by Julian Dollente, RN, Edited by Christopher M. Cirino, DO MPH

What do we know about insomnia? Interestingly, even at this point in human evolution, no one knows exactly why we need to sleep. Sometimes it makes you wonder if the lack of certainty means its functions are relatively non-essential or even rudimentary, like the appendix to our digestive system. Our view of life centers on what we do during the day when we are awake. But perhaps our focus is misplaced when we factor in how important sleep is to the quality of our wakefulness. After all, we spend about one-third of our lives in bed.

Nevertheless, as stubborn as we humans are, there is no limit to our quest for knowledge. In recent years, scientists have built on theories about the nature and functions of normal sleep and the principle behind our circadian rhythm, or internal body clock. 

For instance, we now know that sleep allows our brain to reset, helping to incorporate new things we learn with the consolidated memories we already have. Additionally, sleep-deprived people are more prone to depressive disorders, and insufficient sleep is as burdensome to our hearts as smoking.  

Sleep is as crucial as water, food, and oxygen and one of the primary determinants of health and well-being. That is why poor sleep may lead to several health issues. Insomnia is a potentially dangerous condition that needs to be taken seriously. 

But what does it mean to have insomnia? Is it about your inability to sleep due to an underlying medical condition? Or does it originate in the brain? This article explores more about insomnia, its probable causes, and how to deal with them.

Overview of Insomnia

Insomnia is a subjective perception of difficulty getting to sleep, struggling to stay asleep, and trouble sleeping as long as you would like despite having an adequate opportunity for rest, which results in dissatisfaction with sleep quality and some form of daytime tiredness. 

Almost everyone experiences insomnia at some point. The concept of ‘quality sleep’ varies from person to person, but most adults need 7-9 hours of sleep a night, depending on their age. Studies show that around 25% of Americans experience insomnia each year, but about 75% of these people eventually recover and do not develop long-term problems.

Insomnia is a sleeping disorder that affects as many as 30% of adults. It can disrupt your mood and energy level and affect your health, work performance, and quality of life. You don’t have to endure sleepless nights because simple changes in your daily habits can be helpful.

Types of Insomnia

There are two types of insomnia: primary and secondary.

• Primary Insomnia: This means that your sleep problems are not associated with lifestyle habits or any other existing medical, psychiatric, or environmental cause (such as drug abuse or medications)
• Secondary Insomnia: This means that your difficulty sleeping arises from a primary medical illness or mental disorder (such as asthma, arthritis, cancer, or depression); pain; medication, or substance use (such as alcohol)

You might also hear about:

• Sleep-onset Insomnia: This means you have trouble initiating sleep. This type of insomnia can either be acute (short-term) or chronic (long-term)
• Sleep-maintenance Insomnia: Often described as an inability to stay asleep through the night, which means waking up at least once during the night and struggling to get back to sleep for at least 20 minutes.
• Mixed Insomnia: This type of insomnia is a combination of problems related to sleep onset, sleep duration, and early morning awakenings. 
• Paradoxical Insomnia: A subjective insomnia is a personal report of a pattern of little to no sleep most nights without corroborative objective evidence of a sleep disturbance.

Causes of Insomnia

There are several potential causes of insomnia. In most cases, there may be more than one factor involved. Lack of sleep can also provoke and aggravate other health issues, creating an elaborate cause-and-effect chain of insomnia. 

On a holistic approach, insomnia originates from a state of hyperarousal that disturbs your sleeping pattern. Hyperarousal can be both physical and mental and related to a host of circumstances and health problems.

Insomnia and Stress

Stress can trigger a profound reaction in the body that presents a challenge to sleep quality. Exposure to stressful life events or traumatic situations — such as divorce, death of a loved one, or losing a job may lead to insomnia. Concerning yourself about health, work, finances, or family will keep your mind busy at night, making it difficult for you to sleep. 

Your body’s physical response to stress contributes to a heightened state of anxiety (hyperarousal). Your inability to sleep may become a source of stress, making it more and more challenging to break the cycle of stress and insomnia.

Insomnia and Irregular Sleep Schedules

In an ideal world, our circadian rhythm closely follows the daily pattern of day and night. In reality, most people have sleeping patterns or schedules that cause disarray in their circadian rhythm or internal body clock.

Jet lag and shift work are the two well-known examples that can change your sleep schedules. Traveling across multiple time zones can disturb your sleep because your body can’t adjust to the abrupt change in your internal body clock. In shift work, the same principle applies because people working in shifts are usually required to work through the night and sleep during the day, disrupting the natural order of the sleep-wake cycle. 

In some cases, circadian rhythm may be shifted forward or backward without a clear cause, resulting in constant trouble with sleep timing and overall sleep quality.

Lifestyle Factors

Having unhealthy habits and routines related to lifestyle, including particular food and drinks, can increase your risk of developing insomnia.

Here are some various lifestyle choices that can bring about sleeping problems:

• Keeping your brain stimulated by staying up late in the evening — doing activities like playing video games, working late, watching TV, or using electronic devices just before bed can interfere with your sleep cycle.
• Having an irregular bedtime schedule — such as napping late in the afternoon or sleeping in later to make up for lost sleep can confuse your circadian rhythm and make it harder for you to establish a healthy sleep schedule. Also, when you use your bed for activities other than sleeping, your brain will begin to associate your bed with wakefulness. 
• Overeating in the evening — especially spicy foods can be hard on your digestive process and make you feel physically uncomfortable while lying down, which can keep you awake at night. 

Insomnia and Mental Health Disorders  

Did you know that awakening too early can be a sign of depression? Mental health conditions such as anxiety, depression, bipolar disorder, and post-traumatic stress disorder (PTSD) may cause sleep issues. An estimated 40% of people with chronic insomnia have a mental health disorder, usually an anxiety disorder or depression.

These conditions can disturb your sleep by inciting pervasive negative thoughts and mental hyperarousal. Studies indicate that people with chronic insomnia are at risk for developing mood and anxiety disorders, making symptoms worse and even placing a depressed individual more vulnerable to suicide. 

Insomnia, Physical Illness, and Pain

Almost any condition that causes pain can create sleep problems by making it difficult to lie comfortably in bed. Sleep disorders and pain antagonize each other: stress and sleep problems occur when you focus on pain and lay sleepless in bed. Not to mention, sleep problems, such as sleep apnea, can sensitize a person to pain.

Research has shown that health issues related to Type 2 diabetes can be part of an underlying cause of insomnia. Health issues that can interrupt sleep include:

• Pain from peripheral neuropathy
• Frequent need for hydration and urination
• Sleep apnea
• Rapid blood sugar changes

Other types of physical illness such as respiratory and nervous system diseases may pose challenges to sleep that can lead to acute or chronic insomnia. 

Medications

Insomnia and other sleeping problems can be side effects of many types of prescription medication; examples include certain antidepressants and medications for asthma or blood pressure. Many over-the-counter drugs, such as pain, allergy, and cold medicines, contain caffeine and other stimulants that can interfere with sleep.

COVID

This current COVID pandemic can be considered a stressful event or situation. The stress brought about by this pandemic and not the virus itself can predispose people — especially those who are covid-positive — to sleep disturbances and insomnia. A recent study shows that insomnia is more common in COVID survivors. Researchers evaluated approximately 236,000 patients, and 5.4% of these patients experienced insomnia. The number increases with infection severity, reaching as high as 10% for patients admitted in the intensive therapy unit. 

Risk Factors of Insomnia

Almost anyone can have an occasional sleepless night. But your risk of having insomnia is more significant if:

• You’re a woman. The shifts in hormones during the menstrual cycle and menopause may play a role in sleeping problems. Night sweats and hot flashes during menopause may interfere with sleep. Insomnia is also a common experience among pregnant women.
• You’re over age 60. Insomnia increases with age from changes in sleep patterns and overall health.
• Genetics. There is a large study that confirms that insomnia may be hereditary. Researchers identified specific genes that may trigger the development of sleep problems. They may make the brain go into a hyperarousal state at night, making it difficult for them to have quality sleep. Another sleep research indicated that about 35% of people with insomnia had a history of insomnia in their families.

Dealing with Insomnia

There are many home care remedies and tips that can help manage insomnia. They involve changes to:

Sleeping Habits

• Go to sleep at the same time, establishing a consistent sleep-wake cycle. 
• Avoid using any device with a screen — especially smartphones right before going to sleep.
• Try to relax — such as taking a bath an hour before bedtime.
• Keep your smartphones and other devices outside your bedroom.
• Use curtains and blinds to cover the windows and darken the room.

Dietary Habits

• Avoid going to bed hungry. Have a light, healthy snack if necessary.
• However, do not overeat. Avoid having a heavy meal 2-3 hours before going to bed.
• Limit your caffeine and alcohol intake, especially during resting hours.
• Maintain a healthy diet to boost overall well-being.

Well-being and Relaxation

• Have regular exercise, but not within 4 hours before you sleep.
• Do breathing and relaxation exercises before going to bed.
• Find something that can help you sleep, like reading or listening to music.
• Try to avoid afternoon naps, even if you feel sleepy.
• Be sure to receive medical attention for any health issues, including anxiety and depression.

Treatments (Chronic Insomnia)

The best approach depends on the type of insomnia and its underlying cause, but some options may include:

• Counseling
• Cognitive-behavioral therapy, or CBT
• Prescription medication
• Over-the-counter sleep aids
• Melatonin supplement

However, be advised that there is not enough evidence to support that melatonin is effective and safe to use. Here is an additional article on addressing insomnia from YHF.

Insomnia and State of Mind

Have you ever had sleepless nights due to overthinking unwanted thoughts, commonly referred to as a ‘racing mind?’ These consistent and repetitive thought patterns are difficult to shut down, interfere with sleep, and lead to insomnia. Is it possible that changing your mindset might be a feasible solution to your sleep problems?

 A study suggests that your mind’s ability to actively create an information picture to influence your behavior or cognitive control is associated with sleep disturbance. “Mind over matter.” “Just change the way you think, and you’ll feel better.” For some, it might be true, as mind conditioning techniques have proven to be effective over the years. Unfortunately, not everyone can control their mind the way others can.

So, is it safe to assume that it is all in the mind? How the mind works is never that simple. Yet perhaps it is still a fair question, considering the likes of anxiety, depression, and paradoxical insomnia are all influenced by our mental state — which somehow validates the idea.

However, what isn’t fair is to assume that insomnia is just made up and is not accurate. Although insomnia is a subjective perception of sleeplessness, numerous studies confirm that multiple factors cause it — and stress stands at the core of it all. One may argue that even stress may be all in the mind, given that it is only a subjective feeling for which the brain is responsible. But make no mistake, stress is very real, as well as insomnia. And there is no conclusive evidence to prove that it is purely psychological.

The Bottom Line

The mind is a powerful thing, and you might be surprised about what a conditioned mind can accomplish. It can either cause or treat sleep problems. Nonetheless, one should take their insomnia seriously as it leads to several consequences, including mental health disorders. Anyone who has been suffering from sleep disturbances and feels that it is affecting their daily life should get a check-up. Doctors may be able to help identify the cause and recommend a solution. Also, it is helpful to encourage others who may have insomnia to seek out answers because no one wants to lose their sleep voluntarily.