Sleepless from Seattle

It was 2:57AM. I looked over at my wife and she was dead asleep. We had just gotten back from Seattle after a week long cruise and I was still on west coast time. I started thinking about what bills I had to catch up on the following day. I wondered if I had Dylan’s snack ready. I remembered all the great food I ate during the cruise and how I had to start a diet to get back to baseline. I was glad that I didn’t have that extra cup of coffee at noon, but it didn’t seem to be helping. I looked over at the clock again. 2:59AM.

Occasional insomnia happens to everybody from time to time. Whether it’s related to jet-lag, anxiety or another medical condition, it’s always a nuisance. Losing sleep for extended periods of time can lead to psychiatric issues like depression, but short term effects can affect your work performance and mood. During residency, it was quite common to stay up all hours and crash the following day. Most doctors I know of will tell you that they suffer from insomnia, if not routinely, at least occasionally. These days, they have laws in place to prevent overworking medical residents to hopefully reduce medical errors, but it still happens. It’s a rite of initiation. When you talk to your doctor about insomnia, trust me when I tell you that we can relate.

The amount of sleep needed varies from person to person. I usually don’t need more than four to six hours to function, but my wife needs anywhere from eight to twenty, depending on the type day she had. She sleeps like a log and on weekends, it sometimes feels as if she’s in a coma while I’m busy doing some house chores. If I were to try to wake her before her full eight hours, I’d best be prepared to suffer the consequences. I’d feel like a lion tamer trying to get around a hungry animal.

At 3:20AM, I began to wonder if I ever will get to sleep this evening. I got up and took a second melatonin, went back to bed and closed my eyes hoping for the best. In two hours, I will have to get up and start my day. At this point, I already knew my day was going to suck.

Anxiety plays a significant role in insomnia. In patients with post-traumatic stress disorder, bipolar disorder, substance disorders, quieting an active mind is easier said than done and medical therapy may be the only option. It’s important to set aside time during the wake cycle to work out the stress of the day. It can be as simple as taking a walk or meditating. I prefer exercising at the gym. For some, yoga helps.

With chronic insomnia, habits are usually to blame. Staring at an Ipad or a TV screen, eating too close to bedtime, not exercising enough to the point of physical exhaustion, napping during the day, or fretting about the day’s stress usually are the main suspects. Routine is extremely important in trying to manage insomnia and that’s where most doctors will tell you to start. The circadian rhythm regulates the sleep-wake cycle and when there is inconsistency to a person’s routine, it gets thrown off balance.

Medical conditions can also affect sleep. Sleep becomes less restful with aging to begin with, but when adding chronic medications, urinary instability, chronic pain, reflux, diabetes, thyroid and neurological issues like restless leg,  Parkinson’s or Alzheimer’s, sleep can sometimes feel like a long distant dream. In these situations, it’s important to see what options are available.

Treatments for insomnia include medications, but I’d like to suggest starting with your sleep routine. Exercise and eat at normal, set times. Avoid too much screen time close to bedtime. Avoid too much caffeine and smoking. Avoid napping. If that fails, cognitive behavioral therapy can be an option. Try playing relaxing music or practice deep breathing. Over the counter medications like melatonin can sometimes help, along with tryptophan and valerian root, as well Unisom or Tylenol PM for occasional insomnia.

I blacked out for about two hours and heard my alarm clock go off at exactly 5:45AM. I looked over at my wife and she was snoring. I gave her a kiss on the cheek and went to make some coffee. I had a great vacation, but it kicked my butt. Now, reality had set in and I had to get back to my routine. It’s been fun, Seattle, but I won’t be going back anytime soon.

By: Dr. Juan Borja
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