Dear Dream Doctor—

I am a 17 year old boy who has had problems sleeping all of my life. Even as a child I wanted to sleep during the day, and stay awake all night. Within the last few years I have been thinking about this, and I was wondering if you could help me. I have developed a slight obsessive-compulsive attitude in doing schoolwork by checking answers over and over again. This doesn’t really bother me since I keep a 4.0 gpa by doing this, but this has spread over into my home life slightly. I feel like I have to check things to make sure that they’re right, and I keep my room spotless, and it drives me crazy if it’s not.

Now I’ve been thinking about my sleeping problem. I lay awake at night trying to go to sleep and I hate myself because I can’t stop thinking. My mom tells me to try reading a book (but when I start I have to finish the book). She tells me to watch a boring television station (that doesn’t help, because it usually makes me think of other things). I have a stream of conciousness problem that doesn’t end, just on and on…I can’t go to sleep until I clear my head, even listening to slow music. If I know the song I listen to it because I like it, and if I don’t know the song I try to memorize it as it is playing, so I can’t do anything to stop thinking…That leads me to tonight, well this morning, when I decided at 2:17 a.m. that I might as well try to find information for this problem on the Internet. Please help me. Any advice would be appreciated. Thank you.

—Desperate, Age 17, Holt, MO, USA

Hi Desperate—

Insomnia is one of the most difficult of all sleep disorders to heal. If your problem persists longer than three months, you most likely should seek help from a sleep specialist or a psychologist for some tips—and possibly even some medication to help you get out of your non-sleep “rut.”

Before you do this, though, I can offer you some thoughts and techniques for trying to fix this problem yourself.

First, it sounds as though you may have a natural circadian rhythm that is “phase-delayed.” Most people naturally feel the urge to sleep at about 10 or 11 pm, and awaken at about 7 or 8 am. Many of us, especially as young adults, find our cycle tends to run behind this schedule. For example, you may naturally want to go to sleep at 12 or 1 or even 2 am, and then want to awaken at about 9 or 10 am. This is the phase delay mentioned above. If your cycle was “phase-advanced”—which happens to many elderly people—you might prefer to go to bed at 7 or 8 pm and awaken at 4 or 5 am. Whichever side of the cycle you are on, it tends to be a problem. If you are awake at 4 am, the rest of the world is still sleeping. If you want to wake up at 10 am, you will have missed a good part of the day, or will always be tired at school or at work.

One way to break this cycle is to begin to keep a much more regular sleep-wake schedule. Force yourself to awaken every day at 8:30 am, for example, and don’t allow yourself to take naps during the day. The theory is that soon enough you will be sufficiently tired to fall asleep at an earlier hour—say 11 pm. Once this schedule is adopted, it is important to maintain it. The body tends to become entrained to a particular rhythm. If you were to stay up late again on a weekend, say, and then let yourself sleep late the following day, then you won’t be tired enough to fall asleep at the desired hour the next evening. This technique is certainly worth a try. Most shift workers in the world practice this technique routinely and effectively. The logic behind it is pretty simple. If you want to sleep during the night, don’t let yourself get too much sleep the previous day.

As far as your racing thoughts are concerned —your “stream of consciousness problem”—be aware that insomnia, as an anxiety disorder, is known to be something of a vicious circle. When we find ourselves unable to fall asleep, it tends to reinforce the anxiety we already are experiencing that is causing the difficulty sleeping in the first place. That is, we tend to lay awake and fret about the sleep we are losing when we know that we have to awaken and perform the following day. We know that we are going to feel tired and lousy if we don’t get enough sleep, and so we worry about our loss of sleep—in addition to all the other things that are racing through our minds.

A technique that is frequently recommended for people who can’t “turn off their minds” is as follows. Because we tend to lay in bed thinking and worrying about things we have to do and projects we currently are involved in, insomnia specialists recommend that, prior to bedtime each night, we take ten minutes to make a list of everything we need to do tomorrow, and that we also try to identify whatever sources of stress or ongoing concern we have in our lives. After we make the list, take a deep breath, realize that we won’t be able to do anything about these issues until tomorrow anyway, and then try to lay down. Somehow, cataloging our concerns helps us to achieve a sense of completion about them, at least at that particular point in time. We have done what we can today. Tomorrow is a new day, and we will tackle it when we get there.

If these techniques practiced together don’t help you, you may want to see a sleep or insomnia specialist. Sleep doctors frequently prescribe sleeping pills to their patients with persistent insomnia, but they do it with a specific end-goal in mind. They want you, as soon as possible, to not have to use the sleeping pills. In this sense the pills are prescribed to help you re-set your circadian rhythm. Use the pills for a week to enable you to fall asleep at the desired hour, and then, once the new cycle is entrained, begin to lower the dose until, at the end of a month say, you no longer are using the medication. Your new cycle is set, but then you must continue to practice the healthy sleep tips presented above. Above all, don’t allow yourself to “sleep in” during the day, which will cause you to have difficulty falling asleep again the following night.

Best of luck with treating your insomnia. Please write back to let us know if you are successful or discover any techniques that seem to help. If you do discover any effective new techniques, you can be assured that millions of people will want to learn about them.