Insomnia is the difficulty of sleeping long enough at night to feel good during the day. In fact, insomnia can hinder your daily activities and has consequences for drowsiness, concentration problems, irritability, depression , etc. However, some people sleep poorly naturally and do not suffer the harmful consequences so do not suffer from insomnia.
Insomnia is not a disease but a symptom, a bit like fever . Before treating it, it is important to understand the causes. Among the physical and environmental factors that have a great influence on sleep, there is brightness and noise and also abundant evening meals and at wrong times .
Instead, psychological factors, such as stress or problems , also play an important role. In 50% of cases they would be the cause of insomnia .
Insomnia is a persistent but not necessarily constant disorder over time for symptoms and entities. In fact, there are different types of insomnia from the initial one (where you struggle to fall asleep) to the terminal one where you don’t sleep for more than a month. But also, for example, during pregnancy you can suffer from insomnia .
However, before starting drug treatment , talk to your doctor, to try to change some lifestyle habits and evaluate with him the appropriate therapy for your case .
Insomnia: what it is
Insomnia is a term often used to more generally define a sleep disorder , it is characterized by difficulty falling asleep and maintaining sleep, with repercussions, not to be overlooked, on the quality of life of the individual.
Sleeping poorly and badly can cause chronic fatigue, irritability, decreased concentration and attention.
One of the most important aspects of insomnia is that, more often than not, it is not a pathology in itself, but a symptom of a wide range of mental and physical disorders and it is on these that therapeutic interventions must be concentrated. Taking action on the causes of this sleep disorder automatically means solving insomnia itself .
Mental fatigue, tiredness and depressive states should not be confused with those situations that occur as excess sleep, that is, real sleep during the day.
Why sleep is important
For rest to be of physical and mental benefit, for the majority of people, 7-8 hours per night are sufficient. But, even for sleep, we are not all the same, there are the ” long dormitories ” that need 10 hours and the ” short dormitories ” which take 5-6 hours to feel good and not feel sleepy or tired during the day. Sleep is an apparently passive process in which 4 phases are distinguished:
- non-rem , it is the phase of falling asleep, the muscles relax, it lasts 4-5 minutes
- light sleep , prepares us to enter deep sleep, lasts 10-15 minutes
- deep sleep , the brain is in a “stand-by” phase, it consumes less energy, lasts 40-50 minutes
- Rem, characterized by intense brain activity, under the eyelids the eyes move quickly. It’s the dream phase, it lasts 4-5 minutes, then you go back to phase two and in deep sleep.
These stages can be repeated up to 5 times per night.
Different types of insomnia
An international classification speaks of different types of insomnia:
initial : you struggle to fall asleep when you’re in bed.
intermediate or intermittent : you fall asleep when you go to bed, but in the middle of the night you wake up and you cannot get back to sleep. Interrupted rest causes a feeling of exhaustion the next morning.
terminal or morning : you wake up when it is still dark outside so as to want to start the day immediately, is called the “lark dormitory” because he is already sleepy at 20-21 and at 5 he is awake and feels rested because he has slept enough.
transient : it is related to acute stress situations, for example, intercontinental travel, hospitalizations, etc. Typically it lasts a few days.
acute : inability to sleep for less than a month.
Chronic or long-term insomnia : that which lasts more than 3 weeks and requires a diagnostic evaluation by a specialist because it can be the tip of the iceberg of an underlying pathology, sometimes even psychiatric, which must be treated.
Insomnia in pregnancy
In pregnancy, a period of great hormonal changes, insomnia is a fairly common disorder , but despite being a widespread problem, it should not be underestimated and should be studied in depth with the doctor and gynecologist . The causes can be of different origins and differ according to the gestation quarter.
Sleep disorder in the first trimester of pregnancy
In the first trimester, the cause may be due to hormonal changes , hormones perform various functions including sleep regulation. During this period, estrogen and progesterone hormones increase, which usually lead to nausea and vomiting. This can induce the pregnant woman to take more naps during the day and consequently to struggle, at night, to sleep. The hormones also produce increased urination (the act of urinating ) which forces the expectant mother to get up often at night. Another cause is emotional and psychological , it stems from the enthusiasm present in this first phase where happiness and concern alternate.
In the second trimester , instead, the changes in the body cause insomnia, with the growth of the belly it is more difficult to find the right position to fall asleep. Also, around the twentieth week , the movements of the fetus make it more difficult to sleep .
The growing child presses on organs such as the stomach and bladder, making digestion more difficult and forcing the pregnant woman to go to the bathroom several times during the night.
Insomnia in the third trimester
In the third quarter, they increase:
- cramps caused by the increase in the belly
- tingling in the legs
- other pains due to posture that can lead to insomnia.
But in the last period of pregnancy, the causes can also be emotional because approaching childbirth generates anxieties, fears and fears that make it difficult to relax.
Determining the causes of insomnia is an essential first step in solving the problem. In fact, the treatment if you suffer from sleep apnea or depression will be different. Find out the physical and psychological causes.
When we talk about real insomnia ? “Only when you sleeps little at night, despite adopting the required rules of hygiene of life , and during the day does you suffer from lack of sleep,”
The causes are varied, ranging from:
- stress (excess nerve activation during the day does not allow you to sleep)
- psychiatric disorders , such as anxiety and depression
- respiratory disorders such as sleep apneas
- medications, such as diuretics, can cause insomnia
- restless leg disorder
“In fact, restless leg disorder is a not uncommon disorder characterized by a craving in the legs when you are in bed, which only disappears by moving them continuously,” continues Barbanti.
Causes according to the type of insomnia
The causes can be different depending on the type of insomnia.
If you suffer from initial insomnia
It is usually an anxiety disorder that prevents the mind from relaxing until it reaches rest.
If you suffer from intermittent insomnia
The cause may be due to external factors such as:
- the snoring of the partner
- traffic noise
- room not dark enough, or very cold or hot, which disturb sleep.
Causes of terminal insomnia
If you are ready to shoot in the morning, it is fine, but if, on waking up, you feel tired and exhausted, it means that the rest was not enough and it is true insomnia. However, it can happen after drinking alcohol which, at the moment, induces drowsiness and makes you fall asleep deeply but shortens the phases of night’s rest .
The 40% of people that will appeal to a specialist for insomnia, is suffering from a mental disorder , particularly depression and anxiety. In fact, there is a correlation between depression, anxiety and insomnia.
Insomnia aggravates depressive disorders and is often present in anxiety disorders.
Medicines and substances
The list of substances that disturb sleep is very long: for example, coffee, tea, smoking, alcohol. In addition, insomnia is one of the side effects of many medicines.
Several chronic diseases increase the risk of insomnia , such as:
- heart failure
- gastroesophageal reflux
- Parkinson’s disease
- multiple sclerosis
Classification of causes
Apnea during sleep
The syndrome of obstructive sleep apnea or OSA (Obstructive Sleep Apnea Syndrome) is an interruption of breathing during sleep. The subject snores evidently from the earliest stages of sleep and there is a moment when he stops breathing for at least 10 seconds , never exceeding 3 minutes. If the problem persists, contact a Center for Sleep Disorders , where, with some tests, it will be ascertained whether you suffer from sleep apnea.
Restless leg syndrome
Restless legs syndrome is manifested by tingling or chills in the legs which create a strong need to move them. In addition, the individual continually moves around the bed in an attempt to alleviate this unwelcome sensation, causing insomnia.
Jet lag is a circadian rhythm disturbance that is felt when the body’s biological clock loses synchronization with the light and dark cycles on which it is regulated.
This happens during intercontinental travel due to the different time zone.
The jet lag can cause :
- constant daytime fatigue
- difficulty concentrating.
A suggestion is to anticipate or postpone, the time to go to bed, a couple of days before, depending on the time zone that you will find on arrival .
The most frequent form of parasomnia is sleepwalking which is typically typical of children aged 6 to 12.
The subject apparently wakes up during the early hours of the night, walks, can dress, wash in a few minutes.
However, the mechanism is unclear, but this disorder can persist for many years. Generally it disappears spontaneously and then, in some cases, recur in adulthood coinciding with periods of strong stress and emotional tension
The mental rumination is to have in mind a fixed idea that recurs , that is a circular thinking, which invades the mind and makes you not think about anything else.
“It derives from a strong desire, which cannot be postponed, to find the solution to a problem – explains neuropsychologists.
“There seems to be a neurophysiological mechanism , in particular a reduced activity of serotonin, a brain neurotransmitter.”
Depression is a mood disorder characterized by demeaning, sadness and a listless and indecisive attitude. Abatement not only affects the psychological sphere, but is also associated with a lowering of the physical tone (organic deterioration).
In addition, those suffering from depression also complain of:
- loss of concentration
- lack of stimulus and energy
- he loses all interest in his surroundings.
The panic attacks are a sudden feeling characterized by malaise that is manifested at various levels. These manifestations of intolerable anxiety are associated with neurovegetative physical symptoms and are manifested by:
- negative thoughts
- sudden and uncontrollable anxiety attacks
- fear of losing control over your thoughts, your actions
If they occur during the night, they cause insomnia in addition to the symptoms listed above.
Insomnia can also be present in eating disorders such as bulimia and anorexia . In bulimia, the subject often has difficulty falling asleep but also waking up while those who are anorexic have difficulty falling asleep and frequent nocturnal awakenings which decrease as weight regains.
Even obese people can suffer from insomnia because often, precisely because of excessive weight, they suffer from night apneas that cause frequent awakenings.
Also, eating quickly, skipping meals, or eating large meals can cause sleep disturbances.
Lack of regularity in meals can alter the circadian sleep-wake rhythm.
Several chronic diseases increase the risk of insomnia , such as:
- high pressure
- heart failure
- gastroesophageal reflux
- Parkinson’s disease
- multiple sclerosis
Who suffers from insomnia
Everyone can have episodes of insomnia for a period of life . There is no personality type profile, but some factors can increase the risk of insomnia.
As we age, people may experience episodes of insomnia because aging of the brain changes the functioning of the biological clock.
The women are more likely to insomnia while men are more prone to disorders like sleep apnea . Furthermore, hormonal changes (cycle, pregnancy and menopause) can be, in part, the explanation of the phenomenon.
Tendency to remove emotions
This can translate into physical problems including insomnia. In fact, people who don’t express their emotions during the day tend to bring negative emotions into bed . Inevitably, they are worried, they cannot get rid of their negative thoughts and therefore they cannot sleep.
Hypervigilant or anxious attitude
The anxious people or have a hypervigilant attitude can never detach even when they go to bed. In fact, it is when they go to bed that all thoughts crowd the mind.
Mental and physiological hyperactivity
Mental hyperactivity is one of the characteristics of those who cannot fall asleep in bed. This term describes a state of mental agitation or persistent muscle tension , both at night and during the day. Thoughts overlap in the mind and it is difficult to send them away . In addition, the body can accompany this emotional state with:
- muscle tension
- high heartbeats
- high body temperature.
Insomnia: when to consult
In cases where insomnia lasts for more than 4 weeks , it is best to contact your doctor, who can recommend a visit to a sleep medicine center where specific tests will be prescribed for diagnosis.
The doctor collects as much information as possible:
- type of sleep disorder
- working activity
- relationship life
- previous diseases (had in the past) and those that may be in place
Finally, he suggests keeping a sleep diary where you can write down your sleep habits. After that, he can recommend a series of analyzes.
Exams to do
It is performed in the sleep center during one or more hospitalization nights.
Electrodes are applied on the neck muscles and on the scalp which are used to record the various phases of rest.
During polysomnography, oximetry is also performed, an examination that evaluates the oscillation of oxygen in the blood , if there is a suspicion of night apneas.
It is an examination in which the phases of sleep and breathing are detected with a device (Holter type) applied on the person’s body. It is as small as a mobile phone and you can carry out your normal activities. The examination can be done at home, and the instrument is removed after 24/48 hours in the surgery .
Monitoring of respiratory parameters
You have to wear for a day or two a small microphone to be applied on the neck, a small probe to be held on a finger and a sensor placed under the breastbone. A series of cables connects these instruments to a device that records:
- oxygen saturation in the blood
- body position.
The actigraph is a small device similar to a clock, able to record the phases of sleep and wakefulness but also the body temperature and the noises that surround you but also the light. You have to take it for a few days (1 to 15 days) and write in a diary.
Insomnia: consequence for health
Suffering from insomnia leads to problems of daytime sleepiness, tiredness, irritability.
Not only that, it can have consequences on your physical and psychological health. It could also be a trigger for depression. If the disorders are related to a sleep apnea problem, the health risks are very important. Airway obstruction (sleep apnea) leads to an increase in cardiovascular problems. Not to mention the car or work accidents caused by consecutive fatigue to insomnia.
In addition, according to a study published in the Sleep Medicine journal , in August 2016, scientists analyzed 153 sleep studies that included more than 5 million people. It has been shown that those who slept little, were more likely to have problems with:
- cardiovascular diseases
It is the most documented result of insomnia : if you don’t sleep enough, you gain weight.
In fact, according to several studies, suffering from insomnia leads you to eat more and above all to consume more caloric foods. According to the study, sleeping too little could lead to 385 more calories . In fact, these people are led to eat more fatty foods and less protein. Instead, in the adolescent who sleeps little, the lack of sleep leads to greater consumption of sugary foods .
Chronic insomnia would seem to lead, according to scientific studies, to a decrease in insulin sensitivity and an important risk (about 37%) of developing type 2 diabetes .
Loss of insulin sensitivity would also explain weight gain and is the first stage of diabetes. On the other hand, those who are diabetic also suffer from insomnia. So if you are at risk of diabetes (family history, obesity, high blood sugar, etc.) it is important to be able to resolve insomnia . Talk to your doctor.
For scientists, the lack of chronic sleep leads to:
- increased oxidative stress
- alteration of the inflammatory response
- cardiovascular diseases.
In fact, in epidemiological studies, they have seen that insomnia is associated with:
- coronary heart disease
Sleeping too little or conversely sleeping too much can increase the risk of having a cerebral vascular accident, according to a recent study.
Women who sleep on average 5 hours per night or less have a 39% higher risk of having coronary heart problems after 10 years.
According to doctor Najib Ayas, a sleep disorder specialist at Women’s Hospital in Boston , who conducted a study on insomnia and women, the result highlights a modest but significant relationship between sleep duration and coronary heart disease . In addition, the doctor adds that people should consider sleep not as a luxury but as a hygiene of life .
However, for menopausal women , who were the majority during the study, it turned out to be a complex situation, because they sleep less and often wake up during the night.
Mood disorders and depression
Sleep and mood disorders are strongly linked , numerous scientific studies have shown this. In general, depressed people sleep too much or too little and therefore suffer from insomnia.
By reducing sleep hours, depressive symptoms could be improved. However, lack of sleep can also increase mood disorders or induce depression. In this context, the link between sleep and depression is complex . To date, all that is known is that chronic insomnia can aggravate the symptoms of depression.
Chronic insomnia: consequences
Oddly, sleepiness is not very common among chronic insomnia sufferers . Indeed, they usually suffer from overexcitement both at night and during the day .
Furthermore, acute insomnia can cause a considerable psychological and emotional crisis , especially when it is perceived as a loss of control.
In fact, those who struggle with insomnia every night become increasingly irritable, tense and depressed. Also, a feeling of helplessness can develop in the sense that whatever they try to do, they can’t sleep.
Untreated insomnia that lasts for more than a year exposes you to a risk of depression.
The impact on mood can also make interpersonal relationships (family, friends, colleagues) very difficult. This can lead to a social withdrawal and avoid relationships with others.
Treatments and types of insomnia
Sleep medicine experts urge you not to stay in bed but get up and do something that does not put too much effort into the mind, you should not even turn on too bright lights because they reduce the level of melatonin, a hormone that is produced in the dark and regulates the cycle sleep-wakefulness . To fall asleep faster, it can also be useful to follow a relaxation technique , imagining your body becoming heavier starting from the feet, legs, abdomen, arms, eyes and head.
If results are not obtained, it is better to contact the doctor to undertake a treatment with cognitive-behavioral therapy that teaches to eliminate the conditions that prevent a good rest.
Intermittent insomnia: treatments
The cause may be due to external factors such as: partner’s snoring, traffic noise, a room that is not dark enough, or very cold or too hot, which disturb sleep.
You can try to make the environment you sleep in as quiet as possible by placing soundproof panels or installing double glazing. White noise devices that reproduce the noises of nature (wind, waves, rain and birdsong) can also be useful .
If the early awakening is accompanied by a bad mood and feeling unwell at the thought of facing the day, you can be depressed. In fact, negative thoughts occur mostly in the morning . Talking to your doctor will help you understand if it is true depression or just tiredness . In addition, it will help you evaluate the possibility of following a specific therapy.
If you feel fit, in the morning, you can practice physical activity , such as running for example, as motion develops the hormones of well-being. Instead, if you feel tired when you wake up, you should try not to consume alcohol in the evening or limit its use .
Also, avoid the afternoon nap by replacing it with an outdoor walk.
It occurs when you make long journeys with different time zones for which the circadian sleep / wake rhythm is altered , that is, the biological clock no longer follows the cycle of nighttime sleep and daytime wakefulness.
The drug treatment is not always necessary , but if you use it must provide hypnotic agents (which favors the onset of sleep) to rapid elimination, at low doses and for 1-3 nights maximum.
Meditation and yoga , in particular, help to dissolve the tensions related to travel , are a panacea for the mind and spirit, especially if performed paying particular attention to breathing.
Finally, a nice hot bath, rich in essential oils such as lavender, jasmine and bergamot, before going to bed, turns out to be very effective.
If the disorder is episodic and connected to a long journey or hospitalization, it will be enough to return to normal and the episodes will thin out until they disappear. Instead, if they persist, they can be the telltale sign that your body’s clock has jammed and you need to seek medical attention or an expert.
The 40% of people who turn to a specialist , for the presence of insomnia, is suffering from a mental disorder, particularly depression and anxiety . In fact, there is a correlation between depression, anxiety and insomnia. Insomnia aggravates depressive disorders and is often present in anxiety disorders.
The cognitive-behavioral therapy is the treatment of choice for chronic insomnia. In addition, it is important to keep an interactive sleep diary to record your daily sleep habits. To help rebalance sleep , the use of instruments such as relaxing music or sounds and relaxation techniques may be beneficial.
In the case of chronic insomnia, the first level treatment is certainly cognitive-behavioral therapy.
The phases of the intervention are three:
- sleep hygiene (educational intervention on behaviors that promote good sleep
- study and modification of attitudes related to the absence of sleep
- behavioral techniques including sleep restriction (the amount of time spent in bed is limited compared to the time actually spent sleeping).
Feeding for insomnia
Very often, the difficulty of falling asleep arises from a series of wrong habits, the first of which concerns nutrition.
How to fight insomnia at the table ? Among the useful nutrients we find magnesium , which reduces the excess of nervous excitability , and tryptophan, an amino acid necessary for the synthesis of serotonin , considered to be the wellness hormone . Barbanti states that “recent studies conducted in Japan show that foods with a high glycemic index , such as rice (white or brown), promote sleep, presumably by raising serotonin levels “.
Other anti-insomnia foods are chard and spinach , sesame and pumpkin seeds , hazelnuts and sardines .
On the other hand, foods such as tea, coffee, chocolate, alcoholic drinks and fatty cheeses should be avoided .
Tips to fight insomnia
In addition to nutrition, what are the right tips for patients suffering from it ? Doctors suggests to “keep a diary to record all habits and, first of all, to try to change the lifestyle “.
The bedroom , for example, must be used only for rest (TV in the room and the use of tablets are strictly forbidden).
Furthermore, the temperature in the room must always be a few degrees lower than that of the rest of the house and there must not be excessive light. A good tip is to take a 20-minute bath at 40 degrees before going to sleep: it has an effect on the parasympathetic nervous system that facilitates sleep.
The importance of the mattress to sleep well
The mattress, like the pillow , must be designed so that it does not retain static electricity , an aspect often unknown. The synthetic material of these components, retaining electricity, is unhygienic and does not allow total relaxation . It is necessary to evaluate the fiber composition of the external coatings which must be of excellent quality to prevent them from deforming over time.
It is important that the bed base and mattress adapt well to the shape of the body respecting the curvature of the spine to prevent body compression from occurring in some areas.
Natural fibers are also recommended for sheets and blankets such as : wool blankets, very light duvets, cotton, linen, silk sheets.
In the winter months, a wool cover can be inserted between the mattress and the sheet. The pillow, in natural breathable materials, must not be too high, to allow the spine to remain in a correct position when lying down . Sleeping with too high pillows, in fact, and even sleeping without a pillow, muscle tension and the crushing of the intervertebral discs can be created .
Today, there are various types of mattresses on the market, made of latex foam , a natural product derived from rubber, rigid and non-deformable, hypoallergenic and bacteriostatic, where mites cannot reproduce. Latex foam is placed in the central part of the mattress and, depending on the thickness and chemical composition, allows different densities. With latex, mattresses with different levels of rigidity can therefore be produced. Today we also find high-level water mattresses : the liquid is divided into independent, anti-leakage bags.
Sports to fight insomnia
The balance between sport and sleep is essential because one favors the other. Who sleeps badly is less performing because:
- increases the feeling of tiredness
- recovery decreases
- greater risk of injury (contracture, inflammation, etc.).
On the contrary, doing sports promotes better quality sleep, for:
- energy expenditure
- hormonal stimulation
- better regulation of the wake / sleep rhythm (circadian rhythm).
Also, doing sports leads to healthy tiredness and helps you fall asleep faster with less chance of waking up at night . In fact, doing sports improves sleep quality.
Sleep apnea and restless leg syndrome
Playing sports is good for those suffering from sleep apnea syndrome . In fact, by activating the muscles of the pharynx, sport can help decrease symptoms. Ditto for non-remarried legs syndrome because doing sports would seem to raise the pain threshold and therefore reduce nighttime awakenings.
It may happen that, even if you change your lifestyle, you don’t get out of it. In these cases, when is it necessary to resort to drugs ? A garrison that can prove useful is melatonin , known by now by all. Even the ‘Valproic acid (the active ingredient of valerian) may have some beneficial effect. If it does not resolve with these devices, it is advisable to speak to the doctor, as there are several classes of useful drugs, among which the so-called “Z drugs”.
Drug therapy should be specifically established by a doctor.
It is essential to rely on a specialist who can administer the correct therapy for each individual case and not proceed with self-medication , which could cause serious damage and worsen the problem of insomnia. In fact, it is the doctor’s responsibility to choose the most suitable active ingredient and dosage for each patient, based on the severity of the disease, the state of health and its response to treatment.
The most used drugs for the treatment of insomnia are benzodiazepines , sometimes these drugs can be combined with hypnotics that seem to induce a sleep more similar to natural sleep and, even if their action is less powerful.
In addition, it is good practice not to use them for more than 2 months in a row , with breaks of 15 days and to gradually discontinue them.
Melatonin, also called sleep hormone , is a hormone naturally produced by the epiphysis, or pineal gland, in the absence of sunlight, which has the function of regulating the sleep – wake cycle. Taken as a supplement, it helps you sleep well.
They are sedative drugs that have as their active ingredient:
They act on some receptors of the nervous system, the GABA, exerting a tranquilizing action
Valid natural alternative to drugs and sleeping pills are all herbs with calming properties that can help you sleep:
- chamomile : used for children, adults and even pregnant women. Beware that beyond a certain concentration it has the opposite effect;
- hops: natural hypnoinductive that promotes sleep and is also used to fill the cushions;
- passionflower : acts on the central nervous system, calming palpitations in case of anxiety and stress; helps you sleep easily without daytime sleepiness;
- lemon balm : relieves various disorders of the nervous sphere, from headache to fatigue, from anxious states to insomnia, also used by pregnant women;
- hawthorn : sedative effect on the nervous system and also acts as an antispasmodic (facilitates relaxation of muscle fibers);
- Valerian : lowers the level of stress and anxiety. Beware that it can be addictive and cause mental numbness during the day if dosed incorrectly. Contraindicated for those suffering from low blood pressure. The dried root is used;
- linden : mild sedative effect, relieves tension, calms nervousness and headache; also benefits in pregnancy;
- St. John’s wort known as St. John’s wort : calming and relaxing properties, it helps in case of depression and anxiety;
- sweet orange : calming and antidepressant properties;
- willow : calming effect;
- escolzia : it can be a valid aid in inducing sleep, also thanks to its analgesic and anxiolytic properties.
However, medicinal plants are not without side effects.
Before taking any herbal remedy, it is important to follow the advice of an expert herbalist who can prepare the dosage ad hoc, or a naturopath or even consult a doctor specializing in herbal medicine .