We think of insomnia as the inability to fall asleep, but two other forms of the ailment tend to plague women: With maintenance insomnia, sufferers wake up in the middle of the night and have trouble getting back to sleep; with terminal insomnia, they wake up at 4 or 5 o'clock and are too alert to doze off again. Once up, she starts to worry about how long she'll be awake, or all the things she failed to do during the daylight hours. The more distressed she gets, the less likely she is to fall asleep again.
Certain people are predisposed to developing insomnia, according to Oneil Bains, MD, director of the insomnia program at Seattle's Virginia Mason Medical Center, and some of the reasons are beyond our control—a woman's genetically determined "sleep drive", for example, and her personality. Life changes can also trigger insomnia, and we can't do much about those, either. But the third element in the slumber trifecta is the way we think about sleep, and that's where free will comes into play.
Most insomniacs worsen their condition by worrying about it. Then again, it's hard not to. The 11th commandment in this culture might as well be "Thou must have eight hours of sleep"—we fear anything less means not being as fresh, alert, or productive as our well-rested colleagues.
Letting go of that 11th commandment is the first step toward relief. "Most people with insomnia don't need eight hours," Bains says. When they stop fighting with themselves and settle for less, they feel better.
Robin, for example—an artist and graphic designer in her 50s—has been waking up at 4 a.m. for most of her adult life and happily uses the time to paint, read or answer e-mails from her students. She is admittedly an extreme example, since she gets along fine on five or six hours a night, but the important thing about Robin is her attitude. She has defined her sleep habits in a positive way, says Bains. "And if they don't impact how she functions during the day, then as a doctor, I wouldn't worry about her."