The birds begin to chirp their chipper morning song. Light begins to seep through the slats of the blinds. And there is nothing more infuriating than knowing that you haven't nodded off once. Not for one wink. Your bed, with its plush mattress, becomes a battleground as you toss and turn, legs tangled in the sheets. You demand that your body do what it should know to do instinctively: Sleep! But it doesn't. You bargain (Please, I'll...). You threaten (I will chuck the clock out the window). But ultimately, you're left with nothing but the stark reality that tomorrow—today, rather—is going to be brutal. And so it goes for the insomniac.
"For most people, sleep is pleasant. They go to bed, they sleep, they wake up, they feel good," explains Meir Kryger, director of sleep research and education at Gaylord Hospital in Connecticut and chairman of the board of the National Sleep Foundation. "For some people, going to bed is the last thing they want to do. What they sense is that they're going to have another night of torture." That "torture"—aka insomnia, which just means difficulty falling or staying asleep—is a chronic experience for 1 in 10 adults, according to the National Institutes of Health.
The use of prescription sleep medications by 18-to-24-year-olds has nearly tripled in the past decade, according to a study released in January. Yet the nation's sleeplessness doesn't seem to be improving: About one third of Americans say that worry over the U.S. economy, personal finances, and employment concerns has spawned sleep problems, including insomnia, according to the National Sleep Foundation's 2009 Sleep in America poll, released this week.
"Anything that's going to stress people out has the potential to interfere with sleep, and it's a stressful time now," says Lawrence Epstein, medical director of Sleep HealthCenters in Boston and coauthor of The Harvard Medical School Guide to a Good Night's Sleep. While insomnia can be a byproduct of an underlying medical or psychiatric problem, stress and anxiety can also precipitate it.
Scientists think of the brain as having two competing systems that govern wakefulness, says Ralph Downey III, chief of sleep medicine at the Loma Linda University Medical Center in California. One vies to keep you awake, and the other beckons you to sleep. When worries are brought into the bed, like a shot of espresso, they can snap the brain into a state of hyperarousal. Hyperarousal revs up the body's metabolism, heart rate, and basically everything associated with the fight-or-flight response, says Downey; you're prepared to flee the house as if someone yelled "Fire!" That can overwhelm the sleep drive.
But take care with how you cope with sleeplessness: Your attempts to get to sleep could paradoxically turn an occasional bout into a persistent problem. "People will sometimes react to their insomnia in ways that make it worse...that actually perpetuate it," says Kryger. Like downing five cups of coffee to counteract next-day exhaustion, leading to trouble the next night. Or surfing the Web or watching TV when sleep isn't happening, both activities that will make you more alert. Perhaps the worst move, when in the throes of insomnia, is to just lie in bed as the rage or bewilderment builds, assuming that rest is better than nothing at all. It's not. "If you're wide awake for 20 minutes, get out of bed," says Downey. Go to a different place to relax for 20 minutes, or until you feel sleepy. Otherwise, you may start to associate your bedroom with misery and trauma, not relaxation.
"Insomnia is highly individual and variable," says Gayle Greene, 65, of Claremont, Calif., a lifelong insomniac who interviewed many fellow sufferers for her 2008 book, Insomniac. "There is no one-size-fits-all description or prescription for this problem," she says. In her case, her tendency to wake up and stay up after just a couple of hours of shut-eye got her fired from one of her first jobs; she couldn't arrive on time. (Now an English professor, she feels fortunate to have a flexible work schedule.) Over the years, she tried nearly everything that had reportedly worked for others, from various pills to hypnosis to an Ayurvedic remedy that involved slathering sesame oil on her body.
Greene finally feels that, through trial and error, she's gotten her sleep problem under control. "I don't tough it out anymore," she says. She snoozes in shifts. After getting a few hours of "her own sleep," she takes a partial dose of Ambien, which helps her sleep through the rest of the night. When that doesn't work, Greene finds that listening to a book on tape in total darkness lulls her back to sleep.
Greene's individualized approach certainly hasn't been tested in clinical trials, but it seems to work in the one case that counts. And it's not necessarily a bad model for others to follow, experts say. "You have to become your own scientist and find out what works best for you," says Mary Susan Esther, president of the American Academy of Sleep Medicine.