What is insomnia?

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Disclaimer: This information isn’t a substitute for professional medical advice, diagnosis, or treatment. You should never rely upon this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.

Why is getting enough sleep so important?

Getting the proper amount of high-quality sleep is necessary to function at your best. High quality sleep is uninterrupted and it slips smoothly through each sleep cycle (discussed below). Your body and mind both suffer if either your quality or duration of sleep is insufficient. Prolonged periods without proper sleep can compromise nearly every aspect of your health.

The American Academy of Sleep Medicine and the Sleep Research Society recommend that adults sleep 7 or more hours per night on a regular basis for optimal health. Despite this advice, the CDC estimates that about 35% of adults sleep fewer than 7 hours per night. Sleeping fewer than 7 hours is associated with (either causing or caused by) many diseases, including:

Hypertension (High Blood Pressure)
Heart disease
Increased risk of death
Poor immune function
Increased pain
Higher risk of accidents

The biology of sleep.

Sleep is essential for vital day-to-day activities. We spend approximately one-third of our lives asleep. Sleeping allows us to learn, create new memories, and renew both body and mind. Lack of sleep, or poor quality of sleep, can affect every organ system in the body, leading to an increased risk of high blood pressure, heart disease, diabetes, depression/anxiety, and more.

The sleep-wake cycle (circadian rhythm) is regulated by many complex hormonal signals. Environmental cues (like light), activity level, hormones, and even body temperature, send signals to your brain to promote sleepiness or wakefulness. One of the key hormones in promoting sleep is melatonin, which helps regulate your body’s internal clock (circadian rhythm).

Normally, it takes a person about 15 minutes to fall asleep once in bed. Once asleep the body goes through several stages of sleep, which are called stage 1, stage 2, stage 3, and Rapid Eye Movement (REM) sleep.

Stage 1 is typically the stage of sleep a person enters immediately after falling asleep. In this stage, it is very easy to be awakened. It is a light stage of sleep that is a brief segway between other stages of sleep.

Stage 2 is a slightly deeper stage of sleep. The heart rate slows and body temperature drops.

Stage 3 is often called “deep sleep.” This is the most restorative stage of sleep and is characterized by slow brain waves. It is often difficult to be awakened from deep sleep.

REM sleep is the stage of sleep during which dreams occur. During the night, a person cycles through the different stages of sleep, which all contribute to overall wellness. A typical sleep cycle takes 90–120 minutes.

You can promote high-quality sleep by avoiding electronics before bed, keeping a consistent routine, and having a dark, quiet, cool environment for sleeping. You can also promote high-quality sleep by avoiding consuming caffeine in the afternoon (after 2 pm), not drinking more than 2 drinks of alcohol before bed, and not smoking near bedtime.

What are some other causes of sleep problems and fatigue?

There are many other causes of sleep difficulties and fatigue that are not insomnia. Below is a partial list:

Depression can cause difficulty sleeping and should be addressed in people with both insomnia and depression.

Anxiety can cause difficulty sleeping and should be addressed in people with both insomnia and anxiety.

Sleep apnea (central or obstructive) can cause people to feel tired even after having a full night of sleep.

Restless leg syndrome (RLS) causes uncomfortable feelings in the legs that are more prominent at night along with an irresistible urge to move their legs.

Narcolepsy is a sleep disorder that causes excessive sleepiness, sleep paralysis, hallucinations, and sudden muscle weakness and paralysis while awake (cataplexy).

Waking up to urinate in the middle of the night. This is often caused by benign prostatic hyperplasia (BPH) in men or changes associated with menopause in women.

If you are concerned that you have one of these issues, please see your primary healthcare provider.

A special note about sleep apnea.

Even if you have yet to suffer from these specific conditions, a lack of sleep can affect your quality of life. Everything from your ability to enjoy your free time to your capacity to work may be compromised. Even your relationships may be diminished by mood swings that result from sleep deprivation.

It’s important not to miss other causes of poor sleep and fatigue before starting treatment for insomnia. Sleep apnea is one of the more common causes of fatigue and sleep problems. If you snore loudly, choke/gasp while asleep, and/or feel excessively sleepy during the day, then you may have Sleep Apnea. If this is the case, it is very important for you to be evaluated in person by a sleep specialist for further assessment. Sleep apnea is diagnosed with a sleep study (polysomnography, aka PSG).

Sleep apnea can disrupt your sleep, making it difficult to stay asleep during the night, which can make you feel sleepy during the daytime. Many people with sleep apnea have no recollection of waking up in the middle of the night—even though they may have minor awakenings many times per night. It has many other negative effects on your health, including hypertension, increased risk of heart attack and stroke, heart arrhythmias, and memory impairment. Please, follow up with your primary healthcare provider if you are experiencing any of these issues.

Treatments for insomnia available through Rory

Melatonin (N-acetyl-5-methoxytryptamin) is a hormone made by the pineal gland. It regulates the sleep/wake cycle also known as the circadian rhythm. Light suppresses melatonin secretion during the day to a level that is practically unmeasurable. Blood levels of melatonin begin to rise in the evening and peak around 3 am. Melatonin effects on the body are sedating, including a drop in body temperature, which promotes sleep.

Studies have shown that the active breakdown products of melatonin are decreased in people with insomnia, which suggests that melatonin suppression or deficiency may be responsible for some sleep difficulties. Melatonin is a hormone. It is one of a few hormones that are not prescriptions in the United States. Melatonin is available as a dietary supplement and is sold over the counter in the United States. Learn more about melatonin here.

What are some lifestyle changes that can help with insomnia?

Several behavioral interventions are recommended for insomnia.

Sleep Hygiene: A variety of behaviors contribute to an environment conducive to a good night’s sleep. The National Sleep Foundation recommends the following:

Limit daytime naps to 30 minutes or less.

Avoid caffeine and other stimulants close to bedtime, in particular. However, it is best to forego them after 2 pm.

Exercise. This helps as long as it’s not within a few hours of bedtime.

Avoid heavy, spicy, or rich meals close to bedtime.

Get exposure to natural daylight. Full spectrum lamps are useful in winter.
Maintain a regular bedtime and wake time—even on weekends.
Keep the room cool (60–67 degrees Fahrenheit) and dark. Blackout blinds may be helpful. Move electronic screens (e.g., TV, laptop) out of the bedroom. In fact, it’s a good idea to avoid screens 1–2 hours before bed as the blue light they emit can disrupt sleep.

Get exposure to natural daylight. Full spectrum lamps are useful in winter.
Maintain a regular bedtime and wake time—even on weekends.
Keep the room cool (60–67 degrees Fahrenheit) and dark. Blackout blinds may be helpful. Move electronic screens (e.g., TV, laptop) out of the bedroom. In fact, it’s a good idea to avoid screens 1–2 hours before bed as the blue light they emit can disrupt sleep.

Stimulus Control Therapy: This therapy trains people how to fall asleep quickly. It is effective for people who take a long time to fall asleep (increased sleep latency). However, it can be challenging as people initially become more fatigued by implementing the needed changes. They consist of the following adaptations:

– No napping during the day
– Sleeping only when sleepy (no bedtime)
– Awakening the same time regardless of how much you’ve slept
– Getting out of bed if you do not fall asleep within 15 minutes

Improving your sleep habits

Altering your lifestyle is one of the simplest and most underrated interventions people with insomnia can make. Your insomnia can even serve as your motivation to start healthier habits. Take the time to read everything provided to improve your general health, which often improves sleep.

Insomnia can be the first sign that something is impacting your overall health. This can be stress, bad food choices, lack of exercise, poor sleep habits, or all of the above. Getting your health back on track often results in significant improvements in sleep, which will only make you feel better and more likely to make healthy lifestyle choices.

Exercise and healthy eating

Exercise is one of the best ways to improve your sleep and overall health. Your circadian rhythm depends on you being active during the daytime and sedentary overnight while you sleep. Remaining sedentary during the daytime can alter the circadian rhythm, which can lead to insomnia. You may be asking where you should start. Just walk! Walking is an underrated form of exercise. A great, and achievable, daily goal is 10,000 steps per day. Work towards a goal and reward yourself when you’ve met it; then, set the bar even higher.

Obesity is a primary risk factor for diabetes, high cholesterol, high blood pressure, certain cancers, gallstones, degenerative arthritis, and sleep disorders. Excess fat can interfere with the body’s natural regulation of hormones, including the hormones responsible for healthy sleep. Obesity also predisposes an individual to develop Obstructive Sleep Apnea (OSA), which is a condition that disrupts sleep and leads to numerous other health issues.

Lifestyle habits

Smoking can lead to insomnia. Nicotine causes stimulation of the central nervous system, which can make it difficult to fall asleep. This is especially true if you smoke close to bedtime. Quitting smoking can improve your health immediately. Your risk of a heart attack decreases, your blood pressure improves, and your circulation improves within 2–12 weeks.

Many people think alcohol improves sleep. Alcohol is a central nervous system depressant; so while it may make you sleepy, it also blocks messages between the brain and the body. The result of this disconnection is fragmented sleep with more awakenings than usual. Alcohol increases the amount of alpha activity in your brain, which is a characteristic of wakefulness rather than sleep. Alcohol also suppresses REM sleep. Even if you sleep more hours, they do little to restore your body or prepare you for the next day. Quitting smoking and reducing alcohol consumption can improve sleep and overall health.

Unchecked stress can lead to high blood pressure, heart disease, obesity, and diabetes. Being in a high-stress environment can make it difficult to shut down your thoughts while you’re winding down in preparation for sleep. There are many different ways to manage stress. Deep breathing, meditation, and yoga are all ways to manage stress and promote relaxation. Exercising can also be a good way to relieve stress and to maintain a healthy lifestyle. The method chosen is uniquely personal, but everyone can find something that works for them.

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