Insomnia

The following is extracted from https://www.painscience.com/articles/insomnia.php for the full article (it is very long) click on the link.

I have tried to put the main points of the article below

Some insomnia is caused by sleep disorders such as Delayed sleep phase syndrome (DSPS) or sleep apnea. Or sleep loss may be caused by the pain of another medical condition, such as rheumatoid arthritis. But most insomnia is basically just a bad habit — a learned behaviour, which is usually aggravated into a crisis by emotional stresses.

Here in Vancouver, University of British Columbia psychologist Stanley Coren describes sleep deprivation studies in humans showing a number of ominous effects, and his book Sleep Thieves: An eye-opening exploration into the science and mysteries of sleep generally comes to the conclusion that everyone needs to take sleep deprivation much more seriously than we generally do.

Here are several examples:

•    Insomnia hurts. An internet survey of over 2,500 people with fibromyalgia (a chronic pain condition) showed that insomnia was one of the most commonly identified aggravating factors. There is good reason to believe that what makes fibromyalgics hurt probably predisposes healthier people in the direction of increased sensitivity as well. Another survey found the fairly spectacular statistic that 53% of chronic low back pain patients had insomnia, compared with only 3% in pain-free controls.

•     Insomnia saps your migraine defenses. A study of 1869 migraines clearly showed that “sleep obviously protects against [migraine] attacks rather than provokes them,” while a whopping 29% were actually caused by insomnia. I don’t know about you, but anything that protects against migraine attacks is good and I don’t want to lose much of it.

•    Insomnia makes you sick. It is strongly linked to metabolic syndrome (the term for a stew of factors associated with obesity, poor fitness, diabetes, and heart disease). A statistical analysis of insomnia’s relationship to absences from work caused by illness clearly found that there’s a connection: insomnia is followed by periods of increased absenteeism from illness and disease. Yikes! As if that weren’t bad enough: the evidence shows that the effect is prominent up to two years after insomnia. Shudder. And still more: a 2009 paper shows that people with even minor sleep problems (less than 7 hours per night) get almost three times as many head colds.

•    Insomnia can wreck your mood. 40% of psychiatric mood disorders are preceded by insomnia, and insomnia sets in at the same time as another 20% of mood disorders.

This is just a sampling. For a complete discussion of how insomnia probably increases body pain of all kinds (and muscle pain in particular), see Insomnia Until it Hurts.

The cure for insomnia was ultimately simple, and consisted of a simple 2-point plan:

•         Sleep environment upgrading

•         Behavioural conditioning

Everyone’s circumstances are different, and the solutions will be unique, but stop at nothing to make your bedroom as sleep-friendly as humanly possible.

Buy the best mattress money can buy, get a deluxe pillow, and 900 thread count sheets. Fix the leaky tap. If your partner snores, get rid of them: separate bedrooms, etc.

Sleep is a complex human behaviour, and insomnia is a dysfunctional sleep behaviour — sleep behaviour that results in sleep that is at odds with what we want, usually not enough of it and at the wrong times. Either we start sleeping at the wrong time, and/or we can’t continue sleeping as long as we’d like, and/or we can’t sleep as deeply as we need to.

The sum of our sleep behaviours is called our “sleep hygiene.” Insomniacs usually have lousy sleep hygiene.

Most insomniacs, when they have trouble falling sleep, get frustrated, get up, and do something. This is dangerous. Depending on the activity, this is a message to your brain. The message is, “1:00 AM is for checking my email. Reading a book. Watching a bit of boring telly. Having a snack.” Your ancestors didn’t have those options. Through most of our biological history, they literally couldn’t even put on a light!

It’s this simple: whatever you repeatedly do at 1:00 AM, that is exactly what your brain will think 1:00 AM is about! You are teaching your nervous system not to sleep, and like the miraculously adaptable thing that it is … it learns.

To have any hope of sleeping through the night, you have to have a consistent bedtime and a consistent waking time.

Training for recovery from behavioural insomnia is usually most easily cured by restricting sleep to an inadequate, fixed period each night, and then gradually increasing it. It’ll be unpleasant at first … but you’ve got nothing to lose.

By compressing your Total Time In Bed into just a few hours, the message to the body is "this is all you're getting, so make the best of it."

Instructions:

1.       Start with a 6-hour period, give or take: less than you need, but more than you are getting.

2.       Set the waking time you want to stick with. Count six hours backwards from that time to get your new bedtime. i.e. if you want to get up at 7:00am for the rest of your life, your new training bedtime is 1:00am.

3.       Start this on a weekend or when you have a day or even a week off from work. You don’t want to operate heavy machinery, or make important decisions, when you’re starting this process! You will almost certainly lose even more sleep than usual. You’ll lose sleep during your sleep period and have no opportunity to recover … until the next night.

4.       Do not nap at all or strictly limit napping. This is a significant challenge in itself. Do whatever you have to do. For the serious insomniac, a lot is at stake. All I can tell you is that it’s worth it.

5.       Repeat for 3-14 days. Decide in advance how long to try the strategy, and stick to it. Basically, the worse your insomnia, the longer you need to really reinforce the “idea” that you’ve only got a few hours to sleep each night.

6.       At the end of the first phase, move your training bedtime 15-30 minutes earlier, and repeat for another 3-14 days. Increase your sleep in smaller increments for difficult cases.

7.       The sleep “pressure” will accumulate enough so that you can hardly imagine not sleeping in the time available.

Ritual is particularly important for insomniacs who have trouble falling asleep. Spend some time and create a carefully planned and scheduled bedtime ritual of at least half an hour to repeat every night until you are cured, and frequently for the rest of your life.

The purpose of the ritual is to (a) wind down, and (b) learn to associate your bedtime with a series of predictable steps. It actually makes a difference whether you wash your face and then brush your teeth, or brush your teeth and then wash your face — it doesn’t matter which order you do it in, but it does matter that you always do it in the same order. The more consistent the ritual, the more quickly your brain can learn that face washing followed by teeth brushing equals bedtime.

Some improvements in sleep hygiene combined with sleep compression therapy alone will resolve behavioural insomnia for most people within 4-6 weeks.

I would recommend you read the entire article as there is a much useful information especially if you are an insomniac.