Insomnia Is Not a Trivial Concern

If you’ve struggled with chronic insomnia for years, even if you have some reliable management strategies, you may occasionally find yourself talking about insomnia with people whose looks and responses suggest it can’t be such a big deal.

“Aren’t there pills for that?” “My doctor says that’s self-inflicted. You just THINK you can’t sleep.” Here’s some new research that shows why persistent insomnia is a serious problem deserving of concern and treatment.

Talking about insomnia with friends.If you’ve struggled with chronic insomnia for years, even if you have some reliable management strategies, you may occasionally find yourself talking about insomnia with people whose looks and responses suggest it can’t be such a big deal.

“Aren’t there pills for that?”

“My doctor says that’s self-inflicted. You just THINK you can’t sleep.”

Here’s some new research that shows why persistent insomnia is a serious problem deserving of concern and treatment.

Benefits of Sleep

First, though, let’s review the central role sleep plays in maintaining well-being. In the past, people thought that nothing much happened during sleep and that the human brain essentially shut down at night. How wrong that notion was!

Many critical functions occur during sleep. Sleep enables the shoring up of the immune system and the repair of injuries. During sleep, memories are consolidated and brain waste is pruned. Negative emotion is processed during REM sleep. After a full night’s sleep you awaken in a more positive mood. During sleep energy is conserved. In the morning you awaken feeling rested and restored, and your brain is primed to learn and retain new information.

When sleep is disrupted, whatever the reason, the critical functions that take place during sleep may be compromised. In the case of chronic insomnia, common symptoms during the daytime—tiredness and lack of stamina; moodiness; and impaired attention, concentration, and memory—are suggestive of compromise. They cut down on the quality of our day-to-day lives.

Effects of Persistent Insomnia Over Time

Chronic insomnia also has several more insidious effects.

It increases the odds of our developing depression and anxiety. A new meta-analysis of studies on insomnia as predictor of mental illness has found that chronic insomnia makes us nearly 3 times as likely to develop major depressive disorder and over 3 times as likely to develop an anxiety disorder as people without insomnia.

Insomnia and Chronic Pain

Insomnia intensifies and increases susceptibility to pain. Past research has suggested that the relationship between insomnia and pain is bidirectional, with painful conditions interfering with sleep and sleep disturbances worsening painful conditions. But recent longitudinal studies (studies involving repeated observations over time) suggest that more often it’s insomnia symptoms that predispose us to chronic pain or to the worsening of painful conditions.

Insomnia and Heart Disease

Insomnia, especially when accompanied by objectively measured short sleep duration (less than 6 hours), makes us more susceptible to heart, or cardiovascular, disease (CVD). Meta-analyses have found that people with insomnia are between 33% and 45% more likely to develop and/or die of CVD than people without insomnia.

A new study of sleep duration and atherosclerosis (plaque formation in arteries) has found that short sleepers are 27% more susceptible to atherosclerosis than people who sleep 7 to 8 hours a night, and those whose sleep is highly fragmented are at even greater risk (34%) for plaque build-up.

A disorder that has so many negative effects on quality of life and long-term health cannot be dismissed as a minor annoyance. It’s important to get treatment for insomnia as soon as possible, with cognitive behavioral therapy or, in cases that don’t respond to CBT, medication.

Talking About Things We Know

Despite what you might infer from the fact that I blog about insomnia, I don’t go around seeking opportunities to talk about the problem in my everyday life. Sleep disorders now get quite a bit of attention in popular media, but most of us know the topic has the appeal of moldy leftovers for the good sleepers of the world — and they are in the majority.

Occasionally, though, conversations turn to talk about sleep, at a party or a meeting or anywhere in casual conversation. And who better than us to raise people’s awareness about the problem of insomnia since we’re the ones with all the experience?

If you’ve talked about insomnia with your family, friends, or acquaintances, what has been their reaction?

Short Sleep: A Dose of Perspective on the Risks

A woman attending a talk I gave on insomnia was worried about developing Alzheimer’s because she wasn’t getting enough sleep.

“Sometimes I sleep only 4 hours a night,” she said, “and I’m really lucky when I get 5.”

There’s a lot of talk these days about the health risks that accumulate if we sleep less than 7 or 8 hours a night. But reports that appear in the popular media can make the risks sound greater than they actually are.

short sleep may increase the risk of health problems but not that muchA woman attending a talk I gave on insomnia was worried about developing Alzheimer’s disease because she wasn’t getting enough sleep.

“Sometimes I sleep only 4 hours a night,” she said, “and I’m really lucky when I get 5.”

After the talk I asked for details. Did she have trouble falling asleep? No. Did she wake up frequently at night? No again.

“When I fall asleep,” she said, “I’m out cold.”

What about her energy and alertness during the daytime? I asked. Did she feel tired, out of sorts, or foggy in the brain? No, no, and no. Then what was the problem?

“I read online that you’re supposed to get 7 or 8 hours of sleep,” she said, “but I can’t, no matter what. I read that people who don’t sleep enough get Alzheimer’s, and I don’t want to. I want more sleep.”

The Elusive 7 or 8 Hours

There’s a lot of talk these days about the health risks that accumulate if you sleep less than 7 or 8 hours a night.

  • Cardiovascular Disease. Short sleep (sometimes defined as less than 6 hours of sleep a night, and other times defined as less than 5 hours of sleep a night) is linked to increased blood pressure and hypertension, and a greater risk of heart attack and stroke.
  • Cancer. Short sleep duration makes you more vulnerable to breast cancer, colorectal cancer, and prostate cancer.
  • Dementia and Alzheimer’s. A study of healthy older adults found that short sleep was associated with greater age-related brain atrophy and cognitive decline. Another study found that short sleep and poor sleep quality were associated more beta-amyloid in the brain (the main component of the amyloid plaques found in Alzheimer patients).

No wonder short sleepers are worried these days. Who wants a sentence of any of these illnesses hanging over their head?

Interpreting the Numbers

If you read reports of studies that appear in the popular media, it’s easy to misinterpret the results. Let’s say you learn that people with insomnia (who may be short sleepers and who also experience daytime impairments) are twice as likely to develop depression as people who sleep well (research has shown this to be true). “Twice as likely” might make it sound as though if you have insomnia, your risk for developing depression is pretty high.

But often missing from these reports is mention of the actual number of people who do develop depression at some time in their lives—information that could help you put the study results in perspective. Let’s say the lifetime risk of developing major depression in the US is about 17 percent (as shown in a study by Blazer et al in 1994). This figure, which would include both people with and without insomnia, indicates that most people—83 in 100—will never experience major depression in their lifetime.

Now let’s imagine (because I haven’t been able to lay my hands on actual figures) that among people who sleep well, the lifetime risk of developing major depression is 12 percent. If people with insomnia are “twice as likely” to develop depression, then 24 percent of insomnia sufferers will go on to develop major depression at some time in their lives, and 76 in 100 will not. In other words, your odds of dodging the bullet are 3 to 1 in your favor. “Twice as likely” does not sound so bad after all.

Minimizing Risk

I don’t mean to downplay the significance of research exposing links between short sleep or insomnia and increased vulnerability to Alzheimer’s or any other illness. If sleeping less than 5 or 6 hours compromises health, we need to know it, and to understand why and how to minimize the risk.

I am suggesting that the results of these studies may not be as alarming as they seem at first glance. Beyond that, if they cause you to worry about your sleep, they do more harm than good. How long you sleep is determined in large part by genetic factors resistant to change. And—let’s face it—the last thing you need is one more worry to shorten your nights still further.

So what’s the secret to healthy aging if you clock 5 or 6 hours of sleep at best? You’ve heard it time and time again: get as much sleep as you can, eat healthful meals, and exercise daily.

If you’re a naturally short sleeper, what concerns do you have about your health?