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Finding The Why Behind Sleeplessness

Sleep is a hot topic these days. Everywhere you look it seems as if people are talking about it, and how important it is to get plenty of it – and good quality too. There are sleep clinics popping up all over the country, and apps and sleep monitoring devices too, all promising to analyze the way you sleep and tell you what you need to know about why you’re so darn tired.

And that is really the most important question, because it’s only once you know why you’re not sleeping that you can address and solve the problem. So what are the reasons for sleeplessness?

Though people tend to think that the fastest way to an answer to their insomnia is seeing a physician, and maybe even going to a sleep lab, the truth is that sleep labs are designed to identify symptoms of medical issues surrounding sleep. These may include any of the hundreds of sleep disorders that have been identified in the last few decades that sleep science has evolved into a respected area of medical practice, but in most cases the diagnosis is obstructive sleep apnea, a serious and chronic condition in which the airway is blocked during sleep, robbing the body of oxygen and forcing it to awaken constantly in order to breathe. A single apnea episode awakens a patient with a start, then they drop back to sleep – and this highly disruptive process can happen hundreds of times in a single night.  The solution to apnea lies in finding a way to keep the airway open, usually through the use of a device known as Continuous Positive Airway Pressure, or CPAP. CPAP (or oral devices that keep the airway open) can solve sleep apnea, but that condition accounts for only ten percent of sleeplessness in America – in fact, it has been established that medical conditions account for just 15% of insomnia occurrences. So what about the other 85%?


Taking internal, medical conditions out of the mix leaves us with two main reasons for poor sleep. One is environmental causes, such as noise, or light, or even the temperature I our rooms. The other is psycho-physiological sleep issues, which revolve around the things that go on in our brain that keep us from getting drowsy and falling asleep. Though most people spend a lot of time and energy on trying to fix the things in their environment that cause sleeplessness, that may be time wasted, as those factors also only represent 15% of the cases of sleeplessness. A full 70% of poor sleep is a result of psycho-physiological issues.


Addressing psycho-physiological issues of sleep is not a difficult task, but it takes a good understanding of what it is that is misaligned in the brain in order to address it and solve the problem. Generally speaking, the problem lies in one of three areas:


  • Sleep Drive – How tired we feel when it is time for us to go to sleep
  • Circadian Clock – Our internal biological clock that tells us what time to wake up and when to go to sleep, as well as when to feel hungry and a number of other biological drives
  • Flight-or-Fight System – Our evolutionary protective system that alerts us to danger has developed into a stressor that keeps us from falling asleep when there is something that is bothering us.

Though it may seem as though addressing these types of problems would be extremely challenging, the truth is that there is a proven method of addressing and correcting psycho-physiological issues of sleep. The method is known as Cognitive Behavioral Therapy for insomnia (CBT-I), and it has been identified as the single most effective method of treating insomnia. CBT-I addresses each of the three causes of insomnia individually, and over a period of several sessions it not only addresses the immediate problem, but also puts tools into the hands of the sleep deprived patient that they are able to return to should the problem ever arise again. The CBT-I approach modifies behavior through a series of small, easy-to-adopt steps that build upon one another and retrain the brain to recognize the bed as a cue for sleepiness rather than wakefulness, realigns the body’s circadian clock so that it falls asleep more easily at the appropriate bedtime and stays asleep throughout the night, and introduces stress-relieving techniques that teach the patient how to avoid the cues that lead to hyper-arousal at night and instead embrace relaxation.


The secret to a better night’s sleep begins with identifying whether your problems are medically based, environmentally based, or psycho-physiologically based. Environmental sources of poor sleep can generally be identified or ruled out through simple observation or common sense – do you have noisy neighbors? Are you waking up at night to adjust the covers because you’re too hot or cold, or waking up with an aching back because it is time to replace your mattress? Many people identify the existence of environmental factors when they sleep outside of their normal environment and realize that they had a much better night of sleep. This provides clues as to how to correct the problem.


Identifying medical conditions is more difficult, but may be more important, as sleep disorders like obstructive sleep apnea can contribute to other medical conditions such as heart disease, diabetes, and obesity. There are a number of physical symptoms that generally accompany these disorders, most notably loud snoring at night and falling asleep in the middle of the day.  Those who suspect a medical cause for their insomnia should have a medical screening at their earliest convenience.


For those whose insomnia is a matter of staring at the ceiling because they simply aren’t tired, or tossing and turning due to inescapable thoughts and worries, cognitive behavioral therapy is likely the best bet. Though there is a shortage of therapists that are trained to provide this type of counseling, there are several apps, and even online CBT tutorials, that may be of great help.

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