Insomnia: Why Getting Good Sleep Matters and How to Get it Again

We are in a sleep crisis.

Did you ever notice how sleep deprivation has become romanticized, normalized, and popularized in movies, television, and books, as characters stay up all night doing important hero stuff or college students “pull all-nighters?” Despite this, our society is in a very real sleep crisis.

About 30 to 40 percent of American adults have reported experiencing insomnia⁴. Insomnia is an inability to fall asleep and/or experience waking up during the night and having difficulty going back to sleep. The average American sleeps six hours or less per night^2,10,13. 10 to 15 percent of people who experience sleep deprivation indicate their sleep loss is chronic or severe¹⁰. In addition, the Centers for Disease Control and Prevention (CDC) and the Maternal and Child Health Bureau (MCHB) showed that 34.1% of children and 74.6% of high school students fail to get a good night’s sleep. A recent study of 7,600 college students showed that 60% of college students across six universities met the clinical cut-off criteria for poor sleep³. Having poor sleep carries with it broad negative implications for cognitive functioning, mental health, physical health, work performance impairment, and safety^2,13. 

Sleep deprivation is associated with⁶:

1. Poor decision-making
2. Negative moods
3. Low work engagement and performance
4. Distress
5. Obesity
6. Higher risk of cardiovascular disease
7. Higher likelihood of injuries and motor vehicle crashes
8. Increased impulsivity
9. Increased irritability

In addition, sleep deprivation causes more than 100,000 automobile crashes each year¹⁰, with 16% of undergraduate college students have reported having fallen asleep while driving at least once in their lifetime¹⁴. Because of this, organizations like the American Academy of Sleep Medicine (AASM) have made public announcements that sleep is absolutely essential to good health, and other organizations have announced that we need more healthy sleep curriculum in schools, colleges, medical schools, graduate programs, and workplaces^5,10,13.

But, how did we get here?

We are in an ever-encroaching 24-hour society, which is fueled by the increasing economic demands of globalization. More people are forced to work outside regular working hours, and shift workers are expected to work flexible hours due to the ever-growing needs of non-stop news coverage, information technology, and stores that fuel consumers’ needs¹³. There is also the ongoing integration of digital devices into our everyday lives, which has created unintended consequences, and as a society, we are experiencing compounding psychological stress¹¹.

How do I know if I have insomnia?

According to the International Classification of Sleep Disorders (ICSD), chronic insomnia is characterized by having symptoms at least three days per week for at least three months¹. People with chronic insomnia show a greater risk for developing depression, anxiety, and substance use disorders¹⁴.

What do I do if I have insomnia?

If you feel you have insomnia, visit your Primary Care Provider (PCP) and explain to your doctor your sleep disturbance symptoms and the duration of them. Often, a PCP will ask screening questions for anxiety and depression because there is a bidirectional relationship between sleep and mood disorders — meaning that poor sleep impacts mood disorders and mood disorders impact sleep — so it is important to tackle both at the same time. A PCP can also discuss various pharmacological treatments, including non-habit-forming sleep aids.

Next, I would recommend making an appointment with a therapist, especially if you believe you have other accompanying disorders to your sleep disorder. For treating insomnia, the American Psychological Association (APA) suggests CBT-Insomnia (CBT-I) as the first-line treatment¹⁴. Your therapist may not be trained in CBT-I, but not to worry! I have created my top 10 practical tips for healing from insomnia, which incorporate CBT-I suggestions and other recommendations from major sleep researchers and organizations.  

1. Learn about sleep.

What is sleep? Sleep is cyclical program each night consisting of two basic stages: REM (rapid eye movement) and NREM (non-rapid eye movement) experiences^12,13. NREM is broken into:

• Stage 1 (a very light sleep)
• NREM Stage 2 (has special brain waves called sleep spindles and K complexes)
• NREM Stages 3 (deep sleep, heart decreases and the body relaxes further)
• NREM Stage 4 (the deepest kind of sleep where it is hard to be awakened by external stimuli)

During sleep, people experience repeated cycles of NREM and REM sleep, beginning with NREM, with cycles lasting 90 to 110 minutes and being repeated four to six times per night. As people go through their sleep cycles, it is very common for people to knowingly wake two to three times and then go back to sleep.

How long should I sleep? Major sleep researchers and organizations recommend that adults sleep seven to nine hours a night¹³.

2. Reestablish your biological clock.

What is a biological clock? A biological clock regulates the timing for sleeping and waking in humans. Our clock cycles with a 24-hour period called a circadian clock. It is located in the suprachiasmatic nucleus (SCN) of the hypothalamus in the brain; it regulates our circadian rhythms and controls the release of melatonin, a hormone produced to help us sleep^10,16. Healing from insomnia starts with reestablishing a biological clock, basically, developing a consistent set bedtime and awake time, so the body can expect and predict its own sleep/wake rhythm again.

3. Assess whether your sleep environment is conducive to good and uninterrupted sleep.

A good sleep environment is generally a darker and colder room; colder temperatures promote deep sleep⁷. You need a comfortable bed with breathable sheets and comforters that reduce night sweats (which happen when anxiety is high, during hormonal changes, and often during menopause) and help regulate your body temperature. You also need a sound-protected environment; try using white noise, sound-blocking curtains, or fans, to drown out noise.  

4. Turn off your phone one hour before bed.

Blue wavelength light from LED-based devices increases the release of cortisol in the brain, which makes us more alert, and inhibits the production of melatonin⁷. Because of this, the NSF recommends people turn off their phones at least one hour before bed and replace this time with wind-down activities.  

5. Reduce anxious thoughts before bed. 

Many people have a hard time turning off their anxious minds before and in bed. Apps, like CALM, CBT-I, and PZIZZ (and many more) offer breathing exercises, guided imagery, and meditations that help reduce anxious thoughts and quiet your mind. Three common exercises I suggest are:

• Envision a container you can put your anxious thoughts into, telling yourself you will open the container in the morning.
• Visualize being in a peaceful place, like a beach and place your thoughts on the waves as they go out.
• Visualize sitting by a river watching leaves go by and place your thoughts on the leaves and watch them float away.

6. Reserve the bed for sleeping.

Healing from insomnia involves the mind and body associating the bed with sleeping again. Any other activities, like working on the computer, watching shows/movies, or reading should not be done in other comfortable places.

7. Choose to do wind-down activities before bed.

Reduce consuming or doing over-stimulating, anxiety-inducing, or overly-physical activities before bed, and detach as best you can from work or school-related stressors. Instead, choose to do activities, like stretching, reading in a dimly-lit room, watching a predictable, calming show/movie, folding laundry (imagine how much our laundry piles would reduce!), etc.

8. Go to bed when you are sleepy.

Go to bed only when you are sleepy, not tired. Being tired is needing to rest, lie down, put your feet up after a long day, turn your mind off by doing an activity that helps you unwind (i.e. watching a show or movie), but being sleepy is when you feel yourself nodding off, your body feels heavy and still, your eyelids want to close, etc.

9. Reduce or eliminate day-time caffeine and/or naps.

Caffeine is a central nervous system stimulant, whose half-life, the time it takes to reduce it in your body by half, is about five hours, but can range between one and a half to nine and a half hours⁹. Consider reducing your consumption of caffeine past noon. In addition, avoid napping during the day Instead, go outside for a brisk walk, stay busy, sit in the fresh air, etc. or keep naps to no more than 20 minutes.

10. Get up if you can’t sleep.

Many people toss and turn for hours, which only increases their anxiety about not sleeping. When you lie down, give yourself 10 to 15 minutes to fall asleep. If you cannot fall asleep in that timeframe, get out of bed and do a wind-down activity for a set short period of time and then try again. My favorite Insomnia Podcast in the middle of the night is called Nothing Much Happens.

O.k., I promised you 10, but I have one more. Healing from Insomnia also involves committing to staying active every day. Sleep experts recommend that you exercise at least 15 to 30 minutes a day preferably toward the morning, which aids in establishing circadian rhythms again that allow you to sleep again at night. Exercise is important for overall health and well-being, but it also releases endorphins, which has a stress-busting effect. Reducing overall stress and anxiety makes it easier for us to slip into deep sleep.

If you or someone you know or love is struggling with insomnia, I hope this information and tips were helpful. If you are beginning to take steps toward healing from insomnia, I encourage you to stay with it, be patient, be consistent, protect your sleep. You will not regret it. And if you are struggling with sleep, do not hesitate to reach out!