Insomnia: Are we sleepwalking into a crisis?
A quarter of us have problems sleeping – and our 10 million prescriptions for pills aren't helping
Jeremy Laurance is a writer on health issues. He is former health editor of The Independent and the i and has covered the specialism for more than 20 years. He thinks the harm medicine does is under-appreciated, the harm it prevents over-rated, and that cycling works better than most drugs. He was named Specialist Journalist of the Year in the 2011 British Press Awards.
Friday 20 January 2012
We are a nation of insomniacs. One in four people is dissatisfied with their sleep and one in 10 suffers from a sleep disorder. Yet despite decades of research we still do not understand why we sleep, and many insomniacs go unrecognised and untreated.
More than 10 million prescriptions for sleeping pills were doled out in England in 2010. Yet drugs are not the answer to our insomnia epidemic, according to researchers writing in The Lancet. Their sometimes severe side effects mean they can create more problems than they solve.
The best treatment, the researchers argue, is with behavioural and psychological techniques – collectively known as cognitive behaviour therapy – to help people drop off at the appropriate time and stay asleep through the night. But a shortage of therapists able to provide the treatment means that many people are forced to rely on drugs, over-the-counter treatments and herbal remedies. Insomnia is now so common that doctors say the preoccupation with it is in itself a medical problem – the greatest enemy of sleep is worry about not getting enough of it.
Most people who lose sleep will be able to recover it the next night, and will be able to cope in the meantime. Prolonged sleeplessness, however, is crippling. Sufferers are more than five times as likely to be anxious and depressed, have double the incidence of heart failure and diabetes and a higher risk of dying early.
Insomnia also imposes a heavy economic and social burden on communities through lost productivity, absence from work and deterioration in quality of life.
The damaging effects of sleeplessness can be catastrophic. Tiredness is known to be a key cause of motorway accidents and has been been blamed for the Chernobyl nuclear reactor disaster in Ukraine, the Three Mile Island nuclear reactor breakdown in the US and the Challenger space shuttle accident that claimed the lives of its seven astronauts.
Successful treatments for insomnia begin with a warm drink before bedtime, that can soothe and relax – avoiding tea and coffee which contain caffeine. The herbs valerian, lemon balm and hops are all reputed to induce sleep and may hold more appeal than conventional sleeping pills. Alcohol helps people drift off but fragments sleep during the second half of the night.
Behavioural treatments include stimulus control (no working in bed), sleep restriction, relaxation techniques and education about "sleep hygiene" including diet and exercise.
The stuff of nightmares: Insomniacs' stories
My theory is that I didn't develop insomnia; I caught it. An ex-girlfriend of mine used to suffer terribly, and her continual problems with getting to sleep made me vividly aware of the process of nodding off – something which, up until that point, I'd never thought about. It just happened automatically. But about five years ago I started thinking about it every night.
In an attempt to cure her insomnia, she bought a relaxation CD featuring the whooshing sounds of a cheap synthesiser and a hypnotic voiceover informing her that, by the end of the CD, she'd be dreaming peacefully. The first night she put it on, she fell asleep within 10 minutes. I, however, listened attentively to the full 75-minute performance and then lay there, wide awake, pondering the mechanics of sleep. Subsequent nights were even worse; I became haunted by this voice telling me to focus on my breathing, when all I wanted was to focus on nothing.
It snowballed, thanks to that perennial question of the anxious mind: "What if?" What if I never get to sleep? What then? One night I failed to sleep a wink but completed a day's work without incident, and this helped to banish some of the demons. It's perfectly possible to function without sleeping; you just feel a bit tired. And these days I'm much better – but only because I've somehow managed to erase the memory of that supposedly hypnotic CD. Fingers crossed it doesn't start flooding back.
The early signs were ominous. As a tiny baby my mum would put me down for an afternoon nap, hoping that she could get on with dinner. But the mere sound of onions sizzling in the pan would be enough to wake up the child who never wanted to sleep.
When I was little, I hated bedtime, convinced I'd be missing out on something interesting. I would fight sleep as long as I could and the first glint of sunlight or the sound of a toilet flushing would act like an alarm clock with no snooze button.
In those days I didn't want to sleep, but now as a grown up with a busy life I cannot sleep, even when I desperately need to. Sometimes I can't fall asleep for hours because my thoughts are racing, other times I suffer from what is known as early morning awakening. And then there are those nights, my least favourite, when I wake up in the night with my heart racing, worried about something I can't quite put my finger on. There are some nights, weeks even, that I sleep OK, and I guess that's when my body catches up. I use the occasional sleeping tablet when I'm desperate; and have even tried hypnosis, but insomnia has always been part of me.
I can't pinpoint when or how my insomnia began, but I don't remember living without it. It was there in my childhood and carried on into my teenage years and beyond. It would take me four, five, sometimes six hours to get to sleep, if sleep came at all, but it didn't begin to affect my life until my mid-20s.
There is very little I didn't try when I still believed there to be a cure. Getting to bed early and at the same night each time, exercise, no exercise, yoga, ear plugs, eye masks, light-blocking curtains, no coffee, endless cups of camomile tea. They didn't even take the edge off.
I would find myself lying in bed, my head throbbing with life. At its worst, I felt as if I was taking part in some terrible thought experiment or trialling a new hallucinatory drug; there were random, repetitive images, conversations and lines from annoying 1980s pop songs ranging through my mind.
Still thinking I could beat it, I tried New Age remedies. They would work for a few nights, but ultimately, it was as if the insomnia was a superbug, mutating to overpower everything I tried. I felt rundown and prone to illness. The one thing that worked in my most traumatic years was a technique called Autogenic Training, a cross between meditation and self-hypnosis, which relaxed me, at least, and even sent me to sleep at times.
Nowadays, it comes and goes, and I've found that the greatest remedy of all is simply to give in, and let it takes it course.
Top tips: How to sleep better
* Go to bed only when sleepy
* Get out of bed when unable to sleep (i.e. get up and read a book)
* Get up at the same time every morning, and avoid napping
Sleep restriction therapy
* Go to bed later and get up earlier
* Limit the time spent in bed to induce mild sleep deprivation
* Then expand the "sleep window" till the optimum duration is achieved
* Don't worry about losing sleep – you will still be able to function next day
* Avoid watching the clock in the night
* Banish unrealistic expectations
* Avoid caffeinated drinks – tea and coffee – and nicotine before bed
* Avoid alcohol – it fragments sleep in the second half of the night
* Exercise regularly
* Practise progressive muscle relaxation
* Use imagery training or meditation to banish intrusive thoughts
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