What’s the difference between insomnia and occasional sleeplessness?
With insomnia, we’re talking about a disorder that needs some sort of treatment. To be considered insomnia, the symptoms—difficulty falling asleep, problems staying asleep, or waking up very early without an alarm—must occur at least three nights per week for at least three months; also, the person needs to have daytime consequences, such as fatigue or trouble with memory. If a person complains of difficulty falling or staying asleep but doesn’t have any negative daytime consequences, we don’t call it insomnia or treat it.
Is depression a cause of insomnia or a result of it in some people?
We consider depression a comorbidity, which means that many people with primary insomnia will also have depression. There’s also good research suggesting a causal connection between the two: Psychological disorders, including depression, are generally associated with insomnia, but we don’t exactly know how depression may cause insomnia. The real issue, though, is that if someone has depression and insomnia, we may need to treat each condition independently; treating just the depression may not solve the problem.
How can you eliminate or minimize middle-of-the-night awakenings?
Sometimes, these are a manifestation of insomnia. Other times, there’s a physiological reason for such sleep disruptions, whether it’s heartburn, a peptic ulcer, low blood sugar, or the consumption of alcohol before bedtime; in cases like these, we’d need
to treat the underlying cause. Some sleep disorders can result in middle-of-the-night insomnia—especially restless legs syndrome; periodic limb movements during sleep; and
in women, obstructive sleep apnea (which involves blockage of airflow). For restless legs syndrome, we’d look for iron or vitamin B-12 deficiency first.
What’s the best way to handle late nights? Wake up at the usual time or sleep in if possible?
I tell people to try to maintain the same sleep schedule every day. So if you have a night where you end up going to bed one or two hours past the usual time, you’re better off maintaining your regular schedule, because if you start switching things around, it can lead to problems falling asleep later on. However, if you’re up until 3 a.m. and usually get up at 7 a.m., that’s not enough sleep, so I’d recommend you sleep an hour or two beyond your normal wake time (if possible), and then maybe take a brief nap later.
How can you relieve anxiety about falling asleep before you turn in for the night?
Some people develop anxiety if they have had a few bad nights and expect to have another one—that’s a difficult thing to get over. You should not get to the point where you start to associate the bed with not sleeping. If you can’t get to sleep in 20 minutes, get out of bed and do something boring until you can fall sleep. Otherwise, you may lie awake and get angry or anxious about falling asleep. If the problem persists, cognitive behavioral therapy for insomnia may help.