Sleepless in the Suburbs
Some see insomnia as the new normal. Are we victims of our own bad habits?
It’s 3 a.m. in Arlington and Jim Sawyer* can’t sleep. He couldn’t sleep last night, either. Or the night before that. After tossing and turning, he gives up, goes downstairs, and opens his laptop to log onto HBO GO. When insomnia sets in, he catches up on his favorite TV shows, listens to music, or uses the extra time to work. (“But I don’t do emails in the middle of the night because it looks weird,” says the 44-year-old, a director of government programs for a scuba diving company.) He takes Ambien, a prescription sleep aid, almost every night, but it doesn’t always help. He remembers having “second winds” in the middle of the night even as a kid. “I was diagnosed with ADHD when I was in kindergarten, so ‘hyper’ runs in my veins,” he says. As a little boy, he would climb out of bed to play with his toys in the dark.
Sawyer isn’t the only area resident who’s wide awake in the wee hours. In Falls Church, Amy Doyle, 35, is blinking at her ceiling and worrying about the fact that she can’t sleep. She grabs her iPhone and sends a quick message to her boss at the private nonprofit organization where she works to say she’ll be late. Then she turns off her alarm.
Pick any night of the week and you’re likely to find lights on all over town. And they’re not just shining on college students pulling all-nighters, parents with newborns, or health-care professionals working the graveyard shift. According to the National Institute of Neurological Disorders and Stroke, at least 40 million Americans suffer from chronic sleep disorders. Another 20 million experience occasional sleep disruptions.
Even those who do manage to get core sleep may not be logging in enough hours. Although the National Sleep Foundation recommends seven to nine hours of sleep per night, a recent study by the Centers for Disease Control and Prevention found that 41 million American workers (30 percent of the civilian workforce) get fewer than six hours a night. Some research suggests that this level of sleep deprivation leaves a person’s reasoning and reaction times in a state akin to drunkenness.
There are statistics to prove it. Each year, drowsy drivers cause more than 100,000 car crashes, 40,000 injuries and 1,550 deaths, according to the National Highway Traffic Safety Administration.
The CDC study also found nearly 38 percent of adults reporting that they had unintentionally dozed off during the day at least once in the previous month.
Although the medical community has identified more than 70 different kinds of sleep disorders—including ailments as strange as “exploding head syndrome” (in which sufferers experience a loud “bang” inside their heads while sleeping) and sleep paralysis (the inability to move or speak at sleep onset or waking)—insomnia is the most prevalent.
“Most people take 10 to 15 minutes to fall asleep,” says Dr. Lawrence Stein, director of Virginia Hospital Center’s Sleep Lab in Arlington. You may have insomnia if it takes you 30 to 60 minutes to fall asleep, or if you have trouble maintaining sleep—meaning, you get up more than twice a night to urinate or for other reasons. Women struggle with insomnia more than men.
Falls Church resident Linda Hyatt says her insomnia was at its worst when she was in her 40s and working as a high school teacher for Fairfax County Public Schools. She went through a stressful time where she was butting heads with school administrators and worrying about it kept her up. Looking back, she estimates she only slept between two to four hours per night.
“In meetings, my eyes would droop,” recalls Hyatt, now 58. “One time another teacher told me she had seen me falling asleep. I was so embarrassed. It’s not a good thing to do in a professional situation.” The fatigue affected her home life as well. A divorced mom of two, she often came home so exhausted that she would collapse on the couch, unable to be an engaged parent.
Many view sleep deprivation as a simple fact of life in an area dominated by type-A overachievers. (Some weary-eyed warriors even boast about their ability to get by on very little shut-eye.) But inadequate sleep is not a good thing. New research over the past five to 10 years has linked sleep disorders to serious medical conditions, including cardiovascular disease, high blood pressure, arrhythmias and obesity.
“Ten years ago, I would have said sleep disorders make people not function well, make people feel badly, change their mood and impact their job performance,” Stein says. “[Now] we’re starting to realize sleep disorders have serious implications for your body and can cause chronic medical disorders.”
Experts now believe that sleep, among other things, plays a role in hormonal regulation, body temperature, learning consolidation (by helping us process our memories from short term into long term) and our ability to fight infection. Sleep is restorative; it is a time to rest our organs, and for the body to recheck its functions to make sure things are running well. Cut back on zz’s and many of those functions get thrown out of whack.
Equally alarming are new findings about risks associated with drugs designed to counteract insomnia. A recent study conducted by researchers at the Scripps Clinic Viterbi Family Sleep Center in San Diego found that regular users of sleeping pills such as Ambien, Lunesta, Restoril and Sonata have a risk of early death that is at least 4.6 times higher than for those who do not take prescription sleep aids. The research suggests that even patients who take fewer than 18 sleeping pills a year are at elevated risk.
“What our study shows is that sleeping pills are hazardous to your health and might cause death by contributing to the occurrence of cancer, heart disease and other ailments,” says study author Daniel F. Kripke, a doctor at the Viterbi Sleep Center.
Dr. Gary Kaplan, founder of the Kaplan Center for Integrative Medicine in McLean, calls the study “significant and worrisome,” adding that “sleep medications are way overprescribed.”
Kaplan believes that doctors who are treating patients with insomnia need to focus more on strategies that promote sleeping naturally, in lieu of chemical intervention.
“There is unquestionably a need for these medications, but we have to be diligent in making sure they are used appropriately,” he says. “In a seven-minute [patient] visit, it’s not possible to take a proper sleep history.”
Falls Church resident Amy Doyle, who developed insomnia a few years out of college, says she ran into that very problem during an early visit to her primary-care physician. When she mentioned her sleep issues, her doctor “dismissively” gave her a few sample packets of Ambien. “Looking around the doctor’s office, I noticed the clock said Ambien, and her pens were from Ambien, too,” Doyle says. “I don’t like taking medication, but that was her only solution for me.”
On her own, Doyle has since tried herbs (valarian root and melatonin) and dietary changes such as cutting out sugar at night. “But it doesn’t seem to make a difference,” she says.
Of course, in an age of portable technology and a 24-hour news cycle, we are often our own worst enemies.
Doyle admits that her tech habits likely contribute to her insomnia. “I don’t have cable, so I’ll watch TV and videos on my laptop, and if I do that too late, there’s no way I’ll fall asleep, even if I’m exhausted,” she says. The stimulation and flickering from the screen keeps her up long after she’s powered down. She has an iPhone, which she tries not to play with “too much” before bedtime, but it’s hard to escape the emails, text messages, Facebook posts and Tweets that bombard her waking existence.
“The Internet and smartphone explosion has given people more and more things to do into the wee hours of the morning,” Stein observes. “This encroaches on our sleep time. It is a major factor in why less people get adequate sleep and more people are sleep deprived.”
And then there’s the Starbucks factor. Dr. Deborah Gofreed, medical director of Arlington Sleep Medicine, says she’s often amused by some of the habits she sees in patients who visit her practice in Ballston. “Patients come in with a grande [coffee] at 4:30 in the afternoon, put it down on my desk, and say, ‘I can’t sleep,’ ” she says.
For many adults, habits like this have become a coping mechanism—manipulating energy levels up and down with caffeine, alcohol and drugs in order to power through a 60-plus-hour workweek, plus the added demands of getting the kids to and from school and activities; managing a household; socializing; and trying to squeeze in their own workouts or “me time.”
“My indoor soccer team sometimes plays at 11 at night,” says one local mom who works full time and plays in the over-30 masters division at the Fairfax Sportsplex in Springfield—a facility serving players from all over Northern Virginia and D.C. “Schedule-wise, it’s nice to be able to sneak out for a game once the kids are in bed…but then I come home wired and I’m up until 3 a.m. I drink wine to wind back down.”
Falls Church resident Mary Garver often finds herself rummaging through her bathroom medicine cabinet in the middle of the night, looking for a pill to swallow—a painkiller, allergy medicine, the herbal supplement melatonin—anything that will make her drowsy.
Garver, 58, says she has struggled with insomnia for more than 35 years, including the chaotic years she was a stay-at-home mom raising two boys.
Getting her mind and body to relax has often been a challenge, she says. Add to that, allergies and chronic jaw pain, which tend to keep her up. Although her kids are now 17 and 22, the insomnia remains. She has tried everything from prescription sleeping pills to alcohol to try to lull her body to sleep. “Three cups of coffee gets me going in the morning,” she says. The frenetic pace of modern life is, in fact, “quite mad,” Kaplan says. “Sleep—like everything else in our frantic lives—needs to be prioritized and scheduled.”
But it often falls low on the priority list. Most insomniacs are well aware of the behaviors that can help or hinder their sleep patterns; they just find it difficult to abide by the helpful ones. It’s often a push-pull.
Although former schoolteacher Hyatt has been sleeping much better ever since she took early-retirement two years ago (she usually sleeps six to eight hours a night now), she still sometimes makes tea in the middle of the night—not chamomile, known for its soothing and calming effects, but caffeinated English Breakfast tea.
Sawyer concedes that his brain tends to race, but he brushes off the idea of writing down his anxious thoughts before bed—a strategy that is frequently recommended by sleep experts.
“Writing down my worries? It would take six days!” he says. Meanwhile, he has found ways to work around his night owl tendencies. The fact that his employer is based in San Diego allows him to maintain West Coast hours while telecommuting from Arlington.
For Garver, it’s taken a lot of trial and error, but she has made some helpful lifestyle changes. She no longer drinks orange juice or takes vitamins at night because they pep her up. And she carves out time for aerobic exercise several days a week. Now she usually sleeps at least six hours per night.
“Techniques to calm down are quite learnable, but they require effort and self-discipline,” Gofreed says. “It’s a lot of work to retrain yourself.”
Still, for some insomniacs, like Doyle, exhaustion often trumps good decision-making. She refuses to adhere to a fixed wake-up time, even knowing that doing so would help her establish a more regular sleep schedule. “When I actually do fall asleep, I consider it a luxury,” she explains. “I don’t want to stop.”
After two nights in a row of insomnia, Doyle may take Tylenol PM, which sometimes does the trick. But not always. “I’ve resigned myself to this life,” she says. “It’s amazing because I’ve become incredibly functional.”
Perhaps you’re not creating optimal conditions for your body to succumb to rest. Experts suggest these strategies:
- Purge your mind. Before bedtime, make a “to do” list for the next day and write down all your worries. But try not to think of sleep as another item on your “to do” list.
- Unplug. Step away from your computer, TV, smartphone, bills and household chores at least an hour before bed. All can be sleep disruptors. Try reading or listening to relaxing music to wind down.
- Prep your environment. Make sure your bedroom is not too hot, too cold or too noisy. Close the shades and turn your clock around.
- Relax. Once in bed, practice breathing or relaxation techniques. Focus on relaxing different muscle groups, starting at your head and ending at your toes. This will help you avoid fixating on the fact that you don’t feel sleepy.
- Think before you drink. Don’t drink caffeine late in the day, and avoid drinking alcohol within four hours of bedtime. “Alcohol initially is a sedative, but ultimately, after it gets metabolized, it becomes a stimulant,” says Dr. Lawrence Stein, director of Virginia Hospital Center’s Sleep Lab.
- Fix your wake time. Get up at the same time every morning, regardless of what time you fall asleep. Don’t allow yourself to sleep in, and don’t nap, no matter how lousy you feel. You’ll be tired the next evening.
- Exercise. A study out of Northwestern University suggests that regular aerobic exercise may help insomniacs improve sleep quality. Just don’t get your heart pumping within four hours of bedtime.
- Try CBT. Cognitive Behavioral Therapy is a psychotherapeutic method aimed at changing faulty beliefs and attitudes about sleep, insomnia and daytime consequen-ces. A sleep doctor can refer you to a psychotherapist trained in sleep disorders.
Common Sleep Disorders
For some individuals, insomnia isn’t a syndrome, it’s a symptom of another problem. Here are three common sleep disorders that can often be pinpointed with a sleep study or careful medical history.
- Sleep apnea. More than 18 million Americans suffer from sleep apnea, although an estimated 10 million remain undiagnosed. Apnea occurs when the throat muscles relax during sleep, causing an obstruction of the airway passage. When this happens, blood-oxygen levels fall, causing the sleeper to instinctively gasp or snort for air. The condition more often affects men, typically between the ages of 30 and 60, and is more prevalent in people who are overweight. The gold standard for diagnosing sleep apnea is a polysomnogram, a test in which the patient visits a sleep center overnight and has various electrodes placed on his or her body to monitor breathing, oxygen, heart rate and brain wave activity. A sleep study can help determine whether a person is snoring or breathing regularly, whether there is adequate airflow, and how often he or she is waking during the night. As treatment for apnea, doctors may prescribe a continuous positive airway pressure machine, or CPAP, a device that fits over the nose and mouth and is connected by a tube to a motor that blows air constantly and acts as an air “splint,” preventing the upper airway blockage from occuring.
- Restless legs syndrome. RLS affects as much as 10 percent of the U.S. population. Characterized by irregular movements or sensations in the legs, it is disruptive to normal sleep. Doctors aren’t sure what causes RLS, but it runs in families and may be exacerbated by iron deficiency or certain drugs.
- Circadian rhythm disorders. These occur when a person’s natural time clock is off. There are several types. One of the most common is delayed sleep phase disorder, in which a person is genetically wired to stay up late and wake up late. Treatment may include melatonin (a natural hormone supplement) and therapeutic light therapy. Devices such as “dawn simulators,” which mimic sunrise, can help people become better synchronized by signaling, with light, when it’s time to wake up.
*Names have been changed for privacy.
Jenny Rough is a former insomniac whose sleep habits improved dramatically after she gave up afternoon coffee, took up yoga, and left her high stress job as a lawyer to become a freelance writer. She lives in Alexandria.