The Epidemic of Sleeplessness
Insomnia is incredibly common, with around 10% of the global population having chronic insomnia and roughly 30% experiencing acute insomnia symptoms. The DSM-5 defines insomnia disorder/chronic insomnia as “dissatisfaction with the quantity or quality of sleep for at least 3 nights per week for 3 months, associated with difficulty falling asleep, staying asleep, or early morning awakenings that lead to distress or impairment in daytime functioning”. Acute insomnia has the same symptoms, just for a shorter time period (anything under 3 months).
"Poor sleep" or acute insomnia can be caused by a variety of different things, including stress and stress-related conditions, travel/jet-lag, changes or disruptions to the sleep environment or sleep schedule, illnesses, surgical procedures, medications, the list goes on! Episodes of acute insomnia can either resolve or turn into chronic insomnia depending on its cause and how it’s managed. Meaning that managing acute insomnia is just as important as managing chronic insomnia. Chronic insomnia can be primary (meaning it has no obvious underlying cause or condition causing it) or secondary, where it occurs due to or as part of another condition.
Common Secondary Causes of Insomnia:
- Mental health conditions: depression, bipolar disorder, anxiety, PTSD
- Sleep disorders: OSA and other breathing conditions
- Neurological disorders: TBI, MS, restless leg syndrome, periodic limb movement disorder, Neurodegenerative diseases, etc.
- Substance use disorders and prescribed medication.
- Cardiovascular conditions, diabetes, COPD, chronic pain, malignancies, perimenopause/menopause, etc.
The Impact of Poor Sleep
Aside from the obvious and all too familiar feeling of fatigue that plagues us after a (or multiple) bad night's sleep, why do we care about insomnia? Sleep deprivation and Insomnia have numerous links to serious health conditions, including cardiovascular disease, diabetes, obesity, psychiatric conditions, accidents, lower quality of life, and overall increased morbidity.
Insomnia and The Brain
Sleep has a multitude of regulatory functions in the brain; when it is impaired, it can cause issues with neuroplasticity and stress-related immune pathways that have a negative impact on mental health conditions like depression, anxiety, and how we respond to stress in general. Insomnia can contribute to, occur alongside, or be a symptom of various mental health conditions. Research shows that improving sleep/managing insomnia improves mental health outcomes and experiences.
Brain fog is another common concern that comes along with poor sleep and fatigue. It has been shown that chronic insomnia impacts a variety of cognitive measures, including attention, episodic memory, memory retention, and problem-solving. On top of all of this, chronic insomnia is also considered to be a marker of cognitive decline and is linked to the development of neurodegenerative conditions. Specifically, a 2016 meta-analysis found that insomnia is associated with a 53% increase in dementia risk.
Additionally, sleep deprivation has negative effects on reaction speed, alertness, and decision-making skills while driving as well. One study found that 17-19 hours without sleep was equivalent to driving with a blood alcohol content of 0.05% with some of the response times being further impaired than those with this blood alcohol content. In the US between the years 2009-2013, drowsy driving was the cause of 21% of car accidents that resulted in the loss of a life.
Insomnia and The Body
The circadian rhythm and sleep are responsible for regulating elements of both the innate and adaptive immune systems. To such an extent that insomnia and sleep deprivation lead to an increased susceptibility to infections, including the common cold, herpes zoster, and pneumonia.
Beyond the immune system effects, insomnia is also associated with increased cortisol levels, impaired glucose metabolism, a higher rate of endothelial dysfunction, and elevated systolic blood pressure. All of these are risk factors of the development of cardiovascular diseases like hypertension and coronary artery disease. Supporting optimal sleep and treating insomnia is an essential piece of weight management programs that’s often missing. Additionally, sleep deprivation causes altered metabolic rates, which leads to more hunger and a decrease in insulin sensitivity, contributing not only to weight gain but also increasing the risk of developing diabetes.
In people who suffer from chronic pain, roughly 75-88% will also have sleep problems. Concurrently, in people suffering from both chronic pain and sleep problems, there is a greater pain severity and disability, longer duration of pain, decrease in physical activity, and higher rates of depression, anxiety, and suicidal ideation.
After multiple bad nights of sleep, anxiety and frustration about sleep and its side effects can start to build. With this can come negative beliefs about sleep and poor coping strategies that can ultimately result in the development of chronic insomnia. Luckily, there are effective evidence-based treatments for chronic insomnia, like CBT-I or medications.
Cognitive Behavioural Therapy for Insomnia
Cognitive behavioural therapy for insomnia (CBT-I) works on sleep behaviours to improve sleep onset, sleep drive and quality, and correct negative beliefs about sleep. It is generally recommended as a first-line therapy for chronic insomnia. Due to the high chance of side effects and issues with pharmaceutical sleep aids, CBT-I is often considered above them. CBT-I can be conducted in person or virtually and typically consists of an 8-week course, comprising 4 biweekly sessions. The program uses sleep diaries throughout to help with the initial evaluation, track progress, and personalize the experience.
The Five Main Components of CBT-I:
- Stimulus Control: Establish a positive relationship and association between sleep and bed to improve sleep scheduling and drive.
- Sleep Consolidation: Temporarily limiting time spent in bed to improve sleep efficiency and continuity by improving sleep drive.
- Relaxation and Mindfulness: Using various relaxation techniques (progressive muscle relaxation, breath work, guided imagery, etc) to decrease the arousal that is interfering with sleep.
- Cognitive Restructuring: Working with the negative thoughts and beliefs about sleep and insomnia to help make them more productive.
- Sleep Hygiene Optimization: Lifestyle and environmental adjustments that help to optimize sleep quality.
It is important to note that sleep hygiene can be an effective management strategy for acute insomnia, to improve sleep in general, and as a part of CBT-I for chronic insomnia. But alone, it is not an effective treatment for chronic insomnia.
Other Evidence-Based Sleep Supports
As with sleep hygiene, there are many other sleep supports and nutrients or herbs that are evidenced to support sleep and acute insomnia, but not to treat chronic insomnia. This can lead to hopelessness in people with chronic insomnia who feel like they have “tried everything” to no avail. Many of the nutrients, herbs, and lifestyle adjustments that are popular for sleep support either target arousal or help with the production of neurotransmitters involved in sleep.
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- Herbal support:
- Lavender
- Valerian
- Chamomile
- Nutraceuticals for sleep:
- Magnesium
- Zinc
- Melatonin
- L-Theanine + GABA
- Addressing underlying causes: Stress, low iron, anxiety, perimenopause, pain, etc.
- Herbal support:
- Sleep Hygiene
Improving sleep is essential for both your short-term and long-term health and well-being. Working up issues such as fatigue, brain fog, and other sleep-related issues is important to get the right support and treatments in place.
Let’s get to the bottom of what’s keeping you up at night.
Dr. Tia Patychuk, ND
Naturopathic Doctor in Vancouver
Helping you restore balance, energy, and resilience.
Disclaimer: This blog is for educational purposes only and does not replace individualized medical advice. If you're experiencing severe symptoms of burnout, depression, or anxiety, please consult a qualified healthcare provider.
