We tend to think of sleep as something we will finally get to when everything else is done, like the last check box on a lengthy to-do list. At that point, we expect to turn sleep on as easily as flipping a switch. We believe sleep is supposed to come naturally, which makes it all the more stressful when it doesn’t. Ironically, that stress is part of the problem – the more stressed out we are about not sleeping, the harder it is to fall asleep.
Our busy schedules and our reliance on technology have resulted in increased problems with insomnia, sleep deprivation and other serious disorders such as recurring nightmares and parasomnia, in which people act out their dreams.
Shelley Mahon, a psychologist specializing in sleep, says most of us approach sleep all wrong. We work long hours, watch TV in bed and wake frequently to the ping of a new text message from a phone on the nightstand. Many clients come to her citing difficulty sleeping, and it’s no wonder they can’t sleep well, says Mahon – people can’t just throw themselves into bed expecting their busy minds to suddenly melt into sweet dreams.
“Sleep is like inviting a guest for dinner,” she says. “You need to clean the house, and you cook something you think they’ll like. You need to set the scene. But we tend to view sleep like an unwanted guest. We’re like: ‘Oh, it’s you again.’ And we resent it because we have so many darn things to do.”
Mahon says many of her clients are professionals who are frustrated that they can’t sleep as well as they would like. Ironically, the harder they try, the more difficult it becomes. But sleep can’t be forced, and, rather than seeing it as something to conquer, Mahon says, we should embrace it as a reason to slow down, giving us some separation from the busy chatter of the day and a chance to recharge.
Rather than seeing sleep as just another task to check off our to-do lists, we should look at making lifestyle changes, says Mahon. That’s not to say we need to toss out our cellphones, but we definitely need to get them off our bedside tables. Mahon says that when she was growing up, everyone saw the time after 9 p.m. until the morning as a buffer from any requests, interruptions or distractions. “Now, we don’t have those boundaries in place, and our bodies need that protected buffer time,” she says.
In order to sleep well, we need to feel safe, says Mahon. If we know the phone could ping with a text at any moment in the night – even if it’s regarding something mundane – it creates a level of anxiety that can keep us alert when we should be drifting off, or even while we’re asleep.
Sleep issues are not just the purview of the worriers among us; trouble getting enough shut-eye has become so common that sleep physician Dr. W. Jerome Alonso is always busy, scheduling about 45 patients a week. Alonso operates Canadian Sleep Consultants, a Calgary-based sleep clinic where he tests people for disorders including physical problems such as sleep apnea and snoring – both of which, he says, are incredibly common – along with other issues that keep us up at night.
Alonso says while some of the things affecting our sleep are new, the problem isn’t – as long as humans have been sleeping, they’ve been concerned with getting enough of it. “We don’t know the overall function of sleep, but we know it’s involved in a lot of different mechanisms to conserve the body,” he says. “We know sleep is involved in metabolism and our likelihood of developing conditions like obesity. It’s involved in memory consolidation, and there are studies that show it helps in the management of chronic pain.”
So, it’s little wonder we worry when we sleep poorly. Many people are unaware that the activities they do up until bedtime, including the way they view their bedrooms and even the way they think about sleep, can affect the quality of their shut-eye. The same stress that keeps people awake can also cause secondary problems while we’re asleep, for example, tooth grinding, a condition Alonso says affects up to 80 per cent of the general population.
While some people deal with lack of sleep by popping sleep-aid pills, this doesn’t address the root cause of their insomnia. This is where cognitive behavioural therapy (CBT) can help. Patients undergoing CBT learn about good sleep behaviour, and how to identify thoughts that disturb their perspective on sleep. According to Dr. Charles Samuels, medical director for the Centre for Sleep & Human Performance in Calgary, CBT has been compared to drugs in medical studies and it comes out on top.
Arguably, the most important part of CBT involves the way it teaches patients to think about sleep. By constantly worrying about sleep, how much they are getting and how they will feel in the morning, insomniacs, ironically, make their situations much worse. Worry is insomnia’s best friend, creating a hyper-aroused state that feeds into the overall anxiety that makes it difficult to sleep well.
Sleep hygiene – the habits that help people sleep consistently well – is also important. Experts recommend keeping the bedroom dark and the bedroom temperature cool. It’s important to avoid watching TV, playing video games or texting prior to bedtime because the light from the devices interferes with our production of melatonin, a hormone secreted by the pineal gland in the brain that makes us feel tired (melatonin can be taken as a homeopathic remedy, but, like sleeping pills, it may not deal with the root issues of a physical or psychological sleep disorder).
Sleep clinic patients are told that the bedroom should be strictly for sleep and intimacy – no phones, TVs, tablets or work allowed. They’re asked to come up with a bedroom routine that involves slowly unwinding, rather than just moving from task to task until they think they’re tired enough to sleep. And they’re told that once they’re in bed, if they are tossing and turning, they should get up and do something relaxing until they’re tired enough to sleep.
Surprisingly, a lot of CBT patients are initially prescribed a restricted sleep period – rather than trying to increase the amount of sleep they get, doctors lower it in order to improve sleep efficiency. The goal is to get these patients to sleep better during that smaller frame of sleep, which eventually trains them to be tired by a certain time of night, says Samuels.
Many insomniacs obsessively order themselves to sleep, but this sets their minds at alert, causing them to wake up throughout the night, watch the clock (or grab their smart phone) and count down the time before the ring of their alarm. CBT shows patients how to challenge these thoughts and realize that they can – and often do – function well enough on less sleep than what they’ve been told is conventionally optimal.
“They think they need eight hours, but they don’t,” says Samuels. “They need six hours of good sleep, and they need to stop worrying about it, and they will sleep better.”
Once those anxious thoughts are under control and the patients stop making each sleepless night into a catastrophe, they’re able to relax, which in turn helps them get better sleep.
For some, falling asleep is not the main problem; rather, it’s the quality of sleep that is the concern. If a sleeping person continuously wakes throughout the night, they are at risk of not getting enough rapid eye movement (REM) sleep, a highly restorative stage in the sleeping process.
It’s believed that dreams often happen during this stage, and when our bodies lack REM, these dreams can spill into the state of wakefulness – a condition known as “REM sleep intrusion.” In this state, people may experience auditory, visual or tactile hallucinations. Hypnopompic hallucinations occur as the body is transitioning between sleep and wakefulness, while hypnagogic hallucinations occur during the transition from wakefulness to sleep. One of Alonso’s patients saw a multi-coloured spider descend from her ceiling every night due to a hallucination. The patient suffered from sleep apnea, which caused her breathing to start and stop throughout the night, continually waking her up. Luckily for her, the hallucinations stopped once her sleep apnea was treated.
A common auditory hallucination involves hearing your name being called, while a common visual hallucination involves seeing a figure at the foot of the bed, says Alonso. “Sometimes these hallucinations happen in conjunction with sleep paralysis, where
we wake up and our bodies are still paralyzed. It brings up the old stories of having [an] old hag lying on top of you when you wake up,” says Alonso. That particular combination of sleep paralysis and hallucination was thought to be a suffocating evil spirit, he says.
Parasomnia is a sleep disorder that can take on various forms. In some cases, parasomnia causes people to act out their dreams – one of Alonso’s patients injured himself after crashing into furniture while involved in a dream fight. Parasomnia sufferers can also have trouble distinguishing between being awake and asleep. Another form of parasomnia disrupts the body’s normal pattern of inhibiting movement during sleep, allowing the sleeper to move around in a sleeping state. Some people suffering from parasomnia eat, some talk and in rare cases some may pursue sexual activity – all while asleep – while others, like Alonso’s sleep-fighting patient, become violent.
Another serious sleep disorder is recurring nightmares. This can stem from a number of issues, including post-traumatic stress disorder, during which the sleeper relives a traumatic experience while asleep. Nightmares can interrupt the REM cycle, causing REM fragmentation. If this is the case, Alonso aims to get his patients to sleep through a full REM cycle; if successful, the patient is more likely to have a resolution to their dream, which can make the nightmares cease.
At Canadian Sleep Consultants, new patients are tested for physical issues such as sleep apnea and snoring via a take-home test or a series of tests administered while spending a night at the clinic. Often, treating these physical conditions takes care of sleep disorders such as parasomnia and nightmares. Alonso’s sleep lab has four examination rooms, as well as two additional rooms for surgical procedures. In the evening, the examination room’s tables fold into the wall, and Murphy-style beds pull down, so patients can sleep overnight at the clinic and be tested for a host of ailments and conditions.
During a session of data collection known as polysomnography, Alonso’s staff attach EEG electrodes to several points on a patient’s head to detect brainwave activities that indicate different sleep stages. They monitor breathing through a cannula (a small tube used for collecting data) and gather other vital data through electrodes on the chest, while the amount of REM sleep is recorded via electrodes attached to the corners of the eyes.
The collected data is then used to determine whether the patient is experiencing a physical problem (such as sleep apnea or snoring), a sleep disorder or a combination of both. The clinic also uses blood tests to rule out other issues such as iron deficiency, which can lead to problems like restless leg syndrome, where a person experiences excessive leg movement during the night.
In some cases, sleep problems are, in fact, inherent. Samuels says there is truth to the convention that some of us are, simply, “night owls,” who have a genuine desire to stay up later and sleep in longer. However, being a night owl doesn’t really fly with most employers. “We can ‘fix’ those people through a combination of melatonin and light therapy,” says Samuels. Melatonin is available in capsules that can be purchased at most drug stores, while lights mimicking the UV rays produced by the sun can help regulate patterns of wakefulness, particularly during Calgary’s short winter days.
Whether you’re one of these night owls, an anxiety-ridden insomniac or someone who suffers from a serious sleep disorder like parasomnia, chronic sleep deprivation has been linked to significant health, performance, safety and even financial problems, so it’s crucial to find a solution. Ultimately, we all need a good sleep regimen that closes out our day and guides us into a restful slumber. Like most of the other good advice about our health – it’s about creating good habits and sticking to them.