As I listened to the events unfold in Newtown, Conn. last week, my mind was pretty far away from my self-imposed Friday Huffington Post sleep post deadline. As the parent of three school-aged children, all I could think about, when I allowed myself to, was the friends and families in that community and how they were coping with the horror they all experienced. I decided that I would try to write something that would hopefully be helpful, even if in an immeasurably small way.
It took me several days before I could mentally approach my laptop and write. The intervening time did little to dampen the extreme feelings I have about the situation, nor had any brilliant idea or topic popped into my mind as to how a sleep specialist could offer any help. As I unloaded my emotions onto my wife about the events that transpired and how the sleep of those touched by this tragedy must be ravaged, I made the comment that I was unsure what to write. I told her that sometimes, it's okay to have insomnia. In her infinite wisdom, she simply said, "Write about that."
Sometimes, it is okay to have insomnia.
Doctors like to fix things. There is no doubt that I do. I often tell patients that I will be as aggressive as they want in terms of fixing their sleep problems, but that it is okay sometimes to say, "enough." As much as I want to talk to every person affected by the shooting and help him or her find serenity in their sleep, that simply may be beyond the control of even the best sleep doctor in the world.
So instead of the standard "warm milk" and "no television in bed," my advice is to accept the fact that for many people, sleep problems may be a part of their lives right now. Imagine having a pet snake get loose in your bedroom. The stress of the situation might make sleep very difficult or even impossible. It would be unnatural if sleep were not affected by certain situations. The Sandy Hook shootings and the stories that are emerging are beyond anything I have ever heard in my life -- it is only natural for our brains to struggle with how to comprehend and compartmentalize these events. During this time, people may find that they have a hard time "shutting their brains off." The more they fight to quiet their mind, the more they struggle to sleep.
The goal in a situation like this is not to fight this acute insomnia. The goal is to prevent the acute problem from developing into a chronic problem. I treat many patients with insomnia. I always try to dig into the precipitating event that initially created the problem. Fortunately, shootings are relatively uncommon; but lost loved ones are not. Stories of divorce, job loss or financial stress abound. For many, the only thing that can lessen the effects of these events is time. How much time? That is really impossible to answer. During this period, though, it is important for patients to not engage in behaviors that will serve to perpetuate the sleep impediments.
The most important thing to do in the midst of a sleep crisis is keep your schedule intact, especially your wake time. There is often a strong urge to "make up for lost sleep" when a night of sleep goes poorly. The temptation to hit the snooze button, call in sick, or take a nap in the afternoon can be overwhelming. Resisting the urge to sleep outside of your schedule will strengthen your brain's drive to sleep when you retire at your normal bedtime.
Speaking of bedtime, it is okay to stay up a little later in the midst of sleep difficulties. There is a natural tendency to try to go to bed earlier when sleep is failing you. It seems to make sense that if sleep is problematic, going to bed at 10:00 p.m. rather than 11:00 p.m. to get a little "extra sleep" might be a good idea. This move usually only worsens the problem; if you are not sleepy at 11:00 p.m., how is going to sleep earlier going to help?
Acute insomnia in many people will fade as the pain of the precipitating event starts to lessen. For others, the negativity of the fading precipitating event is gradually replaced by a growing fear of not sleeping. In my opinion, it is this fear of not sleeping that generally causes people to develop chronic sleep problems. There are many things people fear in this world -- darkness, heights, violence. Do not let not sleeping creep into your list. Remember, that sleep is an absolute: Everyone sleeps. To worry about not sleeping is in some ways as irrational as worrying about not eating!
So for people struggling with the events of last Friday, I want to tell you that it is okay to have sleep struggles. The insomnia you are experiencing is a pretty normal reaction. During this time of feeling as if aspects of your life are out of control, focus on what you can control -- your schedule (and most importantly your wake-up time) and your emotional reaction to your insomnia. Keep faith that the difficulties will pass, and if they do not as quickly as you would like, there are doctors who want to help.
I want to extend to everyone who has taken the time to read one of my posts (or fan me -- thank you!) my warmest holiday wishes. I hope that my words have been helpful and enlightening. Make it your New Year's resolution to make 2013 your best year of sleep. Finally, to everyone touched by the Sandy Hook tragedy, I hope you are able to find some peace and rest as the year comes to an end.
For more by Dr. Christopher Winter, click here.
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