Insomnia: The Hidden Costs of Poor Sleep

By May 31, 2018 Uncategorised
Insomnia is a common problem for people of all ages, with a number of people suffering from an inability to sleep.  Based on estimates derived from population-based studies, approximately 30% of adults worldwide report symptoms of insomnia: difficulty initiating or maintaining sleep, waking up too early or poor quality of sleep.  Common comorbidities associated with insomnia are psychiatric disorders, with an estimated 40% of all insomnia patients experiencing a coexisting psychiatric condition.  Among these psychiatric disorders, depression is the most common, and insomnia is a diagnostic symptom for depressive and anxiety disorders.

“We as a society are losing sleep because we are working too hard, and it’s causing a variety of health concerns. We often don’t even think about sleep or consider it important. However, there is nothing more important than sleep. We need to focus on therapies that can help you have quality sleep, not just sleep.” – Mahesh Thakkar, MU School of Medicine’s Department of Neurology, PhD

Several well-identified risk factors for insomnia have been identified, including: age, gender, shift work and comorbid medical conditions.  Both women and older adults tend to experience insomnia with greater prevalence than other demographic groups.  A partial decline in functionality of sleep control systems and coexisting medical conditions are believed to be significant contributors to the increased prevalence of insomnia in the elderly. Additionally, in women, insomnia is more prevalent with both the onset of menopause.  In addition, working rotating shifts represent significant risks for insomnia.
The presence of these factors do not cause insomnia, but can precipitant insomnia in individuals predisposed to this disorder. For others, their insomnia has no recognizable source. For people suffering from insomnia, medically induced sleep is a possibility through medications such as Trazodone, which was initially developed as an anti-depressant but has a secondary use as an insomnia treatment. Trazodone has never been proven successfully in studies to be effective for insomnia, but many patients self report that the drug works for them. 
The side effects of some sedatives and depressant medications can be challenging for patients. Ambien, one of the most common sleep aids, comes with side effects that can be seriously debilitating — as well as the potential for abuse. Somnambulism, colloquially known as sleepwalking is one of the common side effects of sleep medications. However, somnambulism is not limited to walking while sleeping. People taking sedating drugs have been known to cook while in a state of unconsciousness, wander out of their homes and even drive while incapacitated.
For people who wish not to use medical sleep aids because of the potentially debilitating side effects, there are alternative treatments.  Melatonin is one well known way to treat insomnia — and a well studied one. Researchers currently believe that melatonin interacts with MT1 receptors to increase feelings of tiredness and signal to the brain that it’s time to sleep.
A lesser known therapy known as repetitive transcranial magnetic stimulation (rTMS) can be utilized for insomnia as well. rTMS is an electroconvulsive therapy alternative, which has had record success in studies thus far.  rTMS works to stimulate the brain with low levels of electricity, thereby increasing alpha wave activity.  rTMS therapy is used not only for treatment of insomnia, but also of anxiety and depression — which can cause insomnia.
While it is an alternative to electroconvulsive therapy, which is a controversial and sometimes dangerous treatment for a number of psychiatric disorders, rTMS has been shown to be incredibly safe so far. Unlike electroconvulsive therapy, there is no anesthesia required, no medical supervision needed and it is easily accessible to the average person, with little to no recovery time required after treatment.
For another insomnia treatment, forehead cooling is another method of inducing sleep. Cooling the forehead has been shown to reduce metabolism in the frontal cerebral cortex, which induces feelings of tiredness. A potential ideal temperature to be used in forehead cooling is somewhere between 57 and 61 degrees Fahrenheit, as demonstrated in a double blind study.  The study showed that forehead cooling helped patients to fall asleep faster, but was inconclusive on whether or not it helped patients to maintain a higher quality of sleep.
Since many people experience racing thoughts and worries that prevent them from sleeping, cognitive-behavioral therapy (CBT) can be effective in addressing insomnia.  CBT is a form of psychotherapy that treats problems by modifying patterns of behavior, which in turn affect negative thoughts.  CBT is remarkably accessible and can be conducted individually, in a group, or online. A study at Harvard Medical School found that CBT was more effective at treating chronic insomnia than prescription sleep medication—but without the risks or side effects.
In this digital age, there are even apps that can help you with your sleep through CBT, such as Sleepio or Sleep Guru.  Sleep Guru, for example, will help you develop good sleep hygiene, the habits necessary to develop a routine to induce sleep effectively.  Through a series of reminders, Sleep Guru will track your use of electronics and the self reported quality of sleep.  Developing these effective sleep habits allows you to fall asleep naturally, and experience higher quality sleep.
While insomnia can be tricky to treat and many patients go through a number of attempts at finding successful treatment before finding one that works for them, there are a rapidly expanding amount of treatments for people suffering from insomnia.