Why can’t I sleep?

You’ve just finished watching the Toronto Raptors win their FIRST NBA championship in history. You smile at yourself for being so smart as to get this awesome 60″ plasma screen TV installed in your bedroom. You belt out one last rendition of “O Canada,” before you check the time and realize, “oh fuck it’s almost midnight!”

You hurry off to bed, and give half an honest effort to brushing your teeth in a slight haze as you digest the half dozen beer you drank over the last three and a half hours.

Finally. Bed. You lay down and close your eyes, just to be flooded with images of – Kentucky Fried Chicken?! You think that’s odd, before you remember the commercial for KFC playing repeatedly throughout the game.

You wonder, “why can’t I sleep?”

Your brain is essentially a large glob of fat, composed of microscopic cells, that act like wires. Likes wires, the cells connect to each other. Brain functioning in every domain – think attention, cognition, mood, vision, movement, everything you can imagine – is not about the individual brain cells, but rather, how the cells connect to each other.

Why is this important? We have a saying in medicine that goes like, “neurons that fire together wire together.” That means that in a baby, the cells in the brain are essentially randomly connected, with very weak connections, and the end result is very little complex behaviour. Over time, as a baby matures into a child into a teen into an adult, they use their brain more, and the brain recognizes what connections are being used. The brain reinforces and strengthens those connections, and gets rid of, “or prunes,” extra connections that are needlessly using up energy. (As a side note, this neurological phenomenon is also behind the old adage, “if you don’t use it, you lose it!”)

The end result is that the brain becomes very good at recognizing patterns. I promise that’s all of the complicated brain science!

This ability to recognize patterns is why when you smell baking blueberry pie, you may think of your grandmother. It’s why a caveman, when he smells bison scat in the air, might think there’s a herd nearby. This is an over simplification of the human brain, but on a surface level, the evolutionary benefit of pattern recognition is obvious.

As things go, in our modern day society, this ability for patter recognition can sometimes cause us harm. In particular, in bed.

The number one environmental factor I see in my clinic that contributes to insomnia is screen time in the bedroom. When people spend time in bed on their cellphone, answering emails, using a laptop, or watching TV, the brain learns to associate the bedroom with a place where work is done. Train your brain to read emails in bed too often, and that’s where your brain will immediately go when you lay your head down to rest, even if you’re on vacation and haven’t received an email in two weeks. I recommend to patients that cellphones be charged at night outside of the bedroom, and that there should not be a TV in the bedroom. I myself can attest to this – when I was in medical school, I had roommates, and all of my belongings in the world (including the TV) were in my bedroom. Since beginning residency, I don’t have roommates, and I get to sleep incredibly easier, now that my TV is in the living room!

You should also not spend time in bed awake. What do I mean? If it’s late at night, and you just can’t seem to fall asleep, get up! Go in another room, and sit down for a few minutes. Some people might read a chapter of a calm book under low light for a few minutes. Once you feel tired again, which is usually within fifteen minutes, go back to bed. This way, your brain begins to associate the bed with sleep. The more often you practice this, the better reinforced those brain connections get, and it gets easier and easier. As we say in the field, the only things you should do in bed, are sleep and sex!

Finally, we can also use our brain’s super powered pattern-recognition to our advantage, with having regularity to our sleep schedules. This means going to bed and waking up at the same time, each and every day, even if you don’t feel too tired at one, point, or really want to sleep in the next day (I give you a free pass on Saturday’s). This can be difficult at first and you may find you become slightly under slept. Don’t worry, hang in there! I promise that it will get easier, with practice!

Hopefully you find this helps you and your sleeping patterns (ba-dum-pshhhhh)!

 

Editor’s Note: Stay tuned for more on sleep hygiene and the effect of day/night cycles on sleep!

 

Dr. Travis Barron is a resident physician in Toronto, Canada.