Has Insomnia Become a Public Health Emergency?

Jennifer Senior used to have no trouble sleeping. Until she did. In her new article for The Atlantic, called "Why Can’t Americans Sleep? Insomnia has become a public-health emergency," she looks at how insomnia is now tenacious and pervasive. She joins us to discuss her reporting, and talk about how America is actually making its sleep crisis worse.

Alison Stewart: This is All Of It on WNYC. I'm Alison Stewart. Americans are having trouble sleeping. According to the American Academy of Sleep Medicine, out of a survey of 2,000 people, 12% had chronic insomnia, 30% to 35% of those surveyed struggled with symptoms of insomnia, like struggling to fall asleep or staying asleep. Atlantic staff writer Jennifer Senior dealt with insomnia since her late 20s.

Jennifer has written some new articles about her experience and also debunked some myths about our conventional wisdom about what it means to get a healthy night of sleep. The article is called "Why Can't Americans Sleep?" It's available now online and in the print edition of The Atlantic magazine, the August print edition. Jennifer Senior is with me now. Hi, Jennifer.

Jennifer Senior: Hey, how are you?

Alison Stewart: I'm doing okay. I feel so bad saying this. You first started struggling with insomnia in your late 20s and you've had trouble sleeping since then. I'm so sorry, first of all.

Jennifer Senior: Oh, thank you. Yes, quarter of a century. I've had like 10,000 hours of experience with it. I'm an expert.

Alison Stewart: [laughs] Well, putting that aside for the moment, as a journalist, what did you want to know about sleep and insomnia?

Jennifer Senior: Oh, good question. The answer is so many things. I was very interested in debunking myths. I can talk about what some of those are. I think there are certain tyrannies out there that insomniacs just feel terrorized by. There's some of that. I think the title of this story might be a little misleading, and you did a good job in the intro of sort of explaining what it's really about.

It's really about don't feel bad if you can't sleep. What I was interested in doing in the piece itself was making sure that people didn't feel like they were being judged or rebuked because so many stories about sleep are actually terrifying and about all of the deleterious consequences of not sleeping, how horrible it is for your health. They basically all say, "You are going to die," and I didn't really want to do that.

Alison Stewart: Listeners, we'd like to get you in on this conversation. Are you someone who struggles with insomnia? When did it begin? What have you done to try to sleep better? Give us a call or text us at 212-433-9692, 212-433-WNYC. Why do you think you have a hard time sleeping? How do you get through the day when you're struggling to sleep? Call and text us at 212-433-9692, 212-433-WNYC. Okay, now I'm going to ask you about personal questions. [laughs]

Jennifer Senior: Oh. Go for it.

Alison Stewart: According to your article, it came at you out of nowhere.

Jennifer Senior: Right.

Alison Stewart: What happened?

Jennifer Senior: Well, I guess by definition, because it came out of nowhere, I don't know, that was what was so upsetting, like-- Oh, but you mean what happened, like what did the insomnia look like?

Alison Stewart: Yes.

Jennifer Senior: I wasn't trying to mock the question. I'm trying to play up. Yes, I felt like I'd been poisoned. It was so weird. Just to back up, I slept with almost annoying regularity. I slept from one o'clock to nine o'clock, one o'clock to nine o'clock, one o'clock to nine o'clock every night. It was alienating to boyfriends, it was remarkable to friends. I didn't need an alarm clock when I lost mine. I bought a new one when I had an early morning flight to catch, but I was really supremely well regulated.

Then suddenly, without the circumstances of my life having changed one iota, I one night, rather than falling asleep at my customary 1 o'clock, was up until 5:00, and I thought, "Weird," but didn't think anything of it. Then it happened again a few nights later, and then again a few nights after that until it was closer and closer together. Then I started pulling involuntary all-nighters. You can imagine my bewilderment, and then my anxiety, and then my outright panic over this because it was without explanation and it couldn't be subdued no matter what I tried. I tried everything.

Alison Stewart: At its worst, how has insomnia affected the way that you live your life day to day?

Jennifer Senior: Now it's regulated. I take something for it. I have learned-- I meditate when I can, and that always makes some kind of difference. It doesn't banish it. I know the right things to tell myself at night, but when I was leading a life of acute stress; namely, when I was a book critic for The New York Times, and one of the daily book critics. I had three books to review every two weeks. Do the math on that. They were nonfiction. They were often these big fat doorstops. I couldn't afford a night of no sleep, and I was a wreck. I would often not get out of bed. I couldn't plan socializing. It was a nightmare. It was really truly terrible. I had to change jobs essentially, is what I had to do. I couldn't do it.

Alison Stewart: Let's talk to Mike from Sayville, Long Island. Hi, Mike, thanks for calling All Of It.

Mike: Hi, how are you doing? I was struck when she said, "It happened in my late 20s." It happened to me when I was 27. I slept fine till then. Then boom, out of nowhere, nothing. I'm 66 now. I'm still struggling with it, still trying to figure it out. I have a routine that kind of works. I got an Ambien prescription, 10 milligrams. I break it in half. I take one half about 45 minutes before I go to bed. Then I do fall asleep, because that was my big trouble, is my gears grind, I think, I think, I think. Then I get up about three o'clock in the morning to go to the bathroom. It's a one-shot deal. I take the other half. That seemed to work okay.

I tried gummies, and I didn't like them. I don't like being stoned, but what I have tried lately and it seems to be working. When I get up in the middle of night to take the second half of the Ambien, I take a gummy, and they take like an hour to kick in, so I'm already asleep. Now, since I've been doing that, which is only recent, I do feel a lot better in the morning. That's all I got.

Alison Stewart: Mike, yes, I'm glad you feel better. He had a lot of information in that question. First of all, Ambien.

Jennifer Senior: Right.

Alison Stewart: How do you feel about Ambien? What did the experts tell you about Ambien? When is it good to take Ambien?

Jennifer Senior: I am here not to pass judgment. I take something every night too. I take the lowest dose of Klonopin. I have tried every therapy out there, including the gold standard, cognitive behavioral therapy, and sleep compression is a major feature of it. It's really, really agonizing for some people, including me. I've tried it twice. Sleep restriction. I would like to make another run at it. I will tell you about Ambien. Can I focus on one thing that he said also?

Alison Stewart: Sure. Go.

Jennifer Senior: Grinding his gears at night. Often it's the anxiety about not sleeping, regardless of what started it, that keeps people from sleeping eventually, like that almost takes over, and it assumes a life of its own; the anxiety surrounding and the neuroticism about-- leading up to it, and fearing the nighttime and the dread of night, as I think it was Kafka who said it. Yes, "Dread of night, dread of not-night," I believe was the quote. Anyway, Ambien, obviously people don't consider this the optimal solution. It is a very popular solution, taking drugs for sleep.

18.4% of Americans do it either every night or some nights. I'm not talking about-- When I mentioned this to an academic, who's a giant in the field, she said, "That's low," suggesting people are either embarrassed to cop to it, or maybe they don't consider melatonin or weed an actual sleep medication. Who knows? Ambien, look, if the primary and only side effect of being on a drug is dependence on the drug, and one does develop dependence, although you can wean yourself off.

If you're not escalating in dosage, and believe it or not, it's actually quite rare to escalate beyond the prescribed dose. 7% of those who've been on benzodiazepines, which includes Ambien and Ativan and Klonopin and all these things. Only 7% of a giant Swedish cohort did this after three years of being on it nightly. The real risks are falling at night as you get older, cognitive decrements. It's better to get off of it, of course. For some people, the benefits outweigh the risks. That's a personal choice.

It's not the first line of therapy, and it shouldn't be. There are other things you can do. You can meditate. You can do cognitive behavioral therapy for insomnia that just has the cognitive component, where you're just changing your thoughts about sleep and not being so terrified at night about not getting a good night's sleep.

Alison Stewart: Actually, I want to go to a caller who has tried cognitive behavioral therapy.

Jennifer Senior: Great.

Alison Stewart: That's Steve from Astoria. Hey, Steve, tell us your story.

Steve: Yes, I had insomnia back in '18 and '19. I totally get the anxiety. It only takes a couple of weeks to feel like it's totally ruining your life, and you go to try anything. I did use melatonin. I went to therapists. I went to-- I used some other, I can't remember the name of it, but a friend of mine sort of warned me that it's easy to get addicted, so I weaned myself off of it over a period of months, but I did use basically the sleep restriction or compression. Seriously, I would go to bed strictly one o'clock and get up at seven o'clock.

No matter how much or how little I slept, I just had to do that. You're not allowed to lie down the rest of the day. You're not allowed to take a nap. Eventually, by September, which was about nine months into it, eventually I had a week where, "Hey, the whole week I didn't have insomnia. It's amazing." I'm a big proponent of that cognitive behavioral therapy, which I did from a book, not from a therapist, because very few therapists are covered by insurance.

Alison Stewart: Yes, [crosstalk] you did the cognitive behavioral therapy and the restriction. Is that what you did?.

Steve: There's record-keeping, like you write down on a grid what time you got into bed, when you were awake during the night, how much sleep you got at the end of the, you know, when you wake up in the morning.

Alison Stewart: I got you. I got you. Does this sound familiar to you, Jennifer?

Jennifer Senior: Yes, and it actually includes cognitive behavioral therapy for insomnia. The main tent pole is sleep restriction. It's just the hardest to endure, and props to you. It is really effective if people can do it. You got six hours. I was told to start with five, I think. I was only sleeping every other night by the time I went in to get it. I was just desperate for relief, and yet I tried it anyway, and my sleep would not contract. I was out of my head with exhaustion, and I was so depressed from not having slept. It can be hard, but for those who can stick with it, it is fantastic. It's very impressive.

Not enough therapists do it, and as the caller said, most don't take insurance. It's tough. The other piece of cognitive behavioral therapy, you don't only restrict your sleep, you think differently about your sleep. You keep those diaries so that if you have these thoughts about, "Oh, I'll never be able to function the next day," you can consult your diary and think and see, "Oh, actually I kind of did function okay," or when you're lying in bed, rather than going, "Oh my God, oh my God, oh my God," you say, "So what? So what?" You don't look at the clock. It's all sorts of restrictions therapy in terms of your behaviors, like you keep the bed only for sex and for sleeping, and that's it. You stay out of it. All the things he said.

Alison Stewart: We're talking to Jennifer Senior. She is a staff writer at The Atlantic. We're talking about her recent piece "Why Can't Americans Sleep?" Are you someone who struggles with insomnia? When did it begin and what have you done to sleep better? Our phone number is 212-433-9692, 212-433-WNYC. We'll have more after a quick break. This is All Of It.

[music]

Alison Stewart: You are listening to All Of It on WNYC. I'm Alison Stewart. My guest is Jennifer Senior, staff writer for The Atlantic. She wrote a great piece called "Why Can't Americans Sleep?" Which looks into how Americans struggle with sleep. I did want to ask you a question. From your research, how do the insomnia statistics change depending on a person's race, their employment, their social class?

Jennifer Senior: Yes, it's a great question. African American women have the worst rates, I believe. I know that--

Alison Stewart: That's what I'm talking about now. Sorry. [laughs]

Jennifer Senior: It's true. It's correlated with class, but I'm sure it's also correlated with what happens when you move through the world as an African American, I'm sure it's about women. I'm sure it's about race and gender and racism and sexism. Latinos sleep worse. Black men sleep worse. Poor people sleep worse. If you look at, geographically, where the lousy sleep patterns are in the United States, they run across the south and through Appalachia, and it's correlated by income.

We also know that 16.4% of Americans work non-standard hours, and that's just a formula for disastrous sleep. It's finding your own biological rhythms, essentially, so that-- Even the most basic things like keeping your room dark and making sure that your body gets the right cues. You're coming home, commuting home in broad daylight. It's hard to make your room dark when it's light outside. The World Health Organization has identified night shift work as a probable carcinogen. This is tough stuff.

Alison Stewart: It's interesting hearing you talk. You're describing everything that happens outside of the bedroom affects what happens in the bedroom.

Jennifer Senior: Correct. That is exactly right. I think you can extend this more broadly. Electrification really laid waste to our circadian rhythms a long time ago. Midnight was no longer midnight, right? Midnight is now when many of us stay up. Behaviors outside, yes, we go to restaurants that are brightly lit. We watch television, which has blue light emitting from it. Kids do their homework and socializing on screens, which has blue light coming from it. That suppresses melatonin. If you're a professional, your boss is bugging you on weekends, after hours. Everything affects your sleep, rhythms in your sleep. Absolutely. As I said, if you're a shift worker, if you've got a second job, forget it, forget it.

Alison Stewart: Let's take a couple of calls. Let's talk to Alice, who's calling from the East Village. Hi, Alice, thanks for taking the time to call All Of It today.

Alice: Hi. Yes, I think there's a lot of things going on. I did the sleep study at Langone, and I saw every single sleep official. They never talked to each other. I started to feel like my-- that I had a lot of shame when I couldn't sleep regular hours. Now I've just decided that that is who I am. I go to bed at around 12:45, I wake up at 5:30. I function, and then I have to take a nap. That's all there is to it. I feel like in some weird way it reflects me trying to be so normal, and I just can't be.

Alison Stewart: Alice, thank you for calling in. Let's talk to Lisa from Chelsea. Hey, Lisa, thank you for making the time to call All Of It today.

Lisa: Hi, Alison and Jennifer. Thanks for taking my call. I really loved your emphasis, Jennifer, in the article about medications. I'm someone who suffered from insomnia from my teenage years, and I'm in my 50s now, and years and years where I would ask doctors, "Can you give me something?" They would say, "Oh, there's a million other things you should try first. We don't want you to be Valley of the Dolls, et cetera, et cetera."

In addition to, I think, being from a family who thought medication for sleep was absolutely not something I should pursue. I finally, at the recommendation of a friend, saw a psychiatrist. I'm a lawyer, I'm a mother, and I live in New York City. I'm a wife. Life is stressful. Every doctor would say, "Can you reduce your stress?" I would just burst out laughing. What am I supposed to do?

[laughter]

Lisa: When I had this recommendation from a friend to see a psychiatrist, I saw her. I'm not exaggerating, that within 15 minutes of just speaking to me, she said, "Lisa, you have anxiety. You have actual anxiety, and I'm going to put you on some medication for that, and let's see how it goes." This is three years ago, and I'm a new person. Like the last caller, I feel like I felt guilty or shame about the fact that I just can't sleep, and there was a solution for me. One day I'll consider weaning myself off it, et cetera, but it wasn't worth it for me to avoid it all these years. Not even close. I'm a new person now.

Jennifer Senior: Can I please, please, please say something? I am so desperate to say something. May I go?

Alison Stewart: Go.

Jennifer Senior: Okay. I am so glad-- I'm so thankful to you both fawning in and saying this. One of my main goals in writing this was to destigmatize the solutions people seek, including pharmacological ones, and the fact that some people can't sleep themselves. The Parker Posey character on The White Lotus, I found her [unintelligible 00:20:48], but narcotizing herself into La La Land at every step, and both at night and during the day she was a punchline. I don't think that sleep meds-- As a culture, we no longer stigmatize depression and taking Zoloft and Paxil and all these things, and Prozac, we still stigmatize this stuff.

Failure to sleep looks like a failure of will, a failure of discipline, you're too frail, you're a neurotic. I don't know. We don't have the same kind of expansiveness and compassion. There's also all these misunderstandings that you're going to turn into Judy Garland and suddenly need like a fistful of pills and a fifth of vodka. She, I think, overdosed on pills, which was tragic. To sleep, when most people don't even up their doses, even if they're regular takers of sleep medication. This is not to say-- I tried everything, exercise, acupressure, acupuncture, neurofeedback, meditation. I tried everything. I would like to go back to those things.

I've tried two runs at CBT-I. Three, actually, in a way, and I'd like to do more. When benefits outweigh the risks, I think people who are relying on whatever they're relying on have to stop feeling shame, and people have to stop shaming them.

Alison Stewart: Jennifer, why do you think there is still a judgment, a judgmental tone about how we deal with our sleep issues?

Jennifer Senior: Well, I think that some of it might have to do with the idea that-- to the extent that people associate it with neuroticism, it's just not as romantic or interesting as depression or as-- That might be some of it, or anxiety, but I think the anxiety gets interpreted as neuroticism, which is sort of ugly. I think that because medications can be abused or used for fun, and there's misconceptions about them, that it means escalating doses. There can be some-- There used to be a study that was quite influential, that said that benzodiazepines, which were the Ambiens and Klonopins and Xanaxes and Valiums of the world, that those things caused dementia.

Then two years later, another study came along saying, "No, sorry, nothing to look at here." That could be wrong too. We don't know, but that probably contributed to a stigma. Hard to say, and I think a number of things.

Alison Stewart: Are you sleeping well now?

Jennifer Senior: I have long COVID.

Alison Stewart: Oh, no.

Jennifer Senior: At first, I slept. Well, I'm an immunocompromised wreck. I always have been.

Alison Stewart: Oh.

Jennifer Senior: Oh, yes, so like-- I knew this going in. I'm just grateful I'm alive, honestly, and I'm sure it's also connected because those with immune issues and sleep issues were more prone to get long COVID. My immune issues started from when I was a baby. They're patented, they're measurable. My mom has an autoimmune disease. anyway, "Am I sleeping okay?" I'm calmer about it, it's regulated, and it fluctuates with my symptoms.

Alison Stewart: We are sending you our very best, Jennifer.

Jennifer Senior: Thank you.

Alison Stewart: Jennifer Senior has written "Why Can't Americans Sleep?" for The Atlantic. We wish you our best, Jennifer.

Jennifer Senior: Thank you, and right back at you.