“BRRRRRRIIINGGG!!!!” The alarm clock rings and I gaze drowsily towards the blurry clock. The bright red LED screen flashes “7:00AM”, a brilliant reminder that, once again, I fell asleep in bed late last night while watching television and am now waking up too tired for work.I fell into a pattern of staying up late at night to finish up work back when I was still in high school. Many years later when I began trying to sleep at an earlier hour, I found myself wide awake. “I’m just a night person,” I would say to myself. Countless sleepless nights later, I switched from a self-proclaimed “night owl” to an “insomniac”.
Does this sound familiar? As a primary care physician, I see countless working adults and even teenagers following a similar pattern with the same problem self-diagnosed insomnia. They often turn to the Internet for answers due to a desperate inability to fall asleep or to maintain sleep. Here are the criteria used by doctors to diagnose insomnia: 1) difficulty initiating sleep, difficulty maintaining sleep, or waking up too early, 2) impaired sleep producing deficits in daytime function, and finally, 3) sleep difficulty occurs despite adequate opportunity and circumstances for sleep. Unfortunately, I find that many “insomniacs” do not take into account this final and most important condition.
Sleep hygiene refers to self-controlled actions that improve the circumstances for good sleep. This involves very simple and common-sense ideas: leaving enough time for sleep at night (typically 8 hours on average for adults), maintaining a regular sleep schedule, exercising daily, and having a sleep environment with little outside stimuli (ambient light, background noise, televisions, computer screens, unfinished work, etc.). Also, I advise against caffeinated beverages after lunch; daytime naps; and the following practices close to bedtime: exercise, alcohol or nicotine, and excessive worries that can keep the mind racing.
If patients still complain of insomnia despite perfect sleep hygiene, then “delayed sleep phase syndrome” is the likely culprit. Years of sleeping late shifts the sleep-wake cycle later into the night. The biological clock induces sleep later and so patients complain of insomnia when unable to fall asleep at a regular hour. Often, a combination of photo therapy, behavioral techniques, and medications will help shift the biological clock to its original state.
If you think you suffer from a sleep disorder such as true insomnia or delayed sleep phase syndrome, it is best to seek the help of a physician to manage this condition. With an open mind and a willingness to make small lifestyle changes, we can all wake up to the alarm clock well rested and happy.
