Sleepless in Alabama

I remember sitting on my great-grandmother’s rural Alabama porch as a child. We always visited in the afternoon and early evening, as we knew that she would eat her dinner at 5pm and go to bed soon after the sun went down. She would rise with the sun in the morning. Even though she was in her 80s and 90s in my memory and no longer had cows to milk and chickens to feed, long-held habits of sleeping in sync with the sun and the Alabama farm life stayed with her. Roosters don’t know weekends from weekdays, so schedules had to stay the same, regardless of the day. Our brains produce chemicals that help our bodies know when to sleep and when to wake, and light and darkness are a major driver of these chemical changes. Unfortunately, artificial light in modern times often confuses our body and makes it extra hard to get a good night’s sleep. My great-grandmother often told me about her family getting electricity at home and how they had a single light bulb with a pull chain. Of course, her rural Alabama community added this light long after cities like Birmingham. This change meant they could have light even long after the sun went down, but no doubt she couldn’t even imagine smartphones and tablets shining their light at all hours of the night. We also know that a full day of physical activity on the farm was more conducive to sleep than sitting at a computer all day. 

It's easy to view history with rose-colored glasses, but when we study historical journals, we know that Alabama residents have had trouble sleeping since the dawn of time. When we think about how people develop insomnia, it’s helpful to consider the “3 P Model”—Predisposing, Precipitating, and Perpetuating factors. Predisposing factors are things that make us more likely to develop insomnia. These are things beyond our control like genetics and age. Predisposing factors haven’t changed much over the centuries, and they remain remarkably consistent whether you live out in the country or in a city like Birmingham, Huntsville, Montgomery, Tuscaloosa, or Mobile. Precipitating factors are things that initially trigger those first few rough nights of sleep. Some of these are the same across the generations, such as having a serious illness or being a caregiver for a sick loved one. Maybe our ancestors were stressed because one of their oxen were injured, so they didn’t know how they would get the fields plowed, whereas today we feel stressed because our car quits, and we don’t know how we will manage until it’s fixed. Whatever the trigger, we know that people may temporarily have trouble sleeping in times of stress. However, many people resume sleeping okay once the stressor is over.  Perpetuating factors maintain insomnia long after the initial precipitating event is over. Spending time awake in bed worrying is a great example of a perpetuating factor, whether it’s worry that a pack of wolves will kill your milk cow or worry that your HVAC will suddenly quit in the middle of July. Maybe it was moonshine before bed 100 years ago and Trader Joe’s wine today, but either way, we often turn to substances as a way to help our sleep while ultimately finding that good night of sleep is still elusive. 

Certainly all of us find ourselves staring at the clock and wishing for sleep occasionally. However, if you have trouble falling asleep and staying asleep at least 3 nights per week for at least 3 months, and this is causing problems in your day-to-day life (e.g., feeling tired or irritable during the day, nodding off when you need to be awake, or feeling unfocused or distracted because you are tired), then it’s time to seek expert help. Sadly, behavioral health treatment wasn’t an option for our ancestors, and oral histories and journals tell us that many of them just put up with sleeplessness throughout their lives. Just as we can now take antibiotics for strep throat, science has also given us evidence-based behavioral strategies for issues like insomnia. The great news is that research shows that Cognitive Behavioral Therapy for Insomnia can often help a person’s sleep substantially in just 6 sessions. Picture yourself 6 weeks from now and what it might be like to consistently get great nights of sleep! 

Thankfully I don’t lie awake at night worrying that we will lose the year’s crops to a horde of grasshoppers, but I do sometimes lie awake and worry about things that my great-grandmother couldn’t possibly picture, such as online bullying and when my children should get cell phones.  The 24-hour news cycle and world news coverage also mean that I worry about happenings local to me in Birmingham as well as those all over the world. Our ancestors primarily knew about happenings within their communities. No doubt our great-grandchildren will have things keeping them awake that we can’t fathom today. However, I do know this: They won’t need to struggle with insomnia alone, and if I’m still around, I’ll be advising them to see an expert to get good sleep!