Nanci Crotti, The Daily Record Newswire
Is that motion to compel compelling you to stay awake? What about imaginary retorts to a snotty comment made by opposing counsel?
These thoughts and many non-law-related ones can lead to insomnia. Insomnia can last for years, fueled by a dread of being unable to fall or stay sleep.
It can also drive lawyers into therapy, according to attorney and licensed clinical social worker Elizabeth Wittenberg.
"Lack of sleep and sleep disturbance is one of the things that make people feel really crazy," said Wittenberg, who is also president of Lawyers Concerned for Lawyers, a nonprofit mental health and addiction assistance program for lawyers, judges, law students, and their immediate family members.
Usually, however, insomnia is a symptom of her patients' anxiety and depression, Wittenberg said.
"We have to relax enough to fall asleep, and it's at that time that anxieties and fears surface," she explained. "We don't have our usual ways of coping with them because we're in bed and the lights are out."
Lawyers, in particular tend to ruminate at night about problems they have been able to avoid during the day by keeping busy, according to Wittenberg.
"Rarely are they coming up with solutions," she said. "That is not a good time for anybody to be doing productive work."
Mark Mahowald, M.D., a sleep specialist and retired University of Minnesota neurology professor, agrees.
Lying in bed trying to fall asleep compounds the problem, as does the anxiety that arises during the day about being able to sleep later, Mahowald said.
He suggests that people with insomnia get up and do something innocuous, like reading a novel or watching some TV, rather than balancing a checkbook or trying to tackle a work issue. The latter activities subconsciously reward the non-sleeper, perpetuating the cycle, he said.
Mahowald defines insomnia as an inability to sleep long or well enough to awaken feeling rested or restored. Everyone's sleep requirements are different, with some needing 10 hours and others getting by just fine with four, he said.
However, someone who needs eight hours but regularly sleeps only six hours suffers from insomnia. So does 20 to 30 percent of the population, according to Mahowald. Many worry that a psychiatric disorder causes insomnia or that insomnia can lead to disease, but neither is the case for most people, he added.
"It's the people who are constitutionally fragile sleepers who develop insomnia," he said. "The most common kind is conditioned or learned insomnia."
Mahowald prefers a behavioral approach to insomnia before resorting to medication, and that requires a little sleep deprivation. It may seem counterintuitive at first, but restricting one's time in bed to say, six hours, and sleeping for those six hours, will win the sleeper 15 more minutes in bed on either end. Sleeping for that additional time will allow for another 15 minutes of sleep, and so on.
"They should start seeing improvement in a couple of nights," Mahowald said, unless the problem has been going on for years.
As for medication, Mahowald pooh-poohs natural remedies such as valerian as being scientifically unproven. He believes that over-the-counter drugs such as Benadryl, Tylenol PM or Advil PM have a placebo effect.
Benzodiazepines such as Librium, Ativan and Xanax can induce sleep, as can non-benzodiazepines, such as Ambien, Lunesta and Sonata. All carry the possibility of addiction and impairment of daytime performance.
Two other drugs have yielded encouraging results, according to Mahowald. The tricyclic antidepressant Sinequan, taken in very small doses, as well as the recently FDA-approved Belsomra, an orexin receptor antagonist that regulates the sleep cycle, can treat insomnia.
"They can be very effective, but they come with a price tag," Mahowald said. "There's no free lunch with any drug."
Published: Tue, May 12, 2015
