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Insomnia. Risk Factors, Consequences and Recommendations


The term Insomnia comes from Latin, which directly translated means “without sleep.” The added prefix ‘ia’ is used in naming disorders and diseases. As implied by its name, people who suffer from Insomnia have difficulty initiating and maintaining sleep, or wake up before reaching the number of hours their doctors recommend are necessary for sufficient nightly rest.

In some cases, insomnia can manifest by poor quality of sleep, regardless of the amount of time spent asleep. It is important to note that this symptomatology must be present regardless of proper conditions such as a quiet, darkened room with proper temperature, bed, awakenings caused by others, noise, alarm and opportunities for sleep.

Insomnia is diagnosed by healthcare providers when the above symptoms persist for at least one month, or occur on three or more occasions during the week. In addition, clinicians will consider whether insomnia is solely caused by sleep disturbance, or mental health disorders, such as result from a medical condition, or alcohol/substance abuse.

Insomnia can be both a stand-alone diagnosis or a comorbid condition. The literature indicates that approximately 40% of insomnia diagnoses are co-occurring with other neuropsychological disorders, depression and anxiety being the most common. The symptomatology of both aforementioned disorders includes insomnia or sleep disturbances as one of the diagnostics criteria.

It is worth noting that it's unknown whether depression/anxiety or other ailments cause Insomnia or vice versa; however, studies indicate that all of these disorders are interrelated in some way. Whatever the cause, it is recommended that you consult your physician if you experience persistent sleep disturbances of any sort over time.

Risk factors

To date, literature indicates that among all the demographic factors involved in determining an Insomnia diagnosis, age and gender are the most clearly identified risk factors. Studies on aging suggest that the number of diagnosed insomnia cases increase with age. Even though the relationship between healthy aging and increased difficulties sleeping are not well defined, studies suggest that this potentially occurs due to deterioration of sleep control systems. The loss of neuronal cells and connections between them is part of naturally paced healthy aging (link to circadian rhythms throughout lifetime). In addition, the comorbid conditions that are more commonly occurring in elderly demographics have been shown to be a significant contributor to insomnia. Several most commonly occurring comorbid conditions with insomnia include, but are not limited to:

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

Aside from aging, women tend to suffer from sleep impairments more often than men, with differences in prevalence becoming apparent after the onset of puberty. Studies investigating the gender differences as they relate to Insomnia note that even though the difference between the number of cases is noticeable early on, with the increasing age the gap between rate in women and in men tends to widen. Evidence also suggests that menstrual cycles, pregnancy, and menopause can negatively affect sleep cycles and its architecture (link to sleep architecture article). However, it is essential to keep in mind, that menstrual cycles, pregnancy, and menopause do not independentently cause insomnia, rather they are the contributing events that mostly affect woman who are already predispsposed to insomnia.

In addition to the above, there are several other factors that are 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 (later on link to sleep apnea)
  • Chronic snoring

The exceptions in insomnia cases are healthy young adults and adolescents. Healthy in this context refers to the absence of pre-existing breathing, sleep or neuropsychological disorders, and chronic conditions. In the case of younger individuals, the leading cause for insomnia is phase delay syndrome. It has been suggested that the social culture of “going out” late on weekend nights contributes heavily to phase delays, as well as the social jetlag that follows after two days off work. In addition, occupations that require shift work, frequent and distant travels, as well as frequent awakenings during the sleep hours, are other causes of insomnia.

Consequences of Insomnia

It is essential to note here, that during times of acute stress, which could be loss of a close one, trauma, relocation or similar anxiety-producing events, it is common to experience insomnia. During these times, please contact your physician, who will help guide you through these difficult situations. The majority of consequences described in this section 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)

Proper Sleep Hygiene Recommendations

  1. Avoid phase shifting, (which means going to sleep and waking at the same time)
  2. Limit daytime naps
  3. Follow a healthy lifestyle, which includes getting physical exercise, even a ‘’light one, like going for a walk every day, can help you fall asleep at night
  4. Limit eating (especially heavy meals before bedtime) and drinking sugary or caffeinated drinks. Avoid stimulants. Nicotine, and some medication (such as asthma inhalers) contain stimulants. Avoid nicotine use (cigarettes, patches, gum) before bed. Check with your physician regarding prescribed medication and what time of the day would it be best to take them.
  5. Make sure your sleeping environment is comfortable, not only the bed itself, but temperature, lighting, noise.
  6. Activities in bed. You should use your bed for sleep and sex only, not working or watching television. These activities have a stimulating effect, which might lead to difficulties initiating sleep.
  7. Make to-do lists for next day activities before you go to bed, and reduce stress and worry by putting any problems out of your mind.

Key take-aways

Insomnia is a serious sleep disorder that significantly affects overall wellbeing.

It can occur alone or as a symptom of another physical or psychological condition.

It is vital to contact a physician if you experience persistent problems initiating or maintaining sleep.

References:

American Psychiatric Association, D. S., & American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (Vol. 5). Washington, DC: American psychiatric association.

Roth, T. (2007). Insomnia: definition, prevalence, etiology, and consequences. Journal of clinical sleep medicine, 3(5 suppl), S7-S10.

Krishnan, V., & Collop, N. A. (2006). Gender differences in sleep disorders. Current opinion in pulmonary medicine, 12(6), 383-389.

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