Insomnia is the most common sleep disorder in adults. Chronic untreated insomnia leads over time to exhaustion, reduced ability to concentrate, poor memory, low tolerance to frustration and small annoyances, and loss of enthusiasm. In the long term, insomnia is a risk factor for obesity and can affect the proper functioning of the cardiovascular system.
Symptoms and causes of insomnia
Insomnia and Obstructive Sleep Apnea Syndrome (OSAS)
How does lack of sleep affect us?
Restless sleep directly affects physical and mental health
How do we treat insomnia and sleep disorders?
Insomnia is caused by a number of psychological factors, some medical conditions, and medications, including other sleep disorders – such as obstructive sleep apnea syndrome (OSA). For people who suffer from insomnia, the good news is that insomnia is curable. Depending on the causes involved in the occurrence of insomnia and its type, it can be diagnosed and treated with the help of a doctor or through one’s own efforts, it depends on each case.
Symptoms and causes of insomnia
Insomnia refers to the inability to fall asleep or maintain sleep during the night so the person affected by insomnia will have a shallow, restless sleep. Insomnia is a medical condition that manifests itself regardless of the degree of fatigue, in many situations, people suffering from insomnia feel tired, but cannot fall asleep.
Symptoms of insomnia include:
- Difficulty falling asleep despite feeling tired
- Frequent awakenings during the night
- Difficulty falling back to sleep after night awakenings
- Restless sleep, even after a satisfactory number of hours of sleep, the person wakes up in the morning tired
- The need to take sleeping pills or drink alcohol to fall asleep
- Waking up too early in the morning
- Drowsiness during the day, fatigue, irritability
- Difficulty concentrating on daily activities, regardless of their nature (domestic, professional)
The causes of insomnia are multiple, they can coexist and influence each other:
- Stress, anxiety and depression are among the common causes of chronic insomnia. Trauma and physical or emotional abuse are significant risk factors. Also, some intense emotional states (anger, excessive worry) can cause acute insomnia to set in and/or increase chronic insomnia.
- The existence of some diseases can disrupt the quality of sleep: asthma, allergies, Parkinson’s disease, hyperthyroidism, gastroesophageal reflux disease (GERD), kidney disease, cancer, as well as chronic pain caused by various pathologies, for example arthritis.
- The administration of some medicines prescribed by the doctor: antidepressants, corticosteroids, thyroid hormones, medicines for high blood pressure, including some contraceptives.
- The existence of other sleep disorders – insomnia itself is a sleep disorder, but it can be caused by another untreated sleep disorder, for example, obstructive sleep apnea or restless legs syndrome.
Primary insomnia is not associated with other medical conditions. Secondary insomnia can be caused by some medical problems, such as those previously mentioned.
Insomnia and Obstructive Sleep Apnea Syndrome (OSAS)
Sleep apnea affects a large number of people and affects the quality of sleep. Loud snoring and episodes of stopping breathing during sleep are among the most well-known symptoms of OSA.
According to some investigations published in Sleep Medicine Reviews (2019), the coexistence of obstructive sleep apnea syndrome (OSAS) and insomnia causes deficiencies in terms of physical, mental, and emotional health and a low quality of life in general.
The diagnosis of obstructive sleep apnea often requires a multidisciplinary approach because it involves the evaluation of some clinical characteristics that belong to different medical specialties. Pulmonology consultation is the first step in establishing the diagnosis of Obstructive Sleep Apnea Syndrome (OSAP).
On a case-by-case basis, consultations and investigations with the ENT specialist may be necessary – in patients with obesity, short and thick neck (minimum 43 cm) – changes in the ENT sphere or at the cardiologist in situations where the patients have hypertension, medical history with myocardial infarction, cerebrovascular accident, atrial fibrillation.
Diabetologist or endocrinologist intervention may also be necessary for patients with diabetes and/or medical conditions such as hypothyroidism and acromegaly that favor sleep apnea.
Insomnia risk factors
The risk factors of insomnia can be divided into non-modifiable risk factors and risk factors that are more related to the lifestyle and certain habits of the person in question.
In the category of non-modifiable risk factors, age is included. Insomnia in the elderly is a common problem because the quality of sleep tends to decrease with age.
Also, women are more prone to insomnia, one of the explanations being the hormonal changes they go through during the menstrual cycle/menopause or during pregnancy.
Some studies claim that genetics has an important role in the manifestation of insomnia, several members of the same family can face insomnia.
The sphere of lifestyle factors includes:
- People who work in stressful environments and those who do not have a sleep routine either because they work night shifts or because they have an unbalanced lifestyle (improper diet, excess alcohol).
- Lack of habits conducive to sleep: going to bed at approximately the same time in the evening, drinking alcohol in the evening, consuming caffeine-based products and drinks in the second part of the day or in excess during the day, sleep (atypia) during the day can also interfere he with night sleep, hard-to-digest meals and foods with a high sugar content before bedtime, practicing sports at late hours or vice versa, sedentarism – lack of physical activity during the day.
- According to the American Academy of Sleep Medicine, people who have recently divorced, who have lost their life partner and who are facing financial problems are more prone to insomnia. Such major events are one of the causes of acute insomnia.
How does lack of sleep affect us?
Sleep is essential for the health and well-being of all people, regardless of age, sex, or nationality. Sleep disorders are increasing in many countries around the world, and their non-diagnosis, and lack of adequate treatment have serious consequences in the short and long term.
Insufficient sleep decreases performance and productivity and increases stress levels. In turn, stress damages the quality of sleep by favoring the onset of insomnia.
The effects of poor quality sleep also affect other aspects: drowsy driving increases the risk of serious car accidents and substance abuse. These are generally used to be able to maintain the work rhythm with the daily activities (domestic, social, etc.) in the absence of sleep.
Restless sleep directly affects physical and mental health.
Sleep problems can occur in any person throughout life: when stressful situations arise (exams, moving house, divorce), the work schedule in a certain period is over-demanding, the trips are long and the time zone change is significant. These can interfere with your ability to get restful sleep. When such episodes occur regularly and negatively influence daily activities, impacting mood, ability to concentrate and health in general, then it may be a sleep disorder.
What are sleep disorders?
Insomnia is the most widespread sleep disorder in adults. According to the International Classification of Sleep Disorders (2014), the most important sleep disorders can be ranked as follows:
- Acute/subacute insomnia (short duration)
- Chronic insomnia (month-long)
- Central sleep apnea, obstructive sleep apnea, hypoventilation and other respiratory disorders that do not allow restful sleep
- Hypersomnolence, includes several conditions such as narcolepsy, Kleine-Levin Syndrome, Chronic Sleep Deprivation Syndrome and others
- Circadian rhythm disorders – for example, those caused by time zone differences during travel, by jobs that involve working in shifts, and others
- Parasomnias, as in the case of night terror, better known as nocturnal terror, sleepwalking, sleep paralysis, etc.
- Motor sleep disorders – for example: Restless legs syndrome (Willis Ekbom disease), bruxism, the consumption of certain drugs and the presence of other conditions associated with motor disorders
How do we treat insomnia and sleep disorders?
Depending on the causes involved in the onset of insomnia and sleep disorders in general, the treatment may consist of:
- The administration of adjuvants such as melatonin, especially indicated for patients who have problems falling asleep, but who can later maintain an uninterrupted sleep
- In case of chronic insomnia associated with health problems, the treatment is recommended by the specialist doctor (depending on the existing pathology) and addresses the respective condition directly to be kept under control – allergy, asthma, obstructive sleep apnea
- In the case of patients with chronic insomnia without association with other medical conditions, a complex consultation is indicated. The American Academy of Sleep Medicine recommends a medical examination in order to eliminate suspicions related to the presence of some diseases, an anamnesis that includes the patient’s medical history, including psychiatric history. For patients with chronic insomnia, drug treatment, cognitive-behavioral therapy or mixed treatment: pharmacological and cognitive-behavioral therapy are prescribed
- Sleeping pills, antidepressants and antihistamines are administered on the doctor’s recommendation
- Meditation, exploring some relaxation techniques can produce effects in treating insomnia, especially if it is determined by the existence of stressful experiences, major changes that involve strong emotions and feelings
Sleep medicine is a medical super specialization. Research in this field has intensified in the last decade and a half, as more and more people from all over the world complain of difficulty falling asleep and maintaining uninterrupted sleep. Today, the effects of disturbed, restless sleep are being investigated at the cellular and subcellular level, as well as the effects of sleep deprivation on the entire body: at the metabolic level, in gene expression and on hormonal regulation.
Insomnia and sleep disorders are medical conditions that require diagnosis and treatment in order not to generate other health problems and to maintain the quality of life.
References:
- Poor Sleep Challenging the Health of a Nation, M.E. Wells & B.V. Vaughn https://www.tandfonline.com/doi/abs/10.1080/21646821.2012.11079859
- Management of Insomnia, D.J. Kupfer, M.D., and C.F. Reynolds https://www.nejm.org/doi/full/10.1056/nejm199701303360506
- Hyperarousal and insomnia, M.H. Bonnet, D.L. Arand https://www.sciencedirect.com/science/article/abs/pii/S1087079297900125
- Insomnia, Sleep Foundation https://www.sleepfoundation.org/insomnia
- Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults, American Academy of Sleep Medicine https://jcsm.aasm.org/doi/10.5664/jcsm.27286
