Being deprived of sleep can increase your chance of sickness by 50%, reduce your ability to lose weight, increase your chance of stroke and heart attack and drain you mentally. But, sometimes, we are unable to sleep despite all efforts to — we could be struck with insomnia.
Insomnia: What is It?
Insomnia is defined as being unable to sleep despite having plenty of opportunity to sleep (1). People with insomnia usually have one or more of the following symptoms (as defined by the national sleep foundation):
- Difficulty falling asleep
- Difficulty staying asleep (waking up during the night and having trouble returning to sleep)
- Waking up too early in the morning
- Unrefreshing sleep (also called “non-restorative sleep”)
- Fatigue or low energy
- Cognitive impairment, such as difficulty concentrating
- Mood disturbance, such as irritability
- Behavior problems, such as feeling impulsive or aggression
- Difficulty at work or school
- Difficulty with personal relationships, including family, friends, and caregivers
But how long do you have to be unable to sleep for it to be called insomnia?
Insomnia: Duration and Types
Acute Insomnia is when you are unable to fall asleep in the short term. This is usually due to a stressful event at work or school or home and usually only lasts a handful of nights. Usually, this type of insomnia resolves on its own after the stressful event has passed.
Chronic Insomnia is when you are unable to fall asleep for at least 3 nights a week for at least 3 months in a row. At this point, it has become very disruptive to your daily life and is severely impacting your ability to function.
Insomnia is considered Secondary if it is caused by other health conditions. However, it may be deemed primary if it is found that no other health conditions caused insomnia you are experiencing.
But what can cause Insomnia?
Insomnia: The Causes
A variety of things can lead to chronic insomnia. Let’s step through each of them:
- Severe circadian disruption: your brain has a sleep and wake cycle it uses to manage the maintenance of your body. If you severely disrupt your circadian rhythm, this can cause severe insomnia.
- Your travel or work schedule: Danish nurses were compensated due to working graveyard (through the night) shifts over 20 years. The Danish ruling found that the activity had an impact on their sleep patterns (2)
- Eating late in the day can disrupt your ability to fall asleep
- Extreme stress at work or home
- Particular medical conditions may have insomnia associated with them
- Chronic Pain
- Sleep Apnea
- Heart Disease
- Alzheimer’s Disease
- Parkinson’s Disease
- Psychiatric conditions can come with insomnia, too
- Depression – note that insomnia can actually aggravate depression and anxiety.
- Bipolar Disorder
- Nicotine: As Nicotine is a stimulant, it has several effects on sleep that has been shown in research (3)
- Smoking any type of tobacco such as cigarettes, pipe tobacco, and also vaping. You can read more about it here.
Are There Specific Psychological Causes of Insomnia?
One of the questions I always wondered when struggling sleeping is, is it all just in my head? Am I causing this with my feelings and thoughts?
Here are some psychological causes of insomnia:
- Anxiety & Worry – does it cause insomnia? Perhaps: the sleep foundation states it can make insomnia worse. (4)
- Stress: work, family, or emotional
But don’t worry too much: We cover how to battle all of this below!
What Are the Effects of Sleep Deprivation?
I want to be very explicit here: there have been tons of research done into the effects of sleep deprivation. If you are struggling with insomnia, don’t be afraid to ask your physician for help. If your job is really interfering with your ability to sleep, consider these effects of sleep deprivation:
- Keep in mind that sleeping as little as 4 hours can have as much effect on your brain and sleeping zero hours. Humans are notorious for our inability to recognize this weakness when we are missing sleep.
- 17 hours of sleep deprivation is equivalent to being drunk in terms of cognitive performance (link).
- Did you know your ability to perform actually decreases with how long you’re awake?
- Ten days of sleeping 6 hours a night is equivalent to having a night with no sleep according to brain function.
- Sleep Deprivation Affects Your Heart (sleep foundation research).
- Long nights cause a detrimental effect on your cancer-fighting cells: a study was done (Michael Irwin, University of California) where 70% of the cancer-fighting cells were reduced from a 4 hour night of sleep.
- Sleep deprivation increases your calorie intake and reduces your calorie burn.
- Consider this: when living on a reduced calorie diet get your sleep! A study was done on two groups — both on a low-calorie diet — but one group only got 5.5 hours of sleep vs. 8 hours of sleep. They both lost weight, but the 5.5 hours of sleep group lost 70% from muscle mass! The full sleeping group lost as much as 50% of their weight from body fat.
- Sleeping less is associated with shorter telomeres: the end cap of our chromosomes that protect the cells. They are associated with faster aging if they are shorter, (i.e. people with less sleep have shorter telomeres and people with shorter telomeres age biologically faster, but it is unclear which is causal) — but given the sheer amount of evidence against sleep deprivation, I strongly recommend you get your 7-9 hours of sleep.
- A study by Prather injected people who slept fully and people who had been sleep deprived with a strain of the common cold: the chance is up of getting sick as much as 50% if you sleep 5 hours vs. 8.
- Adults who sleep 6 hours a nights vs ones that sleep 8 hours a night have a 200% increased risk of heart attack or stroke in their lifetime. This is increasingly important as you approach mid-life.
- When you are sleep deprived, you crave more sweets, heavy carbohydrate foods, and salty snacks by 30-40% (Van Cauter).
When you deprive yourself of sleep, you increase your risk of heart attack and stroke, increase your chance of getting sick, reduce your ability to lose weight, crave high-calorie food more, reduce your cognitive function severely, potentially age faster, and reduce your ability to fight cancer.
A good point of view to have in mind when defining health for yourself for the rest of your life 🙂
This is why I wrote this post about insomnia — I want to help as many people as possible!
What can help with insomnia?
Finally! My favorite part! What can YOU do to address your insomnia?
Let’s tackle this in groups.
Environment: Setting up your Sleeping Base
- Make your bed a place for sleeping! Don’t watch TV, Netflix, Hulu, Crunchyroll, or even movies on Youtube or Facebook. The more “awake” activities you do in bed, the more your brain will associate bed with being awake. I actually used a version of this to associate my bed with waking up when I overslept all the time as a kid. Read about it here.
- Try to do no screens (tv, cell phones, tablets) 90 minutes before you sleep. The light from your screens disrupts Melatonin production which is what helps you fall asleep (5). Try using f.lux for your computers to reduce the bluelight.
- No caffeine 6 hours before bedtime: Caffeine stops the accumulation of Adenosine and when it wears off you get a very large crash (urge to sleep). If you take say, coffee, with your dinner before bedtime, this can severely inhibit your ability to fall asleep (6)
- Remove digital clock faces from your bedroom — they cause clock-watching anxiety at night.
- Make your bedroom dark, quiet and somewhat cold (60- 67 F) as your body drops in temperature right before sleep (7)
Habits: These are things you learn to automatically do that can ease the path to sleep?
- Go to bed and wake up at the same time each night of the week (I recently implemented this one and it’s made a tremendous difference)
- Never lay awake in bed for a long time (more than 15 minutes). If you feel awake, you do something quiet and relaxing until you feel sleepy. Which leads to…
- Meditation! Meditation can be wonderful for slowing down your anxious brain. It worked in this (8) study. In fact, the researchers even made the meditation guided videos available for free! Check it out 🙂
- Decelerate before bed: don’t do anything that drives up your adrenaline right before bed. Either listen to an audiobook, read a nice book, or do something that calms you. Relaxing music is another option!
- Don’t have nicotine even several hours before bedtime: 6 hours is a good rule (same as used for Caffeine). If possible, give up smoking as it will improve your quality of sleep.
- If it makes you have trouble sleeping at night, avoid daytime napping
- Avoid heavy meals late at night: these can keep you up when you try to sleep
- Avoid sleeping in later to make up for lost sleep: this can really confuse your body of what is daytime and what is night time. And science suggests it has limited benefit (9)
- Exercising in the early evening or late afternoon (4-6 hours before you sleep) can shorten the time to fall asleep (10). So, get out those dumbbells!
- Go outside every day for at least 15 to 20 minutes. The natural light will help you get into a natural pattern of sleeping.
- Taking a hot bath before bed will cause your internal temperature to drop, while it raises the temperature on the surface of your skin. In this study (8) it increases NREM (Non-Rapid Eye Movement) stage 2 sleep by 10-15% and helps people fall asleep faster.
Medical Treatments: There are a variety of medical treatments available of severe insomnia, they fall under 4 categories
- Hypnotics: These either induce sleep or help stay asleep for longer periods of time. As this is truly the purview of a physician, I recommend the sleep foundation’s article on the topic.
- Sedating Antidepressants: These are not recommended by National Institutes of Health guidelines for insomnia but are generally handled on a case by case basis. You can read about them here in detail. They tend to be abused, are addictive and not terribly effective at treating insomnia.
- Over The Counter Treatments: These often cause daytime sedation and are too strong to be effective for a normal person’s typical day, however, the sleep foundation as a good summary of research done on them so far, so if you truly intend to use over the counter medications, I highly recommend reading this. Interestingly, all of the herbal treatments have not shown scientific evidence of a benefit to sleep when compared with a placebo.
- Other Medical Treatments: This is the everything else bucket: gabapentin, tiagabine, and atypical antipsychotics such as olanzapine and quetiapine. To read about them in detail, a detailed reference can be found here.
- Cognitive Behavior Therapy: This one is part habit and part medical treatment. This is a special therapy that helps a person avoid negative thought patterns that promote insomnia, along with regular sleep habits, relaxation techniques, and other behavioral techniques that improve sleep. This study shows that when people are given cognitive therapy, 36% got rid of their insomnia vs a control of 16% — not bad! If you’ve tried several of the steps above, I strongly recommend reading this write up by the new york times: it’s quite interesting and helpful! A sample program for this therapy is run at sleepio.com.
So, what is the best insomnia cure? Good habits and avoiding all the bad stuff :-).
This is how I approached changing things in my own life:
- I switched exercising right before bed to do it in the morning: sadly I can’t follow the advice above with my schedule.
- I installed f.lux on all my devices to limit blue light from keeping me up (from here).
- I avoided sources of caffeine after 10 a.m.
- I started reading or writing in my journal before bed (away from my bed).
- I started meditating right before bed to slow down my brain.
- I already did this, but I really started avoiding any non-sleep activity in my bed. No playing my Nintendo Switch in bed. No reading in bed.
- Some nights I take baths before I go to bed.
Everyone’s action plan will be slightly different, but that’s my humble example.
Insomnia: Women and Men
Are there differences between men and women? Yes, women tend to suffer from insomnia about 40% more than men (1.4X) according to the Department of Health and Human Services.
Why? Hormonal changes.
- The menstrual cycle, in the days leading up to their period, can cause sleeping difficulty for women.
- Pregnancy, especially in the third trimester, can cause sleep disruption due to discomfort, leg cramps, or restroom needs.
- Parimenopause and menopause can cause sleep disruptions with hot flashes and night sweats.
Insomnia: Getting Older
As we age, we actually have a declining ability to get quality sleep. Specifically, NREM Stage 2 sleep is often lost as we get older which is often the type of sleep that helps us firm up new memories and learnings. Your body puts out signals to the brain when it is tired, but the strength of your receptors for those signals becomes weaker with age. You can read in detail how they discovered this in mice here.
It’s actually not this sudden drop: you don’t turn 50 and suddenly solid sleep evades you: it’s a gradual decline that starts in your late 20s and early 30s. The typical result is a person at the age of 50 gets about 50% of the deep sleep as they did in their early 20s. This is primarily caused by waking up more often in the middle of the night, which interrupts your sleep cycle. When this happens, the quality effect of your sleep is reduced.
But remember when I said bathing before bed increases NREM Stage 2 sleep about 10-15%? This is excellent for older people! Get your bath on!
What else can help? Sedatives have little effect on this deep quality sleep, but Cognitive Behavior Therapy has been shown to help. There have been experiments with electric brain stimulation, but nothing conclusive has been found yet. Sleepio was founded by a sleep scientist, so it may be worth your time. It tries to digitally replicate cognitive behavior therapy.
I Tried All These Things You Listed, What Else Could I Do?
- Dr. Oz: I’d be remiss in not mentioning Dr. Oz — he has an entire show about sleep! There is an app for android and apple devices. Interestingly, the reviews on android are heavily about complaints around bugs, but on apple the reviews are glowing and positive. If you’ve tried all the above, I’d give it a try.
- Dr. Oz does have a full list of alternative treatments: if you’ve tried all the above will limited success, take a look. It’s a pretty good coverage of natural remedies for insomnia that are not habit or environment based.
- Consider seeing your physician: Sometimes we need help. If you’ve tried to solve your sleep problems your self, but you are still struggling to fall asleep, enlist the help of a professional.
Bonus! Sleep Apnea
What is it? Sleep apnea is when your upper airway becomes blocked while you sleep. Typically it’s diagnosed with sleep studies with a sleep doctor.
Why should you care? Sometimes it can cause Insomnia.
Loud snoring can indicate a potentially serious problem, but not everyone who has sleep apnea snores. Talk to your doctor if you have signs or symptoms of sleep apnea.
Don’t be afraid to ask your doctor about any sleep problem that leaves you fatigued, sleepy and irritable.
That’s it! You made it to the end!
Thanks for reading this far, I really appreciate it.😍😍😎
Did you think of something that is missing from this guide? Let me know in the comments — I would love to add it to this guide if you can think of it.
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