Searching for a Good Night’s Sleep
Lying in bed, tossing and turning, not being able to fall asleep. Or waking up in the middle of the night, over and over again. Or waking up way before the alarm clock is supposed to ring. These are the classic signs of insomnia: medically speaking, the inability to sleep when sleep should normally occur.
Insomnia was not Mary Hontz’s initial medical problem. In 2004 Mary, now 65, had a massive heart attack. She underwent coronary artery bypass surgery at Wake Forest University Baptist Medical Center and, six months later, the installation of a pacemaker/defibrillator. In the summer of 2005 she completed the Cardiac Rehabilitation Program.
Still, even though, as Mary said, “the Cardiac Rehab Program really got me going again,” she wasn’t sleeping well. “When I don’t get enough sleep, it affects me the same as being sick,” she said. “I am just not much good and feel terrible.”
Finally, after a night when she got very little sleep at all and was unable to go to her job as a computer applications developer, she talked to a primary care physician, who referred her to W. Vaughn McCall, M.D., M.S., Professor and Chair, Department of Psychiatry and Behavioral Medicine. During the first visit, Dr. McCall made several suggestions.
He told Mary to set her alarm for the same time each morning (in addition to going to bed at the same time every night, which she was already doing). He asked her to keep a sleep diary. And he said that she should give up caffeine.
“The first couple of weeks were pretty rough,” said Mary. “After I let Dr. McCall know what a hard time I was having, he recommended that I go outside for about 20 minutes every morning before 7:30, and that I stay awake an hour later at night.”
Mary followed his instructions, except for the one about giving up caffeine, which, she said, she loves. Within a couple of weeks, she said, “I was delighted with how well I was sleeping. It really wasn’t magic, but in retrospect it does seem so easy.”
Dr. McCall explained that he recommended the bright sun exposure first thing upon wakening because it has an alerting effect in the morning, and Mary has found that she really enjoys her time outdoors, and often includes stretching exercises on her patio.
Dr. McCall also noted that “waking up at the same time each day is important to promote the sleep tendency within a specified, desired interval of time, and to limit the opportunities for lying in bed awake.” The purpose of the sleep diary was both to track her progress and to give her a sense of actively participating in the process, he said.
Dr. McCall did not need to resort to either drugs or the Sleep Disorder Center to help Mary. “Sleep laboratory testing should not be conducted on a routine basis to manage insomnia,” he said. “It would only be justified if there is suspicion of a specific problem such as sleep apnea or restless leg syndrome. Mary’s success can be credited to her willingness to implement exactly what I suggested.”
Other than the occasional bad night, Mary said, “I now have a lot of confidence in being able to sleep. A bad night is now just a bad night, not a disaster.”