HEALTH & FITNESS : Insomnia Can Defy Counting of Sheep

In pursuit of a fit and healthy lifestyle, North County residents have pursued all the usual routes--walking, cycling, running--and quite a few of the unusual routes, too. They climb rocks, chase trails marked with flour and ride their bicycles in circles.

For every variation in taste, schedule and physique, there seems to be a route to fitness out there. Some folks have charted their own way, others have connected with an established program. Whatever your own program or lack thereof, fitness starts--or ends--with a good night’s sleep. And whether you exercise occasionally or often you’ll feel a whole lot better if you do it without injury.

If you’re ready to get up and get going, still just thinking about it, or looking for new ways to put yourself through your paces, we offer these suggestions for getting the lead out:

She wants the window open. He hogs all the covers. She grinds her teeth. He snores like a chain saw.

A double, or full-size, bed provides two adults with a sleep space no wider than a baby’s crib. If one partner is 50 pounds heavier than the other, the lighter person will roll into an impression in the mattress aptly called a trough.

Is it any wonder that insomnia (the inability to fall asleep or stay asleep) is the most common of more than 100 specific sleep disorders known? Among a number of sleep studies done, a Gallup Poll commissioned by the National Sleep Foundation in June, 1991, reported that 27% of adults had occasional insomnia, and 9% had regular or chronic insomnia.

Just as eating well and staying in shape are keys to enjoying good health, so is getting a good night’s sleep.

Some of the main side effects of insomnia are grogginess, excessive sleepiness, an inability to function properly during the day and impairment of social and family relationships. Studies have also shown that insomniacs are 2 1/2 times more likely to have vehicular accidents because of fatigue.

Despite the high percentages of adults who suffer from insomnia, only three in 10 people discuss their sleep problems with their physician, let alone seek medical treatment, said Dr. Milton K. Erman, head of the Division of Sleep Disorders at Scripps Clinic & Research Foundation on Torrey Pines Road. One of the reasons people don’t seek medical help for insomnia is because of a fear of being told that there may be an underlying psychological problem, Erman said.

“One assumption that often is made is that most insomnia is related to depression, and we don’t think that’s necessarily the case,” Erman said. “Depression can be made worse by a sleep problem, but the inference is that a person who is sleeping poorly is depressed or has bad habits or is neurotic.”

Erman said many people are also concerned that their personal physician may not understand their sleep problems or might trivialize them. As it is, Erman said, relatively few medical schools in the country have structured programs to teach their students about sleep disorders, and it may be common for a general practitioner or internist to not know much about a sleep problem such as insomnia.

Body clocks and physiology varying so much from person to person, it can take as little as a few days to a couple weeks for a person to throw off his or her circadian rhythm. Going to bed too late or too early a couple of nights, taking certain medications or the stress of daily life can all contribute to an insomnia that may require medical treatment to correct, such as medication, behavioral modification, light therapy or relaxation training.

“It’s (insomnia) a normal human reaction to stress,” said Encinitas neurologist Renata Shafor, who specializes in sleep disorders both in her North County practice and as director of the Sleep Disorders Center at Harbor View Medical Center in San Diego. “It’s like our way to survive is to stay awake, to think things over, to be prepared for things,” she said.

“But, if that lasts more than two or three nights, it becomes an abnormal reaction, and a lot of times people will have persistent insomnia, even after the stressful situation is over and everything has gone back to normal.”

Shafor says that women, in particular, who are otherwise healthy--but juggle career and family--and college-age students, are prone to insomnia. She recounted a story of one of her patients, a lawyer working on a lengthy project, who literally moved into her office, slept two or three hours a night on a couch until the project was over and ended up with severe insomnia and depression that required monitoring in a sleep lab, and medication.

“It especially hits women who have to spend so much time raising the children, having a career and social life. Students, too, want to party, and they want to study, but we cannot just command our bodies to stop sleeping two or three hours less. It’s going to hit us sooner or later.”

Shafor says it wasn’t until fairly recently that clinicians and scientists began to pay attention to the fact that one-third of our lives are spent in bed. A seemingly simple concept that a bad night’s sleep could effect daytime performance had been ignored for decades, Shafor said.

“It always fascinated me. Why are we ignoring what we are doing? Our body functions at night, too,” she said.

What can a person do on their own to correct occasional insomnia? Erman said that sometimes common sense is the first thing that is overlooked, and often people ignore the advice of relatives or friends.

For example, if you aren’t sleepy at 9 p.m., don’t go to bed at 9 p.m. There are patients who discount that simple advice from people they know, but find it helpful if they hear it from a doctor, Erman said.

It’s also important to have a comfortable mattress and be aware that it needs to be replaced--generally every eight to 10 years. Older mattresses do not provide the proper support and begin looking like the Grand Canyon after a while.

As for that all-important piece of sleeping paraphernalia--the pillow--the Better Sleep Council in Washington suggests to stop fluffing it and give it the old heave ho after 1,000 nights of use. If the thought of retaining that kind of information keeps you awake at night, a good rule of thumb is that a pillow should be pitched after three years. (People keep their pillows an average of 7 years).

Aside from the official list of do’s and don’ts, there are as many effective nighttime rituals as there are imaginations. Many people, for example, have turned the midnight snack into an art form.

One woman, to avoid leaving the warmth of her bed for her nocturnal snack, stocks her bedside table every night with a glass of milk, a glass of water, an assortment of imported hard candies, dry macaroni, cough drops and lip balm. Without this arsenal, she cannot fall asleep, much less soothe her restless soul if she does wake up in the wee hours.

One intermittent insomniac--unbeknown to her snoozing husband--quietly snaps her fingers for her beagle, who will hop into bed beside her. His comforting presence usually allows her to fall back to sleep almost instantly.

Shafor said sleep rituals are helpful for the generally healthy person as long as they are continued, and patience is practiced. Since it takes as little as two weeks of poor sleep behavior to break a normally good pattern, Shafor says that, in order to restore what has been broken, it often requires more time and effort to regain a good biological clock.

“In terms of counting sheep or listening to music or to the ocean waves, that’s fine as long as you keep the routine going,” she said.