Question:

I am suffering from insomnia for the past 10 days or so. I am 71 yrs old, retired from service at the age of 58. I have enough income to lead a fairly comfortable life. There is no obvious cause, no tension, no stress. I am actually visiting my daughter in California. I and my wife are having an enjoyable time here with my daughter's family consisting of her husband and two grand daughters aged 8 & 6.
I must say i do suffer from insomnia from time to time even in India, but this time it has been continuously for 10 days even though i normally take just half a tablet of Restyl, (my doc said I cant take this without any side effect), the full tablet of which is just 0.25 mg, and I take just half of it!....But now even  with the full dosage of 0.5 mg. I am not able to sleep. Actually i am enjoying the cool weather here and am happy to be out of the scorching heat in India.

Whenever i visit my daughter which is every 2 yrs, i take one glass of beer during lunch and one small peg of hard liquor before dinner. In India, I used to take one small peg of Vodka every other day in the evening.

I am a total vegetarian and enjoy my meals at regular timings. I take regular walks, do some yogic exercises etc. I do not smoke or take tobacco in any form. I have no health problems, no BP, no diabetes, my lipid profile is ok. I am mild mannered and doesn't get ruffled very easily.

I would be very grateful if any cause can be identified for my insomnia, which bothers me now and again and comes up without any warning.

I would like to mention here that even when i sleep, i am troubled by awful dreams, which don't seem to have any relevance.
Even with less sleep at night i am able to carry on with my regular activities without much trouble. And also I don't get any sleep even during the day even though my eyes feel tired.

Dr. Gautham's Reply

First, let me raise a toast to your continued good health! At your age we have to define insomnia. The perception or complaint of inadequate or poor-quality sleep because of one or more of the following: difficulty falling asleep; waking up frequently during the night with difficulty returning to sleep; waking up too early in the morning; or unrefreshing sleep. Insomnia is NOT defined by the number of hours of sleep a person gets or how
long it takes to fall asleep. Individuals vary normally in their need for, and their satisfaction with, sleep.

The older you get, the less sleep your brain needs. Winston Churchill managed on about 3 or 4 hours a night, Jawaharlal Nehru, on less. A behavior that often LEADS to insomnia is expecting to have difficulty sleeping and worrying about it.

From the description that you have given me, it appears that you have taken to medication because of your worry over being unable to sleep, and now become dependent on the Alprazolam, requiring higher doses to sleep, with consequent hangover effect during the daytime, and REM (dream) spill over at night. I would suggest that you try to sleep without the Alprazolam. You could try replacing the Alrazolam with a beer (instead of having it in the afternoon).

Keep awake as long as necessary, keeping yourself occupied in some way till you feel sleepy enough. Then hit the sack with a relaxing environment (see my sleep page http://www.docgautham.com/sleep) and don't worry about the number of hours of sleep you get. It can take about a week for your body clock to reset, but it will. Once you start sleeping normally, don't worry about the number of hours you sleep, as long as you wake up fresh, and are energetic through the day.  Have a nap in the afternoon if you feel like it. Keep yourself busy at night till you feel good and sleepy (even if it is 2 am) , before you hit the bed.