Facts and Myths About Insomnia
By James Shaffer, MD // July 20, 2012
EDITOR’S NOTE: When I asked my good friend, Dr. Jim Shaffer, to develop a topic for the Q&A section of the June issue of Space Coast Medicine and Central Florida Medicine magazines he immediately said, “Why can’t I sleep, why can’t I stay asleep, and why do I feel horrible all day?” But, rather than “answer questions” he suggested that he address the “urban legends” and the “ground truth” associated with insomnia.
Jim has been the subject of several features in our magazines related to his innovative work in critical care medicine and his prowess as a runner and triathlete. We are now delighted to tap into his expertise as a Board Certified Sleep Medicine specialist and have him on board as an editorial contributor to share his thoughts on insomnia with our readers and viewers.
“I can’t get to sleep!”
“I can’t stay asleep!”
“I feel horrible all day!”
At some point in the lives of 80% of all Americans, these and similar complaints are expressed in various terms. There are few experiences more distressing than the frustration of total wakefulness while it seems the entire world slumbers peacefully.
Insomnia Complex, Simple Solutions Rare
The darkness of night coupled with sleepless silence has a way of transforming minor concerns into relentless worries. As a result, sleeplessness may become a self-perpetuating cycle that culminates in what may feel like total emotional and psychological meltdown.
Successful management of insomnia is never straightforward. Personality, coping skills, physical and mental health all factor heavily in to how every individual grapples with the lonely specter of sleeplessness that we all face at some point.
Rarely does a simple pill, new mattress, bed partner or boss ever resolve this complicated conundrum. Therefore, it is best to approach such a struggle with a few guiding principles which serve to dispel myths and change one’s perspective when we feel ensnared within a hopeless black hole of sleepless nights.
Poor Sleep Is The Result, Not The Cause.
Following a few nights of disrupted or limited sleep, regardless of the cause, anyone will perceive a change in how we feel, function, cope or relate to individuals with whom we routinely interface. We may become irritable, more distractible or just downright sleepy.
Almost anything can interrupt a healthy sleep pattern depending on the individual. Psychological, physical and emotional stress presents in many ways and is almost always unexpected. Grief, physical pain, excitement, sorrow, fear, anxiety and dread all upset our natural rhythms that drive sleep onset and maintenance.
It is imperative to realize that sleep is almost always the victim, not the perpetrator, of the daytime consequences for which we usually seek help. Knowing this, we can focus our energies on eliminating the source or acquiring new skills with which to cope.
A common example is the sleep disruption associated with the intense pain of grief over the loss of a loved one. Insomnia under these circumstances is perfectly normal. The key is to focus on grieving effectively and knowing when to seek help when grief begins to encroach upon sleep beyond a certain period of time, or impacts our original ability to manage emotions and appropriately socialize.
Sleeping Pills: Friend or Foe?
More than ever, we live in a society that demands rapid and effective response to what ails us. Antibiotics for that runny nose, cream for the itchy rash, a pill to elevate our mood and a pill to put us to sleep. The truth is, hypnotics [aka” “sleeping pills”] are one of the most effective and helpful pharmaceuticals we as a society can utilize…but only under the proper circumstances.
It is my experience that the majority of individuals who would most benefit from the proper use of a sleep aid actually decline treatment because of some unfounded fear of addiction. The reality is that addictive patterns of hypnotic use are essentially unheard of when prescribed by a qualified healthcare professional with whom you’ve established a consistent relationship.
In general, sleep aids are best employed during the early days of troubled sleep following a highly disruptive event. The longer the duration of insomnia, the less effective these medications will be at restoring healthy sleep patterns. These medications become problematic when they exacerbate underlying daytime symptoms of sleeplessness, including fatigue, poor concentration and accurate memory.
Beyond about three months, effective treatment for insomnia focuses more on changing behavior and thinking about sleep in general. Take home points: 1) Don’t overlook the potential value of sleep aids in the proper setting nor dismiss them for unfounded concerns of developing a habit and 2) Don’t expect a sleep aid to have meaningful impact upon long term insomnia because for many, they may serve to compound its very consequences.
From Curse To Blessing
For many, chronic insomnia dominates all aspects of their life. The recurrent anticipatory dread of bedtime and erosion of self-esteem culminates in a vicious cycle of relentless fatigue and irrational phobias that spring up like weeds. Sadly, those who struggle with chronic insomnia have higher rates of depression and suicide.
Effective treatment almost always involves the development of new cognitive and behavioral skill sets that can take a lot of time and resources. Sleep aids are rarely useful and may exacerbate the daytime consequences of less than optimal sleep duration and quality.
It is my observation that many who battle with chronic insomnia have devolved in to a state of hopelessness mired in a few or many false beliefs about the consequences of their plight. “I will die younger.” “I can never achieve [fill in the blank] under these circumstances.” Years of “dead-end” thinking often solidify a nihilistic attitude that may permanently bind one from ever leading a fulfilling life.
For this reason I often take what may seem like a radical proposition: Change your perspective about insomnia from that of a life-long curse to that of a blessing. While those with chronic insomnia may suffer from a higher rate of mood disturbances and even suicide, there is no evidence to suggest that modest sleep deprivation itself has any bearing on mortality. Indeed, there is more evidence that those spending too much time in the sack have higher mortality presumably related to lesser physical activity. The mere acceptance that one’s diminished sleep drive and heightened cognitive arousal is possibly a harmless asset may well be the most therapeutic cognitive measure directed at actually restoring sleep.
Sleep is a delicate gift that takes on many forms given the spectrum of human variability. Disruption of sleep is almost always the consequence of some imbalance that must be corrected in order to restore its restorative power. For some of us, acceptance of a “different normal” may well be the key to reaping the intended benefits of sleep.
ABOUT THE AUTHOR
Dr. Jim Shaffer, a native of Youngstown, Ohio, graduated cum laude from Malone College in 1988 and completed his medical training at The Ohio State University College of Medicine. He completed residencies and board certifications in Internal Medicine and Pediatrics followed by fellowships in Pulmonary, Critical Care and Sleep Disorders at The Ohio State University Medical Center. He also attained a Masters in Health Administration at the University of Florida in May 2005.
Upon completion of his training in July 2000, Dr. Shaffer joined a large multispecialty group in Melbourne, Florida where he developed a successful traditional combined Pulmonary and Critical Care practice. In 2003, Dr. Shaffer focused his career efforts on developing critical care services at both the local and national level when he joined Health First to lead a clinical and cultural transition in the critical care service areas.
Dr. Shaffer currently serves as the founding Medical Director of VitalWatch, the nation’s first eICU to be implemented in the southeast United States. He also maintains a sleep disorders practice where he treats a variety of conditions including sleep disordered breathing, narcolepsy, insomnia and circadian rhythm disorders.