Sleepless in Manhattan

Dear Shrink Rap:
I am exhausted, and I don't know whether I should even be asking you for advice, or whether I should head over to the Health Services clinic. Is sleep deprivation caused by a physical or a mental problem? I don't fall asleep easily, and then I wake up all through the night. I can barely stay awake through my classes and I can't concentrate. I do have a lot on my mind, and things are feeling more than a bit stressful, but I have always been able to sleep, so this is kind of scary because it keeps happening. Should I take a sleeping pill?

Restless

Sleep problems are not uncommon for college students. However, it is important to find out the cause of your sleeplessness. It is not a bad idea to check in with the Health Services clinic to rule out a physical cause for this. Because the clinic and the Counseling Service work closely together in providing care to Juilliard students, the clinic practitioner can check you and, if necessary, run tests to rule out any physical cause, and can also give you some guidance about whether seeing a counselor might be helpful. Don't take any medication that you think might help you sleep without first discussing it with a clinic practitioner. Do tell the practitioner about your use of such things as coffee, tea, chocolate, cigarettes, or over-the-counter medications that might contain stimulants that interfere with sleep.

Sleep problems are not uncommon for college students—but if they continue, you need to find out the cause of your sleeplessness.

You give us some clues by saying that you have a lot on your mind and that stress is a factor in your life right now. We doubt there is a person reading this who has not experienced a few sleepless nights of worry, fear, and anxiety caused by some issue or occurrence. We would guess that the most common reasons are fear of failure (i.e., nervousness about an audition or lesson), relationship problems, family illness and death, jet lag, and just too many things to get done in a short time. Another possible cause is the worry about getting enough sleep. Sometimes the nightly worry interferes with a person's ability to fall asleep and this can become a pattern that is hard to break. Usually a good night's sleep returns when there has been some resolution of whatever it is that has been upsetting or stressful. Short-term sleep loss is not a cause for a lot of concern. However, if sleep continues to elude you, we would be concerned about the effect on your health and well-being.

Chronic sleeplessness, or insomnia, might be a sign of depression. This too would not be unusual. Depression is the most common reason students seek counseling. When a person goes for several days without sleep, irritability and anxiety may accompany a general feeling of tiredness. These factors work against someone who is already feeling depressed, and can make the depression feel much more out of control.

There are many treatment options for working through sleep problems and depression. We hope that you will try speaking with a counselor in our service. Even if it turns out that depression is not an issue for you, a counselor can help you gain control of the stresses and worries that are keeping you awake at night. Sometimes it is helpful to talk to someone who can give you a different perspective and can help you sort things out.

We offer therapy to students for whatever length of time they want. Sometimes students see us just three or four times to work out a particular issue in their lives that they need to talk about.

Additionally, there are a number of habit changes that you might look into. It is hard to go to bed at the same time every night as a student, but if you can strive to be in bed close to the same time most nights, it will help establish a rhythm that your body needs. As enticing as it might be to lounge on your bed to study, it is better to use your bed only for sleeping when you are having sleep problems. Sometimes a warm shower or bath, a hot cup of herbal tea, or reading a book for pleasure before bedtime will work to calm you and get your mind off of things. An hour or so before your bedtime, try to avoid things that stimulate you, such as exercise, phone calls, and reviewing schoolwork or schedules. Some musicians discover that listening to music is actually a stimulating activity, while others find it relaxing.

We have brochures about sleep in the Counseling Service hallway, and if you do an Internet search for "sleep problems," "insomnia," and "sleep and depression," you will discover many organizations that have really helpful Web sites. You are always welcome to come ask anyone in the Health and Counseling Service for guidance.

Shrink Rap is the monthly advice column of the Juilliard Counseling Service. Students are invited to submit anonymous questions that we can print and answer here by using our suggestion and question box, located in the hall outside the Counseling Service on the 22nd floor of the Rose Building.