A Look at Insomnia… from A to Z’s

Insomnia is nothing new. Henry IV laments in William Shakespeare’s “Henry IV, Part II,” “Oh sweet sleep, nature’s gentle healer, what have I done to frighten you? You won’t weigh down my eyelids anymore, or dull my mind to make me forget.”

The play was first performed in 1600, but it’s a pretty sure bet it’s a bigger problem today than it was in 16th century Elizabethan England.

The American Academy of Sleep Medicine estimates that up to 35 percent of this country’s 250 million adults experience occasional problems sleeping while roughly 20 percent have short term or acute insomnia and approximately 10 percent have long-term or chronic insomnia. Sleeplessness is an equal-opportunity disorder that crosses all age, ethnic and gender lines although women are generally more susceptible to insomnia than men.

Sleep isn’t an elective. It’s a requirement for physical and mental well-being. Why then are there so many more sleep-deprived individuals these days?

“A lot of it has to do with our electrified society,” said Dr. Gray Bullard, a pulmonologist and sleep medicine specialist at Wake Forest Baptist Medical Center in Winston-Salem. “We live in an era of electrically powered 24-hour activity. That was not the case in most of human history. Our brains have a circadian light-clock that’s the perfect programming for natural sleep, and we’ve drastically manipulated that.

“Compounding the problem further is the explosion of electronic devices and access to them that’s quick and easy at all times, even when we should be going to sleep.”

But insomnia isn’t just a problem of going to sleep. It also includes the inability to stay asleep, waking up prematurely and not feeling refreshed upon waking. And insomnia isn’t defined by the number of hours a person sleeps or how long it takes them to fall asleep.

“Insomnia is not what a doctor says is poor sleep but what a person perceives to be poor sleep,” Bullard said. “It’s self-reported problematic sleep.”

The negative effects of that problematic sleep frequently include fatigue; daytime drowsiness; difficulty concentrating, learning and remembering; subpar performance at work or school; moodiness, impulsiveness and irritability; and higher incidence of errors and accidents. Insufficient sleep over the long term can increase the risk of heart disease, diabetes, cognitive impairment and other conditions.

Insomnia itself is usually a secondary disorder – a symptom or side effect of another problem. (Cases of primary insomnia, those not caused or made worse by other factors, are relatively rare.)

Acute insomnia, which can last from a few nights to a couple of months, is often triggered by stress or anxiety related to work, school, family, finances or a traumatic event; an injury, short-term illness or surgery; a reaction to medication; a schedule disruption (jet lag or a change in work shifts); or environmental factors (noise, light, temperature extremes).

These circumstances can also contribute to chronic insomnia, which occurs at least three times a week for at least three months, as well as simply worrying about not being able to sleep. But long-term insomnia is most frequently associated with persistent stress, chronic medical conditions, other sleep disorders (such as sleep apnea), medication or substance use or abuse, lifestyle habits, and mental health issues.

By Wayne Mogielnicki, Wake, Forest Baptist Healthwire