Insomnia and What to Do About it
Trouble sleeping is a common complaint among adults and an estimated 10-30% of the population have insomnia. (R) This has also grown over the years as people report less sleep than decades ago, more fatigue, and more consumption of caffeinated beverages to aid them throughout the work day. Anxiety and depression often coincide with insomnia and may influence or be the consequence to this condition, too. (R) Studies have shown that insomnia increases the risk of depression and with improvement of sleep parameters, depression usually gets better. Those with chronic pain and medical conditions such as diabetes, coronary heart disease, and heart failure, among others, may lead to sleep abnormalities.
Insomnia Definition
Insomnia is simply defined by difficulty initiating or maintaining sleep or early morning awakening that leads to poor sleep quality. As a consequence, social, academic, behavioral, and occupational function is affected. Patients experience this at least 3 nights per week for a duration of at least 3 months. Insomnia may either be acute or chronic with the cutoff being at 4 weeks. Most people have chronic insomnia for years before they eventually reach out for help, unfortunately.

Insomnia Mechanisms
Insomnia is usually associated with high sympathetic function and arousal. Worrying about daily stressors can lead to difficulty sleeping. This may include work deadlines, financial difficulty, a recent death, or not being able to control worry. Certain medications may provoke sleep changes including, but not limited to dopamine agonists like Wellbutrin, selective serotonin reuptake inhibitors, (SSRI's) and acetylcholinesterase inhibitors. An active stress response is common with those that have insomnia and high serum levels of cortisol and ACTH are seen, suggesting a connection to a dysfunctional hypothalamic-pituitary-adrenal axis (HPA).
Consequences of Insomnia
Sleep is vital and disease rears it's nasty head when deprived. An increased risk of behavioral disorders including anxiety, depression self-harm and suicidality are all linked to sleep deprivation. Work performance may suffer, self medication is common and caffeine consumption is increased. It's a vicious cycle! Sadly, there's even increases in chronic disease such as Alzheimer's, Cardiovascular Disease, Insulin Resistance and Diabetes---just from losing sleep!
Treatment/Management:
Sleep hygiene and cognitive behavioral therapy for insomnia (CBTi) are first-line therapies and just as effective as medication, but without the nasty side effects. It's longer lasting, too! Sleep hygiene consists of things to do and not to do throughout the day and evening that will increase the probability of sleep. These may include a regular bedtime and wake times, avoiding naps, avoiding alcohol or stimulants, avoiding electronic devices and screen time. Sleeping with ambient noise, cool temperature, and using the bed for only sleep and sex. In addition, relaxation therapies such as mindfulness, guided imagery, breath work, and/or progressive muscle relaxation may be added as well.
Another is stimulus control therapy, which many people have never heard of. It's actually simple, though. It involves controlling the environment to maximize sleep and is similar to sleep hygiene techniques. Laying in bed without sleeping is not recommended. If not sleeping within twenty minutes, then one should get up and practice relaxation exercises until tired. The process is then repeated.
Nutraceuticals such as Glycine, and GABA agonists; Valerian, Passion Flower, Taurine, Chamomile, L-theanine and Lavender may help, as GABA is the sedating neurotransmitter. I particularly like Lavender as a calming agent and enjoy a nice cup of L-theanine tea now and then. You can place 5 drops of Lavender on the pillow case to relax, or diffuse diffuse lavender in the room. Other oils such as Jasmine, Spearmint, Lemon or Bergamot work for stress relief as well. In addition, practicing gratitude, journaling, diets without refined sugar, comedy, and community may all help lower stress and improve sleep, too.
Comments