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An insomniac learns to make the most of getting the least sleep

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By Laura Hambleton
Special to The Washington Post
Monday, February 14, 2011; 7:34 PM

In the wee hours of the morning - or is it still night? - my eyes snap open and my mind races. What do I have to do today? What didn't I get done yesterday? Why did I get into that disagreement? Other nights, I am on a high wire, hovering between sleep and wakefulness and chewing over my next move. Do I open my eyes? Do I keep them shut? Can I soothe myself back to sleep? Do I even try?

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That I'm even having this monologue means I'm sunk. I'm awake. And so I crawl out of bed, grab my sweater and shoes, and tiptoe out of my bedroom and through my dark house where everyone else in my family, even the dog and cat, is sleeping soundly.

Call me an insomniac.

I don't like the name, but I'm not alone. According to studies from the National Institutes of Health, one in three Americans has some kind of insomnia, and one in 10, like me, has chronic insomnia.

Lack of sleep is so widespread that NIH has an entire unit, the National Center on Sleep Disorders Research, devoted in part to figuring out why Americans aren't getting enough shut-eye. And the Department of Health and Human Services last year added sleep as an essential ingredient to maintaining good health in its Healthy People 2020 report.

"Is it abnormal to wake up a few times at night? No," said Daniel S. Lewin, the program director of sleep disorders medicine at the NIH center. "We have from five to 10 awakenings a night. Most of those awakenings are not acknowledged or recalled. But are you getting adequate sleep when you are up for an hour or two a night or truncating your sleep on either end?"

Lewin thinks not. He believes that in the long run there is a cost to overall health, whether it is sleepiness during the day - which could lead to an accident or poor performance on a test or on the job - or depression, anxiety or weight gain. While we sleep, scientists believe, memory and learning are consolidated and the heart and vascular system get a chance to rest. Hormones and chemicals are made and broken down during sleep cycles. According to Lewin, this may help repair the immune system, encourage growth and regulate appetite.

We feel sleepy when our biological clock, responding to growing darkness, stimulates the production of the hormone melatonin. The brain begins producing melatonin as the sun sets. Each cell is hard-wired with its own internal clock "that regulates glucose metabolism, digestive processes, tissue repair and immune functions, and relates to the clock in the brain that regulates our 24-hour cycles," Lewin said. "We need to sleep at the time we are programmed by our brain."

Acute insomnia is the most common reason that sleep is disrupted. Medications, alcohol, a sleep disorder such as restless leg syndrome or an illness can also cause it. Treat the problem, and a full night's sleep usually returns. Chronic insomnia can be triggered by an instance of acute insomnia, a chronic illness or long-term use of medication.

Bad timing

My restless nights started 19 years ago, after the birth of my first child. As so many baby books recommended, I timed my sleeping to hers - and she did not sleep like a baby for a few years. My pediatrician at the time told me that my child had too many things to do. At first, she woke up to nurse. Next, she woke to practice crawling, then walking and finally to look at her books.

By the time baby No. 2 came along, my husband and I were living in Jerusalem, and that inspired another set of worries. My nighttime tossings and turnings vacillated from bus bombings and other scary items from the daily news cycle to worries about my son's coping in a preschool where he didn't speak the language.

When my third child came, I was desperate just to nap, as many young mothers are. But between three kids' worth of bad dreams, sore throats and other ailments, that just wasn't in the cards.

As they grew up, my kids slept through the night; I didn't.

At first I blamed another overseas assignment - in this case, beautiful South Africa - where serious crime was spiking and my journalist husband was on the road for weeks at a time. For the first year, I woke on and off every night to listen to the noises of the dark. Sometimes I'd awake at 3 a.m., and there was no sinking back to sleep. I read "Long Walk to Freedom: The Autobiography of Nelson Mandela." I answered e-mails from the United States and worked while everyone in my house slept.

I got a lot done, but I didn't like the pattern.

A doctor I consulted suggested taking antihistamines, which would also help with my allergies to our cat and dog. But the antihistamines made me thick-headed and groggy in the morning. Later, another recommended a two-week trial of sleeping pills, just to break the cycle. I thought about it - the doctor suggested it twice - but in the end I'm not one for prescription drugs and decided against it. My OB/GYN said melatonin pills might help. They didn't seem to make any difference.

I began adjusting my daytime regime. I started exercising more. I stopped drinking coffee. I refrained from black tea after noon. I tried to go to bed at the same time every night. And still, years after my first child was born, I often woke up at 4 a.m. after just four or five hours of sleep, six if I was lucky. My pattern was stubborn.

Now it makes sense

But here's what finally changed. I stopped being anxious and upset about my early wakings. I started using the time for working, reading, exercising or walking the dog. I began to look forward to the deep, uncomplicated silence in my house in the middle of night. I made peace with my insomnia.

Usually I have a cup of hot tea and a few crackers when I first get up, which can be anywhere from 3 a.m. to 5 a.m. a few mornings a week. My dog is slumbering in her bed by the kitchen. When I'm ready to go for our daily walk, I rouse her and we slip silently out the front door.

I'm not tired anymore during the day, more out of sheer willpower and the occasional nap. Some evenings, too, I retreat to my room by 8.30 p.m. to try to catch up on lost sleep.

And I have found evolutionary and historical precedent for my sleep cycles. Just the other day I spoke with Roger Ekirch, a Virginia Tech historian who has focused on sleep in Western cultures and has written "At Day's Close: Night in Times Past." He told me that in the preindustrial era, before the proliferation of modern lighting, people routinely used to wake from their "first sleep" sometime after midnight to talk with others, smoke a pipe, rob the nearby orchard or bring in the cows. After about an hour, he said, people returned to bed for their "second sleep" until dawn.

"It makes perfect sense if you accept the premise that segmented sleep was the dominant form of slumber before the Industrial Revolution," Ekirch said. "It makes perfect sense that a biological pattern since time immemorial would not relinquish its hold easily, that it would not fade rapidly into the mists of history. The process instead would be prolonged and erratic. Consolidated sleep is an artificial invention of modern life."

So call me old-fashioned. I like the sound of first and second sleep way better than insomnia. I can rest my head more soundly on those.

Hambleton is a freelance writer and documentary filmmaker living in Chevy Chase.



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