Why Can't I Sleep?! Hyperarousal and The Three Types of Insomnia

Tuesday, August 08, 2017 by Meg   •   Filed under General

Insomnia may be a byproduct of our evolution. I assume this is due to the fact that, as a mom, mother nature was up all night anyway checking on children and getting in some last minute “me time”. Or perhaps, more likely, we are more prone to arousal than to sleep for survival purposes. We can rise and become aggressive or anxious in moments as anyone who has awoken to a loud noise can attest. But we calm down slowly. Only those at the top of the food chain can rest during the day in plain view. 

Cocky ass lions. 

We need to be pickier about our rest than lions. Always have. This might be why circumstances and mental state need to be aligned in order to sleep. And depending on what forces are acting against you, you may treat the issue differently. Because trouble falling asleep, trouble staying asleep and broken sleep tend to have slightly different treatments, though there is some overlap. 

First things first: what needs to be in place for us to rest? I mean besides your husband NOT poking you for sex?

Things we need to regulate our sleep: 

  • The Sleep Drive is the internal drive to fall asleep. The sleep drive is low at awakening (because you just satisfied it) and increases throughout the day until it’s high enough that you are driven to rest. This drive begins to decrease upon falling asleep. 
  • The Alerting Force follows an inborn rhythm that rises in the day to make you alert and falls to permit sleep. However, it is not effected by how well or how long you rest. It’s got its own clock, suckas. So if your alerting force says “Rest!” at midnight and you stay up until 2a.m., it might be gone. And if that happens, you’ll end up with a second wind and not be able to go to sleep even if you want to.

Basically, the alerting force gives you a window in which you can pass the hell out. The sleep drive lets you take advantage of the opportunity, provided the two sync up with the high drive and the altering force both going on at the same time. 

Sleep is also informed by a few other internal forces that can be double-edged swords in and of themselves. For instance, melatonin is a hormone secreted by pineal glad as dusk falls. Light suppresses this secretion and lets us stay awake. In addition, cortisol begins secretion before dawn and is what gets us up in the morning. But because cortisol is highest at that time, those with anxiety sometimes experience panic attacks or awaken with anxiety symptoms. Like the altering force, these are examples of circadian rhythms (or internal processes that have a schedule of about a day). On a nightly basis, we also have cyclic alterations of NREM (slow wave deep sleep) and REM or dream states. These REM states occur later in the night and oscillate every ninety minutes or so. 

At least that’s how REM sleep it supposed to work. But with all these different things going on, it is not surprise that there are a number of ways for sleep to get off track. 

Why do some people get insomnia? 

There are three main reasons for insomnia according to researchers Glovinsky and Spielman in The Insomnia Answer1

1. Predisposing characteristics or things that happen before insomnia shows up such as: 

  • Higher levels of wakefulness or alertness, sometimes called hyperarousal. This trait is especially common in those with a history of anxiety, depression or trauma. In these cases, individuals secrete higher levels of adrenocorticotropic hormone from the pituitary and cortisol from the adrenals which leads to more activation. They may also have a higher metabolic rate, elevated hormone levels, increased heart rate, and activation of the hypothalamic pituitary axis (HPA) which helps regulate fight/flight. They also tend towards cognitive hyperarousal, or constant worrying or racing thoughts. Because alertness has been so historically important for our survival, these traits are widespread, far more so than Big Lebowski-ish mellowness.
  • Idiopathic insomnia, or those who are reported to have been sleepless from day one. And Glovinsky and Spielman note that some may be triggered into insomnia down the road through receiving training in how to sleep instead of embracing normal rhythms. (Uhoh.) 
  • Pain or injuries may also predispose one to be more alert, and less able to rest. 
  • Circadian rhythm is a stable inherited biological clock that may predispose one to be a night owl. These individuals have physical differences such as delayed temperature rhythms, which shift their altering force later, unlike a morning person whose altering force and corresponding temperatures are earlier in the day. Some have such excessive exhaustion when trying to conform that it effects their work and their daily functioning in major ways.
  • Depression alters not only psychological patterns but also physical ones (read more here in Is Depression a Physical Illness?). Due to this connection, early morning awakenings are hallmarks of Major Depressive Disorder. Those with depression tend to have fewer NREM cycles and more REM sleep complete with vivid and disturbing dreams. Mood disorders will need to be addressed in order to conquer insomnia, because, in these cases, the insomnia may be a symptom and not the issue itself.

2. Precipitating Events, or things that changed your sleeping habits or that seemed to happen at the onset of the insomnia, such as having a baby, the death of a loved one, health issues or acute pain.

3. Perpetuating Attitudes and Practices that came about after the insomnia shows up. These are often thoughts such as worrying about sleeping which ironically make sleep less likely, or the belief that you won’t be able to get to sleep so why bother trying. Some also engage in practices that make sleep more difficult such as staying in bed too long, drinking caffeine (especially later in the day), napping or sleeping in. Once these practices or thoughts start, you can turn temporary sleeplessness into a chronic issue.

So what do we do about insomnia?

For any type of sleep issue, there are good sleep hygiene practices that can go a long way in promoting restful sleep, says Glovinsky and Spielman1

  • Improve sleep hygiene by avoiding naps and going to bed only when tired so you spend fewer hours actually in bed. (You may need to keep a log of the time when you start to feel tired and try going to bed closer to that time each night.) 
  • Get up if you haven’t fallen asleep within twenty minutes 
  • Avoid naps
  • Avoid caffeine after lunch, and avoid nicotine or alcohol in the evening
  • Keep hot baths and exercise to at least three hours before bedtime. Increased heat can trigger higher body temperature and delayed sleep drives in those with primary issues falling asleep and may also shift sleep cycles in those with other issues. 
  • Limit fluids late in day (to avoid awakening for this reason)
  • Make sure your bedroom is dark and well ventilated
  • Maintain a buffer period between activities and bedtime (so you have time to wind down) 
  • Set aside worry time before bed or in the morning in an attempt to avoid worrying all night (more on this here in CBT and Worry Time
  • Use guided imagery, meditation or relaxation techniques to bring your thoughts to a peaceful, less worried place. This is a good skill to have if you can’t fall asleep or when you wake up at night. I love the book Guided Imagery For Self Healing if you need some ideas. You can also try relaxing each muscle one by one while breathing deeply, or concentrate on the rise and fall of your belly as you breathe. 
  • Get help for depression or anxiety
  • Challenge worrisome thoughts about how much sleep you get and challenge thoughts that turn sleep into a chore instead of something to look forward to. Tell yourself, “Well even if I don't sleep, at least I get to rest and not have to do anything for a little bit.” You may also use thought substitution, mindfulness or self compassion techniques discussed in the posts hyperlinked through those words. As for the worry, we usually get enough for basic maintenance even if we are sleeping poorly. We may not like it, but we will be fine. Learn to rest, without focus on the sleep. 
  • Calm dreams with imagery reversal therapy, by writing dreams out and adding different endings with storytelling (discussed more here in CBT and Storytelling).

But there are some more concentrated techniques depending on the type of insomnia you suffer from. Let’s do a quick run down based on the three types of insomnia

1. Difficulty Falling Asleep: With this issue, individuals have trouble passing into rest, usually taking forty minutes or longer to fall asleep. If you have difficulty falling asleep you should: 

  • Move your bedtime later and your rising time earlier 
  • Try bright light treatment. Due to blue light sensors in our eyes, a therapy light such as this one may help to shift sleeping cycle earlier (thus allowing you to fall asleep faster) if you set it to turn on in your room during the last third of your sleep cycle (a couple hours before you usually wake up). 
  • Try wearing dark or blue-blocking sunglasses like these to filter evening light, and shift sleep earlier 
  • Take melatonin three to four hours before the time you typically fall asleep 

2. Difficulty Staying Asleep: With this type of insomnia, individuals may awaken in the middle of the night and end up watching television because they are unable to return to sleep. Those with difficulty staying asleep should:

3. Broken Sleep: Here, awakenings add up to more than an hour a night, during which people may be dimly aware of surroundings and thoughts. For these folks:

  • Move your bedtime later and rising time earlier 
  • Try a sleep restriction where you limit the number of hours in bed asleep, down to five if necessary. Then add 15 to 30 minutes each week until you get to your ideal number of hours. If you find that you are awake longer than 45 minutes a night, pull back and spend fewer hours in bed. Glovinsky and Spielman note that over time this may serve to encourage more concentrated sleep when in bed and balance patterns until you get to your ideal number of hours1

But many of these processes take time. And while some resort to medications to promote sleep, others explore alternative treatments to encourage sleep in a gentler way. 

Herbs For Insomnia 

Some studies cite numerous herbs used in Chinese medicine as effective in the treatment of insomnia2,3,4,5, possibly due to their ability to effect GABA5, a chemical that releases the “chill” much like Valium. However, because they are usually given in combination, it is difficult to tease apart which are most effective and they are more difficult to come by. In addition, as is the case with all herbal supplements, more study must be undertaken to verify effectiveness. (I have more detailed posts about many of these already on the site.)  

For today, here are the more popular herbal supplements for promoting resultful sleep: 

But there is also a new treatment on the horizon, recently labeled "orgasms for the brain." 

What the what? That’s right, people. Welcome to the word of ASMR.

Autonomous Sensory Meridian Response (ASMR) 

Autonomous Sensory Meridian Response (ASMR) is a newly emerging treatment that remains somewhat controversial. The premise  is simple: listening to certain sounds (such as someone whispering) ignites certain memories or certain parts of the brain and gives you that pleasant tingly sensation on the back of your neck or elsewhere on the body (like you got when you played that telephone game as a kid). A little anticlimactic for a brain-gasm if you ask me, and potentially creepy. But for some, this tingly sensation, along with the things happening in the brain, may work together to combat insomnia.

Many swear by this technique, leading ASMR videos to become an immensely popular commodity on UTube. However, this treatment is not backed by much scientific exploration or clinical study, unlike choronotherapy (bright light treatment) and the  cognitive and physical techniques described above. And the wide variation in the types of sounds that relax people will surely make that exploration quite tricky. But, while I am not a huge proponent, it’s free on UTube and probably doesn’t have any side effects. There’s no harm in trying it out for a night. The most you’ll lose is a few minutes of listening, and possibly be weirded out by some dude whispering from your computer screen (and if you have a  traumatic history where whispering is a trigger, for the love of pete, don’t do this).

The take away is this: while there are many temporary treatments available, finding ways to get your body back on track and shift your sleep cycles to a place that works for your body and your life will be critical. And because some medications, health issues and other mental health factors alter the ability to fall asleep, this is a tall order. At the end of the day, insomnia can be debilitating. It sucks worse than listening to Rush Limbaugh (and that’s saying a lot). By finding ways to avoid the worry that goes with insomnia and learning to focus on the relaxation instead of the actual sleep, you may be able to avoid at least some of your insomnia triggers. Worst case scenario you get really good at meditation and mindfulness practices while waiting for morning. Two birds and all that.  Moving forward, using tactics that alter your personal rhythms to a more ideal place can make all the difference in self adjustment and hopefully promote the long-term ability to fall asleep, stay asleep and rest effectively. 

Now if only someone could make husbands stop that poking thing. 

Citations
  1. http://www.amazon.com/The-Insomnia-Answer-Personalized-Identifying/dp/0399532978
  2. http://www.ncbi.nlm.nih.gov/pubmed/19753680
  3. http://www.ncbi.nlm.nih.gov/pubmed/11773674
  4. http://www.ncbi.nlm.nih.gov/pubmed/21910065
  5. http://www.ncbi.nlm.nih.gov/pubmed/22118921
 



Topic-Relevant Resources

The Insomnia Answer: A Personalized Program for Identifying and Overcoming the Three Types ofInsomnia
My all-time favorite book on insomnia. Full of background information and tips to treat sleeplessness, this is a must read for anyone suffering.

Say Good Night to Insomnia: The Six-Week, Drug-Free Program Developed At Harvard Medical School
Many swear by this program to get their sleep back on track in a little over a month.



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