In today’s interview I get to speak with insomnia research journalist, Lois Maharg, about how she went on the hunt to understand what causes insomnia and how to fix it.
Lois is very passionate about understanding what causes people to suffer with insomnia and how it is different to other sleeping disorders.
She is has personally suffered with insomnia since a child so relates to others in the same situation. It is also a reason why she was keen to find out as much as she could about how to help people with difficult sleeping.
We not only talk about her personal journey, but also what she learnt from speaking to sleep researchers & sleep clinic doctors about how to diagnose and treat sleep disorders.
If you know someone who struggles to sleep at night and feels they struggling with insomnia then this episode is for them!
I enjoyed this interview as I hear people say how they struggle to sleep at night, especially as we get older. The word insomnia is used by many people, but might not be the most accurate diagnosis of the reason why they feel they don’t get quality sleep at night.
After speaking with Lois I have a better understanding that there is a medical difference between insomnia vs circadian rhythm sleep disorder (a.k.a night owl syndrome or delayed sleep phase syndrome). Not only that, but people can suffer insomnia and sleep apnea at the same time too. Plus learning what are considered the gold standard ways to fix insomnia.
Special thanks to Lois for joining me on the show. Enjoy the episode!
Show Notes with Timestamps
Highlights of what we talk about during the interview:
Click on one of the timestamp links in the brackets to jump to that point in the interview audio.
[00:20] – Introducing Lois, a journalist and author of the book called: “The Savvy Insomniac: A Personal Journey through Science to Better Sleep“; a book that helps us better understand insomnia and what can be done to help it.
[00:56] – How Lois’ own experiences with having trouble sleeping, as well as getting good quality sleep, led to a growing interest insomnia. She explains how up until her late forties she was, what she calls, a ‘gorilla sleeper’, catching sleep whenever she could and not having any sort of sleep rhythm. She finally decided that she wanted to look into this problem further and the research on her book began.
[02:55] – Insomnia can take many different forms: some people have trouble getting to sleep, some people wake up during the night or too early in the morning and others don’t feel rested or like they had any sleep at all. This is why it was important for Lois to talk to as many different people suffering from insomnia and find out what each of their experience was so she could then decipher what most insomniacs need to know about in order to improve their sleep.
[03:46] – Medically speaking, for a diagnosis of insomnia a person needs to have trouble sleeping in the begging, middle, or end of the night at least three times a week for at least three months. In addition, they need to suffer some kind of impairment during the day; this might be physical like feeling tired or exhausted; it could be emotional where you experience low mood, depression or irritability; or it could be cognitive functions that are affected and you feel forgetful, have difficulty learning or thinking well. (ref)
[04:49] – You don’t need a sleep study for a diagnosis, rather, a sleep expert can take a personal history and from this decide whether the problem is insomnia or another problem such as sleep apnoea or circadian rhythm disorder. Overnight sleep studies conducted in sleep labs are performed in cases where sleep apnoea is suspected but aren’t necessary for insomnia. There are cases where people could have both, but generally in sleep apnoea where sleep is interrupted constantly during the night, people are so tired they are dropping off to sleep during the day. In insomnia, this isn’t the case, rather, they tend to feel hyper-arousal and are less likely to fall asleep during the day.
[08:31] – Lois explains how there isn’t an objective test to determine the type of insomnia a person has. It is currently determined based on a person’s symptoms, with the exception of paradoxical insomnia and psychophysiological insomnia which are determined in a sleep lab. In paradoxical insomnia, people perceive that they are getting only one hour of sleep every night, but during a sleep study an objective reading shows they are getting a full night sleep. In psychophysiological insomnia, which is more common, the perceived sleep is reflected more accurately as determined by the polysomnogram.
[11:07] – Insomniacs are notoriously inaccurate in figuring out how much sleep they are getting. There are more categories of insomnia – such as the short-sleep category with people who get substantially less sleep than the standard 7-8 hours a night, but for the most part these haven’t been all figured out yet. There is genetic research on the way that may help determine some of the underlying factors in the different types of insomnia in the future.
[12:37] – Is there a difference between insomniacs and light-sleepers who are easily roused during the night? Lois believes that the non-restorative sleep category – that light sleepers who hover in the lighter stages of sleep would fall into – is still considered to be a type of insomnia. In fact, these cases can be harder to treat and are better handled by sleep experts.
[13:32] – Talking about the different phases of sleep. During the night, we go through four or five different cycles. Starting out we go through lighter stages of sleep, then we move into deeper sleep, then back to lighter stages again and then we go into REM sleep – which is often associated with dreaming – we then repeat the cycle going back into the light sleep, deep sleep etc. We get most of our deep sleep at the begging and REM sleep at the end of the night.
[14:41] – Lois explains that we used to think of sleep and awake as being whole-brain states, either the whole brain was awake or it was sleeping. Now using tests that can look into people’s brains to see what is going on we have discovered that in insomnia, while most of their brain can be sleeping, there are certain key areas of the brain behaving like they are awake; causing a hybrid state.
[16:11] – Explaining the difference between sleep quality vs. sleep quantity. People often assume they are not sleeping enough but maybe it is not the duration of sleep that is the problem but rather the sleep quality. Lois explains that even a shorter night of sleep can feel good if the person is getting enough deep sleep during the first half of the night, and as recent research suggest, a sufficient amount of REM sleep; both are necessary for good sleep quality. A cognitive behavioural therapy treatment for insomnia may help you uncover if this is the case for you.
[19:00] – It is important to note that quality is very subjective and there are no objective measures of sleep quality. Sleep clinics can assess numerous other factors such as: quantity of sleep; sleep efficiency, which measures how much of the time in bed is actually spent sleeping; and sleep onset latency, which assess how long it takes a person to get to sleep.
[20:00] – Are most people either a lark (morning type) or an owl (evening type)? Lois explains it is important not to confuse the night owl who may have a symptom of insomnia with someone who has the disorder of insomnia; the night owl is easily able to sleep a full night when allowed to do so at a time it suits them. The problem arises when they need to get up early but they stayed up late and haven’t been able to get enough sleep. These types of disorders are called circadian rhythm disorders and specifically when people are going to bed and rising late it is called delayed sleep phase syndrome. Therapies are available for this type of disorder that wouldn’t work for insomnia.
[24:42] – Talking about the concept of polyphasic sleeping (sleeping in short bursts). Lois tells us that nothing about the way the human body behaves suggests this method would be good for human beings. Lois explains the reason why some cultures might practice resting during a part of the day e.g. have a siesta in the afternoon is due to a dip in core body temperature that makes us sleepy. Even when removed from all external time stimuli humans experience this circadian dip twice a day – right before we wake up and during the middle of the afternoon. Anything more fragmented would not be good.
[27:42] – There is still research being done on the benefit of naps. Keeping a nap to under 30 min means the deep sleep phase is avoided but during a therapeutic process for insomnia, which uses sleep restriction therapy, people are advised to refrain from taking naps to avoid falling into deep sleep.
[28:52] – What are some of the causes of insomnia? Are we born with it or can we develop insomnia due to a variety of reasons? Scientists are starting to uncover genes that are associated with insomnia and it does seem that certain people are predisposed to it. While we know that circadian rhythms are a 100% genetically based, for insomnia it is widely accepted belief that it is a combination of genetic predisposition and personal experiences, even early childhood experience. Severe stress, such as suffering a bereavement, job loss, etc., can trigger insomnia which can then resolve itself in more resilient individuals once the stress is gone. Individuals who struggle to return to normal sleep may worry and set off on a cycle where worrying about sleep (or other issues) makes it difficult to fall sleep. Biological factors, psychological factors, environmental factors, as well as acute situational factors are all involved.
[32:50] – Does drinking too much coffee contribute to insomnia? Every individual will react differently and some people will be more sensitive to coffee than others; our sensitivity to coffee is genetically determined. People who are predisposed to insomnia do tend to be more sensitive to coffee then others. Like most other drugs, coffee has a half-life. It enters the body and affects us in a certain way, before it is cleared from the body. The half-life varies depending on age and numerous other factors but when consumed in the morning it will be cleared out of the system by the evening and won’t be a problem, even for insomniacs. The commonly held advice is not to drink too much of it or drink it too late. (ref)
[35:42] – Remedies! Lois explains that, at this time, sleeping pills are not considered first line treatment for people with insomnia. Cognitive behavioural therapy is a treatment comprising of several different components which is known to be very effective, 70-80% of people see improvements in their sleep. It involves following recommended changes in habits, sleep restriction therapy, stimulus control therapy, relaxation as well as a cognitive component that challenges misguided beliefs around sleep and people’s fears. While it is not widely available, normally it can be administered by trained doctors, nurses and therapists.
[38:26] – It is worthwhile to note that going to bed earlier, after noticing you are struggling with sleep, will only exacerbate insomnia. Lois explains sleep restriction; the idea is to stay in bed only when you are actually sleeping. Initially this sleep window is very narrow and it slowly gets widened to find the ideal sleep window, so that it becomes easier to fall asleep and stay asleep.
[41:00] – Lois believes establishing a rise time in the morning and sticking to it is one of the most important things so that you can stay awake for long enough to build up enough sleep pressure making it easy to fall asleep and stay asleep throughout the night.
[41:42] – An interesting question to consider is: should we be shifting our sleep according to the natural daylight hours with the change of season? While she is not sure what sleep experts might say, Lois prefers to adhere to the same rigorous get up time throughout the year. If people wish to get up earlier in the summer that’s fine but they need to remember to adjust their bedtime accordingly as well. Gary is currently thinking circadian thoughts; we need to consider the shifts in seasons and our latitude, as well!
[43:17] – Exposure to blue light at night can have an effect on sleep as it affects the secretion of melatonin which helps us stay asleep, it could be especially bad for night owls as well as insomniacs. Daniel Georgiev’s Iris awesome blue light filter software, has a setting which blocks the blue light from the computer screen and turns it red. This makes it much easier to fall asleep when you are working on the computer late at night.
[44:56] – In terms of food timing and sleep quality, Lois explains that, in terms of insomnia, research on meal times indicates regularity is more important than timing in promoting better sleep. The same is true for exercise, which has greatly helped her personally. It is up to the individual to determine the time that works best for them; what is more important is regularity when it comes to sleep.
[46:19] – Lois explains that melatonin supplements are chronobiotics which change the timing of sleep, but not the ability to get to sleep and stay asleep. This is why, it can be helpful for circadian rhythm issues, shift work and jet lag problems, but is not generally prescribed for insomnia. She also adds that melatonin is beneficial for people who are not secreting enough melatonin, such as older adults or people with a partially calcified pineal gland. (Biohackers Lab Tip: list of good melatonin supplements here)
[47:59] – In terms of other sleep aids such as blackout curtains, good eye masks for sleeping, earplugs for sleeping, white noise machines etc., most individuals will be able to identify factors that pose a problem in preventing them from getting to sleep – be it light or noise or some other factors in the environment –and can then take steps to mitigate these. While white noise or the sound of TV can sometimes be helpful, Lois explains that most insomniacs need to realise that they can sleep, without aids, if they have the right habits and the right frame of mind.
[50:56] – Lois’ book is aimed at anyone who might have a symptom of insomnia, is diagnosed with insomnia or circadian rhythm disorder, as well as anyone with a comorbid disorder like depression and anxiety. The book also contains helpful tips and resources for people to help with sleep and in addition to her own book Lois recommends The Insomnia Workbook: A Comprehensive Guide to Getting the Sleep You Need on Amazon and The Insomnia Answer: A Personalized Program for Identifying and Overcoming the Three Types of Insomnia on Amazon.
[52:47] – The best way to follow Lois or get in touch with her is through her website: thesavvyinsomniac.com plus she also has a Facebook page and you can find her on Twitter @LMaharg
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