In “The Insomnia Answer,” Dr. Paul Glovinsky and Dr. Art Speilman offer a program designed to tackle the three most persistent sleep problems — getting to sleep, staying asleep and broken sleep — using drug-free methods. The authors visited “Weekend Today” to discuss their book. Here's an excerpt:
Chapter One
Why Is Sleep So Unreliable?
Discovering Why Sleep Doesn’t Come NaturallyAdam lay expectantly on his newly laundered sheet, his wife sleeping quietly not one foot away. Everything was in order: he was fresh from a shower; the briefcase on his desk was emptied of files; he could sense a wave of sleepiness approaching. The sounds outside the window were reassuring. The late stragglers on the sidewalk, the traffic noise, the hum of the air conditioners — all meshed into a soothing blend. Adam knew his sleep required such a harmonious context, and he took pains to provide it. He glanced with envy at Jen, who laughed at his precautions, and who was known to fall asleep on buses, on sofa beds, even once at the ball game. Adam tried to rein in his thoughts, but they drifted toward the presentation he had to make the next afternoon. If this happened to be one of his bad nights, he would really be out of sorts by two o’clock. He could feel his muscles tighten at the thought. Adam loosened his jaw the way he’d been taught and tried to slow down his breathing.
He had grown quite competent at hiding the effects of his sleeplessness. Sometimes he would play the stolid manager, unperturbed by the most harrowing crises. Other times he would slip into hyperactive mode, keeping himself awake by keeping everyone else hopping. But a presentation to the parent company could not be finessed so easily. Adam became aware of his increased heart rate. He could no longer pretend that nothing was wrong. Perhaps tomorrow would be the day when, sleep-deprived, his fumbles and miscues would alert senior management to his real predicament: on a fundamental level, he was out of control.
This was going to be a long night.
How is it that so many of us cannot readily fall asleep or stay asleep? After all, sleep is inborn, a state attained in infancy without any instruction or practice. It should be automatic.
We may eat too much or too little, but almost all of us are able to eat when food is available. Unless we are contending with serious medical illness, we all take breathing in and out for granted. Insomnia, by contrast, is widespread in otherwise healthy people. In its intermittent, acute form, it is familiar to practically everyone. As a chronic sleep disorder, it afflicts 10 to 15 percent of the population. How can something so crucial to normal functioning be so unreliable? And how is it that some people require everything to be just right before they can sleep, while others seem to be able to drop off at will?
These are questions that may come to you in the middle of the night, as you watch the glowing red lines on your alarm clock. Your dog snoring away on the rug seems to be able to sleep on cue. He circles into bed every evening as darkness gathers, and soon afterward seems to be chasing dream squirrels. Sleepy animals outside your home also find their havens and perches by nightfall, while the nocturnal ones begin to stir, all according to schedule. Even most of your human neighbors are sleeping — despite whatever might be on their minds. It all looks so easy, so natural. Why can’t you sleep?
Your question is straightforward, but unfortunately, its answer is not. When your car won’t move, the fact that you can describe the problem succinctly doesn’t mean its solution will be self-evident. To get on the road again, you might run through a simple checklist: Is there gas in the tank? Is the battery dead? Do I need to find a mechanic? In other words, to solve your problem, you would have to know something — either a little or a lot — about cars.
This analogy holds true for sleep as well. A checklist to consult if your sleep has stalled does exist. It is called a list of Sleep Hygiene Instructions. We assume that most of you will be familiar with these recommendations — although whether you can actually adhere to them is another question! It makes sense to review this list before proceeding, because it just might supply a direct fix for your sleep. In the course of our work together, you will come to understand how these sleep hygiene prescriptions enhance your prospects for sleep.
For now, our advice would be to simply be sure you are following them — if your sleep starts running smoothly, you can then read on and learn why at your leisure!
Sleep Hygiene Instructions
- Avoid going to bed until you are drowsy. Maintain a consistent rising time, even if you go to bed late, whether during the workweek or on weekends.
- Limit napping. If you must take a nap, it should be short — about half an hour — and finished by mid-afternoon.
- Avoid all caffeine after noon. Limiting yourself to one cup in the morning is best.
- Avoid nicotine and alcohol in the evening, or if you awaken at night.
- Avoid exercising in the late evening, or if you awaken at night. Vigorous exercise ending four to six hours before bedtime, on the other hand, may deepen your sleep.
- Limit fluids as much as possible in the four to six hours before bedtime.
- Be sure your bedroom is dark, quiet, and well ventilated. Keep it at a comfortable temperature. Turn your clock so you cannot read the time if you awaken at night. Be sure your pet is not disturbing your sleep.
We understand that these prescriptions are deceptively straightforward.
It’s easy enough to pledge to “Limit napping,” for example, but much harder in practice to pass up the opportunity to catch up on sleep for an hour or two after a particularly rough night. If your sleep does not improve following reasonable compliance with these instructions, do not despair. We have written this book with you in mind. We won’t pretend that it will make you a full-fledged sleep specialist. But you should be able to perform tune-ups and basic repairs.
Let’s get started with a discussion of why something as fundamental as sleep can nonetheless be so unreliable. You will soon learn that the apparent simplicity of sleep is also deceptive — its appearance actually depends upon the coordination of a complex array of factors. Moreover, some of the key attributes that differentiate our species from other animals also predispose us to sleeplessness. In effect, insomnia is all too human!
Sleep Is ComplicatedSleep used to be thought of as a kind of backdrop — a dark, inert curtain against which our waking lives played out. We believed sleep simply appeared by default whenever alertness waned. But after more than fifty years of research, we can decisively reject this lifeless view of sleep. Sleep is actively produced by subcortical brain mechanisms. Its structure (known as its architecture) reflects a three-way parlay among competing interests: the body’s requirement for deeper, quieter Non-Rapid Eye Movement (NREM) sleep; intermittent need for more physiologically active and cognitively stimulating Rapid Eye Movement (REM) sleep; and a fluctuating propensity to be awake. The result of such internal negotiation is a cyclic alternation of NREM and REM sleep stages occurring about every ninety minutes, with the deepest NREM sleep stages, known as Slow Wave Sleep, taking precedence in the initial cycles and REM sleep gaining ascendancy later in the night. Ideally, five or so NREM/REM cycles provide us with about eight hours of sleep, after which we should awaken refreshed for the day ahead.
The complexity of sleep goes beyond its structure. Sleep is
- a physical state, characterized by relative stillness and repose.
- a mental state, characterized by reduced arousal and lowered vigilance.
- motivated by a physiological drive — our craving for sleep grows stronger when we stay awake and is sated as we slumber.
- regulated by an inner body clock that orchestrates our internal workings while keeping us synchronized to the cycle of day and night.
- responsive to behavior — sleep is inhibited by activity and induced when we are sedentary.
- dependent upon finding an appropriate environment.
In all these ways, human sleep is similar to sleep found throughout most of the animal kingdom. Animals generally seek out safe havens and stop moving when they sleep, although there are surprising exceptions — such as the dolphins that sleep with half their brains at a time as they slowly circle on the water’s surface. The timing of most animals’ sleep is cyclic, with one major sleep period — whether during the night or day — aligned to the environmental light/dark cycle via the same biological clock we humans share.
Again, there are exceptions, such as the repeated snoozes of your house cat, reflecting its predatory heritage.
Excerpted from “The Insomnia Answer: A Personalized Program for Identifying and Overcoming the Three Types of Insomnia” by Paul Glovinsky and Art Spielman. Copyright © 2006, Paul Glovinsky and Art Spielman. All rights reserved. Published by Perigee Trade. No part of this excerpt can be used without permission of the publisher.