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What keeps you up at night?
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Pondering deep questions?
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Excitement about a big trip?
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Or is it stress about unfinished work,
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an upcoming test,
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or a dreaded family gathering?
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For many people, this stress is temporary,
as its cause is quickly resolved.
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But what if the very thing keeping
you awake was stress about losing sleep?
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This seemingly unsolvable loop
is at the heart of insomnia,
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the world’s most common
sleep disorder.
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Almost anything can cause
the occasional restless night -
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a snoring partner,
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physical pain,
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or emotional distress.
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And extreme sleep deprivation like jetlag
can throw off your biological clock,
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wreaking havoc on your sleep schedule.
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But in most cases, sleep deprivation
is short-term.
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Eventually, exhaustion catches up
with all of us.
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However, some long-term conditions
like respiratory disorders,
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gastrointestinal problems,
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and many others can overpower fatigue.
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And as sleepless nights pile up,
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the bedroom can start to carry
associations of restless nights
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wracked with anxiety.
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Come bedtime, insomniacs are stressed.
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So stressed their brains hijack
the stress response system,
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flooding the body with
fight-flight-or-freeze chemicals.
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Cortisol and adrenocorticotropic hormones
course through the bloodstream,
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increasing heart rate and blood pressure,
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and jolting the body into hyperarousal.
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In this condition, the brain is hunting
for potential threats,
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making it impossible to ignore
any slight discomfort or nighttime noise.
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And when insomniacs
finally do fall asleep,
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the quality of their rest is compromised.
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Our brain’s primary source of energy
is cerebral glucose,
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and in healthy sleep, our metabolism slows
to conserve this glucose for waking hours.
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But PET studies show the adrenaline
that prevents sleep for insomniacs
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also speeds up their metabolisms.
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While they sleep, their bodies
are working overtime,
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burning through the brain’s supply
of energy-giving glucose.
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This symptom of poor sleep leaves
insomniacs
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waking in a state of exhaustion,
confusion, and stress,
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which starts the
process all over again.
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When these cycles of stress
and restlessness last several months,
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they’re diagnosed as chronic insomnia.
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And while insomnia rarely leads to death,
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its chemical mechanisms are similar
to anxiety attacks
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found in those experiencing depression
and anxiety.
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So suffering from
any one of these conditions
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increases your risk of
experiencing the other two.
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Fortunately, there are ways to break
the cycle of sleeplessness.
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Managing the stress that leads
to hyperarousal
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is one of our best-understood treatments
for insomnia,
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and good sleep practices can help rebuild
your relationship with bedtime.
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Make sure your bedroom is dark
and comfortably cool
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to minimize “threats” during hyperarousal.
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Only use your bed for sleeping,
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and if you’re restless,
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leave the room and tire yourself out
with relaxing activities
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like reading,
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meditating,
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or journaling.
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Regulate your metabolism by setting
consistent resting and waking times
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to help orient
your body’s biological clock.
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This clock, or circadian rhythm,
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is also sensitive to light,
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so avoid bright lights at night
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to help tell your body
that it’s time for sleep.
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In addition to these practices,
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some doctors prescribe medication
to aid sleep,
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but there aren’t reliable medications
that help in all cases.
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And over-the-counter sleeping pills
can be highly addictive,
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leading to withdrawal
that worsens symptoms.
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But before seeking any treatment,
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make sure your sleeplessness
is actually due to insomnia.
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Approximately 8% of patients diagnosed
with chronic insomnia
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are actually suffering from a less common
genetic problem
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called delayed sleep phase disorder,
or DSPD.
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People with DSPD have a circadian rhythm
significantly longer than 24 hours,
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putting their sleeping habits out
of sync with traditional sleeping hours.
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So while they have difficulty
falling asleep at a typical bedtime,
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it’s not due to increased stress.
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And given the opportunity,
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they can sleep comfortably
on their own delayed schedule.
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Our sleeping and waking cycle
is a delicate balance,
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and one that’s vital to maintain
for our physical and mental wellbeing.
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For all these reasons,
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it’s worth putting in some time
and effort
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to sustain a stable bedtime routine,
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but try not to lose any sleep over it.