Dear Christine: Why Can’t I Sleep?

Dear Christine,

I’m a college student and I haven’t been sleeping well since I got back to school. My sleep tracker app says I’m sleeping about six hours a night, but I’m literally having the worst sleep of my life. I couldn’t fall asleep for hours last night even after taking two melatonin and I’ve been up since 6 a.m. I’m falling apart and not functioning. I’m anxious. I can’t focus in class and I think it’s affecting me socially, too. It’s making me a lot less happy with my college experience. Should I get a prescription for sleeping pills?

Please help,
Sleepless Student

Dear Sleepless Student,

Oh, I feel you. Sleep deprivation is miserable. You are right: A poor night’s sleep is the ultimate mood killer, and over time those bad moods add up. People who regularly get less than seven hours of sleep at night are far more likely to develop depression or severe anxiety.

Did you know that modest reductions in sleep quality, even without a decrease in sleep quantity, tend to make us feel lonely? More than that, poor sleep quality leads us to act in ways that increase our isolation, not reduce it. Sleep-deprived people are more likely to avoid contact and are less inclined to engage with other people. Worse still, sleep-deprived folks tend to be judged as socially unattractive by others. And as if that isn’t enough, the effect is contagious: Well-rested people feel lonelier after even a one-minute encounter with a sleep-deprived person.

The good news is that you can learn to get a good night’s sleep again, and this will soothe your anxiety. Here’s how.

1. Reset your circadian rhythm

Our sleep is primarily governed by a “biological clock” in the center of our brain called the suprachiasmatic nucleus. It sits just above the place where our optical nerves cross. This biological clock keeps time thanks to the light pulsing through the optical nerves below it. Unthwarted by modern life, the sun is a reliable winding mechanism: Every day since the dawn of the earth, the sun has risen and set in a 24-hour cycle.

As the sun sets, the suprachiasmatic nucleus detects the darkening world, which triggers the release of melatonin, the chemical messenger that commands the body to prepare for sleep. We feel sleepy and our body gets ready to fall asleep when melatonin starts to build up in our system, a few hours after dark.

When we expose ourselves to artificial light after sunset, though, our biological clock loses its primary winding mechanism. These days, light doesn’t stop pulsing through the suprachiasmatic nucleus until we turn off our bedside lamp and close our eyes—and even then, if there is still even a tiny source of light in our room, it might not. When we can’t fall asleep, often it’s because we don’t have enough melatonin built up in our system.

For that reason, looking at a phone, iPad, or computer is about the worst thing we can do before bed. One study found that reading on an iPad suppressed melatonin release by over 50 percent, compared to reading a paper book at night. The blue light emitted by our devices can delay the rise of melatonin by three hours, causing us to lose significant amounts of REM sleep—the type of sleep that is important for dreaming and that, when limited, most affects our moods.

You might be surprised to hear that even the tiny string lights that many college students string up around their dorm rooms can keep you from falling asleep. “Even a hint of dim light—8 to 10 lux—has been shown to delay the release of nighttime melatonin in humans,” writes UC Berkeley neuroscientist Matthew Walker in his book, Why We Sleep. “The feeblest of bedside lamps pumps out twice as much: anywhere from 20 to 80 lux.”

So, the first step is to turn the brightness on your screens way down at night, and to crank the “night shift” display settings to “most warm.” Unfortunately, according to some recent research, this won’t be enough to prevent light-induced melatonin suppression. So how can we best give ourselves the darkness we need to prepare for sleep?

• Wearing dorky orange wrap-around glasses for an hour or two before bedtime tricks our biological clocks into thinking it is dark. This means that the suprachiasmatic nucleus will trigger the release of melatonin as though it were dark out.
• We can also reset our biological clocks using light in the morning rather than darkness at night; bright light exposure for at least six and a half hours during the day can eliminate the hindering effects of artificial light exposure at night. On days when we aren’t able to expose ourselves to bright sunlight for this long, 20-30 minutes in front of a lightbox early in the morning can increase evening melatonin levels by 81 percent.
• Although light is the primary way that our biological clock keeps time, our habits also influence our circadian rhythm. This is why so many of the best “healthy sleep guides,” like this one from the National Sleep Foundation, emphasize going to bed and waking up at the same time, as well as establishing a good bedtime routine.

2. Reduce your stress

While it’s clear that not being able to sleep stresses most people out, stress itself is also often what starts a cycle of sleeplessness in the first place. According to Walker, the most common cause of chronic insomnia is psychological, rather than biological. 

If your mind starts spinning with worry the moment your head hits the pillow, you aren’t alone. Our smartphones make it entirely possible for us to spend every waking minute (out of bed) consuming information rather than processing it. Instead of reflecting on our lives or about what we are feeling during the daytime—while, say, we eat our lunch or wait for class to start—we check our phones for new messages or updates. Our devices are a never-ending source of stimulation and distraction. They might keep us from ever feeling bored, but they are also often preventing us from ever feeling calm.

Constant stimulation during the day keeps us wound up like tops that are only free to spin once the lights go out. But when we wait until our head hits the pillow to process our day or to feel our emotions, we are more likely to start worrying and less likely to feel relaxed enough to fall asleep. Our nighttime worry and anxiety rev our body’s fight-or-flight system, a mechanism that is designed to keep us awake. Its job is to get us to fight or flee a threat, neither of which we can do if we are asleep. This makes it much more likely that our endless nighttime ruminations are both irrational and unproductive—even if they don’t feel that way when we have them.

It’s critical that we have time for quiet reflection during the day, and that we have ways to process our emotions and cope with stress so that we don’t take it to bed with us. Tons of research shows that daily exercise, meditation, and therapy (especially Cognitive Behavioral Therapy for Insomnia, or CBT-I) are all effective at reducing the worry and anxiety that can keep us up at night.

3. Rule out a biological issue

Sleep, and sleeplessness, are complicated. Sometimes we lose our ability to sleep well because of a change in our biochemistry. Our hormones are intricately tied to our circadian rhythms, and when our hormones get out of balance, our sleep usually does, too. Women famously sleep poorly when they are pregnant or going through menopause.

Even when we aren’t pregnant or menopausal (or female!), our hormones influence our sleep—and are often at the root of sleep problems. We know that the synthetic hormones found in birth control pills, for example, can change the structure of our sleep. (Researchers don’t know exactly why, but they do know that progesterone acts as a natural “hypnogenic,” a chemical that induces sleep.)

Changes to our diet can also cause changes to our sleep. Eating a high-carbohydrate, low-fat diet for just two days can decrease the amount of deep sleep we get. Other studies have shown that sugary foods and other carbohydrates are associated with lighter, less restorative, and more disrupted nighttime sleep.

If you have fixed your circadian rhythm and reduced your stress and you still aren’t sleeping well, then something else might be going on. Have you recently started or stopped birth control pills or had a significant hormonal disruption? Is your menstrual cycle (and therefore your natural hormonal rhythm) regular? When you went back to school, did your diet change? Did you start on a new medication or supplement? If so, you’ll do well to make an appointment with your doctor to discuss these changes and how they might be affecting your sleep.

That’s a long-winded way of saying, no, I don’t think getting a prescription for a sleeping pill will help. In addition to being highly addictive, pharmaceutical sleep aids don’t produce the deep or dreaming sleep that we need—they only sedate us. Even if they make us feel like we’ve been asleep, we haven’t been asleep in the way that we need to be, and so we’ll still suffer from the same problems that insomnia causes. I’m sorry to say that there isn’t a quick fix, sleepless student.

Wishing you many sweet dreams—as well as deep and dreamless sleep.

Yours,
Christine