A Sleepless Night, Signals of Recovery from the Body

According to data released by the National Health Insurance Service in 2023, the number of patients who received treatment for sleep disorders reached 1,099,000 as of 2022. This is a 28.5% increase from 855,000 in 2018 over five years. Those in their 60s make up 23% of all patients, but the increase is evident across all age groups.

Insomnia is different from a temporary sleepless night. If symptoms such as difficulty falling asleep, frequent awakenings, waking up early in the morning, or not being able to sleep deeply persist for more than three months and interfere with daily life during the day, it is considered insomnia.

It is not simply a matter of insufficient sleep time, but rather a state where the brain's arousal system is overactive, with the sympathetic nervous system excessively activated, putting the body in a continuous state of tension.

If this state continues, memory and concentration decline, and emotional regulation becomes difficult. In the long term, it can easily lead to depression and anxiety disorders, as well as a decrease in immunity.

The overactivation of the sympathetic nervous system is also linked to hypertension, diabetes, and cardiovascular diseases. Lack of sleep is not just a problem of fatigue but a reason that disrupts the overall homeostasis of the body.

The priority for treating insomnia recommended by the American Academy of Sleep Medicine and domestic sleep-related societies is cognitive behavioral therapy. Cognitive behavioral therapy is conducted by correcting incorrect sleep habits, unrealistic expectations about sleep, and negative beliefs.

In a study conducted in 2011 on Korean college students, the group that received cognitive behavioral therapy showed a significant reduction in insomnia severity scores and time spent awake in bed. In a study of chronic insomnia patients in 2010, sleep efficiency improved from 51% to 92% after treatment, and the time taken to fall asleep was reduced from 60.2 minutes to 10.6 minutes.

A 2020 study confirmed that the power in the high-frequency band decreased after treatment through EEG measurements, indicating a reduction in the arousal state.

Cognitive behavioral therapy consists of sleep hygiene education, sleep restriction, stimulus control, relaxation training, and cognitive therapy. Sleep hygiene education includes maintaining regular wake-up and bedtime, limiting caffeine and alcohol intake, and reducing smartphone and TV use before bed.

Sleep restriction is a method of adjusting the time spent lying in bed to match actual sleep time to increase sleep efficiency. Stimulus control redefines the bed as a space solely for sleep, reinforcing the conditioning of bed-sleep.

Several studies have shown that effects appear when sessions are conducted once or twice a week for a treatment period of about 6 to 8 weeks, and the effects continued even after treatment ended. In a 2018 study of patients with comorbid insomnia, follow-up investigations one month after treatment showed that insomnia severity, sleep efficiency, depression, anxiety, and quality of life remained improved.

Sleep hygiene management can be applied either in conjunction with cognitive behavioral therapy or independently. Waking up and going to bed at the same time every day is the most basic. Maintaining a similar schedule on weekends as on weekdays stabilizes the biological rhythm.

It is advisable to avoid caffeine intake after 2 PM. The half-life of caffeine is about 5 to 6 hours, meaning that coffee consumed in the evening can affect sleep late into the night. Alcohol may seem to induce sleep temporarily, but it decreases sleep quality and causes frequent awakenings.

Set aside 1 to 2 hours before bed to reduce exposure to blue light from smartphones, tablets, and TVs. Blue light inhibits melatonin secretion, disrupting sleep. Instead, activities that relax the body and mind, such as reading a book, light stretching, or taking a warm shower, can be helpful.

Keep the bedroom temperature cool, around 18 to 20 degrees Celsius, and create a dark and quiet environment. If noise is a concern, white noise or sounds of nature can be utilized. Use the bed only for sleep and avoid habits of working or looking at smartphones in bed.

Patients with insomnia often experience a paradoxical situation where anxiety and obsession about sleep actually interfere with it. The pressure to sleep, repeatedly checking the clock, and worrying about not being able to fall asleep further enhance arousal.

Mindfulness meditation is effective in letting go of such anxiety and obsession. By focusing on the breath and staying in the present moment, one can observe thoughts without judgment, which can alleviate the state of hyperarousal. Regularly meditating about twice a week is helpful, and doing a simple breathing meditation for about 10 to 15 minutes before bed is also good.

In traditional Korean medicine, insomnia is approached by categorizing it into types such as worry type, surprise type, heat sensation type, and digestive disorder type. Treatments such as acupuncture, herbal medicine, and moxibustion are used to adjust physical imbalances, and traditional adjunct therapies like moxibustion or foot baths may also be used.

There have been reports of patients who have taken sleeping pills for 20 years reducing their dosage by half and improving sleep efficiency after two months of combining acupuncture and meditation.

Insomnia is a signal sent by the brain. It is a signal that indicates excessive tension and that the body needs time to recover. If sleep problems persist for more than three months or if daytime fatigue interferes with daily life, it is necessary to consult a professional. However, in that process, it is important to prioritize cognitive behavioral therapy and lifestyle adjustments over relying solely on medication.

Research consistently shows that correcting incorrect sleep habits, letting go of unrealistic expectations about sleep, and restoring the body's rhythm enable more sustainable recovery than medication. Although 6 to 8 weeks of effort is required, during that time, the body learns to fall asleep on its own again.

Sleep cannot be forced by will. Rather, letting go of the obsession with sleep and creating an environment where the body can naturally recover is the beginning of recovery.

Regular rhythm, relaxed mind, and space for sleep. These small changes can accumulate to help reclaim nights of deep sleep.