Why do I have insomnia?
The complaint of poor sleep is very common and is a common reason for consultation. This complaint can be caused by a multitude of medical and/or psychiatric illnesses, some medications and even primary sleep disorders themselves.
It is for this reason that it is very important to have your insomnia evaluated by a doctor specialized in sleep medicine in order to provide a specific treatment for each type of insomnia and not to fall into the temptation of self-medication or taking benzodiazepines prescribed by the general practitioner, since often what is achieved is to perpetuate the problem and therefore favor the appearance of medical, psychiatric and/or occupational consequences, thus increasing the risk of mortality. Remember that a good night’s sleep is good health and extends the years of life.
How is Insomnia defined?
The symptoms that define the symptom of insomnia, i.e. “the complaint of sleeping poorly”, is that, despite having the appropriate circumstances and the opportunity to sleep, there is great difficulty in falling or maintaining sleep and/or early awakening, which causes the person not to be rested and active the next day, providing a deterioration in social, occupational and / or behavioral functioning.
From this point on, when referring to insomnia, we will focus mainly on chronic insomnia disorder, leaving aside the insomnia that can be caused by snoring, sleep apneas, restless legs syndrome, circadian rhythm delay, circadian rhythm advance, sleepwalking, nightmares and/or REM sleep behavior disorder, among other medical or psychiatric illnesses and some medications.
From what moment is a person considered to suffer from chronic insomnia? Why?
Chronic insomnia is a sleep disorder according to the International Classification of the American Sleep Society (ICSD-3). The defining symptoms are that, despite having the appropriate circumstances and opportunity to sleep, there is great difficulty in falling or maintaining sleep and/or early awakening, which results in the person not being rested and active the next day, but that, in addition, there is no other primary sleep disorder to justify it.
A person is considered to suffer from chronic insomnia when he/she has been having the insomnia symptoms described above 3 or more days a week for more than 3 months and without getting more than 5-6 hours of sleep per night.
Between 10 and 15% of the adult population suffers from chronic insomnia, while about 50% of adults suffer from insomnia at some point in their lives, and 25-35% have had occasional or transitory insomnia, due to stress caused by various situations. Although insomnia is a very common sleep disorder, only 9% of people who suffer from it see a specialist.
If you want you can easily evaluate the degree of severity of your insomnia through this questionnaire.
Are some people more prone to suffer from chronic insomnia?
Chronic insomnia in people can be caused or facilitated by several reasons, either by age, sex, family history and genetics, environment or occupation (work), lifestyle, stress or worry about sleep.
- Age: Chronic insomnia can occur at any age, even in children, but your chances of getting it increase as you get older.
- Gender: Chronic insomnia is more common in women than in men. Feeling uncomfortable and experiencing hormone changes during pregnancy and menopause can cause sleep problems.
- Stress: Stress or worry about school or work, relationships, money, or the death of a loved one increases the risk of insomnia. Worrying about whether you will get enough sleep and monitoring the clock can also increase your risk of insomnia or make it worse.
- Family history and genetics: Genes can increase the risk of insomnia, as insomnia sometimes runs in families. Genes can also determine whether you are a deep or light sleeper.
- Environment or profession: the following choices can alter your sleep-wake cycle:
- Night shift or night work.
- Noise or light during the night
- Uncomfortably high or low temperatures
- Frequent travel to different time zones
- Lifestyle: Your lifestyle habits may increase your risk of having trouble sleeping.
- Following an irregular sleep schedule or changing your normal routine frequently.
- Experiencing interruptions in your sleep, such as waking often to care for a baby.
- Taking long naps frequently during the day.
- Getting too little physical activity during the day.
- Consuming caffeine, nicotine, alcohol, or illegal drugs.
- Watching television or using electronic devices close to bedtime.
What factors in our lives can influence the development of chronic insomnia?
As mentioned in the previous section, poor sleep habits can be the cause of chronic insomnia, so it is very important to know the hygienic sleep measures to prevent insomnia.
The hygienic sleep measures are:
- Always get up at the same time.
- A reasonable bedtime for your age.
- Relax at the end of the day.
- Light supper, avoiding excess of liquids and exciting drinks.
- Comfort in bed.
Moreover, if a person suffering from insomnia has applied the hygienic sleep measures for a month and the insomnia does not disappear, it could be a warning sign that your insomnia should be evaluated by a medical specialist.
In what way does our mind affect our insomnia (e.g. as yesterday I did not sleep and the day before yesterday I did not sleep either, today I think it will be the same and I become obsessed)?
Within chronic insomnia there is what we call the subtype of insomnia called psychophysiological insomnia, which is one in which there is real mental activation.
In psychophysiological insomnia people make an enormous effort to get to sleep, and to this end they try to relax, to concentrate on sleeping, they try to calm down with all their strength, but, paradoxically, they become anxious and desperate to achieve their goal. It is precisely this effort to sleep that prevents them from falling asleep. It is something similar to what happens when someone tells us to do everything possible not to think about a pink cat, most likely the opposite will happen and we will not be able to stop thinking about that cat. In the same way, if we try too hard to sleep, we will almost certainly not be able to get to sleep.
At this point, the person wonders if he/she will be able to fall asleep once and for all, but at the same time he/she dreads bedtime because he/she imagines an endless and anguishing night without sleep. At that moment thoughts appear related to the consequences of the lack of sleep: “I will feel bad, tomorrow I will not be able to perform, I will be in a bad mood all day…”. The situation begins to be perceived as more and more desperate and horrible. It is no longer seen as an isolated event, but as something that seems like it will never end. The uncertainty as to when she will be able to sleep again generates even more anxiety and distress.
Like a fish that bites its own tail, all these worries, anguish and discomfort caused by the very fact of not being able to sleep, aggravate insomnia even more and contribute to perpetuate it. What might have been just a few bad days can eventually turn into a serious sleep disorder.
How can we help someone in our environment who suffers from insomnia, and not become “desperate” trying to fall asleep?
There is not much that can be done on a companion level. The best thing to do would be to make the person aware of the need to see a medical specialist to start treatment for chronic insomnia.
The first choice treatment for chronic insomnia disorder is cognitive behavioral therapy, this treatment is a personalized and individualized treatment where different techniques are combined, such as time restriction in bed, stimulus control, sleep hygiene, but also and very importantly, relaxation and mechanisms to avoid the feedback of negative thoughts of sleep that have been discussed above are also worked on. All this to achieve 90% of significant improvement of sleep without medication and 70% can reach a total cure of the disorder.