Psychological Services

Insomnia: What it is and How You Can Manage it?

Insomnia means that it takes you longer than twenty minutes to fall asleep; (usually hours), that your sleep is different every night (taking one, two or even three hours to get to sleep) and that once you sleep you may either wake up or have micro arousals. Micro arousals are when you move to a higher stage of sleep but you remain unaware of this as you do not wake up. Typically people with insomnia actually do sleep but report either unfreshed sleep or that they have not slept at all because their sleep is so poor. They may report that they hear everything at night because they do not move into a deep sleep.

To further explain, there are four sleep stages:

Stage 1: This is the lightest stage of sleep and if you spend a lot of time in this stage you will feel like you did not sleep at all.

Stage 2: This is where we spend most of our time in sleep, it is deeper but still rather light and you can be easily awakened.

Stage 3 and 4: People will have a hard time awakening you from this stage of sleep, this is the restorative sleep for the body and if you get enough of this sleep you wake up feeling strong, refreshed and peppy. We get less of this sleep as we age.

REM: This is the restorative sleep for the brain and this sleep remains constant throughout the lifespan occupying roughly 20 to 25 percent of our sleep. This is our dream sleep and you can be easily awakened from this sleep but will feel refreshed due to the rest your brain received.

There are two things that influence how sleepy you feel during the day:

  1. Sleep-Wake Balance Process S: How long it has been since you last slept; the longer you stay awake the sleepier you become.
  2. Circadian Rhythm Process C: Your body’s biological clock; the natural timing system which tells you when to sleep and when to be awake.

It is Process C that results in your becoming sleepy in the afternoon where your body temperature drops. So if you have not had enough sleep you become really sleepy during this time. This is why accidents tend to occur when sleep has been of this quality. If you manage to get through that time period then you will find renewed energy and you are not tired until the next big drop in your core body temperature between 11:00 and 12:00 that evening. At that time your core body temperature drops, melatonin kicks in signaling that it is time to go to sleep. It is the Process C that provides for hormones to be released during sleep. If you have insomnia and awakenings that disturb your ability to go into deep sleep then these hormones cannot be released. The awakenings when you actually wake up or the times when you move to a higher stage of sleep, micro arousals, that you are not aware of, both contribute to poor restorative sleep. This means not getting enough REM or stage 3 and 4 to restore the brain and the body. Recent research is showing that learning takes place during stage 3 as well. So you can see that the presence of insomnia can cause a lot of disruption both at night as well as continuing to negatively affect you during the day.

What are the consequences of poor sleep?

  • Insomnia is emerging as a problem affecting all ages, increasing by 5% each year.
  • One-half of elderly population diagnosed with insomnia, affects the ability to age gracefully.

As a result of poor sleep there may be increased:

  • Irritability
  • Problems with attention and concentration
  • Short term memory difficulties including word retrieval (can’t find the word)
  • It is easier to make mistakes
  • Increased distractibility
  • Increased feeling of stress
  • Everything bothers you
  • Feeling tired and fatigued
  • Loss of energy
  • Mood and emotional changes
  • Depression
  • Loss of motivation
  • Low blood sugar
  • Insulin resistance syndrome making it more difficult to lose weight
  • Risk of Type 2 Diabetes
  • Weight gain
  • Impulsivity
  • Increased anger and aggressiveness
  • Increased falls and accidents

There was a recent study done that found the following statistics regarding women and sleep:

  • 31% reported daytime problems of sleep disturbance
  • 25 % reported significant daytime sleepiness
  • 27% reported impaired job performance
  • 24% report impaired ability to care for their family
  • 14% reported falling asleep while driving
  • 53% experienced insomnia in the past month
  • 31% used medication to remain alert during the day
  • 86% of working women reported fatigue and exhaustion
  • 60% reported difficulty sleeping

Women tend to have more symptoms of insomnia during times of PMS and/or menopause. See the article; Women and Sleep on this website for more information.
Research is telling us that long term insomnia can eventually lead to dementia; that there is a big interaction between aging gracefully, sleep and overall health. Poor sleep can result in increased immune system problems, obesity and vascular markers.

Sleep does change with age leaving the elderly at risk for more bouts of insomnia. The elderly have:

  • More awakenings and arousals during sleep
  • Decreased REM sleep
  • (Probably) decreased SWS
  • Increased stage shifts
  • Fewer “cycles” of sleep
  • Overall reduced sleep efficiency
  • They may have Phase Advancement which means falling asleep early in the evening and then waking up in the wee hours of the morning.

Statistics tell us that about fifty percent of the elderly have insomnia; that women in particular are more likely to experience insomnia. Finally, that insomnia in the aged population can lead to more depression, respiratory symptoms, poor health, problematic sleep habits and way too much time in bed. The elderly are more at risk for insomnia due to the natural changes in their sleep as well as events that occur in their life such as illness (themselves or their spouse) widowhood, and adjustment to different living circumstances.

Insomnia issues:

  • Problematic sleep habits
  • Irregular sleep wake schedule
  • Too much time in bed: TIB
  • Falling asleep to the radio/TVs
  • Trying too hard to get to sleep
  • Clock watching
  • Long awakenings

An insomnia survey reported the following:

  • 25 percent of the U.S. population meet diagnostic criteria for insomnia
  • 60 percent of the population have sleep maintenance insomnia
  • 40 percent have early morning awakening insomnia
  • 10 percent have pure non-restorative sleep
  • In the total U.S. population 40 percent have some difficulty with sleep at night
  • 14 percent of the American population report daytime sleepiness
  • 10 percent reported daytime attention, concentration and memory problems
  • 16 percent reported daytime fatigue
  • The reduction of one hour in children results in a threefold risk factor for increased weight and being overweight, if under 3 years of age there is a risk factor for obesity at age 7 years

Treatment approaches for insomnia:

  • Rule out other sleep disorders contributing to insomnia.
  • Specific behavioral programs to address misperceptions about sleep; the anticipatory anxiety that develops, unrealistic sleep expectations and worry about sleeping.
  • Separate out all of the variables surrounding the diagnosis of insomnia.
  • Address effects of napping.

We have an excellent treatment team at our facility that is having great success in treating insomnia from a behavioral perspective. See the article on Non-Medical Treatment for Sleep Disorders.