Tired of Insomnia

Article excerpt

3:15 - Wake up.

3:17 - Toss, turn.

3:25 - Flip through the pages of a book.

4:13 - Stress out about a long day at the office on too little sleep.

This is a typical night for someone suffering from insomnia. For John Wiedman, a mortgage banker from Memphis, Tenn., nights like this went on for years.

After a while, Mr. Wiedman grew accustomed to being up at night. He jokes that he is now an expert on the juicers and abdominal toners sold on late-night television.

That doesn't mean he grew any more comfortable with less sleep.

"The cycle got worse and worse until I was up until 4 or 5 a.m. four nights a week," says Mr. Wiedman, 51. "If I ever got six hours of sleep, it was like I had napped all day. It was horrible. I was usually grouchy all the time."

Mr. Wiedman eventually took control of his sleep by modifying his daytime and evening behavior. He chronicled his struggle in a book, "Desperately Seeking Snoozin': The Insomnia Cure From Awake to Zzzzz."

His case was severe, the kind of chronic insomnia that endures for decades. That type of insomniac could benefit, as Mr. Wiedman did, by seeing a sleep specialist, undergoing behavioral therapy and changing the sleep environment, says Dr. Richard Hoffman, a sleep medicine specialist at Inova Alexandria Hospital.

Other types of insomnia exist, too, and from time to time almost everyone will be afflicted.

"Technically, primary insomnia is defined as the inability to fall asleep after 20 minutes of lying in bed trying to," Dr. Hoffman says. "But really what characterizes it is a sense of distress about not being asleep."

Insomnia can be characterized as transient, which is temporary sleep trouble related to a definable event, such as a big work project, he says. Short-term insomnia is the type that may go on for a few weeks due to ongoing stress such as a family crisis.

Chronic insomnia often has underlying stress as a symptom, but a person should be evaluated for depression, anxiety, allergies and restless leg syndrome (a condition where leg discomfort interferes with sleep), Dr. Hoffman says.

There also is sleep maintenance insomnia, where one gets to sleep but cannot stay asleep, and psychobiological insomnia, where the worry over what time one gets to sleep exacerbates the problem.

"It becomes a self-fulfilling prophecy," Dr. Hoffman says. "You develop habits that make it difficult to get to sleep."

HOW SLEEP WORKS

"Sleep is a very complex thing," says Dr. Michael Twery, a program officer at the National Heart, Lung, and Blood Institute's National Center on Sleep Disorders Research. "There is a buildup of chemicals that drives sleepiness."

The coordinator of those chemicals is the hypothalamus, the part of the brain that drives the biological clock, setting the circadian rhythms that tell us when to be awake or sleepy. The biological clock and the circadian rhythms change through the years as humans age, Dr. Twery says.

During a normal night, humans pass through stages of sleep. Stage 1 is light sleep, the 10-minute transitional period between wakefulness and sleep. Stage 2 is deeper sleep, and after about 20 minutes, an individual enters Stages 3 and 4, which are similar and hard to differentiate. At Stages 3 and 4, a person experiences the deep sleep with restorative powers. This deep sleep is known as delta sleep from the delta waves the brain makes.

About 90 minutes later, rapid eye movement sleep, the deep sleep in which we dream and rapidly move our eyes, takes over.

Most people cycle back and forth through the stages of sleep several times throughout the night. Problems occur when the cycle is broken, such as when a person wakes up before falling into restorative sleep.

"As we mature from childhood, the pattern changes," Dr. …