The Evidence Points to a Better Way to Fight Insomnia(nytimes.com)
nytimes.com
The Evidence Points to a Better Way to Fight Insomnia
http://www.nytimes.com/2015/06/09/upshot/the-evidence-points-to-a-better-way-to-fight-insomnia.html
53 comments
Anyone know if melatonin helps?
I take melatonin as a sleeping pill whenever I need to get to sleep, it knocks me right out with less grogginess the next day compared to over-the-counter stuff. My doctor later said it was hit or miss with different people, which is why you probably hear very mixed results about it. Still, I try to avoid taking it unless I really need to get to sleep on time - despite relative safety, no clue what weird longer-term effects may get reported in the future.
Side note: I visited a sleep specialist/neurologist a while back, who said the proper way to use melatonin was to take it in the middle of the day and stay awake until your regular bedtime. I haven't been using it like that, but thought I'd recommend looking into it first if someone is going to consider taking it. He was the expert, after all.
Side note: I visited a sleep specialist/neurologist a while back, who said the proper way to use melatonin was to take it in the middle of the day and stay awake until your regular bedtime. I haven't been using it like that, but thought I'd recommend looking into it first if someone is going to consider taking it. He was the expert, after all.
Not terribly, I've found. I've just come off a pretty terrible stretch of insomnia (being unable to sleep for two or three days in a row every week for months), and what I've found helpful is taking a bunch of Vitamin D3, 8000 IUs a day for me. I'm 260 lbs, so you may want to adjust downward if you're not similarly large and male, because it is a fat-soluble vitamin.
Taking four gelcaps in the morning has made all the difference in the world to my mood, and I actually sleep now, which is a huge improvement.
https://www.vitamindcouncil.org/blog/why-does-the-vitamin-d-...
Taking four gelcaps in the morning has made all the difference in the world to my mood, and I actually sleep now, which is a huge improvement.
https://www.vitamindcouncil.org/blog/why-does-the-vitamin-d-...
Good point about D3. I remember reading somewhere that it might also help to take them first thing in the morning. (I guess you're already doing that though).
Have you tried cutting out caffeine? How about exercise?
Have you tried cutting out caffeine? How about exercise?
I don't think there's a peer review study, but in the quantified self community, it is common knowledge that you should take it early (5am - 10am) or you will harm your sleep instead of helping it.
It is a http://en.wikipedia.org/wiki/Zeitgeber , and you might want to read http://www.gwern.net/Zeo
It is a http://en.wikipedia.org/wiki/Zeitgeber , and you might want to read http://www.gwern.net/Zeo
I didn't have insomnia as bad as some on the thread and with the caveat that every case of insomnia seems to be different enough that there isn't a single fix for it:
I found melatonin helped to get me started on a sleep schedule, but, in the long run, not as much as using f.lux and making my room as dark as possible at night. Got rid of my TV and listened to audiobooks instead.
I weaned myself off the melatonin supplements over a few months.
For the last two years I've been able to get a full night's sleep without much problem.
I found melatonin helped to get me started on a sleep schedule, but, in the long run, not as much as using f.lux and making my room as dark as possible at night. Got rid of my TV and listened to audiobooks instead.
I weaned myself off the melatonin supplements over a few months.
For the last two years I've been able to get a full night's sleep without much problem.
Melatonin is sold as a supplement, so it's subject to much less regulation than other medication.
Some consumer organisations have tested the pills being sold and found wide variation in the quantity of melatonin in the pills.
In the UK melatonin is a prescription only medication.
Personally: I found it useful. I strongly prefer zopiclone. That preference might be connected to how insomnia affects me.
Some consumer organisations have tested the pills being sold and found wide variation in the quantity of melatonin in the pills.
In the UK melatonin is a prescription only medication.
Personally: I found it useful. I strongly prefer zopiclone. That preference might be connected to how insomnia affects me.
Gwern's authoritative writeup/analysis, http://www.gwern.net/Melatonin
I found I had to up the dose to ~15mg to make a large difference. I went from sleep problems 1/4 nights to <1/10.
I found I had to up the dose to ~15mg to make a large difference. I went from sleep problems 1/4 nights to <1/10.
It's helped me a lot - a lot more than prescriptions, anyway. I have been taking it for a very long time, so I'm pretty dependent on it, unfortunately. Going to try and taper down soon-ish, but I haven't noticed many bad side-effects. YMMV though.
Yes, but only for occasional short-term use. You get used to it pretty quick, so for chronic insomnia it loses effectiveness.
Definitely!
I have tried Puritan's Pride products and they helped me a lot to get over those ugly sleepless nights without the nasty and horrible effects of those sleep aid meds.
I have tried Puritan's Pride products and they helped me a lot to get over those ugly sleepless nights without the nasty and horrible effects of those sleep aid meds.
As someone who has a lot of sleep problems due to physical problems, I find it frustrating that insomnia seems almost always assumed to be always a psychological issue.
I share that frustration. Also the assumption that increasing sleep time by 10% would be helpful - 10% of zero is still zero. My last marathon of chronic insomnia was 96 hours without sleep. Not being restless in bed, but just not sleeping at all. I'm about to start CBT for this but I'm skeptical, given that it's related to a medical problem for which I'm still awaiting treatment.
I laughed when he said he was helped by seeing his "bad" night was one hour less than his targeted 7.
I can go 4 or 5 days a week not going to sleep before 4 AM and I am at work by 7 AM. I can also go 3 or 4 days waking up every hour on the hour and take 20 or 30 minutes to go back to sleep.
Most people don't know I am that tired thankfully.
I can go 4 or 5 days a week not going to sleep before 4 AM and I am at work by 7 AM. I can also go 3 or 4 days waking up every hour on the hour and take 20 or 30 minutes to go back to sleep.
Most people don't know I am that tired thankfully.
Every time I've looked back on a period when I've woken up every hour on the hour, I find that I was under untenable stress levels. Just a thought.
It's been since I was 15. I have gone through a sister and a son having terminal cancer and I don't notice a difference when I was in high stress or low stress. Just frustrating.
I got five hours last night, I'm grateful. I try to hide it from others but that's tricky when you can't stay awake at your desk :-}
Honest question... why not just get some sort of excuse to be able to sleep at those times when you are ready to sleep. Sure it might be during "working hours" but if that is when your mind decides it wants to sleep then for purely health reasons doesn't it make sense to seize that moment and sleep? Would you sleep for hours at that time or would you just wake up in an hour? Either way I can see scenarios where this could work.
I can sometimes get 20 minutes at work but there are few private places where this is possible. I got a 10 minute nap once and woke to find two very concerned people wondering if I'd had a heart attack or something!
If you haven't experienced insomnia it is, like most maladies, far more complex and difficult than you might imagine. Everyone has a suggestion or two, but it differs for each individual and has a multitude of causes (as I hinted, in my case a heart problem plus various complications from that, which I hope to get sorted soon).
If you haven't experienced insomnia it is, like most maladies, far more complex and difficult than you might imagine. Everyone has a suggestion or two, but it differs for each individual and has a multitude of causes (as I hinted, in my case a heart problem plus various complications from that, which I hope to get sorted soon).
That would be an awesome thing to be allowed to do. Outside of high workload Asian offices I haven't heard of sleeping during hours was anything but firing material.
Did you miss where the article says "In this way, unless exacerbated by physical causes — like sleep apnea or restless leg syndrome — insomnia is a condition of the mind that then infects the body. "
It's a minor aside in the second last paragraph of the piece. The rest of the article is written in a way the presents insomnia as a psychological matter.
For most people it is a psychological problem and for those people it was being unsuitably managed. Obviously that's not true for everyone.
CBT is also used in some patients who experience pain as a result of cancer.
Sometimes CBT is about fixing the problem; sometimes it's about helping someone cope better with a problem.
Sometimes CBT is about fixing the problem; sometimes it's about helping someone cope better with a problem.
By and large it is a psychological issue. When it comes to physical problems, doctors focus on treating that instead of secondary symptoms like insomnia, so that's why when you present complaining just about insomnia, doctors initially assume a psychological cause.
Why are you treating this as an issue to do with "complaining to doctors"?
I'm saying that there seems to be a near universal assumption that sleep problems are psychological. In my experience, a lot of people will basically refuse to believe that someone has sleep problems due to non-psychological factors.
I'm saying that there seems to be a near universal assumption that sleep problems are psychological. In my experience, a lot of people will basically refuse to believe that someone has sleep problems due to non-psychological factors.
Out of curiosity, what physical condition causes your insomnia?
Musculoskeletal kinds of issues, involving a lot of inflammation and muscle spasm (this is a weirdly-named technical term, and not something where the muscles noticeably jerk). Unclear where it all originally came from, possibly from long-undiagnosed celiac disease.
Have you considered CFS/fibromyalgia? Your symptoms (including insomnia) are all very typical of CFS/fibro, but not celiac. Typically the cause is stress/burnout.
Regarding people not "believing" that your insomnia is physical rather than psychological: I think it's just that your symptoms are typical of a stress-related cause rather than an organic cause.
Regarding people not "believing" that your insomnia is physical rather than psychological: I think it's just that your symptoms are typical of a stress-related cause rather than an organic cause.
I think I have looked into those in the past, but it must have been quite a while ago. Something I'll try to look into again (once I get a bit of a break from phd work...)
I've had these problems all my life (or as long as I can recall), and for that and other reasons, I don't think it's stress/burnout.
I've read of people having a lot of musculo-skeletal and inflammatory problems due to celiac disease. I don't see what the "typical" symptoms have to do with anything -- they don't say anything about a specific case of a particular person.
> Regarding people not "believing" that your insomnia is physical rather than psychological: I think it's just that your symptoms are typical of a stress-related cause rather than an organic cause.
I do not believe that is the case. It seems to me that the majority of people believe such things can only be psychological in nature... it's like they do not want to believe it could be otherwise.
I also question what evidence people have for the idea that insomnia is primarily caused by psychological factors. It seems to be mainly an assumption. I'm sure there's been some medical studies, but I feel that the medical profession is also strongly influenced by this assumption, and I really wonder how much any studies have been able to properly factor in non-psychological factors as the cause of insomnia.
I've had these problems all my life (or as long as I can recall), and for that and other reasons, I don't think it's stress/burnout.
I've read of people having a lot of musculo-skeletal and inflammatory problems due to celiac disease. I don't see what the "typical" symptoms have to do with anything -- they don't say anything about a specific case of a particular person.
> Regarding people not "believing" that your insomnia is physical rather than psychological: I think it's just that your symptoms are typical of a stress-related cause rather than an organic cause.
I do not believe that is the case. It seems to me that the majority of people believe such things can only be psychological in nature... it's like they do not want to believe it could be otherwise.
I also question what evidence people have for the idea that insomnia is primarily caused by psychological factors. It seems to be mainly an assumption. I'm sure there's been some medical studies, but I feel that the medical profession is also strongly influenced by this assumption, and I really wonder how much any studies have been able to properly factor in non-psychological factors as the cause of insomnia.
I see that osteomalacia can be a complication of celiac, but it should clear up once you fix the vitamin D deficiency. Have you actually been properly diagnosed with celiac and osteomalacia?
Having some kind of issue all your life doesn't necessarily rule out stress as a cause (assuming you don't mean "every day of my life", but rather "I've had this issue off and on all m y life"). Everyone tends to have slightly different responses to stress/burnout, which will likely remain the same for most of your life.
Anyway, I would certainly recommend looking into all possibilities. For me CFS due to stress/burnout seemed to be the most likely cause of my health issues, and making significant changes to my lifestyle completely resolved the issues. I'm not saying this is the case for you, just giving you an example.
Having some kind of issue all your life doesn't necessarily rule out stress as a cause (assuming you don't mean "every day of my life", but rather "I've had this issue off and on all m y life"). Everyone tends to have slightly different responses to stress/burnout, which will likely remain the same for most of your life.
Anyway, I would certainly recommend looking into all possibilities. For me CFS due to stress/burnout seemed to be the most likely cause of my health issues, and making significant changes to my lifestyle completely resolved the issues. I'm not saying this is the case for you, just giving you an example.
I mean every day of my life (as far back as I can recall). Literally every single day.
I find it very difficult to describe the nature of the symptoms. There's definitely a lot more than the general description I gave.
Regarding celiac disease, I have no idea why you're mentioning osteomalacia, as that does not seem at all related to the symptoms I described.
I would really really like to get a biopsy for celiac disease, but the effects of gluten on me are too severe for me to presently spare the few months of eating gluten required for the test. Unfortunately I got given, and followed, poor advice -- to go off gluten for a few months and then reintroduce it and see the consequences. I wish I had gotten the test initially. Being off gluten has cleared up a number of fairly bad symptoms that I've had all my life, and my brother and his daughter also have similar issues with it.
The inflammation/muscle spasm stuff has generally improved after avoiding gluten, but seeing as it is a chronic problem and has gotten into the state it current is in, even if the gluten was the root cause simply removing it is, by now (it seems) too late to make those things simply go away. (...and it's complicated by damage to some joints and muscular weaknesses from it being chronic for so long).
I find it very difficult to describe the nature of the symptoms. There's definitely a lot more than the general description I gave.
Regarding celiac disease, I have no idea why you're mentioning osteomalacia, as that does not seem at all related to the symptoms I described.
I would really really like to get a biopsy for celiac disease, but the effects of gluten on me are too severe for me to presently spare the few months of eating gluten required for the test. Unfortunately I got given, and followed, poor advice -- to go off gluten for a few months and then reintroduce it and see the consequences. I wish I had gotten the test initially. Being off gluten has cleared up a number of fairly bad symptoms that I've had all my life, and my brother and his daughter also have similar issues with it.
The inflammation/muscle spasm stuff has generally improved after avoiding gluten, but seeing as it is a chronic problem and has gotten into the state it current is in, even if the gluten was the root cause simply removing it is, by now (it seems) too late to make those things simply go away. (...and it's complicated by damage to some joints and muscular weaknesses from it being chronic for so long).
In reply to DanBC:
> Offering a psychological treatment does not mean they don't believe you or that your problems are not real and distressing.
I agree. I didn't say otherwise.
They're not the reasons I gave.
> It's pretty stigmatising of you to dismiss the pain felt from a purely psychological cause - did you realise ou were doig that?
what? show me anything I've written that has dismissed "the pain felt from a purely psychological cause"
> Offering a psychological treatment does not mean they don't believe you or that your problems are not real and distressing.
I agree. I didn't say otherwise.
They're not the reasons I gave.
> It's pretty stigmatising of you to dismiss the pain felt from a purely psychological cause - did you realise ou were doig that?
what? show me anything I've written that has dismissed "the pain felt from a purely psychological cause"
But it doesn't matter if there's a physical cause. We know that psychological treatments work for many people.
Offering a psychological treatment does not mean they don't believe you or that your problems are not real and distressing.
It's pretty stigmatising of you to dismiss the pain felt from a purely psychological cause - did you realise ou were doig that?
Offering a psychological treatment does not mean they don't believe you or that your problems are not real and distressing.
It's pretty stigmatising of you to dismiss the pain felt from a purely psychological cause - did you realise ou were doig that?
I spent two weeks in the hospital from my chronic insomnia once, anybody who tells me I just need to relax or stop reading in bed is about as helpful as someone who tells somebody with chronic depression to cheer up.
Not everything is in your head, and no amount of positive thinking will change that.
Not everything is in your head, and no amount of positive thinking will change that.
I think CBT is training your mind to work together with you. Some of the most important things in getting your mind to cooperate (to achieve a result like better sleep), is A) believing that you can, B) Wanting it, and C) Putting in mental effort to achieve your goal. No, it's not a panacea and not guaranteed, but the science* is clearly there.
* Science - It works, bitches! (XKCD quote)
* Science - It works, bitches! (XKCD quote)
CBT isn't "positive thinking" or "relaxing".
What was the cause of your insomnia?
What was the cause of your insomnia?
A lot of my issues stem from work - I have a hard time winding down before I can fall asleep and if I ever wake up to grab a drink etc., it's incredibly difficult for me to fall back asleep. I've started working on meditation to help clear my mind, but even then...
Indeed. Most of us suffer from work-related stress issues, which in turn lead to sleep problems, particularly after one crosses the mid-30s.
What has worked for me is a gym routine in the evening, avoiding browsing the iPad in bed at night, firing up a long podcast to listen to (something without music, loud noises etc). But meditation has been another big factor. Though I must caution you: meditation rarely has a quick payoff. So be patient and don't get anxious about results and keep working at it.
What has worked for me is a gym routine in the evening, avoiding browsing the iPad in bed at night, firing up a long podcast to listen to (something without music, loud noises etc). But meditation has been another big factor. Though I must caution you: meditation rarely has a quick payoff. So be patient and don't get anxious about results and keep working at it.
I've seen several articles that tout the benefits of cognitive behavioral therapy as a solution for various issues.
Is there a self-guided CBT app out there that one could try out?
Is there a self-guided CBT app out there that one could try out?
The article points to http://www.cbtforinsomnia.com but it's not an app. I'm likely to give it to my partner to try.
One that is recommended is "mood gym" - an Australian site.
https://moodgym.anu.edu.au/welcome
A book that is recommended is "Mind Over Mood".
There's probably space in the market for more and better apps and websites.
The English body that assesses efficacy and cost-effectiveness (NICE) have reviews of computer guided CBT here: http://www.nice.org.uk/guidance/ta97
https://moodgym.anu.edu.au/welcome
A book that is recommended is "Mind Over Mood".
There's probably space in the market for more and better apps and websites.
The English body that assesses efficacy and cost-effectiveness (NICE) have reviews of computer guided CBT here: http://www.nice.org.uk/guidance/ta97
Am at the SLEEP conference in Seattle. Two exhibitors in this space:
http://www.clevelandclinicwellness.com/Programs/Pages/Sleep....
http://sleepio.com
This breathing exercise done just before sleep time has helped me sleep better: 5 minutes of even breathing, each breath consisting of a 3-second inhalation and 6-second exhalation. You want to exhale about the same volume of air you inhale, so you should exhale more slowly than you inhale. If 3-6 seconds is too long for you, begin with 2-4 seconds (2 seconds inhale, 4 seconds exhale). It helps to have a metronome app to time your breathing.
This method is discussed in "Anatomy of Hatha Yoga" by David Coulter, Chapter 2. Why does this work? I quote from this book (page 91): "This connection between heart rate and breathing, known as respiratory sinus arrhythmia, ... causes the heart to beat more slowly during exhalation than it does in inhalation. ... If you take longer to exhale than to inhale, especially when you are relaxing, the slowing-down effect of exhalation will predominate."
This method is discussed in "Anatomy of Hatha Yoga" by David Coulter, Chapter 2. Why does this work? I quote from this book (page 91): "This connection between heart rate and breathing, known as respiratory sinus arrhythmia, ... causes the heart to beat more slowly during exhalation than it does in inhalation. ... If you take longer to exhale than to inhale, especially when you are relaxing, the slowing-down effect of exhalation will predominate."
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This reminds me of a TED talk* about dealing with stress, when stress is assumed to be a huge killer / detriment to life. It turns out it's all in how your mind perceives stress. It never ceases to amaze me the power your conscious mind can have over your overall life -- I'm reminded of a quote that "The brain is an elephant, and you are the rider on the back. You cannot steer sharply, but you can urge the brain to go somewhere over a long period of time."
*http://www.ted.com/talks/kelly_mcgonigal_how_to_make_stress_...
*http://www.ted.com/talks/kelly_mcgonigal_how_to_make_stress_...
McGonigal has this really elegant and captivating way of presenting the importance of maintaining a healthy perspective on stress. Recently she presented a similar talk (or the same one? I haven't watched the full TED talk yet.) at the 99u Conference in NYC, in which she made the point: "You can use that stress not as a signal that there’s something wrong with you...but to actually use that same stress as a sign that something you care about is at stake. Take that stress as an opportunity to think about what you care about, to view the situation as an opportunity to learn and grow, to trust you can handle the challenge."
Seen quite a few mentions of doctors using calming, relaxation stimulus before operations to reduce perceived stress and pain. That anticipation if I may say so is a strange thing.
It is pretty poor form for a New York Times article to not bother to define what "cognitive behavioral therapy" is in an article touting it, or even give any examples of what specifically CBT might entail in the context of treating sleep problems.
The second half of the article answers the question of how CBT addresses sleep problems.
Where? It describes some effects of CBT may have but nowhere does it describe what CBT treatment actually entails.
It links both to an academic paper and an online self-help thing prescribed by his doctor, and it talks at a high level about what CBT is. Are you familiar with CBT? If you aren't, the trouble you might be having is that CBT is pretty subtle: it's (in loose terms) a set of exercises you perform to train your mind to respond differently to stimuli. If you've ever read David Foster Wallace's Kendall College Commencement, when he talks about the "default setting", he's giving a pretty decent layman's explanation of the goals of CBT.
My point is that when reading an article in a publication like the New York Times, one should not need to follow links to academic papers or be familiar, a priori, with the subject matter. Providing a high-level overview without requiring the reading of additional sources is precisely what a properly written article in a newspaper like this is supposed do. This article fails at that quite badly.