April 20, 2005

About Shokooh

I am always tired

Dear Shokooh,

I am suffering from a problem that is really affecting my family and life. I just don’t feel like I am getting enough sleep. I work very hard and when I get home at night I am exhausted. I spend a couple hours having dinner with my wife and spending time with my children, and then I go straight to bed. Once I am in bed, it takes me a long time to fall asleep. Then I start worrying about the sleep and get worked up and the sleep I get is restless. As a result, I am tired all the time. How much sleep is enough for me? How do I know if I am getting enough sleep? What can I do to fall asleep more easily at night so that I feel more energy in the morning? My wife thinks I have a sleep problem. She wants to spend more time with me, but I am always tired. Is she right? Is there something wrong with me? I don’t want to take medications—what other options do I have?

Always Tired


Dear Always Tired,

Balancing what sounds like a demanding job with your desire to spend quality time with your wife and children is a difficult task. I can imagine that your situation is leaving you feeling not only exhausted, but also feeling frustrated and stressed. I am impressed with your commitment to your work and family life, and I encourage you to continue asking questions about your sleep and finding treatment to address the problems.

Sleep is absolutely essential for our health and wellbeing. Yet the realities of modern life leave many of us feeling exhausted and suffering from sleep problems. The National Sleep Foundation estimates that 60 percent of American adults have sleep problems. Most of these sleep problems go undiagnosed and untreated, leaving 40 million of us exhausted and suffering. You are certainly not alone. For many, it’s a vicious cycle: we worry about not sleeping, which causes us to stay awake and suffer greater sleep problems, which it turn increases the worry. The combination of sleeplessness, exhaustion, and worry is enough to cause great impact. It’s no wonder that you opened your letter by stating that this problem is affecting your family and your life!

Sleep needs vary from person to person. In general, a healthy adult is built for around 16 hours of wakefulness and needs an average of 8 hours of sleep each night. However, some can go with less sleep and other need more. It absolutely varies by individual. Instead of worrying about averages and norms, I would suggest that you think about how your body is feeling. Is the lack of sleep impacting your mood, emotional responses, memory, productivity, or attention? How are you feeling? Use as many words as possible to describe your symptoms and the way you are dealing with your current sleep patterns. Writing this down is a good start. It’s important to pay attention to your body and mind and be very specific when describing what is happening. What time do you go to bed? What time do you fall asleep? What time do you wake up? Ask your wife to help in listing any sleep-related observations.

Once you have a better and more specific description of your symptoms, take the list to your physician right away! While stress and related emotional issues are by far the number one cause of sleep difficulties, you should start by investigating your physical health and making sure that there is no underlying physiological reason why your sleep is suffering. Remember to share a list of all medications you take with your doctor. Many common medicines have side effects that include causing sleep difficulties. If you doctor gives you a clean bill of physical health, the next step is to examine how your emotions, environment, and behaviors may be causing the struggle for sleep.

Stress is very much linked to sleep difficulties. You mention that you are staying awake at night, worrying. What thoughts are you having? What types of problems are you focused on? Approach this problem as a scientist—gather facts and take careful note of what is happening to your thoughts and feelings. Many people suffer from sleeplessness as a result of school or job related pressures, family problems, marriage difficulties, or a serious illness or death that hasn’t been addressed/processed emotionally. Short-term sleep problems can persist long after the original stress has passed, so it’s important to identify potential emotional triggers.

Behavioral factors also play a role in preventing good sleep. Drinking alcohol or caffeinated beverages in the afternoon or evening, smoking, exercising close to bedtime, following irregular morning and night schedules, and working or doing mentally intense activities before bed can disrupt sleep. Environmental factors (such as room that is too hot or cold, too brightly lit, or loud) should also be examined. Pay attention to what surrounds you. Is your bedroom a place of peace, intended to inspire rest? Or are you trying to sleep amongst paperwork, television, and multiple interruptions?

I strongly suggest that you consider seeking professional assistance from a mental health provider who is trained to help address sleep problems. Your medical doctor may be an outstanding source for a referral to a psychologist or psychiatrist experienced in sleep problems. See my previous column on Finding A Good Psychologist.

Any sleeping problem that recurs or persists for longer than a couple weeks should be addressed by a professional. You stated that you do not wish to take any medications for sleep. The good news is that psychotherapy alone (in the form of Cognitive Behavioral Therapy known as “CBT”) offered by a trained psychologist has an extremely high success rate for helping those who suffer from chronic insomnia.

It sounds like you have a demanding and full life. You deserve some rest. I wish you good health.

Sleep well,



This column is for general educational purposes only-- it is not a substitute for medical attention, counseling, or therapy of any kind. The Couch and the staff of this website urge you to seek immediate medical attention if you are in an urgent, harmful, or potentially dangerous situation. Psychiatric emergencies or urgent matters should be handled by calling 9-1-1 or going to the nearest emergency room.   Please note that your emails will not be answered on an individual basis and your confidentiality cannot be guaranteed. Top

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