It’s 5:30 in the morning and I still can’t sleep. I should be either still sleeping or waking up to work, but instead I’m studying the swirling patterns inside of my eyelids. This has gone on for months. As a freelance writer I make my own schedule, so there’s nothing that acts as a functioning anchor to night or day. As a result, my sleep schedule meanders as all over the place as it damn well pleases. I’ll go for two months of severe sleep problems, trying everything under the sun, before my body decides it’s done keeping me awake. Only then do I sleep like the dead. Sometimes I’ll head right back into another cycle of insomnia, and sometimes I’ll go back to my normal sleep schedule with the next bout of severe insomnia months—sometimes years—away.
Every time another period of insomnia happens it makes me wonder if the lack of sleep is making me careen faster towards my inevitable death. The answer is not necessarily, but insomnia can be pretty fucking bad for your health and quality of life. There isn’t a “cure” per se, but there are things you can do to try to manage it safely. To help me understand what I can actually do to help with my own sleep problems, I delved into the science of sleep. Here’s some of the research behind your restless nights and what’s been shown to help.
I first wanted to know more about why insomnia happens. The answer: It can come from all kinds of places.
A variety of factors can cause insomnia. Medical conditions like hyperthyroidism, asthma, and chronic pain can all keep you up at night. Though they don’t always cause insomnia, sleep apnea and restless leg syndrome are also known to disturb sleep. If you’re having chronic problems sleeping it’s a great idea to talk to your doctor to see what else is happening under the hood. You may be referred to a sleep specialist who can do a deeper dive into your sleep patterns and the potential underlying contributors to your sleep deprivation. In other words, don't just pop a sleeping pill, since you might be just treating the symptom and not the problem.
If there isn’t anything medically awry, there can be any one of a number of things contributing to your sleep woes. Excess caffeine, alcohol or nicotine use, shift work, keeping your devices on in bed, an inconsistent bedtime, irregular sleep patterns (frequent napping or sleeping late), anxiety, stress, depression, or even something as simple as an uncomfortable bed can wreck your sleep. While some of these have seemingly simple fixes, one of the toughest things about insomnia for me (and for many people) is figuring out how to shut your brain off. And there's good reason for that.
Sleep deprivation can seriously impact both your body and your mind. I'm speaking from experience—it's a vicious cycle, people.
Between some mild visual hallucinations due to my exhausted brain and tired eyes and the existential crises that crop up now that I'm a person in my mid-30s, the restless nights add up.
According to research, chronic insomnia can take a toll on everything from your cognition (we’re talking difficulty concentrating, focusing, and remembering things) to your physical (there seems to be a relationship between poor sleep and hypertension, for example), and emotional health (insomnia is a risk factor for anxiety and depression, and can also exacerbate those conditions if pre-existing). There seems to be a connection between insomnia and elevated levels of cortisol, the stress hormone. It’s all a vicious cycle: being stressed out can make it tough to get good quality sleep, and the less sleep you get, the more stressed you feel. So there’s a good chance you’re not imagining that you sleep like crap when you’re stressed out, and vice versa, no matter which one is causing the other. (Recent studies suggest that insomniacs may exhibit cognitive “stress dysregulation,” meaning their brains have issues effectively regulating stress). In short, a relationship between a racing mind and sleepless nights is pretty clear.
Trouble sleeping can lead to other problems, which can increase stress and anxiety, which can contribute to insomnia. Sigh. Getting good quality sleep seems to be important for maintaining testosterone levels in men. And sleep disturbances and lack of sexual desire and arousal seem to be linked for women. And though it’s a "risk factor” and not necessarily causal, chronic insomnia is associated with higher risk of cardiovascular disease and diabetes.
Anyone who’s had to make a long drive on little sleep can tell you that there are also, of course, hazards that can come along with being fatigued, but being exhausted is actually more compromising than most people realize. According to the National Sleep Foundation, 100,000 car crashes per year are caused by over-tired drivers. And going 18 hours without sleep is equivalent to having a blood alcohol concentration of .08 percent (which is legally impaired) and puts you at equal risk for a crash.
I've tried sleep meds to help, but they're not a permanent fix. In fact, they should be used cautiously.
Trying to manage insomnia with drugs often feels a little like not being able to find your glasses because you can’t find your glasses. Here's the cycle for me: I can’t get that elusive good night's sleep, so I’ll take sleeping meds tonight, which leads to not being able to sleep again tomorrow unless I take sleeping meds again. Been there, bought the tacky keychain souvenir.
There is a place for sleeping meds for some types of sleep disturbances, but they should be used judiciously and should not be considered a magic cure. According to the Mayo Clinic, sleep meds should be used under a doctor’s supervision at the recommended dose and only after other attempts to abate the insomnia have failed. They’re also not recommended for long-term use. Sleeping pills often carry some risk of dependency, so if you’re just having a bit of trouble sleeping for a night or two, it’s best to see if it will pass with other adjustments to your sleep routine before reaching for meds.
That goes for any medication that helps you sleep, not just the ones prescribed by your doctor. Common over-the-counter sleeping medications have one of four ingredients: melatonin, diphenhydramine, doxylamine, or valerian. Melatonin is a naturally occurring “sleep hormone,” and diphenhydramine and doxylamine are both antihistamines. Valerian is a plant. Although over-the-counter sleep aids can typically be taken safely short-term, they all have contraindication and drug interactions (if you are taking other medications make sure you consult your physician before starting a sleeping aid), shouldn’t be used if you plan to drink, and generally shouldn’t be relied on for sleep every night.
The bottom line is that if you’re experiencing sleepless nights or sleep disturbances, you should check with your primary care doctor, who will help you figure out what’s going on, suggest next steps, and, as noted, may refer to a sleep specialist. If you are experiencing high levels of stress, or think you may be depressed, these are important factors to relay during your office visit.
There are also plenty of non-medication options. I've tried most of these myself, with promising results.
For example, you can try keeping a sleep journal—my sleep journal was a lot of “the cat is a jerk and my phone is ringing too much,” but it was helpful for figuring out triggers—or wearing a device that tracks sleep to see what habits occur concurrently with insomnia to find patterns. Maintaining a regular, set sleep schedule has also helped me (it was a bit rough the first several days, but the payoff was worth it). You may also want to try exercising; according to the National Sleep Foundation, it’s been shown that exercise “significantly increases the sleep of people with chronic insomnia.” You can also try regulating the temperature in your bedroom—around 65 degrees is thought to be the ideal temperature for sleeping. So, no, you’re not a weirdo for flipping the pillow over to the cool side.
The next things to consider are some lifestyle habits. Are you a caffeine lover? Try cutting down or switching to decaf coffee earlier in the day. If you’re on medications, talk to your doctor about whether they could be affecting your sleep. Do you love fiddling with your smartphone a little too much or is it ringing off the hook at all hours? Turn the ringer off and switch over to a good paperback, because some research has shown that our screen use may be keeping us up late. Stressed and your mind is racing? A therapist, meditation, and finding relaxation techniques can all help. Is your cat begging you to play fetch at 4 A.M.? Scream at him “Oliver what’s your goddamn problem?! You’re not even the right species for this activity.” Keep in mind, too, that alcohol can interfere with sleep. Several drinks at night may help you quickly zonk out, but they also may wake you up hours later and challenge your efforts to return to dreamland.
The good news is that I’ve found that trying out multiple interventions can make a dent in even the most stubborn insomnia.
Before sitting down to write this article, I was sure that my lack of sleep was a thing I could just deal with. After assessing all the risks tied to sleep deprivation, though, I started giving more consideration to my sleep with regard to my overall health. I put my devices down a few hours before bed, switched over to a good paperback, and I stop the caffeine intake by 2 P.M. I put everyone who pings my phone at ungodly hours on do-not-disturb, and I try to get up from my computer several times a day and get some walking in if I can’t make it to the gym. I’m not entirely back on schedule, but I feel a lot better and I don’t have that bleary-eyed-careening-towards-death look in my eyes anymore.
If you’re at the point where you’ve tried all the common ways to manage your insomnia and you’re still struggling, you should bring your sleep journal with you to your doctor and have a long talk. There are sleep studies you can do in which your sleep patterns can be monitored and analyzed. Your doctor can determine if something more severe than just a love of caffeine causing this, what steps you should take next, and how you can help safely manage this long term. Don’t write off weeks of sleeplessness as just an inconvenience, and please don’t try to manage this with medications without talking to a medical professional.
And now that it’s 7:30 a.m., it’s time for bed.
Yvette d'Entremont holds a B.S. in chemistry, B.A. in theatre, and a master's degree in forensic science with a concentration in biological criminalistics. She worked for eight years as an analytical chemist before her blog focused on debunking bad science, scibabe.com, turned into a full-time job in science communications. Follow her on Twitter and Facebook.