Dealing with Insomnia
On average, in Australia, every 1 in 3 people have trouble sleeping. For many, it is a transitional phase, related to stress, change in career, relationship issues, differences in circumstances such as housing or finances, or due to things such as alcohol, drugs or poor diet. For 10% of the population though, it is a chronic, re-occurring issue, known as insomnia.
Insomnia is diagnosed within strict diagnostic criteria, in an effort to understand the disorder and properly assist suffering individuals, removed from those who simply “didn’t sleep very well last night.”
Specifically, the diagnosis of insomnia, as defined by the Journal of Clinical Sleep Medicine, must meet the following criteria:
1) difficulty falling or staying asleep or having non-restorative sleep;
2) the difficulty is present despite adequate opportunity and circumstance to sleep;
3) this impairment in sleep is associated with daytime impairment or distress;
4) this sleep difficulty occurs at least 3 times per week and has been a problem for at least 1 month.
In addition, the insomnia symptoms cannot occur in the presence of another sleep disorder, mental disorder or the direct physiological effect of a substance or medical condition.
With an understanding of said diagnostic criteria, let’s evaluate the risk factors associated with the development of insomnia, how to reduce insomnia occurrence and how it presents in individuals both during sleep and waking hours.
What are the risk factors or preceding conditions, which may lead to insomnia?
Age and Gender
Age and gender are the most well identified demographic factors which dictate who may develop insomnia. Researchers have found that it is twice as likely to occur in women than in men and that it affects older adults more often than younger populations. In addition, it is extremely common amongst shift workers due to the inconsistency presented to their biological clock as a result of varying working hours. The elderly population is also much more easily impacted by insomnia, but the reasons aren’t fully understood. Researchers believe it could be because of the natural, age-related breakdown in sleep cycle control systems, or because of comorbidity with medical conditions, which typically affect older individuals. It is important to understand also, that these precipitants do not cause insomnia, but rather are contributing factors to the development of the disorder in individuals who are pre-disposed to the condition.
Chronic illness, plays a big role in an individual’s development of insomnia, in particular, those who have restless leg syndrome, sleep-related breathing disorders like sleep apnea and snoring, gastroesophageal reflux, neurodegenerative disorders or circadian rhythm disorders. It is worth noting also, that part of the reason insomnia is more prevalent in the female population is that it is affiliated with the onset of menses and menopause.
What does insomnia look like for those that are affected?
Insomnia can present in a variety of different, and individual forms, but at the root of it is that the individual is unable to sleep. For some people, this means they are unable to get to sleep and they toss and turn for most of the night. For others, they may be able to fall asleep, but do not stay asleep and do not go into a restful sleep cycle which promotes restoration of the body and mind. For still others, it is a combination of these, whereby the individual may fall asleep and then wake up and not be able to get back to sleep or may take a long time to fall asleep and then only be able to sleep for short periods of time.
What are the consequences of insomnia?
Insomnia is associated with impairments in day-to-day functioning and has a strong impact on individuals’ quality of life. These impacts occur from both a safety and health perspective, as well as simply from a personal wellbeing and functionality perspective.
For example, lack of sleep severely impairs driving, and researchers have found that insomniac individuals show signs of impairment on the road, after just 20 minutes of driving.
This includes out of lane excursions, general lateral deviation of the vehicle and increased speed. Furthermore, impairment increases over distance and time driven, but individuals are often unaware, in self-reports of the occurrence of said issues. Obviously, impairment on the road is a risk for both the driver and other individuals and insomniacs are 2.5 – 4.5 times more likely to have an accident.
Work productivity is also compromised among insomniacs. This is due to higher rates of absenteeism, or missed work days, but also because when the individual is present, he or she has difficulty concentrating and difficulty performing mentally stimulating tasks. Insomniac affected individuals tend to be less patient and tolerant, both with other workers, and with their work, and have less drive and motivation to perform tasks. This decreases overall job performance and in many cases can have an impact on job stability, further exasperating the life stresses at the root cause of insomnia.
Research has also shown, that while insomnia can be as the result of a psychiatric condition, preceding the diagnosis, it can also cause psychiatric disorders. For example, researchers found an increased incidence of mood disorder in insomniacs, and insomnia more often preceded rather than followed cases of mood disorder diagnosis.
Compromised Immune System
One of the other consequences of insomnia is that lack of sleep puts you at an increased risk of developing other diseases and medical conditions due to a compromised immune system. The immune system, (and all other systems of the body), requires sleep to be restored and to conduct repairs throughout the body, such as rebuilding muscle, eliminating toxins, cleansing the digestive system and removing invaders. Without sleep, many of these tasks do not get performed and the accumulation of lack of body maintenance can set the body up for the development of conditions such as viruses and bacterial infections, asthma, heart disease, high blood pressure, digestive disorders, diabetes, and obesity. In addition, it is not uncommon to see an increase in inflammation within the body, as compromised bodily systems will initiate inflammation as the first line of defense and to indicate something is wrong. Inflammation within the body is then a precursor to other issues such as arthritis, heart attacks, high cholesterol and several other diseases.
How can you reduce the occurrence of insomnia?
Insomnia is thought to be a disorder of hyperarousal experienced throughout the entire day. In other words, the individual is incredibly energized, awake, focused and mentally in tune all day long and then faces difficulty initiating and maintaining sleep at night. The initial inability to sleep and acute episodes of insomnia is caused by this hypervigilance all day long, and the worry and stress of day-to-day life, such as career, relationships, finances etc. The perpetuated occurrence of the disorder, however, comes from the worry and rumination about not sleeping and the effect this will have on their life the following day. This cycle continues and is exacerbated by the lack of sleep experienced by the body.
Given the understanding of this cognitive model of insomnia, it is easy to see the role of chronic illness and physiological or psychological disease within the individual. For example, having a psychological condition such as OCD, or being very physiologically active, such as in an athlete, would lead to an even higher degree of hyperarousal, hence further heightening said model.
Reducing insomnia then must occur from the root cause. Simply finding a way to help the individual sleep is not enough, because at some point he/she will be woken up again by the issues causing hyperarousal. Many individuals find their insomnia is actually a byproduct of something else that is happening in their life, and when that is fixed, the insomnia is fixed as well. For example, individuals who experience high levels of stress and anxiety, find that once they are able to have their anxiety under control and reduce stress, insomnia disappears.
Likewise, heavy alcohol and drug users experience insomnia as a result of their substance dependency, while insomnia also commonly occurs in adjunct with depression. If you are suffering from insomnia, take some time to evaluate what is at the root of your condition and understand that there is likely more that is causing it than simply your inability to sleep.
While insomnia may affect individuals differently and occur in varying circumstances, for all individuals, it is a life-disrupting condition, which severely impacts the quality of life and day-to-day functioning. Understanding the disorder, how it happens, the consequences and how to reduce the occurrence are key parts in helping minimize the negative impacts of this condition on individuals and their lifestyle.
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