As reported by the New Britain Herald, February 27, 2005.

Habits May Cause Insomnia

By Tricia Stuart

People can prevent or cure insomnia by remembering that sleeping and wakefulness are conditioned reflexes that can be learned or unlearned.
According to Daniel McNally, director of the Sleep Disorders Center at the University of Connecticut Health Center. Sleep disorders relate to how we deal with sleep and our changes in sleep patterns.

"The majority of people say they always have slept fine until recently. Almost all kids sleep pretty well and wake up annoyingly perky and go to bed and get up when mom and dad tell them. It’s only later on that people need to use medications and they have sleep disturbances," said McNally.

Not all insomnia patterns are the same. There are 10 different types of insomnia, each with a different approach.

A common type of insomnia that McNally treats involves a person who has lost his job and can’t sleep. The person worries and wonders how to pay bills and support the family.

"A month later he gets a better job with more money and better opportunities and the person still can’t sleep. They ask, ‘What’s the matter? I get in bed and feel exhausted,’" McNally said. "He’s learned not to sleep. He began to associate being in bed with not sleeping."

Frustration and ‘tenseness’ about sleeping has developed for that person. McNally said the patient has to go through behavioral retraining to break the association with being in bed and being awake, and to strengthen the association with being in bed and going to sleep.

One pattern that people develop is going to bed and then waking up in the middle of the night, when they would rather be asleep.

"An afternoon nap person gets up and fixes dinner, then goes to bed and can’t sleep. Because of the nap, they can’t go to sleep. They develop their own vicious cycle," he said.

McNally tells the patient to set the alarm for that next wake up time and although odd, this action helps the patient retain the pattern.

Mornings Not Good for Teens

McNally thinks the early rising time for high school students is a bad idea. It has been proven that students don’t function well with an early school start time, and some schools are changing because of that data. However, most high school students get up early for school and then are tired all day.

"On Saturday and Sunday they sleep real late. Their biologic clock shifts to a later time; it thinks they should go to bed late and sleep till noon. They can’t go to bed early Sunday night to prepare for school and the cycle starts all over again."

Acid reflux, asthma, heart disease, and alcohol can also be the cause of insomnia McNally said." Some people think alcohol makes you go to sleep, but the second half of the night is more fragmented sleep. The person wakes up tired. The next night they take two glasses of alcohol and they think it helps, but it doesn’t."

McNally works on retraining the person’s habits during the day and the night.

"Some people are staying asleep, and a few have global, life-long insomnia."

For those who want to wear themselves out by exercising, running five miles just before going to bed is a bad idea.

"When the body temperature falls, the body is telling you to go to sleep. If you exercise before going to bed, it raises the temperature and you can’t sleep," he said.

McNally says caffeine is a bad idea for those who want to sleep though the night. Medications or lack of medications, depending on the individual, can exacerbate insomnia.

Nature created the circadian cycle, which lasts about 24 hours, to help regulate the human body.

"The circadian cycle is the biological clock in each of us," he said. "It regulates the body temperature, alertness, and works together with the 24-hour clock. Most people are up and awake during the day, and asleep at night." (The exception for shift workers.)

"If you put people in a laboratory environment, with no light, no TV, no clocks, a VCR that doesn’t know the time, and take away all cues to time, people don’t know what time it is. But they have to be able to control the lighting," he said. "They will set their time every 25-and-1/2 hours, but they think it’s 24 hours. The light we are exposed to and the alarm clock serves to set our biological clock every day. In a laboratory, it was found that sleep and wakefulness is all controlled by the circadian clock and the circadian cycle operates without input from the outside world. Some people run a little fast; others run a little slow."

McNally said that in the past, medicines had a lot of side effects.

"Newer medications are good at reducing side effects and not carrying over to the next day, but they are not perfect. An increasing number of people believe it’s legitimate to be on medication for the long-term.

McNally is not a fan of long-term medicines.

"I have a bias: if you can fix something by behavior, I’d rather fix it by behavior than chemicals. The exception is the people who have had life-long insomnia. Those people have hyper-vigilance and can’t go to sleep," he said.

People need to allow time to get a certain time to sleep, and to be consistent. Inconsistency means poor sleep, or the inability to fall asleep.

"Pay attention to what your body needs. Negative behaviors such as alcohol and other kinds of drugs can impair sleep. There is an over-expectation that people want their sleep to be perfect. It bothers them and they take medicine, and it doesn’t work and the medicine affects how people sleep and they get frustrated. If a person doesn’t get one night of sleep it isn’t the end of the world. People don’t die of it. The focus and attention that people put on it is more trouble than anything else," McNally said.

For people who remember all the times they wake up, the doctor recommends turning the clock around so they can’t read the time.

"People can wake up several times and not remember, but if you are focusing on it and worrying about it, it becomes a whole set of expectations and frustrations."

He recommends that people first allow time to sleep, and then accept that there will be days that sleep isn’t perfect. If you try to perfect it, he said, it might make matters worse.

Shift workers have a sleeping challenge, especially if they work the third shift.

"They almost uniformly have terrible sleep. They have a confused biological clock."

A night shift worker who has two days off will have shifted their biological clock by the end of the week, and then they have to readapt to the rest of the world on the days off, "and that person’s clock isn’t sure what it has to do -- so the sleep mechanism has trouble," he said.

People normally experience jet lag worse on eastbound flights than on westbound flights, because of trying to adapt to an earlier time schedule. The inner time clock likes a longer cycle. Travelers land in a time schedule with light and activity serving to get them back to the right schedule.

"When you are a shift worker, you are driving home during the light and you hope you can get to sleep when you get home, but you may be extra awake at that time."

McNally suggests the shift worker wear sunglasses while driving home. Disconnect the ringer on the phone and connect an answering machine to the phone so it won’t wake you. Tell the family to leave you alone while you’re sleeping, and have black out curtains in the bedroom.

"Balance the size of the meals to support the rest of your schedule so you’re not going to bed on a full stomach. What you eat is probably less stress than the amount of light you’re exposed to," he said.

How much sleep a person has gotten, and how recently, activates the sleep drive. If people get little sleep, they will be sleepy at any time of the day.

If a person thinks it’s 2 a.m., the circadian rhythm will tell that person to fall asleep, but the person won’t feel sleepy if he or she thinks it’s 10 a.m. How safe or how scary the person’s environment is, such as battlefield condition, will determine whether a person can get to sleep or not.

"An insomniac has something specific wrong with how they relate to sleep, so they can’t get that part of the process to settle down."

Noise, naps, the circadian cycle, and habits determine whether the body welcomes or pushes sleep away.

"People shouldn’t take sleep for granted. They say, ‘I go to bed and it [sleep] just happens. People must allow time for it. If people are going to bed at different times and getting up at different times, they will have sleep problems."

Sleep, and sleep-problems, should get more focus than they currently do.

"One-third of life is sleeping; we should have a course about it. Not sleeping well will be a natural consequence that will come if you don’t respect the body and sleep," said McNally.