Law school has a reputation for being insomnia-inducing so at first Annette Campbell, 37, of Denver, didn’t think her four to five hours of sleep a night was that strange. Annoying, yes; exhausting, definitely; but concerning, not so much. “I could fall asleep but then I would wake up in the middle of the night and couldn’t get go back to sleep. Even though this was happening several nights a week, I didn’t go to a doctor,” she says. “Who doesn’t have a hard time sleeping sometimes?”
What she didn’t know was that waking and the inability to go back to sleep is one of the top signs of insomnia and that insomnia and sleep problems are rampant in college; over 60 percent of college students reported suffering from poor sleep quality and nearly 10 percent met the criteria for insomnia, according to a 2017 study published in Neuropsychiatric Disease and Treatment. But it’s not just college students: The American Academy of Sleep reports that about a third of all adults have symptoms of insomnia from time to time, and one in 10 sleep poorly enough to disrupt their daytime activities; under 10 percent are likely to suffer from chronic insomnia, thankfully.
When life gets busy, sleep suffers
“Sleep deprivation and insomnia are not uncommon in college students because when life gets hectic, the first thing that typically gets sacrificed is sleep,” says Shanon Makekau, MD, chief of pulmonology and sleep medicine and the sleep lab director at Kaiser Permanente in Hawaii. It doesn’t help that the methods students often use to deal with the sleep loss make the problem worse in the long run. “Drinking caffeinated beverages, sleeping in on the weekends, using stimulants, and taking naps are often counterproductive and can make your overall health worse,” she explains.
Campbell recalls why she finally went to seek medical help. “I kept getting sick,” she says. “I was only 22 years old but for a year I got a cold after cold that never seemed to get better.”
She made an appointment to see her primary care doctor who, after doing some tests and asking her about her lifestyle, pinpointed her poor sleep as a possible underlying issue of her chronic illnesses. “Sleep is critical to the immune system and without rest, the body isn’t able to heal itself,” says Dr. Makekau (she was not Campbell’s doctor).
However, her insomnia diagnosis raised more questions than it answered. She wasn’t sure why she found herself tossing and turning night after night, even when she went to bed on time, so her doc recommended she get a sleep study done at the university’s sleep lab. Going to a sleep lab allows people to be closely monitored in a controlled setting, making it easier to get a true assessment of the problem and look for underlying causes, Dr. Makekau says. (Here are the different types of insomnia that can keep you up at night.)
miodrag ignjatovic/Getty ImagesA (poor) night’s sleep in a lab
“On the list of strange things I’ve done in my life, this was definitely one of the weirder experiences,” Campbell says. At the sleep lab she was put in a cold, sterile, hospital-type room and hooked up to several monitors with wires attached all over her body, including her legs, chest, and head. The room was kept semi-lit, the machines beeped, and people came in regularly to adjust the wires. “Then they told me to ‘just sleep normally’!” she says. “It was probably the worst night’s sleep of my life.”
Despite her discomfort though, the test showed there was no physiological reason for her insomnia and they chalked it up to stress. Her doctor prescribed her some mild sleeping pills which helped until she graduated. (These are the best sleep doctors in every state.)
The problem with ignoring insomnia
For the next ten years, Campbell’s sleep was mostly fine, but in 2015, she had her son and developed postpartum anxiety—and with it, the insomnia returned. “He was a great sleeper but I would wake up multiple times a night and couldn’t get back to sleep,” she says. “I think it was a combination of the anxiety, the stress of moving to a new state and starting a new job, and to make matters even worse, I was haunted by a recent medical malpractice case I’d had that involved a baby. I’d stay up all night to make sure my son was breathing. Eventually, I was only getting four hours of interrupted sleep a night.”
Her insomnia affected every aspect of her life, causing irritability, mental fog, exhaustion, chronic colds, and extreme daytime sleepiness.
“Chronic insomnia certainly affects your day-to-day functioning but it can lead to long-term health problems like impaired immunity, obesity, high blood pressure, heart disease, and diabetes,” Dr. Makekau adds.
Postpartum depression and insomnia
Still, Campbell didn’t see a doctor about it because as a new mom and a busy lawyer, she didn’t have the time. Plus, she thought they would just tell her it was stress again. She got a wake-up call in early 2019 after she had her second child, a daughter. This time she developed full postpartum depression and both her husband and her OB/GYN expressed their serious concern over her sleep deprivation.
The kind of insomnia after pregnancy Campbell experienced is more common than people think. Postpartum insomnia may have a medical component, like the drop in hormones after childbirth, or be related to depression, but can also be the result of feeling overwhelmed, tense, or anxious about the arrival of a new baby, according to the National Sleep Foundation.
“I just remember my doctor telling me, ‘You have to sleep, it’s critical for both the baby and you that you get eight hours of sleep a night, this isn’t optional,'” Campbell recalls.
Her doctor was right to be concerned. Insomnia during and immediately after pregnancy not only affects physical health but it’s linked with an increased risk for postpartum anxiety and depression, according to a 2019 study published in Journal of Affective Disorders. Insomnia affects children as well: Kids whose mothers have insomnia symptoms fall asleep later, get less sleep and spend less time in deep sleep, according to a 2017 study published in Sleep Medicine.
But knowing she needed more sleep was one thing; actually getting it was another. Campbell wanted to sleep more but, no matter what she tried, she just couldn’t. Her doctor referred her to a sleep lab—her second time around.
Back to the sleep lab
As a new mom she didn’t want to have to leave her children nor did she relish repeating her previous experience, so she tried an at-home sleep study first. “They put a band around my chest, tubes in my nose and mouth, and a pulse oximeter on my finger, then told me to sleep normally,” she explains. “I slept really well in my own bed but there was a machine error and they couldn’t get a good read.”
So she reluctantly made an appointment at a sleep lab. “Because of the baby, we’d already met our deductible for the year, so our health insurance would cover it in full,” she says. “Otherwise I probably wouldn’t have done it because these tests are so expensive.”
In addition to scheduling and financial hurdles, there were practical issues as well. “There were so many instructions: I couldn’t nap, drink alcohol or coffee, or have too much water the day of the study. I also had to have really clean hair so it would be easier to attach the electrodes,” she says. “Not to mention the pressure of having to sleep knowing a bunch of strangers will be watching you the whole time.”
On the day of her sleep study, she was pleasantly surprised to find herself in a room that looked like a nice hotel with a large bed. Sleep specialists put monitors all over her body and hooked her up to several machines. Despite this, she felt more comfortable than she did the previous time and got a relatively good night’s sleep.
Again the tests showed no underlying cause of her insomnia, ruling out clinical sleep apnea, restless legs syndrome, and other physiological issues. “It was actually a relief; both my parents and my brother and sister all have a sleep apnea diagnosis and I remember what they have to go through to deal with it,” she says. “I travel a lot for my job and the last thing I need is to have to lug a continuous positive airway pressure (CPAP) machine through the airport.” 7 things that happen when you get a CPAP machine.
The connection between mental health and sleep
With the physical side accounted for, her doctor returned to potential mental sources of her sleeplessness: The insomnia was likely due to stress and her postpartum depression, as depression and sleep deprivation can become a vicious cycle, her doctor explained. Feeling it was important to address the depression first, her doctor prescribed Campbell a low dose of Zoloft, an antidepressant medication. They also set up a time in the day for Campbell to exercise, meditate, and pursue other stress-reducing activities.
While insomnia is a common side effect of many antidepressants, they can be part of a successful treatment plan for insomnia, according to a 2017 study published in Current Psychiatry Reports. The best results for promoting sleep are achieved using a very low dose of the antidepressant, administered early enough before bedtime and, most importantly, as part of a larger plan to treat insomnia, the researchers concluded.
Daytime habits make a difference
In addition to fostering healthy habits like daily exercise and a high-quality diet, a comprehensive insomnia treatment plan often includes things like making sleep a top priority, creating and sticking with a regular sleep schedule, avoiding cigarettes and caffeine, turning off all screens at least an hour before bed, and keeping your bedroom cool and dark, Dr. Makekau says. If you’re still having problems falling asleep she recommends relaxing with meditation, a warm bath, light yoga or stretching; listening to soothing music; or reading a book (as long as it’s not a page-turner).
Still tossing and turning? “Don’t be afraid to ask for help and discuss your sleep concerns with your doctor,” she adds. “We have a lot of resources to help you—you don’t have to just live with it.”
Campbell took her doctor’s advice seriously, improving her diet and taking up dancing, a passion she’d enjoyed growing up. “The exercise made a really big difference and that combined with the Zoloft has mostly cured my insomnia,” she says. “I’m now getting a good seven hours of sleep every night.”
Overall, she says her sleep lab experiences were positive ones. Even though they didn’t find anything specific, she says it gave her peace of mind and ultimately helped her find a solution for her insomnia. “These days, as long as my baby sleeps well then I do too,” she says, adding that she’s been able to use some of what she learned to help improve her daughter’s sleep as well. “It’s actually pretty funny: Who knew that my baby and I would be going through ‘sleep training‘ together.”