February 4, 2010: Idea/Research Post

My insomnia has gotten worse and worse as I have gotten older. It's funny how I never thought back far enough to examine my sleep habits. It seems upon closer examination that I have had a problem sleeping from a very tender age. For as long as I can remember I have absolutely positively resisted sleep. When I was a young child, putting me to bed was absolutely futile, as I would sneak out of my room and tiptoe down the stairs and hide out behind the sofa watching television with my mother and father without ever being noticed. The millisecond that I heard the click of the TV turn off, I was literally racing up the stairs (in complete silence) into my bed to feign sleep when my mother and father came in to check on me. I would wait another hour or so until they were asleep and I would sneak into their rooms in hopes that in their presence I could find sleep...

One of my most vivid memories was one night coming downstairs after literally just being tucked into my bed. I heard faint screams coming from the television and my interest was instantly piqued. I came downstairs and hid behind my favorite chair that was situated in our living room directly behind the den in our first house. All I remember seeing was blood everywhere in the water and boats and beaches and screaming and panic. I was absolutely horrified by what I heard and saw that night and it haunted me for what seemed like ages after that evening. We all know the film well...it was Stephen Spielberg's Jaws. Needless to say, I slept with my parents for what seemed like the next 2 years...

If I could have it my way I would sleep all day and be up all night. At around 11pm-1am I get this tremendous surge of energy that keeps me awake into the wee hours of the morning. My level of productivity during this time is sky high, but when I am actually supposed to be awake, alert and working during the daytime all I want to do is sleep. This is a problem.

Insomnia definition according to www.wikipedia.com:

Insomnia is a symptom^[1] which can accompany several sleep, medical and psychiatric disorders, characterized by persistent difficulty falling asleep and/or staying asleep despite the opportunity. Insomnia is typically followed by functional impairment while awake. Both organic and non-organic insomnia without other cause constitute a sleep disorder, primary insomnia.^[2] One definition of insomnia is "difficulties initiating and/or maintaining sleep, or nonrestorative sleep, associated with impairments of daytime functioning or marked distress for more than 1 month."^[3]

According to the United States Department of Health and Human Services in the year 2007, approximately 64 million Americans regularly suffer from insomnia each year.^[4] Insomnia is 1.4 times more common in women than in men.^[5]

Types of insomnia

Although there are several different degrees of insomnia, three types of insomnia have been clearly identified: transient, acute, and chronic.

1. Transient insomnia lasts from days to weeks. It can be caused by another disorder, by changes in the sleep environment, by the timing of sleep, severe depression, or by stress. Its consequences - sleepiness and impaired psychomotor performance - are similar to those of sleep deprivation.^[6]
2. Acute insomnia is the inability to consistently sleep well for a period of between three weeks to six months.^[7]
3. Chronic insomnia lasts for years at a time. It can be caused by another disorder, or it can be a primary disorder. Its effects can vary according to its causes. They might include sleepiness, muscular fatigue, hallucinations, and/or mental fatigue; but people with chronic insomnia often show increased alertness. Some people that live with this disorder see things as if they are happening in slow motion, wherein moving objects seem to blend together. Can cause double vision.^[6]

[edit]Patterns of insomnia

1. Onset insomnia - difficulty falling asleep at the beginning of the night, often associated with anxiety disorders.
2. Middle-of-the-Night Insomnia - Insomnia characterized by difficulty returning to sleep after awakening in the middle of the night or waking too early in the morning. Also referred to as nocturnal awakenings. Encompasses middle and terminal insomnia.
3. Middle insomnia - waking during the middle of the night, difficulty maintaining sleep. Often associated with pain disorders or medical illness.
4. Terminal (or late) insomnia - early morning waking. Often a characteristic of clinical depression.

[edit]Insomnia versus poor sleep quality

Poor sleep quality can occur as a result of sleep apnea or clinical depression. Poor sleep quality is caused by the individual not reaching stage 4 or delta sleep which has restorative properties. There are, however, people who are unable to achieve stage 4 sleep due to brain damage who lead perfectly normal lives.

Sleep apnea is a condition that occurs when a sleeping person's breathing is interrupted, thus interrupting the normal sleep cycle. With the obstructive form of the condition, some part of the sleeper's respiratory tract loses muscle tone and partially collapses. People with obstructive sleep apnea often do not remember awakening or having difficulty breathing, but they complain of excessive sleepiness during the day. Central sleep apnea interrupts the normal breathing stimulus of the central nervous system, and the individual must actually wake up to resume breathing. This form of apnea is often related to a cerebral vascular condition, congestive heart failure, and premature aging.

Major depression leads to alterations in the function of the hypothalamic-pituitary-adrenal axis, causing excessive release of cortisol which can lead to poor sleep quality.

Nocturnal polyuria, excessive nighttime urination, can be very disturbing to sleep.^[8]

[edit]Signs and symptoms

A survey of 1.1 million residents in America conducted by the American Cancer Society found that those who reported sleeping about 7 hours per night had the lowest rates of mortality, whereas those who slept for fewer than 6 hours or more than 8 hours had higher mortality rates. Getting 8.5 or more hours of sleep per night increased the mortality rate by 15%. Severe insomnia - sleeping less than 3.5 hours in women and 4.5 hours in men - also led to a 15% increase in mortality. However, most of the increase in mortality from severe insomnia was discounted after controlling for comorbid disorders. After controlling for sleep duration and insomnia, use of sleeping pills was also found to be associated with an increased mortality rate.

The lowest mortality was seen in individuals who slept between six and a half and seven and a half hours per night. Even sleeping only 4.5 hours per night is associated with very little increase in mortality. Thus mild to moderate insomnia for most people is associated with increased longevity and severe insomnia is only associated with a very small effect on mortality.

As long as a patient refrains from using sleeping pills there is little to no increase in mortality associated with insomnia but there does appear to be an increase in longevity. This is reassuring for patients with insomnia in that despite the sometimes unpleasantness of insomnia, insomnia itself appears to be associated with increased longevity.

It is unclear why sleeping longer than 7.5 hours is associated with excess mortality.^[9]