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?

Insomnia and Pain: A New Perspective

It’s no secret that acute pain following an accident can interfere with sleep.

But new research shows that insomnia is actually a stronger, more reliable predictor of pain than pain is of insomnia.

Physical pain can keep people from sleeping deeplyMy worst bout of insomnia occurred two years ago after I fell and broke my wrist. I had an 8-year-old friend who liked to rollerblade, so I decided to buy a pair of used skates and join him one afternoon in skating around the cul-de-sac outside his house.

The sidewalks were a bit uneven. (A red flag, I’ll admit. I’ll incriminate myself further by admitting that because I was a confident ice skater, I had no wrist guards. Bad call!) Stepping over a curb onto an uphill stretch of sidewalk, I lost my balance and fell backward. Both arms flew back to break the fall, resulting in a messy break in one wrist and a sprain in the other. The pain was so intense I nearly passed out.

How the Pain Affected My Sleep

The morphine and codeine they gave me at the hospital kept me doped up around the clock, and for a few days, sleep was easy. But delays in the scheduling of my surgery resulted in my wearing a heavy splint for several weeks. A pain developed in my upper arm that the hydrocodone I was taking barely touched, and the problem with insomnia began.

In bed, no matter where I put my arm, I couldn’t find a position that was pain free. I turned from one side to the other–gingerly, to avoid jarring the wrist—but I couldn’t get comfortable. When I did drift off, the pain in my arm woke me every few hours.

Night after short night turned me into a zombie. I stumbled around the house cursing my heavy splint and the doctors whose spring vacations led to the postponement of my surgery. Lack of sleep made the pain worse, interfering with my concentration. Usually I’m so focused that an hour can pass before I glance at the clock, but I was looking up from my work every 10 minutes. Not knowing how long the situation would last was making me crazy.

The nightmare continued three weeks, until a physical therapist succeeded in helping me get rid of the pain with advice to sleep on my back with my arm resting on a low stool beside the bed.

Insomnia and Pain: A Two-Way Street

It’s no secret that acute pain like mine can interfere with sleep. Signals of distress coming from anywhere in the body can hinder the brain’s ability to shut down completely for the night.

Chronic pain, too, is linked to sleep problems. It can interfere with getting to sleep and also lead to micro-arousals during the night. These micro-arousals may result in wake-ups and sleep that is lighter and less restorative, in turn leaving people more vulnerable to fatigue, depression, and worse pain during the day.

But new research shows that insomnia is actually a stronger, more reliable predictor of pain than pain is of insomnia. A review paper published by the American Pain Society in December suggests that sleep disturbance may impair key processes that protect us from developing new pain and sustaining chronic pain.

What Kinds of Pain Are Insomniacs Susceptible To?

  • Headaches. Three large longitudinal studies show that insomnia tends to exacerbate the severity of existing headaches and increase the likelihood of developing new headaches down the line.
  • Musculoskeletal Pain. In a prospective study of over 1,300 Norwegian women, the presence of sleep complaints predicted the onset, persistence, and worsening of pain.
  • Fibromyalgia. In a larger prospective study of Norwegian women, poor sleep significantly increased the odds of women developing fibromyalgia within 10 years. Two-thirds of the new cases of fibromyalgia were explained by sleep problems, the authors said.

Pain is inevitable following an accident like mine, and disrupted sleep, part of the package. But research now suggests that some pain may be preventable—yet another reason that proactively treating insomnia and other sleep complaints makes sense.