Why Can’t I Sleep?

My Sleep Slog

At 12 years old, feeling the stress of peer drama, bodily changes, and looming teenagehood, I developed a severe case of insomnia. So desperate was I to sleep that, in the wee hours, I’d beg my parents to allow me into their king-sized bed. They’d groggily assent, but eventually Mom marched me to the doctor, who prescribed a couple narcotics that knocked me out every night.

Since then, I’ve battled off and on with my familiar but unwanted friend, Insomnia. Recently, however, I’ve had a breakthrough. I want to share my newfound secrets with you. But first, let’s understand sleep a little better. Since we spend 25-30 years of our lives sleeping, I figure we should know something about it.

How Sleep Works

The psalmist said, “It is vain for you to rise up early, to sit up late, to eat the bread of sorrows; for so He gives His beloved sleep” (127:2). Sleep is a gift of God. Unremitting consciousness would be too much for us to bear, so the Giver of good things anesthetizes us for about a third of our day. Thank you, Jesus.

Sleep comes in, and with, waves. First, the buildup of adenosine throughout the day eventually moves us from beta wave alertness to alpha wave drowse. Betas have high frequency and low amplitude, but with each new stage from N1 to N3 (“N” means “non REM”) the waves get less frequent, as in, slower. In the deepest stage of sleep, N3, the waves look like a slow, rolling ocean tide.

Then, after the brain climbs back up through the stages, REM sets in. REM is a pretty weird, paradoxical thing. In it, the waves increase in frequency until the mind is as active as waking. Now we start to dream. Fortunately, muscle atonia sets in so that most of us can’t act out our dreams, lest we walk off a cliff or set a house on fire.

This cycle repeats itself four to six times per night, with REM increasing as the night goes on. Distinct sleep problems appear in specific stages—for example, obstructive Sleep Apnea during N1, teeth griding during N2, and sleepwalking during N3.

Sleep Pathologies

Unfortunately, the delicacy and sophistication of sleep means much can go wrong. Hello to sleep pathologies. I’ll list them here with a summary of each along with prevalence, causes, and treatments.

Insomnia Disorder

One of the most common sleep pathologies, good ol’ insomnia, impacts 16.2% of people globally. And it seems to be on the rise. Online searches for “insomnia symptoms” has increased since the pandemic and continues to increase. We seem to be less and less able to conk out.

Harvard University presents the causes of insomnia as predisposition, precipitation, and perpetuation. In other words, we have inherited tendencies (predisposition), triggering events and circumstances (precipitation), and then things we do to make matters worse (perpetuation). It turns out many of those perpetuators have to do with lifestyle.

Those pesky insomnia perpetuators include long naps, caffeine, alcohol, and nicotine, screen time, irregular schedule, poor diet, and obesity. Did you know that binge eating on hyperpalatable foods predicts sleep problems? And that then poor sleep weakens the will to binging? Causality can be complex, but we should take the time to change our bad habits, as better habits will make a difference.

Typically doctors prescribe insomniacs sedative drugs, called hypnotics. These work quickly and well but can lead to addiction and should not be used long-term. Believe it or not, the same is true of the supplement melatonin. Use it for jet lag, but long term it can disrupt your body’s own melatonin production.

The treatment of choice for insomnia is Cognitive Behavioral Therapy for Insomnia, or CBT-I. CBT-I uses sleep restriction (don’t take epic naps), stimulus control (turn off the jackhammer before bed), good sleep hygiene (don’t eat in bed, etc), cognitive therapy (don’t catastrophize a wakeful night, you’ll be okay), and relaxation exercises. I have included a sleep reset which uses these principles and methods.

Hypersomnolence Disorder

This very rare (less than .05% of us humans) disorder, is just what it sounds like—hyper (high) somnolence (sleep)—lots of sleep. The person can’t seem to stay awake. Even after a full night, they nod out all day long.

Pharmacology-oriented doctors give stimulants to a person who can’t stay awake. And this seems logical. But since hypersomnolence may be caused by the lack of a metabolite called oxbate which is a precursor to GABA, an inhibitory neurotransmitter which sends us into sleep’s deep stages, new medications addressing that issue may be better options.

Narcolepsy

Similar to Hypersomnolence, Narcolepsy features unwanted sleep. Type 1 includes cataplexy, where the person goes entirely limp in response to intense emotion such as laughing or surprise. Type 2 does not include that, but does include sudden, irresistible daytime sleepiness.

This condition seems somewhat rare but is slightly higher among Japanese people. This hints at a genetic cause, which turns out to be true. People with narcolepsy have a hypocretin deficiency as measured in their cerebrospinal fluid. Fortunately, consuming foods high in hypocretin may help. So break out the high-protein tofu, yogurt, some olive oil and walnuts, and leafy greens and whole grains, which I hope you were going to do anyway.

Breathing-Related Sleep Disorders

Now we’re getting into the realm of common problems. A full one billion people worldwide, including up to 26% of adults 30-70 years old, have sleep apnea (total collapse of airways during sleep) or hypopnea (partial collapse of airways). By the way, this one is also higher in Asian populations. We need to pray for our Asian friends.

Fortunately for apneacs and hypopneacs (I made those words up), the standard treatment, although a hassle, works. So, break out those CPAP therapy machines knowing they are the cornerstone of treatment. But first, try changing a few predictors. Lose weight, because up to 70% of sleep apnea patients have obesity. Stop smoking, because 35% smoke. Oh, and stop being a man, because there’s a 2:1-3:1 ratio of male to female for this disorder, and stop aging, because 90% of men and 78% of women over 70 get it.

For desperate people whose apnea/hypopnea persists even in the face of lifestyle changes and CPAP therapy, there are surgeries such as soft tissue removal maxillomandibular advancement (moving your jaw forward) and hypoglossal nerve stimulation.

Circadian-Related Sleep Disorders

Now we arrive at the diagnoses that make me feel a little guilty. The reason is that I’m not perfect in my circadian habits. Let me explain.

Your circadian rhythm is your brain’s synchronization with the day and night. In other words, if it’s working right, you’re awake during the day and asleep at night. Circadian-Related Sleep Disorders are a persistent misalignment between that internal biological clock and the 24-hour environment.

Circadian-Related Disorders fall into several categories. Delayed Sleep Phase (DSPD) type are night owls who go to sleep too late. Advanced Sleep Phase types are early birds who go to sleep too early. Then there are irregulars, and special difficulties for blind people and shift workers. Much can go wrong with those circadian rhythms.

About 3% of the population struggles here, with the night owl version the most common. Plenty of the night owls are adolescents, as 7-16% of them develop DSPD. Mom, Dad, it may not be their fault. Their neurology changes. Plus, if they’re like teenage me, they’re waiting for the boyfriend to throw a stone at the window.

Genetic predisposition contributes to these conditions, but we can do much to get our brains to work for us, namely watching out for nighttime LED light exposure. Dr. Roger Seheult helps us understand how nighttime LED confuses the brain’s “orchestra conductor,” the suprachiasmatic nucleus, which sets the brain’s sleep/wake rhythm. Those LED lights glaring from your ceiling suppress nighttime melatonin production, he says. Get dimmers installed, swap LEDs out for incandescent bulbs, or wear light-blocking glasses after sunset. Do something to keep those lights from telling your brain it’s daytime when it’s not.

Parasomnias

In my opinion, this is the diagnostic manual’s wastebasket term to describe all the weird things that can happen in sleep. The list includes strange behaviors during REM sleep when sleep paralysis fails, and Somnambulism, a fancy name for sleepwalking. It also includes Sleep Terrors and Nightmare Disorder. For good measure, they throw in Restless Leg Syndrome, which is a leg-twitching condition I sometimes experience if I get dehydrated.

Parasomnias impact children the most, but due to genetic predisposition, stress, sleep deprivation, and sometimes medications, these things happen to otherwise emotionally stable adults. My husband yells in his sleep sometimes, but denies it because, well, he’s not awake to hear it. But I sure am.

General Sleep Helpers

Let’s move on to lifestyle changes we can make to optimize our sleep. After all, the FDA has issued a “black box warning” for several sleep meds. Steve Wholberg gives a powerful testimony of his own struggle with, and treatment of, adverse reactions to sleep meds here. What advice can be given to people seeking safer, healthier approaches?

First and foremost, align your lifestyle with the eight doctors—nutrition, exercise, water, sleep, temperance, air, rest, and trust. Abide Network’s coach Joanne McDermott can help with that. Check her out here.

Next, trust Jesus. Often when something goes wrong with our health, our reaction makes it worse. This is called secondary disturbance, and it can be worse than the problem itself! One form of this is when, because of tossing and turning, we form an association between sleep and frustration. Let’s gently rewire our brain’s tendency to catastrophize, accept that we’re having sleep problems, and act constructively.

Check out my Sleep Strategies and Sleep Reset at the end for some constructive answers.

Back to My Sleep Slog

After my adolescent bout with insomnia, I settled into good sleep patterns except for mid-insomnia about three nights a week. For most of my adult life I would wake up at 3am or so, work for a couple hours, then crawl back into bed at 5am for a couple more hours. Nothing catastrophic, I still got my seven hours, but it wasn’t ideal. Recently, I have included two things in my lifestyle that seem to have overturned my mid-insomnia.

One is intermittent fasting. I had discovered the “two meal a day plan” as a teen and stuck to it for many years, but due to schedule changes started to include a third meal. (And I still do this when I’m traveling.) But my last meal was too late in the day. I didn’t realize it, but this was disrupting my sleep. See, food is a time cue, a circadian rhythm setter. By eating at night, even a small amount, I was telling my body it was wakeup time. My suprachiasmatic nucleus conductor just threw down his baton and let my brain go. Up I would be at 3am.

Intermittent fasting is consuming all of one’s calories during an eight-hour period. I eat my (big) breakfast at around 10:30am and my mid-day meal at around 5pm. That’s it for the day. I have to cope with a few hunger pangs on this program, but believe it or not, I’ve actually gained a bit of (wanted) weight since I started!

Another change I’ve made is cold plunging before bed. I bought a Polar Dive one-person plunge (who cold plunges in groups? It’s a private experience) with a chiller that sits outside waiting for me to do my five minutes at 50 degrees after my nightly hot bath.

I also do the physiologic sigh as taught by Andrew Huberman. I modify it slightly: Breathe in through the nose, breathe in again a short burst to expand the lungs fully, then exhale through pierced lips (to slow the exhale) moving eyes back and forth across the field of vision (this calms the amygdala). I do this in my hot bath to begin the process of nighttime relaxation. I have been sleeping through the night, about seven or eight hours a night, ever since making these changes.

Now that I’ve gone on record as a recovered insomniac, watch me wake up tonight with all six of these disorders I’ve just described. But if I do, I’ll take it in stride, knowing that the same God who gives sleep will give us new bodies at the resurrection, “in a moment, in the twinkling of an eye, at the last trumpet. For the trumpet will sound, and the dead will be raised incorruptible, and we shall be changed” (1 Cor 15:52).

Supplemental Materials:

Sleep Strategies

Do you have trouble falling and staying asleep? Here are some tips that may help.

1. Regulate your schedule as much as possible to help set your circadian clock. Try to sleep and wake at roughly the same time each day.

2. Get bright light exposure as soon as you can after arising. This boosts brain serotonin, which becomes sleep-inducing melatonin later in the day.

3. Don’t eat before bed. Ideally, you should eat your last meal at least three hours before bedtime, and even more ideally it should be a lighter meal.

4. Make sure you sleep in a bed that is only used for sleeping and sex so that your brain doesn’t develop an association with the bed and, say, eating or watching action movies.

5. Make sure the room is the right temperature. Too cold or too hot can keep you awake.

6. Try deep breathing. Breathe in through the nose, breathe in again sharply to fully inflate the lungs, breathe out through pursed lips while moving the eyes back and forth. Do this at least six times.

7. Systematic relaxation can help. Tense your feet as tightly as you can, then relax. Then your calves, then thighs, then buttocks, then abdomen, then shoulders and chest, then neck, then face.

8. Don’t stress about not sleeping. Your body will get enough sleep eventually. If you can’t sleep, get up, sit in another place, and read or do other activity until you feel fatigued. Then go back to bed.

9. White noise can help by blocking out noises that might wake you. You can simply download a white noise app on your phone, or you can buy a special machine.

10. Don’t toss and turn. Get comfortable, and make yourself stay there. Each time you toss you change your brain waves and set yourself back. Try staying put.

11. Avoid caffeine completely, or at least from noon on, as it is a nervous system stimulant and can keep you awake.

12. Don’t drink alcohol before bed to relax! It may initially relax you but it apparently disrupts the second stage of sleep.

13. Try gentle sleep and relaxation aids like chamomile, passion flower, lemon balm, and valerian. Always check with your doctor to make sure these things are the right fit for you.

Sleep Reset

Here’s a circadian rhythm reset that may help you regain good sleep patterns if the sleep strategies are not sufficient. Make sure to adhere to the sleep strategies while doing the reset. This is for severe cases. Check with your doctor before trying this approach.

1. Go to bed at 11 PM each night. Wake up at 6 AM. This is slightly less sleep than most people need, but it will help reset your clock and you will be able to increase your number of hours later.

2. In bed, do not do anything but sleep. No reading, no phone.

3. Get in a comfortable position and do not change that position. Tossing and turning increases wakefulness.

4. Do physiological sigh breathing when you first lay down. Breathe in through the nose, breathe in again sharply to fully inflate the lungs, breathe out through pursed lips while moving the eyes back and forth. Do this at least six times.

5. If after 20 minutes you are still awake, get out of bed and sit in a chair. Do not read or do anything in the chair except sit. When you start feeling tired, go back into bed. Do this as many times as necessary. The first night may be very difficult, but the second night it should get easier.

6. If you have not slept well, power through the next day. Try not to operate motor vehicles or heavy machinery. Give yourself a break from things that require you to be well-rested. Take walks and do light tasks. You will feel tired, but stay awake all day.

Repeat the process. You should start falling asleep at 11 PM and sleeping till 6 AM. You can then increase your number of sleeping hours gradually up to your preferred amount, but not more than nine hours.

This blog is a summary of a talk from Expert Help Webinars. Access the talk below.

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