Department of Psychiatry
Penn Behavioral Health

PAH Outpatient Behavioral Health Clinic

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Newsletter: April 2010

Sleep Problems

Richard Bollinger, MA


Trouble falling asleep last night? Well, if you did, you’re not alone. According to the National Center for Sleep Disorders Research, thirty to forty percent of American adults suffer from intermittent bouts of insomnia over the course of a year. As one discovers when sleep has become disordered, sleep is a critical component of our daily lives. We will spend almost one-third of our lives asleep, which amounts to 26 years if we live to be 78-years-old (the national average). Sleep loss has been linked to becoming more reckless, more emotionally fragile, less able to concentrate, and more vulnerable to infection. Recently, sleep has been shown to enhance memory and learning; studies have shown that the sleeping brain may draw connections and insights that were invisible while awake.

The centrality of a good-night’s rest to a healthy, well-functioning life then is hard to deny. It follows then that a significant lack of sleep can have drastic implications on one’s overall well-being, from decreasing school and work functioning to increasing relational conflict. If sleep is proving to be an increasingly rare commodity in one’s life, the following information may prove helpful to enhancing one’s ability to sleep and thereby increasing one’s functionality in daily living.

First, how much sleep is enough sleep? The National Sleep Foundation explains that there is no “magic number” of hours that each person must obtain. Each person’s sleep needs are unique to their own physiology. However, the National Sleep Foundation does offer a general rule of thumb that adults should receive between seven and nine hours of sleep a night.

If you know that you are not sleeping enough, and have been trying to sleep but have been unsuccessful, the following strategies may prove useful:

  • A glass of warm milk. Warm milk can trigger the natural release of melatonin.  Melatonin helps us to fall asleep and to reach a state of deep sleep.

  • Reserve the bed for sleeping and sex. Try to avoid using the bed as a place to study, read, or watch TV. The bed should be associated with falling asleep. If the bed is used for too many activities, the mind and body may not naturally associate lying down on the bed with falling asleep.

  • Avoid Alcohol before sleep. Although it may relax you, alcohol actually suppresses deep sleep.

  • Avoid stimulants before sleep. Caffeine, Nicotine, and exercise should be avoided within a few hours of going to bed.

  • Establish regular bedtimes and wake-up times. Similar to primarily utilizing your bed for sleep, going to sleep at a regular time will help condition your body to begin winding down at a specific time when you want to go to sleep.

  • Utilize imagery. According to a recent study at Oxford University, trying to bore yourself to sleep by thinking about mundane things (like counting sheep) is not as effective as imagining a relaxing place like a forest with a stream or a beach.

Okay, so you have tried techniques to help you sleep and yet a good night’s sleep is still hard to come by. What else could be going on? Lack of sleep is indicative that perhaps you are suffering from a mental or physical condition which is inhibiting your ability to relax enough to fall asleep.  Difficulty sleeping is a possible indicator of the following disorders (list is not all-inclusive):

  • Anxiety and Depression. Inability to fall asleep due to the constant rumination and worry over one’s troubles and concerns could indicate the presence of an anxiety or depressive disorder. Again, inability to fall asleep or stay asleep is normal for all of us from time to time, but if the difficulty sleeping has been a chronic problem for several months, and if anxiety, irritability, or sadness has also been more present than normal, then an evaluation for anxiety or depression may be warranted.

  • Breathing-Related Sleep Disorder. The most common breathing-related sleep disorder is sleep apnea. This disorder is characterized by periods of very loud snoring, punctuated by periods of silence that last 20-30 seconds. The snoring results from a partially-obstructed breathing airway, and the silence results when the breathing airway becomes fully obstructed. Following the silence, the individual then will either snore loudly, gasp, moan, or move in order to reopen the obstructed breathing passage. Typically, this pattern occurs outside of conscious awareness for the individual since they are still asleep. However, the blocked passage – reopening passage cycle prevents the individual from entering into the most restorative and restful type of sleep, called REM sleep. Therefore, an individual with this disorder usually awakens still feeling groggy and tired, and may habitually fall asleep throughout the day even though they slept for most of the night.

  • Insomnia. Insomnia is difficulty falling asleep or staying asleep when no anxiety, depression, or other medical condition is the known cause. Typically in order to be considered insomnia, the difficulty sleeping has to have been present for an extended period of time.

If any of these conditions seem to apply to yourself or someone close to you, an evaluation by a health professional may be warranted. Hopefully if you have been suffering from disturbed sleep, a good night’s sleep may not be too far away!