Causes and Effects of Insomnia - Research Paper Example

Soon I ceased to sleep altogether, an attack of insomnia set in, so terrible that it nearly made me go off my head. Insomnia does not kill its man unless he kills himself sleeplessness is the most common cause of suicide. But it kills his joie de vivre, it saps his strength, it sucks the blood from his brain and from his heart as a vampire. It makes him remember during the night what he was meant to forget in blissful sleep. It makes him forget during the day what he meant to remember… Voltaire was right when he placed sleep in the same level as hope. - Axel Munthe, physician and life-longer sufferer of Insomnia (as cited in Lavie, Pillar, & Malhotra, 2002). A few years ago, I endured a terrible bout of insomnia. It seemed like, one day, out of nowhere, my body forgot how to fall asleep, and nothing I did changed the dreadful situation. In the beginning, I thought my nights awake were random, isolated incidences; however, as the days, weeks, and months dragged on with not much more than two or three hours of uninterrupted sleep a night, I became a hallow shell of myself. Once vibrant, energetic, and cheerful, the strain of not sleeping completely changed my character, and adversely affected my ability to be productive. During that period, I was physically and psychologically exhausted, I constantly felt anxious and depressed, my level of patience completely disappeared, and my ability to endure the length and challenges of my day was bolstered by an endless stream of caffeine in whatever form I could get my hands on. However, the maddening part of insomnia is that, the more stress and anxiety an individual feels, or the more caffeine a person ingests negatively contributes to heightening and lengthening the duration of sleep disturbances; in effect, my desperate, daily attempt at trying to stay awake further exacerbated my inability to sleep at night, which demanded stronger daily “fixes”. The seemingly endless cycle of insomnia and caffeine was wreaking havoc on my emotional and physical self; so, finally, I decided to consult a physician in the desperate hope that he would take pity on me and prescribe me sanity in the form a sleeping pill. However, after hearing my story, the physician refused to prescribe me any pharmaceutically induced sleep until I had made a concerted effort to sit down and try to figure out the causes of why I simply could not fall asleep. Infuriated by his apparent refusal to help, I left with the intention of going to the free clinic the next day to get a prescription for sleeping pills; however, something in our meeting compelled me to sit down that evening and sincerely take inventory of my life. In the end, I learned that the causes of insomnia are a lot more complicated than drinking too much coffee, and I also learned that solving insomnia involves dealing with those causes, rather than relying on the quick and, at times, detrimental short term solution of sleeping pills. In the United States, approximately 30 to 33 percent of the population endures sporadic sleep disturbances, with approximately 12 percent of the population experiencing chronic insomnia (Milner & Belicki, 2010). The Diagnostic and Statistical Manual of Mental Disorders defines insomnia as follows: “a complaint of difficulty initiating or maintaining sleep or of nonrestorative sleep that lasts for at least 1 months (Criterion A) and causes clinically significant stress or impairment in social, occupational, or other important areas of functioning” (as cited in Milner & Belicki, 2010). Although this definition serves as an excellent starting point, it does not take into account sleep disturbances caused by substance or health conditions, or the effect of mental disorders on sleep patters. Therefore, the International Classification of Sleep Disorders (ICSD) suggests adding a third criterion to the official definition, which includes psychophysiological insomnia, idiopathic insomnia, and insomnia caused by psychiatric disorders (Milner & Belicki, 2010). In addition, the conventional classification of insomnia is problematic because the categories included are often age-specific sleep habits, and thus do not legitimately separate regular age-related sleep patters from bouts of insomnia, and the classifications involve significant overlaps, which makes analyzing each category as an independent component increasingly more difficult. In response to these concerns, Hauri (2000) argues that insomnia should be divided into categories based on duration, including “transient (a few days), short-term (weeks), or chronic (months and years).” In the end, sleep specialists reach the following consensus: sleep disorders may be instigated by common causes which may produce common symptoms or effects; however, each patient suffering from insomnia is a unique case that represents a unique combination of psychopshysicological factors, which requires a course of action (or intervention) that is tailored to the uniqueness of the situation. Prior to engaging in a discussion of the causes and effects of insomnia, it is important to understand the concept of sleep, and the affect of age on sleep patters. When it comes to sleep, there seems to be an endless string of questions about why certain people fall asleep faster than others, why adults need less sleep than children, why physiological changes (puberty, menstruation, and pregnancy) alter sleep patters, etc. However, as sleep science and medicine is considered a relatively new field, even the specialists within the field are still attempting to provide suitable answers to the questions above. Interestingly, prior to the 19th century, physicians equated sleep with death and, in the seminal text, the Philosophy of Sleep (1830), Doctor MacNish argues that “sleep is the intermediate state between wakefulness and death: wakefulness is regarded as the active state of all the animal and intellectual functions and death as that of their total suspension” (as cited in Kryger, 2004). However, this opinion changed when, in the 20th century, it was discovered that the brain remained active, even during sleep. It was during the last half the century in which physicians discovered three states of consciousness, including non-REM (rapid eye movement) sleep, REM sleep, and wakefulness; and non-REM sleep was further subdivided into four categories, in which each subsequent stage is defined by bigger and slower brainwaves, which contribute to deeper levels of sleep (Kryger, 2004). As an evolutionary trait, we are awakened briefly, several times throughout the night, to ensure unobstructed breathing; however, these “arousals” are so brief that we rarely remember them. However, insomniacs experience arousals more frequently and for longer durations than normal sleepers, which significantly hinders their ability to achieve deeper levels of high-quality sleep (Kryger, 2004). The quality and duration of sleep is dependent on the age of the individual; older people tend to require less sleep than younger people to function at the same capacity (Milner & Belicki, 2010; Jacoby & Youngson, 2005; Kryger, 2004). In addition, sleep should not be quantified in terms of time slept, but in the quality of the sleep received because, as each individual is unique, the need for sleep can range anywhere between a couple of hours of quality sleep to ten hours of sleep a night in order to function properly during states of wakefulness. However, adults complaining from chronic fatigue syndrome as a result of sleep disruptions should be taken seriously; older people may require less sleep, but they require the same quality of sleep that younger people need. Milner & Belicki (2010) argue that insomnia is particularly paralyzing for adults because the causes of insomnia in this age demographic is usually exacerbated by psychological issues, such as stress, anxiety, excessive worrying, and depression; “later-life insomnia is a concern because, if left unmanaged, it is related to poor health, depression, angina, limitations to activities of daily living, and long-term use of sedative, or hypnotic, drugs.” The cycle of psychological issues negatively contributing to insomnia, and vice versa, is heightened in this age demographic, as worries about money, marriages, and families take a heavier toll on the individual’s wellbeing. It is common knowledge that we need to sleep, but why do we need to sleep? All animals need sleep, and prolonged periods without sleep can result in death. Some of the common reasons for why people need sleep include the “conservation of energy, the restoration of important bodily functions, and the repair of damaged tissues” (Kryger, 2004). Although no consensus has been reached about the exact reason why the human body needs sleep (as opposed to rest), sleep specialists all agree that existing in a state of perpetual sleep deprivation is dangerous in all aspects of one’s life, especially when completing tasks that require a level of skill and attention, such as driving, cooking, childcare, etc. In addition, as mentioned previously, there is no perfect number of hours of sleep that will ensure maximum restfulness; sleep requirements depend on a myriad of factors that are unique to a particularly group, such as age or gender considerations, and, furthermore, unique to each individual in that group. For example, a woman in her forties may require one, two, or three more hours of sleep than her female peers simply because of the physiological composition of her body. In the end, the body provides clues as to whether the individual is receiving a sufficient amount of sleep; if, upon waking up, the person feels refreshed and able to face the day without the use of stimulants (coffee or caffeine substitutes), an optimal amount of sleep has been achieved (Kryger, 2004). The three most common types of sleep disturbances are psychophysiological insomnia, idiopathic insomnia, and insomnia induced by psychiatric disorders. In the first case, patients experience acute levels of stress, which precipitates insomnia; in turn, the stress associated with not sleeping heightens their daily stress, which inevitably reinforces insomnia. In these cases, insomnia tends to be transient or short term, consisting of a few days or weeks, and patients can be reconditioned to sleep routines through stimulus control therapy, which reinforces bedroom rituals or proposes an alternative sleeping location that may “alleviate some of the cues to which the patient has become conditioned, and thus relieves the associated anxiety” (Lavie, Pillar, & Malhotra, 2002). This type of insomnia also takes circadian rhythm abnormalities into consideration, which states that advanced sleep phase syndrome, delayed sleep phase syndrome, jet lag, and shift work are all significant causes of insomnia. However, these situations also benefit from stimulus control therapy; if the routine is changed and enforced through continuous action, the individual’s body will relearn how to sleep at more appropriate times and for longer durations of time. In the second case, involving idiopathic insomnia, the patient demonstrates chronic sleep disruptions as a result of chronic diseases. The first cause contributing to idiopathic insomnia is poor sleep hygiene, which may involve consuming excessive amounts of caffeinated beverages or substances, participating in vigorous physical activity close to bedtime, working in a night-time profession that is highly stressful or excitable, or taking frequent naps during the day. These problems can be further exacerbated by alcohol consumption, falling asleep to the television or the radio, and sleeping in an uncomfortable environment that may be temperature related. The second cause of idiopathic insomnia are chronic medical disorders, such as restless leg syndrome, eating disorders, chronic pain (ex: arthritis), breathing disorders (ex: asthma), movement disorders (ex: Parkinson’s disease) and neurological diseases (ex: epilepsy). (Lavie, Pillar, & Malhotra, 2002)­. The final type of insomnia may be a result of psychiatric disorders. Patients suffering from schizophrenia, Alzheimer’s disease, post traumatic stress disorder, and several other anxiety and panic related disorders affect the quality of sleep achieved. This is also further complicated by prescription medicines which, as a side effect, may reduce the length or affect the quality of sleep by altering non-REM and REM state sleep patters (Lavie, Pillar, & Malhotra, 2002). The most devastating effect of insomnia is chronic fatigue syndrome (CFS) which can cause the individual to feel like they are living in a zombie-like, half conscious and half unconscious state of existence. In his article on the connection between insomnia and CFS, Abdel-Khalek (2009) highlights the detrimental consequences of sleep deficiencies: Poor sleep results in impaired performance, is a precursor to many injury accidents, impairs tissue healing, alters the immune system, and in some cases may herald early onset of psychiatric impairment, particularly major depression. … Comparisons of subjects (Ss) with and without insomnia show that those with insomnia exhibit the following effects: excessive daytime sleepiness, slower physical reaction times, fewer job promotions, more likelihood of incurring traffic/occupational accidental injuries, at least two times more health care provider visits, poor attention, memory impairment, problem-solving abilities, reduced social stability, 10 times higher absentee rate days from work, higher number of medical problems, and higher hospitalization rates. Abdel-Khalek (2009) argues that CFS involves an interaction between physiological, psychological, and sociocultural factors, and it deserves to receive serious attention from the medical community, especially when it can significantly hinder the individual’s ability to complete necessary personal and professional tasks. However, the studies on sleep disturbances are still not accorded the level of seriousness they deserves. Although there are several causes that require additional medical assistance, especially in the cases of chronic disease related insomnia, there are several at-home treatment suggestions that can provide relief from transient or uncomplicated bouts of insomnia. Some simple remedies include limiting caffeine consumption, avoiding daytime naps, getting a sufficient amount of fresh air and exercise several hours before sleep, maintaining a consistent sleep routine, ensuring that the sleeping environment is at a suitable temperature, and consuming hot beverages before bedtime (Jacoby & Youngson, 2005). In addition, for more complicated causes of insomnia, medication, such as sleeping pills, may be prescribed, which include hypnotic and antidepressant drugs. These prescription drugs may be complemented, or substituted with psychological approaches to the treatment of insomnia, which may incorporate such procedures as sleep restriction, stimulus control, cognitive restructuring, paradoxical intention, and relaxation therapy (Milner & Belicki, 2010). Finally, Espie (2002) conducted an interesting study on the negative impact of dysfunction thinking on sleep patterns, in which insomniacs were found to have more negative thoughts than normal sleepers. In this case, perhaps the best medicine is following the old adage, “don’t worry, be happy.” In conclusion, sleep is a central feature of the human experience. The average person spends approximately one-third of their life sleeping; therefore, sleep disturbances should not be brushed off as trivial and temporary. Chronic insomnia adversely affects a person’s physical and psychological health and their performance levels. In cases of complicated, or disease-related insomnia, further medical intervention (in the form of drugs or treatment) may be required; however, sleep specialists urge patients suffering from uncomplicated or transient insomnia to try to, first, ascertain the causes of insomnia before they reach for the sleeping pill bottle. In the end, dealing with the causes will provide the long-term benefits of quality sleep, rather than the short term benefit of medicine-induced sleep. References Abdel-Khalek, A. M. (2009). The Relation between Insomnia and Chronic Fatigue among a Non-clinical Sample Using Questionnaires. Sleep and Hypnosis, 11(1), 9+. Retrieved December 25, 2010, from Questia database: http://www.questia.com/PM.qst?a=o&d=5045043044 Espie, C. A. (2002). Insomnia: Conceptual Issues in the Development, Persistence, and Treatment of Sleep Disorder in Adults. 215+. Retrieved December 25, 2010, from Questia database: http://www.questia.com/PM.qst?a=o&d=5000597819 Hauri, P. J. (2000). The many faces of insomnia. In D. I. Mostofsky & D. H. Barlow (Eds.), The management of stress and anxiety in medical disorders (pp. 143-159). Needham Heights, MA: Allyn & Bacon. Jacoby, D. B., & Youngson, R. M. (2005). Insomnia. Encyclopedia of Family Health (3rd ed.) (Vol. 7) (pp. 957-959). New York: Marshall Cavendish. Retrieved December 25, 2010, from Questia database: http://www.questia.com/PM.qst?a=o&d=116093699 Kryger, M. H. (2004). A Woman's Guide to Sleep Disorders (pp. 3-14). New York: McGraw-Hill. Retrieved December 25, 2010, from Questia database: http://www.questia.com/PM.qst?a=o&d=116766786 Lavie, P., Pillar, G., & Malhotra, A. (2002). Sleep Disorders: Diagnosis, Management and Treatment : a Handbook for Clinicians. London: Martin Dunitz. Retrieved December 25, 2010, from Questia database: http://www.questia.com/PM.qst?a=o&d=108777323 Milner, C. E., & Belicki, K. (2010). Assessment and Treatment of Insomnia in Adults a Guide for Clinicians. Journal of Counseling and Development, 88(2), 236+. Retrieved December 25, 2010, from Questia database: http://www.questia.com/PM.qst?a=o&d=5042134745 Read More