Fresh Air Episode Summary: "Can't Sleep? You're Not Alone"
Release Date: July 7, 2025
Hosts: Terry Gross and Tonya Mosley
Guest: Jennifer Senior, Staff Writer at The Atlantic
Introduction to Jennifer Senior's Battle with Insomnia (00:16 - 04:10)
In this episode of Fresh Air, host Terry Gross introduces Jennifer Senior, an acclaimed staff writer at The Atlantic. Senior shares her personal struggle with insomnia that began 25 years ago when she was 29 years old. Her journey from regular, restful sleep to chronic insomnia led her to investigate the condition deeply, culminating in her article, "Why Can't Americans Sleep? Insomnia Has Become a Public Health Emergency."
Notable Quote:
Jennifer Senior reflects on her sleep patterns, saying, "I used to sleep through the night. Like, you'd go to bed and you just wake up seven or eight hours later." [02:24]
Early Experiences and Initial Reactions to Insomnia (04:10 - 07:11)
Senior describes her first sleepless night with a sense of "bafflement and curiosity" rather than immediate distress. Initially, she did not connect the lack of sleep to any external factors until insomnia became a persistent issue. The transition from occasional sleepless nights to chronic insomnia was rapid and distressing.
Notable Quote:
Describing her first experience, Senior notes, "I thought, like, have I been poisoned? I really had no idea." [03:03]
Exploring Treatments: Medications and Alternative Approaches (07:11 - 10:30)
Jennifer details the various methods she experimented with to combat insomnia, including acupuncture, melatonin, and behavioral techniques. She found acupuncture to be pleasant but ineffective for her sleep issues. Melatonin, particularly in higher doses common in the U.S., did not align with her body's natural circadian rhythms and was not beneficial.
Notable Quote:
On melatonin, she explains, "Melatonin regulates your circadian rhythms. So it's not necessarily what your body responds to for sleep itself." [09:05]
Debunking Sleep Myths and Understanding Sleep Needs (09:56 - 13:22)
During her research, Senior discovered that the widely held belief of needing exactly eight hours of sleep is a myth. Sleep requirements vary among individuals and change with age. She cites studies, including one by Kripke, indicating that 6.5 to 7.4 hours of sleep correlates with the best health outcomes, challenging the "eight-hour" standard.
Notable Quote:
Jennifer asserts, "You really don't need eight hours of sleep," highlighting the variability in sleep needs. [09:56]
Stigma Around Sleep Medications and Reevaluating Prescriptions (14:05 - 19:18)
Senior emphasizes the stigma attached to using sleep medications, drawing parallels to the destigmatization of antidepressants. She references an editorial from the American Journal of Psychiatry which criticizes the anti-benzodiazepine movement for fostering fear and stigma, potentially preventing patients from benefiting from these medications.
Notable Quote:
She shares her personal experience, "I refused to take anything to help, thinking that I would become an addict. And the irony now is that I refused for so long that now I have developed a dependence." [16:14]
Prevalence of Insomnia and Its Impact (19:12 - 22:02)
Jennifer provides statistics indicating that insomnia affects a significant portion of the American population, with 30-35% experiencing temporary symptoms and 12% suffering from chronic insomnia. She discusses how insomnia not only affects sleep but also has broader health implications, including an increased risk of developing conditions like depression.
Notable Quote:
Highlighting the scope, she states, "18% of Americans take sleep medication every night or some nights. And that's a lot of people." [19:11]
Cognitive Behavioral Therapy for Insomnia (CBTI) (22:11 - 29:31)
The conversation shifts to non-pharmaceutical interventions, specifically Cognitive Behavioral Therapy for Insomnia (CBTI). Senior explains CBTI as a combination of changing thought patterns about sleep and modifying sleep behaviors. A key component is sleep restriction, which involves limiting the time spent in bed to build sleep pressure, despite the initial discomfort and paradoxical thoughts that may arise.
Notable Quote:
On the challenge of CBTI, she remarks, "It's really torturous. I mean, it's murder for some people, and it certainly was for me." [24:47]
Brain Activity During Sleep and Insomnia (25:01 - 28:34)
Senior delves into the neuroscience of sleep, explaining how, in individuals with insomnia, parts of the brain that should be resting remain active. The prefrontal cortex, responsible for decision-making and planning, does not quiet down as it does in regular sleepers, leading to a persistent state of alertness and fragmented sleep.
Notable Quote:
She describes the impact on the brain, "It's like everything looks like the Blair Witch Project. It's really tough." [26:17]
Antidepressants as a Treatment for Insomnia (28:34 - 30:52)
Jennifer discusses her personal trial with antidepressants as a treatment for insomnia. While some antidepressants can alleviate sleep issues, others may worsen them by increasing wakefulness. She highlights the complexity of using these medications, noting that the relationship between depression and insomnia is bidirectional and often interdependent.
Notable Quote:
Reflecting on her experience, Senior shares, "I had to go off that. And as soon as I went on one that left my metaphors intact, I needed a sleep medication." [29:31]
Long Covid and Its Connection to Insomnia (33:21 - 39:27)
Beyond insomnia, Senior touches upon her experience with Long Covid, which has exacerbated her health challenges. She explains her symptoms, including Postural Orthostatic Tachycardia Syndrome (POTS) and Mast Cell Activation Syndrome (MCAS), which contribute to her ongoing dizziness and fatigue. Moreover, she speculates on the possible link between chronic sleep deprivation and susceptibility to Long Covid, citing studies that suggest insufficient sleep may increase the risk of developing Long Covid.
Notable Quote:
On the impact of Long Covid, she states, "I have perpetual dizziness and it's awful. I'm dizzy now sitting up, I'm dizzy standing." [35:00]
Evolving Identity and Coping Mechanisms (39:27 - 40:23)
Senior reflects on how chronic illness has transformed her sense of self. Taking an extended leave from The Atlantic, she contemplates writing a book about living with a "broken body." Despite the challenges, she has developed coping strategies, such as cognitive restructuring and meditation, which help her manage her condition without the fear that once accompanied bedtime.
Notable Quote:
She shares her outlook, "I'm no longer beset by those kinds of terrors. Definitely not." [39:33]
Conclusion and Closing Remarks (40:23 - End)
Terry Gross thanks Jennifer Senior for sharing her profound insights and personal experiences with insomnia and Long Covid. The episode underscores the widespread impact of sleep disorders and the urgent need for better understanding and treatment options.
Additional Notes:
- The episode includes segments of advertisements and discussions unrelated to the main content, which have been excluded from this summary.
- Jennifer Senior's contributions extend beyond her personal experiences, offering a comprehensive look into the societal and medical narratives surrounding sleep and chronic illness.