For the last two years, I’ve tried to befriend my insomnia. Is that insane? Absolutely. But when you’ve tried every “how to cure insomnia” method with no luck, you just come to terms with the fact that, in the words of British singer Faithless, “I can’t get no sleep,” and you make nice with your insomnia.
Understanding that you are not going to get decent rest, you make peace with it and stop trying to sleep. You read, you watch TV, movies, you deep clean your bathroom, you do anything but lie in your bed and try to sleep because it seems futile.
Now, before you ask, “Have you tried this?” I can assure you I’ve tried everything. Meditation apps, no screen time hours before bed, white noise machines, melatonin, and Sleepy Time Tea. The only thing I’ve not tried is prescription sleep medications because they scare me.
I’d pretty much lost hope – until I read this article in New Scientist.
Research shows that “millions of people struggle with insomnia, but the sleep disorder is now a solvable problem – and the most effective therapy might involve your smartphone rather than sleeping pills.”
So, let’s dive into why scientists are throwing insomniacs a much-needed lifeline in the fight for sleep.
New Research On How To Cure Insomnia
Given that insomnia is a prevalent ailment, many people may recognize the feeling. It also has significant economic and health repercussions. But for years, experts have been unable to come up with a workable remedy.
However, a surge in sleep research in recent years has made it possible to pinpoint the neurological and psychological mechanisms that underlie it. We have reached a turning point in the treatment of this crippling ailment because of our improved understanding of how the brain might contribute to it.
Simply put, researchers are now much better able to determine why someone has difficulties falling asleep and the most effective strategy to provide them the rest they so sorely need.
“Insomnia is a solvable problem,” says Colin Espie at the University of Oxford.
Be still my heart – a cure for insomnia?
Given the prevalence of insomnia, the odds are good that you or someone close to you could directly benefit from this new information. Various surveys indicate a third of people regularly experience difficulties falling and remaining asleep.
What Is Insomnia?
This nocturnal restlessness must be present for longer than three months, occur at least three times per week, and, most importantly, not be caused by events outside of one’s control, such as a crying infant or excessive partying. It must also be coupled with symptoms that hinder daytime functioning, such as exhaustion, irritation, or difficulty concentrating. Though there are notable disparities between men and women, only about 10% of the population meets these strict requirements.
The health impact of insomnia includes an elevated risk of depression, diabetes, cardiovascular disease, and Alzheimer’s disease among the people suffering from it. The disease also has financial effects. It costs the economy $50 billion annually in lost productivity owing to insufficient sleep, which equates to 1.7 million working hours. Annually, 9.9 million working hours are wasted in the U.S., which costs the country’s economy $411 billion. These numbers imply that these nations lose about 2% of their GDP due to inadequate sleep.
So how do we deal with it?
“In an ideal world, we would banish insomnia with universally effective sleeping pills that are free from side effects. Unfortunately, such pills don’t yet exist. Earlier this year, Andrea Cipriani at the University of Oxford and his colleagues examined the published evidence on 30 sleeping pills, with a comprehensive meta-analysis of more than 150 clinical trials,” reports New Scientist.
The Drugs Don’t Work
The outcomes were underwhelming. Only two out of 30 drugs were demonstrated to offer both immediate and long-term relief. Eszopiclone, one of them, increases the effects of GABA, an amino acid that suppresses electrical activity in neurons. The second drug, lemborexant, inhibits the neuropeptide orexin’s ability to increase neuronal excitability. Although neither drug has been given UK approval, they have approval in the U.S.
“Significantly, Cipriani’s team found that some of the most commonly prescribed drugs to treat insomnia – including benzodiazepines, which also work through the GABA pathway – appear to offer no long-term relief, while their undesirable side effects include daytime fatigue, dizziness, general mental fogginess and the risk of dependency,” says New Scientist.
“There are also pills that either modulate levels of the hormone melatonin or mimic its action in the brain, where, in people unaffected by insomnia, it naturally builds up as the day fades into night and then drops by morning. But Cipriani’s team found very weak evidence that these pills could provide even significant short-term benefits. There’s no point in prescribing them as a first-line treatment,” the article concludes.
No Easy Solution
Taking sleeping drugs isn’t always the solution, and neither are overly straightforward behavioral therapies. The main approach on this front from the 1970s until very recently was “sleep hygiene” instruction. This includes suggestions for making the bedroom as peaceful as possible, such as getting a comfortable mattress and quality drapes, and steering clear of activities (like watching TV in bed or drinking coffee in the afternoon) that could make someone feel too alert when the lights go off. Even though it all seems like common sense, it might not be very successful.
That was the finding of a review that was released last year after looking at the findings of 89 earlier studies on the subject of treating insomnia. They discovered that providing sleep hygiene education as the only intervention results in hardly any symptom alleviation.
But there are ways to change things. In order to effectively treat insomnia, psychologists must now focus considerably more on the underlying mental processes involved. This has been a significant area of research since the 1990s, and the efforts are beginning to bear fruit.
“Much of this research has centered on the idea that people with insomnia experience ‘hyperarousal,’ fuelled by ruminative thoughts, that leaves them feeling anxious and physically on edge. This makes it harder to get to sleep at bedtime and may prevent them from entering a deep slumber, leaving them more likely to wake up during the night,” says New Scientist.
The Ruminating Brain
This hypothesis is currently supported by numerous lines of data, such as measurements of the structure and function of the brain.
“In 2019, for example, Kira Vibe Jespersen at Aarhus University in Denmark and her colleagues showed that people with insomnia tend to have reduced connectivity between the frontal lobe, the part of the brain associated with self-control, and regions such as the insula that are involved in emotional processing.
“The consequences of this reduced connectivity could definitely be a greater difficulty regulating emotional states and stress responses,” says Jespersen.
This image of a ruminative brain in overdrive is also consistent with research done by Yishul Wei and his colleagues at the Netherlands Institute for Neuroscience in Amsterdam, which was published last year.
“They found that the brain activity of someone with insomnia is generally more fixed, so less able to vary. This ‘inertia’ might help explain the tendency for those with insomnia to lock into fixed patterns of negative, repetitive thoughts,” concluded the researchers.
As one might anticipate, ruminative thinking may be especially damaging if the prospect of sleep itself is the focus of these thoughts, as this would cause someone to remain very alert when they should be relaxing. The amygdala, another part of the brain in charge of processing emotions, is known to become more active in those with insomnia if anything triggers their desire to go to sleep.
More crucially, the nocebo effect appears to exacerbate the daytime symptoms of insomnia, which include exhaustion and difficulty concentrating, when people worry excessively about sleep loss and its repercussions. The placebo effect, the nocebo effect’s less harmful twin, is a form of self-fulfilling prophecy. When that happens, negative expectations produce worse results than they otherwise would.
Anxiety Over Sleep Loss
Numerous observational studies provide data in support of this hypothesis.
“The more that people worry about their sleep loss, the worse their symptoms – independent of how well they are actually sleeping. Perhaps most tellingly, researchers can even identify a group of ‘complaining good sleepers’ who don’t seem to suffer any objective sleep loss, but who experience all the fatigue and concentration problems of people with insomnia, as a result of their negative expectations.
“The worst situation, of course, is to experience poor sleep and excessive worries about the consequences – the ‘complaining bad sleepers.’ People in this category are the most likely to live with the cognitive impairments and the physical signs of insomnia, such as high blood pressure,” says New Scientist.
The good news is that effective psychological treatments are now accessible as a result of our improved understanding of the causes of insomnia and the thoughts that go through the brains of those who suffer from the illness.
Treatments
“One tried-and-tested solution is cognitive behavioral therapy for insomnia (CBTI). When it is carried out in person, this typically takes place over four to six sessions, during which a therapist will discuss strategies to break free of rumination, when it occurs. Rather than willing themselves to sleep, for example, the person may be told to direct their thoughts to staying awake,” says New Scientist.
By reducing a person’s “performance anxiety” before bed, the counterintuitive method known as paradoxical intention can hasten the onset of sleep. If, for example, the patient has begun to catastrophize about the repercussions of even minor disturbances, the therapist will also assist in counteracting attitudes about sleep loss.
In addition to teaching cognitive methods, CBTI also offers information on topics like sleep hygiene.
“Overall, more than 70 percent of people show improved sleep after CBTI and 40 percent go into remission from their insomnia, according to a recent review,” reports New Scientist.
Sleep Strategies
Another rising star is mindfulness and behavior therapy for insomnia (MBTI). As the name implies, it is founded on Buddhist principles of non-judgemental mindfulness and acceptance, with participants being taught to notice any thoughts and sensations they may have related to sleep without necessarily attempting to alter them.
“It’s more how you relate to that thought, rather than just the content itself,” says Jason Ong, a former professor at Northwestern University in Illinois who pioneered the technique and who is now director of behavioral sleep medicine at U.S. company Nox Health.
“The passive observation of the thoughts, and the recognition of their fleeting nature, is meant to defuse some of the person’s frustrations and prevent them from being drawn into the rumination and worry that exacerbate their distress,” says New Scientist.
Clinical studies support this. A 2018 study found that MBTI can greatly lessen the symptoms of sleeplessness, and a 2020 investigation found that these advantages persist long after the therapy is over.
The majority of insomnia researchers concur that the specifics of each person’s insomnia will vary in terms of its origins and effects. But over time, it might be feasible to pinpoint a patient’s specific complaint and anticipate which treatments will be most effective.
Insomnia Subtypes
At the University of Amsterdam in the Netherlands, Tessa Blanken has already made a number of significant strides in this regard. She discovered five separate subtypes of insomnia, each with its own patterns of sleep-time arousal and daytime discomfort, after analyzing vast amounts of data on people’s experiences with the disorder and its potential causes.
“Earlier this year, Blanken showed that people with some of these subtypes are much more likely to develop depression as a result of their sleep loss, and that their mental health was especially likely to benefit from CBTI. In the future, she hopes such discoveries might help to personalize treatments.
“We could find when particular factors are of importance for particular people and the mechanisms through which the treatment works,” says Blanken. “We could then prioritize the people who would gain the most from a particular therapy.”
However, this goal is unlikely to be accomplished anytime soon, mostly due to the scarcity of therapists in the field.
“There are thousands of patients for each person trained in CBTI,” says Daniel Gartenberg at the Pennsylvania State University. This means that the majority of people with insomnia are still given medications, despite the evidence favoring psychological therapies.
“It’s perverse that we have a common condition for which the evidence-based treatment is not [widely] available,” says Espie.
Due to these problems, an increasing number of sleep experts, including Espie and Gartenberg, have started to wonder if the answer lies inside the sophisticated apps on our smartphones that, typically for a little cost, offer the kind of insight and direction usually provided by a therapist.
Sleep Apps
There are certain evident drawbacks to automated therapy compared to face-to-face interactions.
“The human relationship is very important,” says Cipriani.
However, the outcomes of recent experiments indicate that these technology solutions are worthwhile exploring. Consider the app Sleepio, developed by Espie.
With an AI system that helps to personalize the program to the patient’s behavior as reported by an online sleep diary or captured through wearables, this offers a six-week CBTI course. Based on information from 12 recent trials, the National Institute for Health and Care Excellence said in May that Sleepio be made publicly available through the National Health Service in those nations.
“Espie says that the remission rate in one study was greater than 70 percent. Over my career, all we’ve ever been able to give people is pills, you know, so this is a real breakthrough moment,” he says.
In ongoing tests of his software, SleepSpace, Gartenberg is taking a similar approach. It tracks data from a person’s phone or watches for a customized type of CBTI, similar to Sleepio. It also sends brief bursts of relaxing sound through a smartphone’s speakers at night that are intended to trigger the proper frequencies of slow brain waves linked to sleep, and it can be connected to smart light sources that will change their color to correspond to your circadian rhythm. Gartenberg claims that if the study findings are promising, SleepSpace might be utilized either alone or in conjunction with qualified therapists.
We may not yet have a simple, quick remedy for insomnia, but most people with the condition should soon have access to some effective, evidence-based therapies without having to turn to potentially addictive medications.
And that gives this insomniac something I’ve not had in awhile – hope for a good night’s sleep.
Are you as hopeful as we are about a possible cure for insomnia? Share in the comments!
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