Rosa Silverman talks to a man who won his nightly battle with insomnia
It's been estimated to affect up to a third of adults, and for some it can prove debilitating. So when British news anchorman, Tom Bradby, was revealed to be absent from work with insomnia, his plight will have struck a chord with many.
While most of us experience some sleep deprivation and tiredness at times, insomnia - defined as a regular difficulty with falling, or staying, asleep - is different. "Insomnia doesn't just affect your sleep, it affects your life," says Professor Kevin Morgan from the Clinical Sleep Research Unit at Loughborough University. "You don't have insomnia and just brush it off. It pollutes your well-being."
Although women are more likely to present with it than men, and older people are more likely to suffer than younger people, the condition can affect anyone. According to the NHS, the most common reasons include stress, anxiety and depression; noise; a room that's too hot or cold; uncomfortable beds; alcohol, caffeine and nicotine; jet lag; and shift work. For some it can last a few days, for others far longer.
Edward (name changed), a 33-year-old corporate lawyer, experienced several months of insomnia while studying for his law exams. "I had exams looming and genuinely feared I would fail," he says. "My whole future hung in the balance. I'd made myself a revision timetable, according to which I would need to study for 12 hours a day. But then I started worrying: if I don't get to sleep tonight, I'll have to lie in tomorrow, and that will eat into my revision time."
It became a vicious cycle. "The more I feared I wouldn't sleep, the less I slept," he recalls. "On some nights, I went to bed at 10.30pm and lay awake until 7am. On other nights, I'd fall asleep fairly quickly and then wake after an hour and not sleep for the rest of the night. Or I'd wake up for hours in the middle of the night."
After a few weeks, Edward visited his GP and was prescribed a drug, amitriptyline, which may help "improve mood and feelings of well-being, relieve anxiety and tension, help you sleep better, and increase your energy level", according to WebMD.
Edward, who was reluctant to take pills for his sleeping problems, found it did none of the above. "I was told to take one or two pills a night but there were some nights when I took six and they still didn't help," he says. He also tried over-the-counter sleeping medication, but would wake up "feeling miserable. I decided I'd rather not sleep than wake up feeling awful," he says. He wishes his doctor had steered him towards cognitive behavioural therapy (CBT), which evidence suggests is an effective way of treating insomnia. But the response of Edward's GP was not unusual.
Sleep expert Neil Stanley says: "GPs face penalties for prescribing too many sleeping pills, so an insomniac will be given antidepressants, which are sedatives. A patient presenting with insomnia is likely to be tearful or stressed due to lack of sleep, so they're given antidepressants, but they don't get to the root of insomnia."
Another concern doctors have had to reckon with is the addictive property of sleeping pills. Doctors, who a few years ago were prescribing heavily, are "more circumspect now", says Morgan. Still, "The NHS [hands out] 10 million prescriptions for sleeping pills a year," he says. "The demand is robust and consistent."
One explanation is the growing number of old people in our society, the age demographic most likely to be affected. "There's [also] an unexplored consequence of the growth of women in the workplace in senior, pressured positions," says Morgan, who points out that women having more childcare responsibilities to contend with than men, makes them more vulnerable to sleeplessness. On the other hand, as Stanley points out: "Men have always been less willing to admit to weakness. So, perhaps more men suffer from insomnia than official figures show."
Leaving it untreated can cause a raft of secondary problems. "The daytime consequences of insomnia include reduced cognitive ability, drowsiness, poor mood control, depression, impaired immunity and, over time, an increased risk of heart disease, obesity and diabetes," Stanley says. "Insomnia can involve night after night, week after week, month after month, of wakeful, fretful sleep that leaves you feeling wretched."
Insomnia need not be a lifelong affliction. Do-it-yourself solutions abound, including regular exercise, relaxing for at least an hour before bed, sticking to regular bedtimes and cutting out alcohol and caffeine within six hours of turning in.
For Edward, what finally worked was a herbal remedy he bought on the high street - now, he has the odd night when it takes him three hours to drift off; the rest of the time, he sleeps like a baby.
Effects of sleep deprivation
♦ One night of sleep deprivation is enough to cause strain on the heart, according to a 2016 University of Bonn study
♦ People who sleep for less than six hours a night are 12 per cent more likely to die prematurely, according to a 2010 study by the University of Warwick
♦ Sleeping fewer than five hours a night for five years brings a greater risk of hardened arteries, found Harvard Medical School
♦ After 17 hours without sleep, our alertness is similar to the effects of a blood alcohol concentration of 0.05 per cent, found an Oxford University study
Additional reporting by Maria Lally