Insomnia FAQ

What is insomnia ?

Insomnia refers to difficulties with various aspects of sleep, and can include problems falling asleep, as well as frequent or prolonged waking during the night, and frequent waking before the desired wake time.

In addition, many people who experience insomnia also report being dissatisfied with the quality of sleep that they are getting, and often report feeling tired and unable to concentrate during the day.

Insomnia is generally considered to be a disorder of hyperarousal and the manifestations of this excessive arousal are varied.

Studies show that approximately a third of adults suffer from insomnia symptoms, but only 10% also experience daytime symptoms such as fatigue.

Up to 36% of insomnia sufferers have consulted a physician for their sleep problems, while up to 55% discuss these problems with their physicians during a medical consultation for another problem.

In addition, many adults seek to treat sleep problems, often with over the counter medication (up to 10%) and alcohol (13%) (Morin, Leblanc, Daley, Gregoire, & Merette, 2006). This may put them at risk for more severe psychological problems such as substance abuse and dependence.

What are the symptoms of insomnia ?

Insomnia can come in many ways, and many individuals who experience problems with their sleeping patterns may be unware that they are experiencing clinical levels of insomnia. Insomnia is characterized by the following symptoms (Morin et al., 2006):

  •     difficulty falling asleep (sleep onset latency of 30 minutes)
  •     difficulty maintaining sleep (for example, waking up frequently in the middle of the night without being able to go back to sleep for 30 minutes or longer
  •     waking early without being able to return to sleep (more than 30 minutes before the desired wake time)
  •     sleeping a normal amount but feeling tired and worn out upon waking
  •     dissatifaction with one’s sleep

What causes insomnia ?

Age

Aging is one of the most significant factors associated with changes in sleep across the lifetime, but although age-related changes in sleep architecture have been documented scientifically, the majority of changes in sleep patterns are not due to age itself, but rather to medical and psychiatric problems that arise and become increasingly prevalent as people get older.

In addition to factors predisposing older adults to poor sleep, there are a number of factors that can precipitate poor sleep.

These factors include the onset of a medical illness, the loss of physical functioning, or another primary sleep disorder (e.g., obstructive sleep apnea). Furthermore, once a person develops insomnia, several factors that can perpetuate poor sleep behavior and quality, such as social isolation, care-giving deficits, or bereavement (Taylor, Gehrman, Dautovich, Lichstein, & McCrae, 2014).

Environmental Factors

While age may be a factor related to insomnia, environmental factors play an important role. Noise, light, temperature, and the presence of electronic devices in the bedroom can all contribute to problems with sleep, as they can make sleeping conditions uncomfortable and can signal to a person that they are still ‘on’ and ready to act anytime, rather than allow them a period of ‘down time.’

While these factors may not be a persistent problem for healthy individuals, those who struggle with insomnia are often more susceptible to sleep interferences and disruptions. Interestingly, white noise or other repetitive noises such as that of a fan can actually have a soothing effect and can help a patient with insomnia sleep better (Taylor et al., 2014).

As meantioned above, aspects of the bedroom environment can signal to the individual that their day’s work is not yet done and may therefore interfere with a person’s ability to relax and have a resful sleep.

Such factors are the use and/or presence of electronic devicessuch as TVs and mobile phones, or of a desk or work area. Another important environmental consideration is how comfortable a patient finds his/her mattress and pillow (e.g., size, firmness) (Taylor et al., 2014).

Medication

Medical conditions and the treatments that they require can also lead to insomnia and impair sleep. For example, hyperthyroidism can result in significant sleep problems, and therefore patients who present with insomnia should generally be tested for this.

Although insomnia can often be precipitated by a medical disorder, it can later separate from this medical condition and exist independently of it, and can even have a reciprocal effect in which it exacerbates the medical disorder that gave rise to it to begin with (Taylor et al., 2014).

For this reason, individuals who experience insomnia in relation to a medical condition or treatment should be monitored closely throughout the duration of their treatment and after treatment has ended.

What are the signs of insomnia ?

People who suffer from insomnia often feel that their sleep is inadequate, either too short, or too restless. They may describe feeling fatigued and tired during the day, and may come across as more anxious than usual and/or more irritable. These problems do not occur when the person had a good night’s rest.

What is the right amount of sleep I should get?

On average, adults should sleep between 7-9 hours per night (Ford et al., 2014). However, according to the National Sleep Foundation, there is no easy way to determine the optimal amount of sleep, as this may depend on a variety of factors including diet, exercise levels, as well as sleep deficit and stress levels.

How can I tell if I am getting enough sleep?

The first step to help you determine if you are getting enough sleep is to determine exactly how much sleep you are getting currently. To determine this accurately, calculate the time between when you went to bed and when you woke up.

Then subtract how long it took for you to fall asleep, and any periods of time during the night when you woke up. This should give you a more accurate estimate of how much sleep you are getting.

In addition, you may benefit from using a smartphone with an app that tracks your sleep cycles. This may be better able to identify the times when you were restless or woke up, even if you cannot remember them accurately the following morning.

Then, in order to determine if your current sleep patterns are enough, you should seek to honestly answer the following questions:

  •     How often do I need an alarm clock so I can wake up at the right time?
  •     Is it difficult for me to get out of bed in the morning?
  •     Do I have difficulty concentrating at school or at home? How often?
  •     How often do I fall asleep as soon as I lay down? Does it take me a long time to fall asleep?

Your general response pattern to these questions should give you an indication whether you need to change your sleeping habits. As a rule of thumb, most people need approximately an hour more of sleep every night than what they are currently getting.

In order to determine the right amount of sleep for you, you will need to test it out. Add 15 minutes of sleep each week (importantly: not each day!) until you are able to wake up without an alarm and you feel refreshed the next day.

What is REM sleep and why is it important?

Sleep consists of two states that differ in their physiological activation patterns: rapid eye movement (REM) and non-rapid eye movement (NREM) sleep. NREM sleep is associated with minimal mental activity, while REM sleep consists of electroencephalography (EEG) activation, muscle atonia, and rapid eye move-ments.

For most adults, REM sleep occurs approximately 80 minutes after onset of NREM sleep, and alternates with NREM sleep throughout the sleeping period (Taylor et al., 2014). REM sleep is important because deficits in this stage of sleep have been associated with an increased risk for falls, impaired physical functioning, cognitive decline, and memory problems in older adults (Taylor et al., 2014).

Why is alcohol detrimental to sleep?

Many people use alcohol to help them fall asleep. This is supported by scientific evidence, in that alcohol leads to a reduction in sleep onset latency.

In addition, it also leads to an increase in sleep disruption in the second half of sleep. REM sleep in the first half of sleep seems to depend on how much alcohol was consumed prior to going to bed, with low and moderate amounts showing no clear trends in the first half of sleep, but high doses resulting in REM sleep reduction during this part of sleep.

After moderate to high consumption of alcohol, REM sleep percentage across the entire sleep period is reduced, and the onset of the first REM sleep period is significantly delayed at all doses and appears to be the most recognizable effect of alcohol on REM sleep followed by the reduction in total night REM sleep (Ebrahim, Shapiro, Williams, & Fenwick, 2013).
Ebrahim, I. O., Shapiro, C. M., Williams, A. J., & Fenwick, P. B. (2013). Alcohol and Sleep I: Effects on Normal Sleep. Alcoholism: Clinical and Experimental Research, 37(4), 539`–549. doi:10.1111/acer.12006

Ford, E. S., Li, C., Wheaton, A. G., Chapman, D. P., Perry, G. S., & Croft, J. B. (2014). Sleep duration and body mass index and waist circumference among Us adults: Sleep Duration and Anthropometric Parameters. Obesity, 22(2), 598–607. doi:10.1002/oby.20558

Morin, C., Leblanc, M., Daley, M., Gregoire, J., & Merette, C. (2006). Epidemiology of insomnia: Prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors. Sleep Medicine, 7(2), 123–130. doi:10.1016/j.sleep.2005.08.008

Taylor, D., Gehrman, P., D Dautovich, N., L Lichstein, K., & S McCrae, C. (2014). Handbook of Insomnia. Tarporley: Springer Healthcare Ltd. Retrieved from http://link.springer.com/10.1007/978-1-907673-73-3

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