Stressed to the Max and Short on Sleep : Health: Most bouts of sleeplessness are temporary, experts say. But for long-term insomnia, the solution may mean changing when you eat, exercise or worry.

Tina Konczol had plenty to worry about: pressure of meeting work deadlines as an interior designer; personal finances. Then her pet dog of 16 years died.

Before long, the Louisiana woman went to bed at night and stared for hours at the ceiling. The harder she tried, the less sleep she got.

“Some nights I’d finally get to sleep at 5 a.m., and I’d have to get up at 6:30 a.m.,” she says. “It’s a really miserable thing to have. I felt I put my life on hold.”

After seeing five doctors, including a neurologist and a psychiatrist, Konczol finally found help at Ochsner’s Sleep Disorder Clinic at Louisiana State University.

Psychologist William Waters, who treated Konczol, says stress often takes its toll on the body in the form of insomnia: “At bedtime people lie quietly and they are not distracted any more by the day’s activities, and what they do is they think. The cares and woes and problems and stressors that they’ve encountered all day come out.”

While insomnia is common, the suffering it causes shouldn’t be underestimated, experts say. It has been described as being “like vultures landing and then sitting grinning on your shoulders,” Waters says.

And in the most severe, long-term cases, says UCLA psychiatrist Jane Erb, “the bedroom becomes an area one is phobic to.”

As many as one-third of adults occasionally suffer insomnia. It can be caused by physical problems, such as pain, or mental disorders, such as depression. Daily habits, like consuming too much caffeine or having an irregular sleep schedule, also can trigger it. But about half those cases, experts say, are temporary bouts caused by stress, called situational insomnia.

“It can be a positive stress, like getting married, or negative, like war,” says Erb. “As long as it is limited in time, for a few nights, it’s considered normal. When it goes on for a longer period of time, one or two weeks or certainly a month, it’s considered clinical insomnia and it needs to be evaluated.”

Stress and sleep don’t mesh, says Waters. Emotions such as anxiety, anger, fear, sadness, depression, excitement, even joy, arouse the body. Heart rate and breathing accelerate and blood vessels constrict. This speeding-up process interferes at the time when the body is supposed to be slowing down.

“When you’re under a stress, the central nervous system is activated and the systems in the brain that appear to control aspects of sleep are inhibited,” Waters says.

In most cases, the worry or anxiety that started the insomnia pattern passes. But some people continue to have trouble falling asleep and may still approach bedtime with trepidation, worrying that they won’t sleep.

“What occurs is people don’t know why they’re having trouble falling asleep. They are not aware they are thinking of this stuff or they are not aware of what is keeping them up,” Waters says.

In most cases, sleep researchers say they can predict what happens next: The insomniac begins “trying” to sleep.

“They say ‘I have got to fall asleep.’ But trying is work. Trying is effort. When you try to do something you arouse the system and it inhibits sleep,” says Waters.

That’s what happened to Page Nicol.

“I was so afraid I wasn’t going to sleep that I got nervous,” the 26-year-old San Diego man says.

Nicol was a victim of circumstances, just like many others who suffer from situational insomnia, says Teresa Allen, program coordinator for insomnia at the Scripps Clinic Sleep Disorders Program in La Jolla, where Nicol was treated.

He had trouble falling asleep at the end of a Lake Tahoe ski vacation. Anxious about tasks he faced at home--such as preparing his income taxes and purchasing a house--his troubles might have been exacerbated by high altitude, which can disrupt sleep patterns.

Within days of returning home Nicol couldn’t sleep at all. After suffering five sleepless nights in a two-week period and panicked by his condition, he even went to a hospital emergency room.

At Scripps, Allen reassured Nicol he was healthy and normal. She told him not to force himself to sleep and to relax before bedtime.

“Going to sleep was something negative,” he says. “But as soon as I broke the pattern, I knew I wasn’t going to have trouble again.”

Insomniacs who don’t seek treatment can often make them worse, experts say.

Some insomniacs err by using alcohol to help go to sleep, Erb says: “Absolutely avoiding alcohol is very important. Alcohol can promote sleep, but everyone has less refreshing sleep with alcohol. It prevents people from getting into a deep sleep.”

And, she says, alcohol might be toxic to the area of the brain that controls sleep. Studies of alcoholics who have been sober for many years but who have insomnia suggest there might be damage to the brain’s sleep areas.

Insomniacs also should use caution with any self-medication. The food supplement L-tryptophan, which caused dozens of deaths and many cases of serious illness last year, was often marketed as a natural sleep inducer.

Instead, Waters suggests, “the best thing to do is try to do all your worrying during the daytime. A couple hours before bedtime, clear your head, distract yourself, do something enjoyable right up to bedtime.” Watch a relaxing movie or read a book, but once you hit the sheets, “Don’t try to not think, but do try to direct your thoughts to something pleasant.”

In some cases, insomniacs don’t recognize activities that inhibit sleep. For example, someone might have trouble falling asleep if he or she pays bills an hour before bedtime and becomes stressed about finances.

Konczol, for example, learned that dining and exercising late in the evening probably aggravated her insomnia. She rescheduled her activities to eat and exercise earlier, go to bed later (but rise at the same time) and listen to a relaxation tape before bed. She was also told to read a short, pleasant story before bed, and once in bed, continue the story in her mind.

“My mind would just wander at night. I’d think of all the things I would have to do at work,” says Konczol, who improved after two weeks of therapy.

In a 1990 book “No More Sleepless Nights: The Complete Program for Ending Insomnia,” Mayo Clinic expert Peter Hauri says people can keep journals to identify the causes of their insomnia. His book contains questionnaires designed to help identify the physical actions or emotional factors that can cause insomnia.

UCLA’s Erb advises developing a sleep-enhancing routine: “Keeping their hours as regular as possible seems to help. The more they try to catch up, like sleeping weekends and taking cat naps, the more the sleeping regimen seems to be undermined.”

Many people with stress-induced insomnia recover on their own; insomnia disappears with the stress. But, Waters says long-term insomnia is more serious and calls for behavioral changes.

Long-term insomnia is being unable to fall asleep after 30 or 40 minutes several times a week for a month or more. A pattern of waking up several times during the night that lasts for a month or more also requires treatment.

People need help when insomnia interferes with daytime functioning, Hauri says: “You need help if you have difficulty on the job, if you fall asleep driving, if you have troubles with relationships.” Adds Waters: “People with sleep deficiency are usually irritable. There could be problems with relationships at home and on the job.”

Long-term insomniacs build up a sleep debt that leaves them chronically tired, experts say, and sleep deficiency may be a major cause of industrial and auto accidents.

Erb says many insomniacs suffer needlessly: “Most people I see have had their insomnia for at least six months. I’m surprised how often people accept insomnia as part of their life and let it go on until it reaches a point where it interferes with their daily lives.”

People with long-term insomnia are usually recommended to psychologists or psychiatrists for treatment. Patients should seek treatment at established sleep-disorder centers, some of which are accredited by the Assn. of Sleep Disorders Centers in Rochester, Minn., or from board-certified specialists.

Experts agree, however, that sleep-inducing drugs should be prescribed for short-term use only.

Benzodiazepines like Halcion, Dalmane and a new drug called ProSom, make up a $200-million-a-year market in the United States, although sales have declined slightly in recent years. While these substances are considered generally safe, the U.S. Food and Drug Administration has received some reports of anxiety and hallucinations associated with the drugs.

“If they are appropriately prescribed, then they are quite useful,” Hauri says. “We find they are OK for short-term use. If you have a crisis . . . to take a few nights of a sleeping pill isn’t a problem.”

The problem, says Waters, is that “people prescribe these drugs and they are rewritten and rewritten. These drugs are mildly addictive if used in high doses and used for a long period of time. People develop a tolerance to them. There is a withdrawal, so when you stop you are likely to get a rebound insomnia, a very bad insomnia.”

Instead of relying on medication, insomnia is often successfully treated with behavioral therapy during two to four office visits, and home practice, he says. Patients learn to avoid whatever may be contributing to the insomnia and develop a bedtime routine conducive to sleep.

Says Waters: “Behavioral treatments do require people to make alterations in sleep behavior and their schedules. Some people find it difficult to make those kind of changes and they drop out. People with tenacity and the need to succeed do quite well.”