Working as a Licensed Sleep Technologist for many years and more recently as a Certified Clinical Sleep Educator, I keep abreast of changes in the diagnostic criteria for various sleep disorders. For example, Sleep Apnea severity is measured as the number of breathing “events” noted during a sleep study, usually when the airway becomes obstructed and air intake is reduced for at least 10 seconds. When the number of events is more than 5/hour, it is usually clinically significant. For Narcolepsy, a fairly normal sleep study followed by daytime nap testing showing rapid sleep onsets and REM sleep episodes (two or more) leads to the diagnosis. These two examples are very much generalizations, more to the story as they say, but they give you an idea of how two sleep disorders are diagnosed.

Diagnosing chronic insomnia (10-15% of adult population) is different. There really is no medical test for chronic insomnia, so the diagnosis is fairly subjective. After factoring out significant medical (waking or sleeping) and psychological disorders, the diagnosis of chronic insomnia considers the person’s estimation of poor nights, including frequency (three or more nights per week) and duration (for more than a month). For sleep onset insomnia, average time to fall asleep of more than 30 minutes is the threshold. For sleep maintenance insomnia, it is an average time needed to fall BACK to sleep of greater than 30 minutes that earns the diagnosis.

An overnight sleep study is typically not needed to diagnose chronic insomnia. In my experience, most people just come to a point where they know something is wrong with their sleep. Worry and anxiety about sleep develop. Over time, sleep, which was once just something that happened automatically and never a cause of concern becomes an issue.

People often begin to try things – they feel they should actively DO something, anything, to sleep better. Here are a few of the more common strategies that I hear from patients, and the rationale given:

Strategy: Going to bed earlier
Rationale: I want to try to make up for lost sleep
Problem: Links the normal sleep cue of going to bed with being awake

Strategy: Staying in bed when alert at night
Rationale: In case I fall back to sleep I want to be in bed
Problem: Increases frustration with getting back to sleep; makes the bed a “battle ground”

Strategy: Watching TV at night
Rationale: I want to be distracted
Problem: TV emits light, especially blue light, which stimulates the brain

Strategy: Sleeping-in
Rationale: It is oh so comfortable!
Problem: It shifts the circadian rhythm and essentially causes jet lag

Strategy: Taking naps
Rationale: Any sleep is better than none, right? And sometimes naps just happen.
Problem: Naps shift the circadian rhythm and make sleep at night more difficult

Strategy: Becoming less active during the day to conserve energy
Rationale: Resting is almost as good as sleep, right?
Problem: Sleep is different than just resting, and regular exercise is a great way to improve sleep

So have you tried any of these strategies? Can you actively DO anything to reduce ongoing trouble sleeping? The answer is a resounding Yes!

Tune into SleeponQ.com – the next post will have the answer!

Til morning,

Michael