Sleeplessness What is Keeping You Up?

Sleeplessness What is Keeping Me Up?

by Carolle Jean-Murat, M.D.

How well did you sleep last night? Sleeping is as important as breathing and eating. During sleep, your body repairs itself. After a good night’s sleep you are more productive, more apt to learn new things and your mood and memory improve.

But what happens during sleep is still not completely understood. By studying brain wave patterns, sleep researchers have identified four separate stages in a normal period of sleep: Stage 1 begins when you first fall asleep. It is light sleep, when your muscles relax and heart slows down. Stage 2 is called REM sleep because of the rapid eye movements that occur during this stage, during which you dream. The autonomic nervous system is active in REM sleep, causing rapid breathing, increased heart rate, and increased stomach acid secretion. Stages 3 and 4 are deep sleep, when no dreaming occurs. In a normal sleep period, you would cycle from Stage 1 to Stage 4 about every 90 minutes throughout the night.

If you don’t sleep well, you’re not alone: Insomnia is a relatively common sleeping disorder, affecting about one-third of the adult population worldwide. It is characterized as the inability to get the desired quality of sleep, recurring enough to affect daily functioning. Insomnia includes problems falling asleep, difficulty staying asleep, waking up frequently during the night and having difficulty falling back to sleep, waking up too early in the morning, and waking up feeling tired.

Insomnia is more common in women and the incidence increases with age. Midlife women are more susceptible to sleep pattern changes. Some may need more sleep, while others who sleep long hours find themselves still tired in the morning. The incidence of insomnia is higher among people with chronic illnesses such as hyperthyroidism, kidney trouble, multiple sclerosis, and Alzheimer’s disease.

Many life situations like falling in love, an impending trip, an illness, etc. may cause temporary insomnia. But persistent sleeping difficulties for more than three nights a week, for a month or more, are usually a predictor of physical, environmental, and/or psychological problems. Chronic insomnia, present in about 10 percent of the population, can result in irritability, mood swings, difficulty concentrating, and memory problems. In the long term, mental and immune functions can become impaired.

One of these women was Sue, a 45-year-old patient, complained of difficulty sleeping, heavy bleeding, frequent heartburn, fatigue, and crying periods. All these symptoms had worsened during the previous months. She was told her symptoms were caused by hormonal imbalance, had many tests, and tried different modalities to no avail.

Sue was a successful business owner working for nine months partnering with a venture capital firm to take her business to a higher level.

During her consultation with me, Sue discovered that her dream of taking her business to the next level was the stress culprit of her many symptoms. Stemming from a childhood with a difficult-to-please mother, Sue continually put herself in situations seeking success for approval, love, and acceptance. Going into this new partnership would have increased income, but would have compromised service qualities. In her own words I felt that the bottom line was what was important to my new partners. Sue was in tears when finally verbalizing that what she wanted was a company with quality service for existing clients: She did not need to make more money.

Here is what I recommended as treatment:

Sue decided to continue her successful business the way it was. At her 3-month follow-up, most of her symptoms had disappeared.

Is your insomnia a side effect of your environment, an illness, a medication, or over-the-counter drug? Or is your inner wisdom trying to tell you that your life is out of balance?

Causes of Insomnia

• Stress, anxiety disorders, and depression
• Illnesses such as chronic pain, arthritis, restless leg syndrome, sleep apnea, asthma, heartburn, gastrointestinal reflux

• Personal habits such as excessive amounts of caffeine; nicotine, and alcohol especially before bedtime
• Behavioral reasons disrupting sleep a partner snoring, children or pet sharing the bed; jet lag, a change in the surrounding environment, environmental noise, exposure to extreme temperature changes
• Prescription medications such as antidepressants, decongestants, steroids, and anti-hypertensives such as beta-blockers
• Exercising early in the day has been shown to improve sleep quality, however, exercising close to bedtime can produce the opposite effect.
• Insomnia has been tied to the hormonal aspect of perimenopause and menopause — A lack of estrogen with subsequent hot flashes can disturb a woman’s normal sleep cycle, resulting in insomnia, fatigue, and depression.
• Unresolved childhood and adult issues.

Sleep-onset Insomnia

Difficulty falling asleep, called “sleep-onset insomnia,” is the most common sleep disorder. Typically, sleep occurs within about 20 minutes, but individuals with sleep-onset insomnia may take hours to fall asleep. The inability to fall asleep may be related to abnormal fluctuations in body temperature. Body temperature goes through phases during the night, dropping when we fall asleep and rising as we wake up. It has been shown that insomniacs have temperature rhythms that are about 2.5 hours later than normal sleepers.

Terminal Insomnia

Still other insomnia sufferers fall asleep normally, but wake up too early. This early morning waking is called “terminal insomnia. Once awake, the terminal insomniac cannot get back to sleep. Early morning waking is a classic sign of depression. It is thought that this type of insomnia is also related to an early rise in body temperature. A recent study among the elderly with sleep disorders demonstrated that elevated core body temperature is associated with night waking.

Both types of insomnia result in poor concentration, fatigue, impaired mental and physical abilities, diminished memory, reduced alertness, slow reaction times, and muscle aches during the day.

Tips for Better Sleep

• Avoid stimulants such as caffeine and alcohol, especially late in the day.
• Avoid substances such as heroin, cocaine, and other stimulants.
• Exercise no later than three hours before bedtime – stretching and yoga are the exceptions.
• Keep the bedroom temperature comfortable and only use this room for sleepingnot for watching television or reading or exercising.
• Establish a consistent bedtime routine. Go to bed at the same time each night, and don’t watch the clock. If you can’t sleep, leave the bedroom, then return and try again when you feel tired.
• Use breathing exercises and relaxation techniques such as meditation, progressive relaxation techniques, yoga, take a warm bath before bedtime.
• Avoid large meals late in the evening.
• Use white noise devices to block out noise.
• Keep the bedroom dark or use an eye mask to block light.
• Avoid disturbing reading or television programs before bedtime.
• Find out if the prescription medication you are taking may be the cause of your sleeping problems.
• If you are experiencing hot flashes and night sweats, find appropriate treatments.

Natural and Behavioral Treatment for Insomnia

• Aromatherapy, such as using a few drops of lavender oil in bath water
• Herbal therapies to reduce insomnia include valerian root, chamomile, passion flower, and hops
• Chamomile, lemon balm, and lemon verbena together make a delicious tea to promote sleep
• Calcium and magnesium, one tablet each, taken 45 minutes before bedtime, can have a tranquilizing effect
• Natural Progesterone cream 2% for night sweats
• Melatonin
• Behavioral treatment to normalize dysfunctional sleeping habits such as relaxation therapy, sleep restriction therapy, and stimulus control therapy
• Cognitive behavior therapy (CBT), a treatment designed to help insomniacs change thoughts and behaviors that worsen the problem is a good option according to researchers at Beth Israel Deaconess Medical Center.
• Stress management
• Acupuncture.
• Reflexology.

During your midlife years, many stressful changes will occur. If you are experiencing persistent insomnia, consider that it may be a sign of an imbalance in your life. Take a good look at your life to try to find the answer, and ask for help. Your subconscious probably knows what is keeping you awake at night, and an intuitive physician, psychiatrist or other healer can help bring it to the surface.

Unless the root cause is found and corrected, any treatment modalities will eventually lose effectiveness and your overall health will suffer. See your difficulty in sleeping as a blessing — that it is your protective inner wisdom sending you a wake-up call. Make sure you heed that call!

Dr. Carolle Jean-Murat is a board-certified gynecologist, a medical intuitive, award-winning author, and international speaker. She is the founder and director of the Dr. Carolle’s Wellness and Retreat Center in San Diego, CA, which integrates preventative, holistic, and conventional health care and intuitive counseling for women. For more information, please visit www.drcarolle.com or call 619-741-7261