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What, Why, and How of Insomnia

The What

Every day, millions of people worldwide suffer from an inability to sleep. Occasional sleeplessness affects half of all Americans. For some, the occurrence of insomnia can be brief and resolved without treatment. However, insomnia becomes chronic for 1 of every 5 when it occurs at least three nights per week, lasting three months or more. Those suffering from chronic insomnia may require treatment to return to healthy sleep patterns. Learning as much about your sleep issue is the first step to empowering yourself to take control of your life.  This blog will help you understand the what, why and how of insomnia.

The Why

Patients who experience insomnia often describe that their minds are overactive; they can’t turn their minds off to get to sleep at night.  They may feel exhausted from the day, but when their head hits the pillow their minds continue to race.  Scientists who have studied the behavioral aspects of this experience believe that insomnia patients may preferentially focus on their mental activity around the sleep onset period, especially when they’re experiencing what otherwise might be short term periods of insomnia.  This increased focus on their sleep may itself be arousing, thereby making it physiologically less likely that they will fall asleep and stay asleep deeply throughout the night.

Similarly, insomnia patients may have an increased focus on subtle awakenings that can occur during sleep.  This increased attention may be arousing, making it less likely they will fall back asleep. The result is that they may be left feeling as if they’ve been awake all night.  This is especially true if, during this increased period of attention, they are thinking of the negative consequences of not getting a good night sleep. They’re plagued with thoughts like, “I need to get a good night’s sleep or I’ll be miserable tomorrow,” or, “I have a really important presentation tomorrow, so I NEED to get good rest tonight,” or, “I HAVE to get some sleep tonight!”  One can imagine how these added pressures could be physiologically arousing, making it even more difficult for them to achieve what they desperately seek.

As is often the case, it can be difficult for scientists to sort out which came first, the chicken or the egg.  One possibility is that it is the enhanced mental or psychological activity that precedes and may cause physiological arousal, in the brain and body.  Another possibility is that some individuals may be predisposed physiologically to have large arousal reactions to otherwise minor events in their lives.  If you will, they may be genetically predisposed to developing insomnia over the course of their lives.

Various genetics studies have been used to determine where the cause of insomnia might originate.  Many things seem to run in families, hair color, height, weight, etc. so perhaps it’s not surprising that some studies have found that insomnia often runs in families.  It’s reasonable to think that these genes modify some aspect of physiology related to the body’s arousal system, which plays a role in behavioral responses to stress that may be common to all these disorders.  So, some individuals may be born with a predisposition to hyperarousal that puts them at risk for the development of insomnia.

Other studies have been performed to see if the brain’s electrical system (reflected in an EEG study) is in a hyperaroused state in insomnia patients.  Many supportive studies suggest that this is, indeed the case.  Still, it’s unclear whether this hyperarousal is a result of behaviors such as a heightened focus on their sleep difficulties–or if this is also an underlying physiological trait that reflects a predisposition to developing insomnia.  It should be noted that the electrical patterns in the brains of individuals are about as unique as a fingerprint, suggesting some trait individuals may be born with.

The body has a finely developed way of dealing with stress.  One component of this involves the secretion of the hormone cortisol and another involves activity in the sympathetic nervous system, that part of the nervous system that is active in engaging the body’s defenses and responses to threatening situations. This is often referred to as the “fight or flight” mechanism.  Not surprisingly, increased activity in both cortisol and in sympathetic activity have been shown in insomnia patients, suggesting that they may be in a more constant state of readiness, or hyperarousal. It is this state that makes it difficult for them to settle down for a night’s rest.

Advances in imaging brain function, equivalent to taking videos of what is happening in the brain over time, have helped us to understand that the brain itself is in a state of hyperarousal in insomnia patients–even during sleep.

In 2004 we published a study showing that insomnia patients did not show the normal declines in brain activity during sleep that healthy sleepers did.

Insomnia Brain Image
Insomnia Brain Image

It’s conceivable that this increased brain activity is the result of all the factors identified above, from the behavioral or cognitive sensitivity to information, to the enhance arousal noted in the EEG and the increased activity of the body’s cortisol and sympathetic arousal systems.  Clearly, though this study, it demonstrated all these factors have a direct impact on how the brain is functioning during waking and sleeping in insomnia patients.

The How

How is all this information helpful to those suffering from insomnia?  First, this information can be reassuring to many of those struggling to get a good night’s sleep.  Having experienced insomnia for some time, many patients transition through several phases.  The first phase might be one in which they don’t really think anything is wrong, and that it will just go away.  Over time, as the individual starts to become frustrated by their inability to sleep, there may be a sense that they don’t have a medical problem, it’s just all in their head. Eventually, they believe, they’ll be able to work themselves out of it.

However, when someone has had insomnia for long enough and they’ve reached the final phase, their life often becomes severely dysfunctional. Many of the casual recommendations they’ve tried to improve their sleep have not worked and they begin to feel like something is “wrong” with them.  They finally come to acknowledge that they have a problem, and that they need help.  The truth we’re unraveling about insomnia shows us that there isn’t anything “wrong” with those dealing with insomnia, but rather that there are rational explanations for what they are going through.  Furthermore, with increased understanding of the physiology and brain mechanisms of insomnia, we can begin to develop more specific and refined treatments that have direct impacts on the irregularities found. With this knowledge, we can help alleviate the suffering of millions of individuals who otherwise might be facing a life of insomnia.



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