By Kimberly Wulfert, PhD Insomnia, Causes and Solutions
Many people I help in therapy don’t get enough sleep. They present their sleep problems in different ways, and sleep problems stem from a variety of causes. It is estimated that 7-10% of adults who complain of insomnia in the U.S. are diagnosed with a circadian rhythm disorder.*
Women over age 40 are three times more likely to report it than men. Circadian rhythm cycles begin changing with puberty, a time of upheaval in hormones but no gender differences are apparent from youth to age 40.*
It comes as no surprise that the first signs of peri-menopause, indicating a shift in hormone production is underway, can begin around age 40. It’s well known that women in the peri-menopause phase of life have disruptions in their usual sleep patterns, and experience interrupted sleep during the night, in part due to hot flashes and sweating.
So what are the circadian rhythms?
Circadian rhythms influence sleep-wake cycles, hormone release, body temperature and other important bodily functions. Circadian rhythms are produced by natural factors within the body affecting physical, mental and behavioral changes that follow a roughly 24-hour cycle primarily in response to the light and darkness in an organism's environment. Nearly all living things, plants, animal and human, have these rhythms.**
There is an activity-rest cycle in each person and when this is prevented from occurring for too long from the norm, sleep problems arise. Night and graveyard-shift workers are at greatest risk.
How does it show up?
Medically speaking, there are actually nine distinct circadian rhythm disorders dysregulating the sleep-wake cycle. Psychologically speaking, there are four main ways insomnia shows up in your life:
- You can’t fall asleep as usual and sleep fewer hours per night
- You can’t stay asleep; you wake up intermittently during the night, have trouble getting back to sleep
- You wake-up way too early and stay awake, (you may go to bed early so total sleep time is normal)
- Circumstantial, i.e. when you’re jet lagged, after an accident (yours or another’s), during seasonal time changes, travel, caring for an ill person
In general if you, as my client, reported that you couldn’t fall asleep I’d first consider high anxiety or fears are troubling you. If you woke up intermittently during the night, I’d first look at physiological possibilities and refer you to a healthcare professional if necessary. Otherwise, I’d consider depression, worry, grief, or wonder if there is anticipation about the following day or days circumstances. And if you woke up too early for two straight weeks or longer, I’d suspect depression is presenting.
In each and every case, further inquiry is essential to gain a complete understanding to determine what would be best for you. I would inquire about any circumstances that changed in your life before the insomnia began in your routines, health, lifestyle, medication, home, work, family and secondary relationships including pets? I would inquire about the health of your parents, or other significant caretakers you had, at the same age you are now? Is/was there a dreaded anniversary of some kind looming? Are you feeling afraid to fall asleep? Often the reasons are subconscious and take a little sorting out.
When Therapy Interferes with Sleep
Regardless of the cause, getting to sleep and getting enough sleep is also important to the progress and outcome of psychotherapy and your sense of well-being. One hinges on the other, and this can complicate things. There are two major ways therapy and insomnia can be at crossroads.
If insomnia is the entry point for therapy and another emotional disorder is discovered as the cause of it, then that disorder has to be dealt with concurrently. When you are unwilling, or not ready to deal with the “other problem,” and you just want to be able to sleep and get on with your life, it complicates progress in the short term and long term. This is when the client might seek pharmaceutical, medical marijuana or OTC medication in lieu of therapy to get more sleep. Yet you may stay in therapy and not divulge this information, effectively derailing my efficacy to help you from within the blind spot you’ve created. Secrecy is another issue in play here, and one that undermines a trusting relationship which is an essential factor for therapy to work well.
The opposite is when you enter therapy because of anxiety, depression, or a physiological cause, like time of life, chronic illness and you are ready to work on it. More internal demands are put on your emotional, physical and mental resources as the work of therapy gets deeper. Then, in some cases, a lack of restful sleep results, even though temporary, you’re fatigued, foggy-brained, irritable, self-critical and your hopes of therapy working are dampening the longer it goes on. You may begin putting on weight from eating simple carbs in an attempt to get more energy. Your immune system gets taxed without enough steady sleep and you catch colds or viruses. Now problems seem worse to you! If you’re not the type who will turn to medicine or supplements for sleep, you may decide to give up on therapy too early to experience the relief you sought when you first began.
When we get right down to it, whether insomnia is from a circadian rhythm problem, hormone shifts, or significant psychological distress, it’s all the same in the end. The client is tired and suffering! The cause, if identified could help, but rarely does it override a person’s strong opinion about the use of drugs or recently, medical marijuana. She either will or she won’t, and when won’t is stronger, that’s when I see her in therapy.
What to do!
Don’t give up. The cause can usually be identified and relief can usually be found without the use of prescription sleep medications. Needed hormones, herbal teas and natural supplements can sooth you as sleep techniques are put into practice. Once changes are made and new habits form, it gets easier to get the sleep you require most of the time if not all. Your body will rebuild its resources and resilience, and you’ll feel refreshed upon waking.
I will recommend that you see a medical professional or naturopathic doctor if the number of sleep-deprived nights is high and/or the number of hours per night is short because of the serious cognitive difficulties that can result from 1-4 hours of sleep per night. It’s highly likely a medical or physiological cause is behind it. I won’t take the case any further until you seek their input. Fortunately, this is rare.
In most cases I use one or all of the these approaches as needed to help the client find sleepfulness:
- mindfulness throughout the day for stress relief
- guided meditation at night
- progressive relaxation in bed
- tweaking sleep hygiene, beginning 2 hours before bedtime
- suggest herbal and plant-based teas, and natural supplements
- changes to the bedroom environment, wearing ear plugs, eye mask etc.
- sleep separately from snoring partner if this is one cause
- eating healthy meals and a little protein before bed if interrupted sleep is the problem
The main take-away from this article should be to view yourself and situation as a whole when treating insomnia. Incorporate your mind, body and lifestyle, along with known health conditions, known stressors, age, home environment, current stage of life and circumstances. Simply making a psychological or medical diagnosis is not going to be help enough when it comes to overcoming sleep problems. Sources:
* Sleeplessness and Circadian Rhythm Disorder, by Mary E. Cataletto, MD and Gila Hertz, PhD, January 7, 2015 ** Circadian Rhythms Fact Sheet, from the National Institute of General Medical Sciences About the Author...
Kimberly Wulfert, PhD is a California licensed clinical psychologist practicing mindfulness-based therapy, combined with neuroscience, meditation and psychology, a coach for women over 40 who are in transition, and Dr. Kim developed and teaches Meditation for Mind Body Health and Weight Loss MAPPING in southern California. Last Update: 2/11/2015
|