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Trouble Sleeping

The lawyer explained, “just don’t have time to see my doctor.”  Or, the explanation of what he did not have time for could have been, go to support group meetings, see a therapist, play with my kids, or take my spouse out to dinner.  One of the great benefits and burdens of technology has been the increase of demands on our time.  With time pressures comes an increase in stress.  Even fun activities become stressful when one is worried about being late to the next appointment, from which one will have to leave early in order not to be but 30 minutes late to a scheduled working lunch.  The day is just one mad scramble with the clock.  The stress of keeping up with an external clock must be understood in the context of one’s internal clock.

We all have a piece of internal software that programs us to anticipate and prepare for changes in the physical environment that are associated with day and night.  The mechanisms, including our biological time keeping system, are being addressed by researchers in the field of chronobiology.   Research in this area started about fifty years ago focusing on the daily cycle known as circadian rhythm.  The term circadian derives from the Latin phrase circa diem which means “about a day.”  In mammals, the circadian clock resides primarily in two clusters of nerve cells called the suprachiasmatic nuclei (SCN) located at the base of the brain in the anterior hypothalamus.  In 1997, researchers cloned the first mammalian circadian clock gene in a mouse.  The internal clock appears to be based on a feedback cycle of gene expression.

Why is this research in chronobiology important?  In addition to the sleep disturbances associated with jet lag or shift work, sleep disturbances are the hallmark of many mental health disorders.  Alcohol appears to have a major impact in advancing the circadian cycle.  Other leading causes of death, heart attacks and strokes, have time of day synchronicity.

Sleep problems are more common among alcoholics than among non-alcoholics.  During both drinking periods and withdrawal, alcoholics commonly experience problems falling asleep and decreased total sleep time.  Even alcoholics who have been abstinent for extended periods of time may continue to experience persistent sleep abnormalities.

Epidemiological research also suggests that the incident of alcohol abuse is as much as two to three times higher in adults who experienced persistent insomnia during the previous year.  For some individuals, insomnia may be a precursor of alcoholism.  People commonly use alcohol to self-medicate for insomnia, and this may be part of the reason that insomnia seems to precede the onset of alcoholism among some individuals.

Among active alcoholics, between 44 and 60 percent report using alcohol to help induce sleep prior to entering treatment.  Experimental evidence also suggests that sleep abnormalities may be associated with relapse among abstinent alcoholics.  This suggests recovering alcoholics should take persistent sleep problems seriously and consider a range of sleep treatments that exist besides standard addictive pharmalogical ones.

Curiously, experimental animal research indicates that even the timing of alcohol consumption may be influenced considerably by the circadian rhythm.

The brain’s use of alcohol has a complex effect on the human circadian rhythm, including effecting changes in the level of REM sleep, body temperature, cortisol and melatonin release.  While the area of chronobiology research is still relatively new, enough has been learned to suggest that some of alcohol’s negative health consequences may be related to a disruption of the normal timing pattern in which our bodies function.

Sleep is also a very important factor related to depression because of the point in the sleep cycle in which seratonin production is replenished.  Serotonin is the neurotransmitter that causes a feeling of well-being.  There are four phases of sleep, starting with the most active, which is characterized by REM sleep and a predominance of alpha and beta brain waves, to the last phase, which is the least active.  It is during this fourth phase that there is an increase in delta and theta brain waves, which are particularly restorative to the body, and an increase in serotonin.  The problem is that when sleep is interrupted, the cycle must start all over.  In addition, certain chemicals, often taken to relax, such as alcohol and tranquilizers, like Xanax and Valium, actually depress phase four of the sleep cycle.  Similarly, more than 500 mg of caffeine (from coffee, soft drinks, etc.) in any 24-hour period will also tend to prevent stage four sleep.

If you are sleeping eight hours but not waking up feeling good chances are something is preventing a restorative phase four in your sleep.  Being able to get a good night’s sleep is an important marker of good health.  Not sleeping well is often a complex symptom that should be discussed with a health care provider who understands depression and addiction.

– by Don Carroll

The North Carolina Lawyer Assistance Program is a confidential program of assistance for all North Carolina lawyers.  The Lawyer Assistance Program has two outreaches: PALS and FRIENDS.  PALS addresses alcoholism and other addictions:  FRIENDS depression and other mental health problems. 

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