Chronic Insomnia: Surviving Sleepless Nights

Sleep is essential for our health and happiness, and when we don't get enough of it, it can take a toll on our energy, mood, and ability to function during the day. While many people experience insomnia or sleep deprivation at some point, going without sleep for several days is a cause for concern. After 72 hours of sleep loss, you will likely experience an uncontrollable urge to sleep, frequent and longer microsleeps, complex hallucinations, and severe distortion of your perception of reality. If you are unable to sleep for three days, it is important to seek urgent medical advice, as this level of sleep deprivation can lead to a mental health crisis and put you at risk of accidents and errors in everyday tasks.

Sleep deprivation stages and symptoms

Sleep deprivation can occur after just 24 hours of no sleep, and the longer one spends awake, the more severe and less tolerable the symptoms become. Here are the stages of sleep deprivation and their symptoms:

Stage 1: After 24 hours

Missing a full night of sleep won't cause major health problems, but one can expect to feel tired and exhausted. Staying awake for 24 hours may increase the risk of errors and accidents in everyday tasks.

Stage 2: After 36 hours

After missing 36 hours of sleep, one will have an overwhelming urge to sleep. Along with the effects of the previous stage, one may experience an increased appetite, extreme fatigue, and microsleeps. Microsleeps are brief periods of sleep that occur without one's awareness and usually last 30 seconds. Research has also found that one may begin to hallucinate at this stage.

Stage 3: After 48 hours

Missing sleep for two days is known as extreme sleep deprivation, and it will be even harder to stay awake. One is more likely to experience microsleeps, perceptual distortions, increased irritability, and temporal disorientation.

Stage 4: Awake for 72 hours

After three days of sleep loss, the urge to sleep will strengthen and possibly become uncontrollable. One may experience more frequent and longer microsleeps, and sleep deprivation will significantly impair one's perception. Hallucinations might become more complex.

Stage 5: Awake for 96 hours or more

After 72 hours, one's perception of reality may be severely distorted, resembling acute psychosis. The urge to sleep will feel unbearable, and one may enter a state of psychosis.

It is important to note that there is no universal timeline for sleep deprivation, and these stages are general guidelines. The symptoms of sleep deprivation tend to worsen with each stage and can be combated or prevented through various solutions.

Seeking medical help

Sleep deprivation is a serious issue that can have a detrimental impact on your health and quality of life. If you have not slept for three days, it is important that you seek medical help. Here are some steps you can take and what you can expect when seeking medical assistance:

Consult your Doctor

Firstly, schedule an appointment with your doctor as soon as possible. They will ask you questions about your sleep patterns, symptoms, medical history, daily routine, and nightly habits. Be honest and detailed in your responses, as this information will help them understand your situation and make appropriate recommendations.

Underlying Medical Issues

Your doctor will want to rule out any underlying medical issues that could be causing your insomnia. They will review any medications you are currently taking and investigate whether a medical condition, such as restless leg syndrome or sleep apnea, could be contributing to your sleeplessness. Identifying and addressing these issues is an important step in improving your sleep.

Referral to a Sleep Specialist

If your doctor is unable to identify an underlying cause, they may refer you to a board-certified sleep doctor or a healthcare provider who specializes in sleep disorders. These specialists will conduct further evaluations and may recommend additional testing to determine the root cause of your insomnia.

Behavioural Changes and Sleep Hygiene

Behavioural changes and improvements to your sleep hygiene are often recommended as part of the treatment plan for insomnia. This may include establishing a consistent bedtime routine, such as reducing screen time before bed, brushing your teeth, washing your face, changing into pajamas, and getting into bed. Creating a calm and consistent environment can help signal to your brain that it's time to sleep.

Additionally, your doctor may advise you to reduce the amount of time spent awake in bed. If you don't fall asleep within 15 to 20 minutes, they may suggest getting up and engaging in light activities like reading or listening to quiet music in another dimly lit room. This helps to reinforce the association between your bed and sleep, ensuring that you only return to bed when you feel sleepy.

Medication

While sleep medication can be useful for occasional sleeplessness, it is not recommended for long-term use. Your doctor may prescribe short-term sleep medication to help reset your sleep patterns, but this is typically limited to a few weeks. It is important to follow your doctor's instructions and be cautious about the potential side effects and habit-forming nature of these medications.

Therapy

In some cases, your doctor may recommend cognitive behavioural therapy (CBT) to address the underlying causes of your insomnia. This can be especially helpful if stress, anxiety, or other mental health concerns are contributing factors.

Remember, sleep deprivation is a common issue, and seeking medical help is a crucial step towards improving your sleep and overall well-being. Don't hesitate to reach out to your healthcare provider and take advantage of the various treatment options available to address your insomnia.

Sleep hygiene

Set Your Sleep Schedule

• Maintain a fixed wake-up time: Try to wake up at the same time every day, even on weekends. A fluctuating schedule disrupts your body's sleep rhythm.
• Prioritise sleep: Avoid sacrificing sleep for other activities. Calculate a target bedtime based on your fixed wake-up time and prepare for bed around that time each night.
• Make gradual adjustments: If you need to change your sleep times, do so gradually, in small steps, to allow your body to adjust to a new schedule.
• Limit naps: Naps can disrupt your night's sleep. If necessary, keep them short and in the early afternoon.

Follow a Nightly Routine

• Keep your routine consistent: Follow the same steps each night to reinforce the association between your routine and bedtime.
• Wind down for 30 minutes: Engage in calming activities such as soft music, light stretching, reading, or relaxation exercises before bed.
• Dim the lights: Bright lights hinder melatonin production, a hormone that facilitates sleep.
• Unplug from electronics 30-60 minutes before bed: Electronic devices cause mental stimulation and emit blue light, which disrupts sleep.
• Try relaxation techniques: Focus on relaxation rather than sleep. Meditation, mindfulness, and paced breathing can help prepare your mind for sleep.
• Avoid tossing and turning: If you can't sleep after 20 minutes, get up and do something calming in low light before trying again.

Cultivate Healthy Daily Habits

• Get daylight exposure: Sunlight is a key driver of circadian rhythms, which promote quality sleep.
• Exercise regularly: Regular physical activity improves sleep quality and offers other health benefits.
• Avoid smoking: Nicotine stimulates the body, disrupting sleep.
• Reduce alcohol consumption: While alcohol may induce sleep, its effects wear off, leading to disrupted sleep later in the night.
• Limit caffeine in the afternoon and evening: Caffeine is a stimulant that can interfere with rest.
• Avoid late dinners: Late or heavy meals can disrupt sleep as your body is still digesting when it's time for bed.
• Restrict in-bed activities: Use your bed only for sleep and sex to create a mental link between your bed and sleep.

Optimise Your Bedroom

• Ensure a comfortable mattress and pillow: Your sleeping surface is critical for comfort and pain-free sleep.
• Use comfortable bedding: Choose sheets and blankets that match your preferences.
• Maintain a cool temperature: A cooler bedroom temperature, around 65°F (18.3°C), is ideal for sleep.
• Block out light: Use heavy curtains or an eye mask to prevent light from interrupting your sleep.
• Drown out noise: Use earplugs, a white noise machine, or a fan to block out disruptive sounds.
• Try calming scents: Light smells, such as lavender, may induce a calmer state of mind and create a positive sleep space.

Sleep disorders

Sleep is a complex biological process that is essential for our health and happiness. Sleep disorders are conditions that disturb your normal sleep patterns, and there are more than 80 different types. Sleep problems can have a significant impact on your physical and mental health, as well as your daily functioning.

Insomnia

Insomnia is the most common sleep disorder, affecting about one-third of adults. It involves difficulty falling asleep or staying asleep and can be caused by emotional issues such as stress, anxiety, and depression, as well as habits like excessive caffeine consumption or an irregular sleep schedule. Insomnia can be treated with lifestyle changes, relaxation techniques, and medication.

Sleep Apnea

Sleep apnea is a breathing disorder characterised by interruptions in breathing during sleep, often causing snoring, snorting, or gasping for air. It is typically treated with lifestyle changes, such as weight loss, and in more severe cases, a CPAP machine to keep the airways open during sleep.

Restless Leg Syndrome (RLS)

RLS involves a tingling or prickly sensation in the legs, along with a strong urge to move them. It is often relieved by movement and typically occurs in the evening or at night. RLS can cause difficulty falling asleep and frequent awakenings, leading to daytime sleepiness.

Hypersomnia

Hypersomnia is the inability to stay awake during the day and includes narcolepsy, which causes extreme sleepiness. People with hypersomnia may sleep for more than nine hours a day and still feel tired. This disorder can cause difficulty concentrating and memory issues.

Circadian Rhythm Disorders

These disorders affect the sleep-wake cycle, making it difficult to fall asleep and wake up at the right times. They can be caused by internal factors, such as a person's body clock being out of sync, or external factors like shift work or jet lag. Circadian rhythm disorders can lead to ongoing sleep problems and extreme daytime sleepiness.

Parasomnia

Parasomnia involves unusual behaviours during sleep, such as walking, talking, or eating. Examples include sleepwalking, sleep terrors, nightmare disorder, and REM sleep behaviour disorder, which involves acting out dreams. These disorders can cause distress and impair functioning.

Seeking Help

If you are experiencing sleep difficulties, it is important to seek help from a healthcare professional. Sleep disorders can have serious consequences for your health and well-being, and early intervention is crucial. Treatment options may include lifestyle changes, therapy, relaxation techniques, and medication.

Stress and anxiety

Sleep is essential for our health and happiness, and yet many people struggle with sleep disorders or insomnia. Insomnia is the clinical term for people who have trouble falling asleep, difficulty staying asleep, waking up too early, or waking feeling unrefreshed.

Emotional issues such as stress, anxiety, and depression cause half of all insomnia cases. Stress and anxiety can cause a serious night without sleep, and can make existing sleep problems worse. If you have an anxiety disorder, you may find it hard to fall asleep or stay asleep. Similarly, if you have a sleep disorder, you might feel anxious or fearful before bed because you're afraid you won't get the rest you need. One condition usually makes the other worse, creating a vicious cycle.

Research suggests that most people with mental health disorders like anxiety also have some form of sleep disruption. Anxiety is the most common mental health disorder in the U.S., affecting about 40 million people. Sleep anxiety is a feeling of stress or fear about going to sleep. You may be scared about not falling asleep or not being able to stay asleep. Some people also have a distinct phobia about sleep called somniphobia, where they think something bad will happen to them while they sleep, or that they need to stay alert and watchful.

Chronically high levels of stress hormones, especially before sleep, can make it hard for your body to relax. You may have difficulty falling asleep, and if you do fall asleep, you may wake up during the night with stressful or worrisome thoughts and be unable to fall back asleep.

The good news is that most cases of insomnia can be cured with changes you can make on your own, without relying on sleeping pills. By addressing the underlying causes and making simple changes to your daily habits and sleep environment, you can improve your sleep.

• Meditate: Focus on your breath and breathe in and out slowly and deeply, visualizing a serene environment.
• Exercise: Regular exercise is good for your physical and mental health, and yoga can be particularly effective at reducing anxiety and stress.
• Prioritize your to-do list: Focus your time and energy on the most important tasks, break up large projects into smaller, more manageable tasks, and delegate when you can.
• Listen to music: Soft, calming music can lower your blood pressure and relax your mind and body.
• Get enough sleep: Make getting a good night's sleep a priority by blocking out seven to nine hours for uninterrupted sleep, and try to wake up at the same time every day.
• Establish a relaxing bedtime routine: Avoid stimulants like coffee, chocolate, and nicotine before going to sleep, and instead read a book, listen to soft music, or meditate.
• Create a comfortable sleep environment: Make sure your bedroom is cool, dark, and quiet. Consider using a fan to drown out excess noise, and ensure your mattress and pillows are comfortable.
• Use your bedroom only for sleeping and sex: Avoid watching TV, working, or doing other activities in bed.
• Stick to a sleep schedule: Go to bed and wake up at the same time every day, and if you don't fall asleep within 15-20 minutes, get out of bed and do something relaxing.
• Avoid screens before bed: Stop using electronic devices at least 30 minutes before bedtime, as the blue light from screens disrupts your body's production of melatonin.
• Practice relaxation techniques: Try gentle breathing and progressive muscle relaxation every day for two weeks. Rate your level of emotional and physical stress before and after, and then choose the exercise that works best for you and keep it up every day.
• Try cognitive-behavioral therapy (CBT): CBT can be effective in addressing insomnia by modifying negative thoughts, emotions, and patterns of behavior. It can be conducted individually, in a group, or via an online therapy platform.

Frequently asked questions