Human beings spend roughly one-third of their lives asleep. For some, bedtime is a virtual battle, fraught with anxiety and dread, rather than a welcome respite from daytime activity. While the body attempts to rest, the insomnia brain is busy churning out a bevy of ideas, and random thoughts. All of this neurological activity makes it impossible to sleep.
Insomnia is defined as the inability to fall asleep, or difficulty staying asleep. The presence of many nighttime disturbances that hamper quality sleep is also considered insomnia. Insomnia is viewed as both a symptom and a sign and may involve non-restorative sleep, sleeping for only short bursts of time, waking too early, and feeling as if sleep was not refreshing.
How prevalent is sleeplessness/insomnia?
According to many cross-national studies, insomnia is present in about 30% of the general population. Not all individuals will have all symptoms of insomnia, however.
What are the symptoms of insomnia?
According to the DSM IV (Diagnostic Statistical Manual of Mental Disorders) primary insomnia includes one or more of the following complaints:
- Difficulty either falling asleep, staying asleep, or not getting enough restorative sleep for a period of at least one month.
- The disturbance of sleep, and daytime fatigue that follows causes notable distress in one or more aspects of life, including social or occupational areas.
- The sleep disturbance does not coincide with narcolepsy, sleep apnea, parasomnia (nervous system activity while asleep) or any sleep disorder involving circadian rhythm.
- The sleep disturbance does not occur solely concurrent with a mental health disorder such as generalized anxiety disorder, a major depressive disorder, or delirium.
- Insomnia is not caused from another medical condition, or the effects of prescription medication, or illicit drugs.
- Insomniacs may report:
- Tiredness or drowsiness during the day
- An increase in accidents or errors in school or at work
- Excessive worry about sleep
Why We Need Sleep
Sleeping, like eating involves a powerful internal drive. Just as food relieves uncomfortable feelings of hunger, restorative sleep makes us feel better, and allows for relief from drowsiness. Scientists have researched sleep for a number of years, from many different angles and have developed possible theories as to why we need it.
The nighttime inactivity theory suggests that animals adapted sleep patterns over time, to rest at night in order to avoid harmful predators. Animals who stayed quiet in the dark hours, avoided being killed. Noisy creatures fell prey to hungry nocturnal predators in search of food.
Energy Conservation Theory
Some scientists believe that sleep evolved as a way to conserve an animal’s energy for the daytime, when food was more plentiful and safer to obtain.
Metabolism slows at night, body temperature drops, and calorie demand decreases.
Many researchers believe that sleep gives the body time to restore, repair, and rejuvenate itself. Evidence supports this likelihood, when in human studies; immune function rapidly deteriorates within a few weeks of sleep deprivation. Eventually, death would ensue if test subjects did not resume sleep. Restorative functions such as muscle growth, tissue repair, synthesis of protein, and the release of growth hormone are at play during sleep.
Brain Plasticity Theory
Sleep is critical to brain development in infants, and small children. Sleep is vital to adults for memory, learning and the performance of daily tasks.
How is insomnia/sleeplessness diagnosed?
A physician or mental health professional may diagnose the medical condition, insomnia.
To diagnose insomnia, the doctor may:
- Take a full health history
- Interview the patient regarding sleep habits, wakefulness, and daytime drowsiness
- Conduct a thorough physical examination to explore possible medical causes for insomnia
- Order a sleep study, known as a polysomnogram (PSG) that thoroughly checks sleep and bodily responses to sleep patterns
- Have patients wear an actigraphy, a portable device worn on the wrist that tracks and records movement, and uploads information to a computer.
Types of Insomnia
Similar symptoms may be common to many types of insomnia.
Insomnia can be:
- Acute and short-term—Insomnia may only last for a few days or weeks, and may occur in response to stressful or traumatic events, pressure from work or school, unresolved conflicts, or difficult relationships.
- Chronic or ongoing—This type of insomnia lasts for a period of one month or more and may be the result of a medical condition, medication, or another sleep disorder. Stimulants including caffeine, tobacco, or alcohol may also cause chronic insomnia. Shift work, stress, or travel can lead to the condition as well.
- Primary insomnia—This refers to insomnia that is not caused by something else, such as a medical condition, or outside substance.
- Secondary insomnia—Insomnia caused by a medical condition, stimulants, or other reasons, is considered secondary.
Who suffers with insomnia?
- Women (twice as likely as men)
- Older adults
- Depressed/grieving individuals
- Inactive individuals
- Those who travel through several time changes
- Night shift workers
- Individuals who work rotating shifts
Other Causes of Insomnia
- Sinus allergies
- Acid reflux
- Arthritic pain
- Heart Disease
- Alzheimer’s disease
- Parkinson’s disease
- Chronic pain
- Bladder issues or prostate problems that disturb sleep
- Hormonal changes, including menstruation or menopause
- Hot Flashes and Night sweats
- Low carbohydrate diets
- Sleep apnea is also a major contributor to insomnia. The sleep disorder that involves airway obstruction, or the brain’s inability to regulate breathing may cause fragmented sleep, leaving the sufferer exhausted.
What does insomnia feel like?
People with insomnia sometimes report feeling isolated, desperate, and exhausted. Difficulty sleeping can be a lonely experience. When others are quietly snoozing away, the insomniac lays in bed, wide awake, thinking and ruminating. As the sky begins to lighten, insomniacs despair at yet another sleepless night gone by. Insomniacs feel nauseous sometimes, and may develop a pattern of headaches after several days of low quality sleep. Some will develop depression as a result.
What’s happening in the insomniac’s brain?
In studies at John’s Hopkins University, researchers have discovered genetic differences in the insomniac’s brain that don’t appear in normal sleepers. The part of the brain responsible for movement is more flexible in those with insomnia, and is more active overall than that of individuals who sleep well. Behind the brain’s frontal lobe, increased plasticity and excitability in neurons is present in insomniacs. It has been suggested that sufferers are in a hyper state of arousal with constant information downloading. This can interfere with sleep at night and normal function throughout the day.
While tests based on transcranial magnetic stimulation (TMS) reveal heightened plasticity in insomnia, it is not yet known exactly how this information and research can help insomniacs. Rachel E. Salas, assistant professor of neurology at the Johns Hopkins University School of Medicine adds, “It’s a 24-hour brain condition, like a light switch that is always on. Our research adds information about differences in the brain associated with it.”
In addition to TMS studies, 24-hour urine tests reveal high levels of cortisol in insomnia sufferers as well.
Treatment for Insomnia
- Medication—Several medications including anti-Parkinson drugs (dopamine agonists), benzodiazepines, known as hypnotics, Anticonvulsants, opiates, non-benzodiazepines hypnotics, melatonin receptor stimulators, and anti-narcoleptics are all prescribed for insomnia.
- Treatment for any primary medical or mental health condition from which insomnia stems
Natural Solutions for Insomnia
Natural treatment for insomnia may include:
- Cognitive Behavioral Therapy (CBT)—a specific type of therapy to relieve anxiety related to chronic insomnia
- Relaxation therapy
- Melatonin (for insomnia involving circadian rhythm)
Practicing good sleep habits to mange insomnia may help.
- Refrain from napping after 3pm.
- Avoid artificial light and electronic technology at least one hour before bedtime
- Go to bed at the same time every night.
- Do not remain in bed more than 15 minutes if unable to sleep.
- Leave the bedroom if not immediately sleepy.
- Maintain a dark, quiet, and cool bedroom for sleeping.
- No exercise within five hours of bedtime[sad]
- Good, restorative sleep is imperative for vitality, body and brain function, energy, and emotional well being. Finding the cause and proper treatment for insomnia, and associated symptoms is critical for optimal, overall health.
1“Insomnia.” MedlinePlus, U.S. National Library of Medicine, 7 Mar. 2018, medlineplus.gov/insomnia.html.
2Hub. “Insomniac’s Brain ‘like a Light Switch That Is Always on,’ Hopkins Researcher Says.” The Hub, 28 Feb. 2014, hub.jhu.edu/2014/02/28/insomnia-brain-differences/.
3Roth, Thomas. Advances in Pediatrics., U.S. National Library of Medicine, 15 Aug. 2007, www.ncbi.nlm.nih.gov/pmc/articles/PMC1978319/.
4Saddichha, Sahoo. Advances in Pediatrics., U.S. National Library of Medicine, 2010, www.ncbi.nlm.nih.gov/pmc/articles/PMC2924526/.
5“Why Do We Sleep, Anyway?” Sleep and Memory | Need Sleep, healthysleep.med.harvard.edu/healthy/matters/benefits-of-sleep/why-do-we-sleep.