Facts about Insomnia:
bad, but not hopeless.
As a doctor who has spent many sleepless nights on call, the facts about insomnia are a little scary for me personally. They did not teach us much about sleep when I was in medical school, but the field of sleep medicine has advanced quite a bit in 30 years. We know more now about insomnia causes, about the effect of insomnia on physical and mental health, and about how to treat this potentially serious problem. I also have a perspective from my training in Integrative Medicine that may be a little different than my conventional medical colleagues, so this page is definitely a holistic medicine angle on the problem.
Any discussion of the facts about insomnia must start with a definition first. Insomnia is not the same as sleep deprivation. Let me explain. Sleep deprivation is what I have experienced as a physician in practice, staying up nights at the hospital on-call, the pager going off in the middle of the night. So I didn’t sleep much, but you can bet if I had the chance I would have slept like a log! On the other hand, insomnia is the problem of not being able to sleep when you have the time and place to do so. A person with insomnia has the opportunity to sleep, but either has difficulty falling asleep, staying asleep, waking up too early, or finding that any number of hours of sleep are non-restorative (feeling tired and not well rested from the time you get up in the morning). And by definition, the sleep problem results in impairment of daytime function… you are not at your best when you have not slept well.
The next of the important facts about insomnia is the size of the problem. A recent survey of patients in primary care doctors’ offices found that 50% of patients reported at least occasional insomnia, and nearly one in five people reported it as a chronic problem. Another review of medical studies found that perhaps 10% of adults develop chronic insomnia with some decrease in daytime quality of life. It becomes more and more likely the older you get, so elderly people are especially vulnerable. And since you are reading this page, it may be you or someone you know very well who is suffering with poor sleep.
Sometimes the insomnia causes are not mysterious at all, such as occasional insomnia from travel (there’s nothing like your own bed right?), a noisy household, a family member or sleep partner who insists on a sleep environment you find uncomfortable, stress and worry, pain, or even the need to get up and use the bathroom. Other times, sleep may elude you even when everything seems just right.
Most people who suffer with this condition can tell you in an instant what is the effect of insomnia on their life. Low energy and fatigue, increased likelihood of accidents or errors in work, poor concentration, depressed mood or irritability, loss of motivation or ambition, headaches, abdominal pain, and a nagging worry that maybe again tonight you will not be able to rest well. And of course, that mind-racing worry and anxiety by itself then makes it harder to fall asleep again.
But worse than that, the effect of insomnia extends into health. Mental and emotional health is impaired for people with insomnia. Because of that and other reasons, they are less likely to excel and be promoted in the workplace and have lower overall achievement. Memory and balance are partially impaired for people with insomnia. People who suffer from chronic insomnia are more likely to experience high blood pressure and heart attacks, and to experience chronic pain.
So what are the most common insomnia causes? Short term, stress related or adjustment insomnia may be most common. This is the scenario of difficulty sleeping during a difficult time, even in anticipation of a happy event (have you ever been so excited you couldn’t sleep?) Poor sleep hygiene accounts for a large percentage of cases (see discussion of sleep hygiene on main insomnia page). And then there is the insomnia caused by medical conditions such as chronic pain, sleep apnea, gastroesophageal reflux with nighttime heartburn and cough, medications that interfere with sleep (they are many!), and use of substances such as alcohol before bed (even though it makes you sleepy, alcohol actually interferes with quality sleep). And sometimes, sleeping with someone who has trouble sleeping is the problem. If your sleep partner keeps you awake by tossing and turning, snoring and choking, getting up frequently, you both need for him or her to be treated!
This short overview is meant to be a simple introduction to the facts about insomnia. Addressing how to treat it can be found on other pages. I just hope that since you have gotten this far, that you will take the next step from learning the facts about insomnia to taking action and begin some strategies for yourself or your loved one to solve the problem.
For your health and wellness,
Robert Pendergrast, M.D.
