Help, I Have Chronic Insomnia!

Reader’s Question

Six months ago I started my first job. When I was studying, I usually slept from around 2 am, but now my job demands that I sleep earlier. So I tried going to sleep earlier — at 12 midnight. However, my sleep quality has degraded greatly, and I’ve developed chronic insomnia.

I’ve tried many ‘online’ methods to solve my issues but none of these has worked. Finally, I tried to just strengthen my thoughts and be more optimistic. Sure, it helped, but my sleep seems to be permanently modified.

A few years back, I usually slept between seven and eight hours a day. Last week, I managed to sleep only six hours a day. A few days ago I slept only four hours.

Last night however, I managed to get only one and a half hours of sleep. (For your information, I went to sleep at 1 am on these days.) Has the insomnia somehow altered my circadian rhythm?

Due to all this, I am completely demoralized and have run out of ideas. I’m extremely sleep-deprived and I can barely think properly. My senses are totally numb and I can barely feel anything with my hands. I’m still new to my job and I need my sleep to get me on track again.

I have tried, in this order:

1. Antihistamine
2. Milk
3. Warm bath
4. I invested in a high end mattress
5. Aromatherapy
6. Sleeping pills
7. Fasting

Psychologist’s Reply

Sleep is such an important part of health, and one that we often take for granted. As you have described, a lack of sleep can affect our mental, physical, and emotional health. There are several types of sleep problems that can develop. The two that fit most with what you describe are insomnia and a delay in your sleep-wake cycle.

Insomnia is a sleep problem that involves difficulty getting to sleep (i.e. taking more than 30 minutes), difficulty staying asleep at night, or waking too early in the morning. Sometimes with insomnia, it is possible to get sleep and not feel rested the next day. You did not mention whether you were waking up after falling asleep or waking too early, but you have described a primary problem of being unable to go to sleep. Often with insomnia, if a medical problem is ruled out, the difficulty with sleep is a cognitive or behavioral issue. What that means is that cognitions, or thoughts, can get in the way of sleep. Ironically, thoughts such as, “I am not going to be able to get to sleep,” and the feeling of dread that this thought can generate, can get in the way of sleep. It can become a loop in which difficulty falling asleep can lead to feelings of agitation, dread, or worry about sleep, which of course then disrupt the ability to fall asleep.

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Circadian rhythm is what happens in your body over a 24-hour period, including sleepiness and alertness, or awake time. External cues, such as daylight or darkness, can affect circadian rhythms. However, if your body is used to going to sleep at a certain time, it can be difficult to force it to sleep at an earlier or later time. Delayed Sleep Phase Syndrome (DSPS) is noted to be a condition in which a person’s sleep is delayed by at least two hours past the socially acceptable or conventional bedtime. So, it is a delay in the body’s sleep and wake cycle. Similar to what you described, someone with this problem would feel awake and alert until late into the night (or early in the morning). It is common in adolescents and college students, who study late at night. It sounds like when you started working, you attempted to make significant changes in your sleep habit and wound up feeling unable to go to sleep at an earlier hour. Typically these types of changes are best made gradually. For example, if you are used to going to bed at 2 am and want to shift to an earlier bedtime, you might try to go to sleep at 1:45 am or 1:30 am for a few nights, and then make another small change. Some sleep specialists work with light therapy to help people make changes to their body’s internal clock, or circadian rhythm. Specifically, a bright light is used to cue the body that it is time to wake.

As you mentioned, you have tried a number of things to get better sleep. Good sleep hygiene consists of some basic steps, which might or might not sound familiar to you. Good habits include establishing a bedtime routine; relaxing before bed; avoiding caffeine, alcohol, and smoking for a few hours prior to bedtime; refraining from getting into bed until you are sleepy; and getting up after 20 minutes if you are unable to fall asleep. The idea behind getting up is to avoid the experience of lying in bed feeling frustrated or worried for hours, as this can begin to create a negative association with your bed, which leads to even more difficulty falling asleep.

One cautionary note: if you are significantly sleep deprived and finding yourself becoming drowsy during the day, please be careful. If you are driving and become drowsy, this can be a dangerous situation for you and others. Pull over if you find yourself falling asleep at the wheel!

Sleep clinics, such as the one at Cleveland Clinic for example, offer sleep studies for patients and online information about sleep disorders such as insomnia. Typically a sleep study requires an overnight stay at the clinic, which offers medical professionals a chance to observe sleep and run a test such as a polysomnogram during sleep. Cleveland Clinic’s website offers information about various sleep disorders, sleep quizzes, tips for good sleep, and information about what to expect during a sleep study. You might be able to find a similar clinic near you if you feel as if professional help is needed. Your doctor would also be a good place to start as you investigate what might help you get back on track with sleep. It is generally a good idea to use sleep medications, whether over-the-counter or prescribed, under the guidance of a health professional.