this commonsense view is supported by scientific studies.

These studies show that if you don't get enough sleep during the night, you are drowsy during the day. This can affect the quality of your work, your ability to concentrate, and even your ability to interact with people.

How Much Sleep Do You Need?

Sleep needs are different for different people. There are a few individuals who can sleep four to five hours per night and wake up completely refreshed. Others feel sleepy even after awakening from eight hours of sleep. Although sleep needs vary from person to person, most individuals need seven to nine hours of sleep.

Regardless of your age, the best measurement of how much sleep you need is how you feel throughout the day. Studies show that, after a good night's sleep, there should be no daytime drowsiness. If there is, you aren't getting enough quality sleep.

What Kind of Sleep Do You Need?

It may surprise you to learn that during the hours you sleep, your body and mind are actually very busy. During a night's sleep, normal sleepers have a relatively predictable "sleep architecture" - the term used to describe the alternative pattern of REM (rapid eye movement) and non REM sleep. Scientists define the best sleep as that having the right mix of REM and non REM sleep, which will allow you to waken feeling refreshed and well rested.

Do You Have Trouble Sleeping?

Most people - at some time or other - experience disturbances in their normal sleep patterns. This can be a minor irritation or a major health problem. Feeling you aren't getting enough sleep despite an adequate opportunity to sleep is known as insomnia - a symptom of many different problems that deserves the attention of both you and your physician.

What Are Some of the Causes of Insomnia?

LIFESTYLE FACTORS: Many "drugs" and behaviors can result in worsened sleeping problems. Drinking caffeine-containing beverages and smoking are prime examples. Alcohol intake close to bedtime also results in poor sleep. Varying bedtimes from night to night and changing work shifts are other lifestyle factors that can undermine sleep quality.

ENVIRONMENTAL FACTORS: Noise, such as that from passing traffic, airplanes, or a neighbor's television, can disturb sleep. Too much light in the room and extremes in room temperature can also interfere with sleep.

PHYSICAL FACTORS: Primary sleep disorders, such as disorders of breathing or periodic muscle contractions during sleep, figure in more than half of all cases of chronic insomnia, according to a nationwide study of 8,000 people conducted by the American Sleep Disorders Association. Other physical factors, such as arthritis, heartburn, menstruation, headache, and hot flashes may also upset sleep.

PSYCHOLOGICAL FACTORS: While it is generally known that insomnia is a common symptom of depression, more subtle psychological factors are also associated with insomnia. For example, some people seem predisposed to suffer insomnia in times of acute stress or in environments not conducive to sleeping. Similarly, concern about problems such as family illness, or an unrewarding job can interfere with sleep. Finally, if people are worried about their ability to sleep, their concern may actually keep them awake.

What If You Have Trouble Sleeping?

Good sleep habits play an important role in ensuring good sleep. Keeping a sleep log for a week or two often identifies trouble spots. Specify when you go to bed, get up, drink caffeine-containing beverages or alcohol, and exercise. Many times, simple changes in daily routine can improve sleep.

For example:

  • Avoid caffeine within six hours of bedtime. Avoid alcohol and smoking one to two hours before bedtime.
  • Exercise regularly. Get vigorous exercise in the late afternoon. However, strenuous exercise before sleep may actually impair your ability to sleep.
  • Don't nap.
  • Establish relaxing pre-sleep rituals, like a warm bath or a few minutes of reading.
  • Go to bed only when you are sleepy, and use your bed for sleeping only, not as an office or a place to watch television.
  • Get up about the same time every day, regardless of when you fall sleep.
  • If you are a bedtime "worrier," dedicate another time - perhaps 30 minutes after dinner - to writing down problems and possible solutions.

If you can't sleep, don't stay in bed fretting. After 10 or 15 minutes, go to another room and read or watch television until you feel sleepy. 

When Do You Need To Seek Help?

It's important to ask for help if you are having sleep problems. You should consider getting medical advice if your sleep has been disturbed at least several times over the past month, or if sleep problems interfere with the way you feel or function during the day.

Your doctor will evaluate your general health and ask about your usual sleep habits. Sometimes, all that is needed is helpful advice. Better sleep habits, exercise, and attitude can often take care of the problem.

Your physician may recommend that you go to a sleep center to have your sleep evaluated by specialists. They may wish to monitor you while you sleep to identify problems, as well as to point to treatment options.