Insomnia is a global epidemic. How do we fix it?

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3 days ago

On a special episode (first released on July 24th) of The Excerpt podcast: The question is: Why do we struggle to sleep? Jennifer Senior, a staff writer at The Atlantic, joins The Excerpt to talk about insomnia and what we can do about solving our sleep issues.
Hit play on the player below to hear the podcast and follow along with the transcript beneath it. This transcript was automatically generated, and then edited for clarity in its current form. There may be some differences between the audio and the text.
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Taylor Wilson:
Hello, I'm Taylor Wilson, and this is a special episode of the Excerpt. According to a report released by the American Medical Association earlier this year, one-third of American adults experience acute insomnia, an inability to fall or stay asleep for several days at a time, but one in 10 adults suffer from chronic insomnia. That's an inability to fall or stay asleep three nights a week for three months or more. The condition has potentially debilitating health impacts, including an increased risk of depression, anxiety, substance abuse, and even car accidents. So the question is, why can't we sleep? Here to help me dig into the issue is Jennifer Senior, a staff writer at The Atlantic who recently went on her own journey to solve her insomnia and who shared her story in the magazine. Thank you for joining me, Jennifer.
Jennifer Senior:
Thanks for having me.
Taylor Wilson:
So let's start with I guess a 30,000-foot view of the issue. I know you spoke with a lot of sleep specialists, did a lot of independent research for your piece. Jennifer, what's the big picture here on American's trouble with sleep?
Jennifer Senior:
Right. Yeah. What's funny, I think the story was a little misnamed. I mean, this is really more story about, well, if you can't sleep, don't feel awful about it because there are so many shaming stories about people, whatever solutions people seek out. I do talk in the beginning about the way that the modern world absolutely conspires against sleep, that it just lays waste to your circadian rhythms. That people work two jobs, 16.4% of us work non-standard hours. If you're a white collar kind of professional, you've got these woodpecker like peck, peck, peck, incursions into your life all night and weekend long from your boss's work sort of never ends. I mean, we're just no longer yoked to the rhythms of the earth anymore. We're just part of this whirl of a wired world.
Taylor Wilson:
In the course of doing your research, was there something in particular that surprised you most about the problem?
Jennifer Senior:
I'll tell you what surprised me most, just generally. Whenever I interviewed any expert about this, and it didn't matter what species of expert, they could be an epidemiologist, they could be a neurologist, they could be a psychiatrist, they could be a clinician. Most of them said the same thing. There is a slight misconception that you need eight hours of sleep. There is some data saying this. There is another equally robust data set saying 6.5 to 7.4 is associated with the best health outcomes. Now it's very hard to tell. These studies are observational. They're not randomized. There was all sorts of confounds and problems with this, but this one study in particular had a million people in it. It's been replicated. There are plenty of people who believe this data and people vary. And over the course of a lifetime, your individual sleep capacity could change. In a funny way, that was what surprised me most. Right? This mantra, which is kind of a tyranny, get eight hours or else.
Taylor Wilson:
Well, you talked Jennifer about the modern world conspiring against us and our sleep, and I guess let's try to outline a few of the possible causes of what you call a public health emergency, right? What can you share with us here on this?
Jennifer Senior:
About other causes, you mean besides the kind of modernity itself and kids working on... Kids being assigned homework online, kids socializing online. I mean, adolescents are desperate for sleep. They're so hungry for it, and modern high schools and middle schools have them waking up preposterously early when their circadian rhythms are pitched forward. We've got a substantial sandwich generation that's taking care of young kids and their elderly parents. That's going to conspire against it. These are all immutable things. Also, there are elevated levels of anxiety now in our world, and anxiety itself is a huge source of... Or can be a source of sleeplessness, certainly can make one prone. So I mean, those are additional examples I suppose.
Taylor Wilson:
Let's talk through your story a bit here. When did you first realize that you had an issue with sleep? And walk us through your experience with insomnia.
Jennifer Senior:
It was 25 years ago and it was a very mysterious onset. I cannot tell you what brought it on to this day. It is a mystery. I had this extremely well-regulated kind of circadian clock. I fell asleep every night at 1:00. I woke up every day at 9:00. I lost my alarm clock. I still woke up at those times. I didn't have to buy a new alarm clock until I had an early flight one day, and yet sometime very close to my 29th birthday when virtually no circumstances in my life had changed one iota, I had a bad night, fell asleep at like 5:00. Thought nothing of it until they became more regular, and then I started doing all-nighters involuntarily, and I felt like I'd been poisoned.
And to this day, I don't know what happened, but once that happens, the whole cycle starts to happen, then people suddenly become very afraid of not falling asleep and whatever kicked it off whether it's mysterious or known becomes irrelevant because then what you do is you start getting very agitated and going, oh my God, I'm not sleeping. Oh my God, I'm still not sleeping. Now it's 3:00 in the morning. Now it's 4:00 in the morning. Now it's 5:00 in the morning. Oh my God, I have one more hour, et cetera.
Taylor Wilson:
Well, you did write in the piece about the many different recommendations that she tried to solve your own sleep issues. What were some of them, Jennifer, and did any of them help?
Jennifer Senior:
Oh God, I tried all the things. This is before I sought real professional help, but I did all the things. I would took Tylenol PM, which did not work. I did acupuncture, which were lovely, but did not work. I listened to a meditation tape that a friend gave me, did not work. I listened to another one that was for sleep only that did not work. I ran. I always was a runner, but I ran extra, did not work. Gosh, changed my diet. I don't remember. I did all sorts of things. I tried different supplements, Valerian root, all these things. Melatonin, nothing, nothing.
Taylor Wilson:
You wrote in depth about one therapy that was recommended to you, and that was CBTI. That's cognitive based therapy for insomnia. Jennifer, first, what is this? And second, did you find any success by using this?
Jennifer Senior:
So cognitive behavioral therapy for insomnia, as you said, is the gold standard for treating insomnia. It's portable. You can take it with you. It's not like if you leave your sleep meds at home. The main tent pole of it, which is sleep restriction, which I'll get to in a minute, is very hard to do. I found it murder, the kind of easier parts, although they're still in a funny way, kind of paradoxical, are you have to change your thinking around this is the cognitive piece around sleeping and insomnia. You have to decide, okay, I'm not sleeping. So what? Now, this is kind of funny because there's this din surrounding us that says, oh my God, you're not sleeping. You're going to die of a heart attack. You're going to die of an immune disease. You're going to get cancer. All these things, right? You have to set that all aside and decide one more night's sleep that I can't sleep. So what? Right. That's one thing.
You have to change your behaviors, deciding that you are going to consistently go to bed at the same time, wake up at the same time, all that, and not use your bed for anything other than just for sleeping and sex. The hard part and the most powerful part that I found it brutal was the part that said you have to restrict your sleep. If you had only five hours of sleep, but you're in bed for nine hours, you have to choose a wake-up time. Let's say it's 7:00 and then you have to go to bed five hours earlier, 2:00 to s7:00. That's all you can give yourself, and you cannot stop with that schedule until you've slept for the majority of those hours. That's very hard for a sleepless person. And then once you've succeeded, all you get to add on is 15 more minutes of sleep, and then you have to sleep the majority of those hours for three nights running.
This is always for three nights running, and the idea is to build up a enough sleep pressure to regularize yourself. You basically capitulate to exhaustion and you start to develop a rhythm. I couldn't stick with it. I was so kind of stupid and depressed with sleeplessness by the time I started it that it probably was impractical and I refused to take drugs to help me fall asleep at the exact right hour, which many clinics recommend. If you're going to go to bed and sleep from 2:00 to 7:00, take something at 1:30 so that you fall asleep at two. But I was afraid of being dependent on drugs, and you can really wean yourself if you do it for a limited amount of time. You can wean yourself anytime really, if you're shrewd about it and if you taper. But I think that I would tell people to try it and to try it sooner rather than later, and to be unafraid of doing it in combination with drugs so that the schedule worked.
Taylor Wilson:
Well, I am happy you brought up drugs. I did want to bring that up just in terms of what experts are saying about their impact. Even just drugs and alcohol kind of writ large, but sleeping pills specifically. What did you find in researching this in terms of drugs and alcohol?
Jennifer Senior:
Well, there's a real stigma taking sleep medication, and I'm frankly a little sick of it. I'm not sure why this is so very stigmatized. Like, oh, they're drug addict. They're hooked on sleeping pills. It's framed as addiction, and no one says that someone is addicted to their Ozempic, even though a lifestyle change could perhaps obviate the need. No one says that they are addicted... Oh, that person is totally addicted to their blood pressure medication, even though maybe a change in lifestyle would help change that. Or that they're addicted to their statins, So I sort of bristle. And those who prescribe these medicines say like, look, if the benefit outweighs the risk and they're used properly, sometimes the real side effect is just being dependent on these drugs, and there's a difference between dependence and addiction.
A surprisingly small number of people who take these drugs regularly, like benzodiazepines, like Ativan and Ambien and Klonopin, all these things, a surprisingly small number, like 7% increase their doses if they take it every night. So that's very small. However, there are cognitive decrements over time... Or not decrements. It can interfere with your memory and it can increase your odds of falling as you get older. And those are, to me, the real persuasive reasons to get off.
Taylor Wilson:
I want to back up a minute here to talk about something many may not be aware of, and that's that historically, at least in some eras, people used to sleep in two blocks. What do you know about this? How did this function and really why did this kind of sleep pattern work for some folks?
Jennifer Senior:
Well, it was sort of, I think, natural. It seemed that this is, and it has not been proven everywhere, but there's plenty of both historical evidence and also some in a lab by this wonderful guy named Tom Ware that shows that if you sort of just put someone in a room, 14 hours of darkness, what will happen is that their sleep will naturally split into two. They'll sleep for a phase, wake up for a phase, and then sleep for a phase again. And historically, there's all sorts of evidence that people would sleep for a phase, get up and read for a while, do some quiet things, do light tasks, maybe sing, maybe have sex, and then go back to bed. So there seemed to be two phases, and this was much easier to do when midnight was actually midnight. You were going bed when the sun had set, or just after were you were tethered to the rhythms of the earth as opposed to a wired electricity run world.
Taylor Wilson:
What is something you wish you knew when you first started on this journey?
Jennifer Senior:
To get on it earlier and to not be as afraid... Cognitive behavioral therapy is, I think, often done in conjunction with taking something like Klonopin or Ativan or Ambien, and I was so petrified of becoming hooked on them that I didn't... I refused to take them and I couldn't get my sleep to contract as a result of it. My body was so completely dysregulated and confused about it was so all over the place that I really needed something to regularize it and stabilize it, and I flipped out, and I think if anybody goes and tries CBT, I and their practitioner says to them, and I'm going to have to be on their recommendation, do this in concert with a drug, because you really need it. Don't sit there and freak out and think that you can't or shouldn't, because it happens a lot and people freak out a lot.
Taylor Wilson:
All right, Jennifer Senior, thank you so much for coming on the Excerpt.
Jennifer Senior:
Thank you so much for having me.
Taylor Wilson:
Thanks to our senior producers, Shannon Rae Green and Kaylee Monahan for their production assistance. Our executive producer is Laura Beatty. Let us know what you think of this episode by sending a note to [e-mail]. Thanks for listening. I'm Taylor Wilson. I'll be back tomorrow morning with another episode of USA TODAY's the Excerpt.
This article originally appeared on USA TODAY: Insomnia is a global epidemic. How do we fix it? | The Excerpt