Insomnia. Prevalence and Tips for Maintaining Sleep

The term insomnia comes from Latin for “without sleep” and is defined as a difficulty in initiating, maintaining sleep and/or waking up before getting sufficient hours of sleep. Your gender and increasing age are risk factors for developing insomnia. Young adults and adolescents can experience insomnia due to social jetlag, while anyone experiencing acute stress can also be prone to insomnia.

A diagnosis of insomnia can be made if your symptoms persist for at least one month and for three or more occasions during the week. In some cases, insomnia is defined by a poor quality of sleep, regardless of the amount of time you spend sleeping.

In addition, healthcare professionals will consider whether your insomnia is caused by another sleep or mental disorder, from a medical condition, substance, or medication use or abuse.

Insomnia can be a stand-alone diagnosis or occur with another health condition. Approximately 40% of insomnia diagnoses are co-occurring with other neuropsychological disorders, such as anxiety or depression.

There is a role played in insomnia – as well as anxiety and depression – by your body’s hypothalamus and pituitary and adrenal glands, which can severely increase the secretion of the cortisol hormone, something which affects your ability to sleep.

If you are experiencing persistent sleep disturbances, have trouble initiating or maintaining sleep for a period of time, it’s important to contact your healthcare professional for advice.

Prevalence and risk factors

Your age and gender are the most clearly identified risk factors for developing insomnia. That said, young adults can also experience insomnia, along with those who are experiencing acute stress.

While the relationship between healthy aging and increased difficulty sleeping is not well defined, studies suggest the loss of neurons in the brain due to aging will affect your ability to sleep.

In addition, co-occurring health conditions that are common in the elderly can be a significant contributor to insomnia. Some of these can include:

• Low blood oxygen levels (hypoxemia), which tend to cause shortness of breath.
• Conditions that cause shortness of breath, difficulty breathing (dyspnea), such as asthma, pneumonia, and lung diseases.
• Gastroesophageal reflux disease, which causes painful sensations due to acidic stomach juices, fluids, or food from the stomach backing up the esophagus.
• Pain conditions, such as arthritis.
• Neurodegenerative diseases, such as Alzheimer's disease (link to Alzheimer's article), and Parkinson’s disease (link to Parkinson’s).

Aside from aging, women tend to suffer from sleep problems more than men, with the difference becoming apparent after the onset of puberty and getting worse over time.

Evidence suggests that menstrual cycles, pregnancy, and menopause can negatively affect sleep cycles.

However, keep in mind that menstrual cycles, pregnancy, and menopause do not independently cause insomnia. Rather they are contributing events that mostly affect woman who are already disposed to insomnia.

In addition to the above, there are several other factors associated with the increased likelihood of sleep disturbances leading to insomnia:

• Chronic illnesses.
• Circadian rhythms disorders (usually leading to insomnia).
• Restless legs syndrome.
• Sleep apnea. (link to sleep apnea)
• Chronic snoring.

Healthy young adults and adolescents can experience insomnia due to delayed sleep phase syndrome (DSPS), in which their sleep is delayed by two or more hours beyond what’s considered acceptable. This does not apply to those who have existing breathing, sleep or neurological disorders or chronic conditions.

In the case of younger individuals, it’s been suggested that social jetlag after staying up too late on weekends and other days off contributes heavily to DSPS. In addition, occupations that require shift work or frequent and distant travel can cause frequent awakenings during normal sleep hours.

Insomnia can also occur during times of acute stress. If you have experienced loss of a person close to you, trauma, relocation or similar stress, it’s common to experience insomnia. Please contact your healthcare provider, who will help you through this difficult time.

Consequences of insomnia

The majority of consequences described here refer to chronic insomnia:

• Decreased overall satisfaction with life.
• Irritability, mood swings.
• Physical pain.
• Increased likelihood of accidents (workplace, traffic incidents).
• Decreased cognitive functioning (difficulties concentrating, productivity).

Tips for initiating or maintaining sleep

• Go to sleep and wake at the same time, and limit naps.
• Physical exercise, such as going for a walk every day, can help you fall asleep.
• Limit what you eat, especially heavy meals before bedtime, and avoid drinking sugary or caffeinated drinks, including non-herbal teas.
• Avoid stimulant use. Nicotine, and some medications (such as asthma inhalers) contain stimulants. Avoid nicotine use (cigarettes, patches, gum) before bed. Check with your healthcare provider about any prescription medications and what time of the day it’s best to take them.
• Make sure your sleeping environment is comfortable, not only the bed itself, but the temperature, lighting, and noise.
• Do not use your bed for non-bed related activities, such as working, watching television, reading, making calls or appointments. These activities have a stimulating effect, which might lead to difficulty initiating sleep.
• Try making lists for the next day's activities, such planning work or school tasks or balancing finances, before you go to bed. Worrying about bills, work or school can interfere with sleep initiation and increase your stress levels.