By Henrylito D. Tacio
Photos by Mark Inid
“If you can’t sleep, then get up and do something instead of lying there and worrying. It’s the worry that gets you, not the loss of sleep.” – Dale Carnegie, American writer, and lecturer
At one time, Oscar-winning actor George Clooney admitted to The Hollywood Reporter that he has trouble sleeping without the television on. “I’m able to numb out,” he was quoted as saying.
He is not alone. Some of the world’s greatest leaders oftentimes have a hard time getting a good night’s sleep – although some of them opted to have little sleep because of various reasons. To name a few: Abraham Lincoln, William “Bill” Clinton, Margaret Thatcher, and Winston Churchill.
Insomnia – that’s how medical science calls it. “Insomnia is a common sleep disorder that can make it hard to fall asleep, hard to stay asleep, or cause you to wake up too early and not be able to get back to sleep,” the Minnesota-based Mayo Clinic explains. “You may still feel tired when you wake up.”
Insomnia ranks right behind the common cold, stomach disorders, and headaches as a reason why people seek a doctor’s help. In a Gallup poll of more than 1,000 adults, one-third of them complained that they woke up in the middle of the night and couldn’t get back to sleep.
Actually, insomnia is not a disease. It is just a symptom and can be caused by psychiatric and medical conditions, unhealthy sleep habits, specific substances, and/or certain biological factors, according to the US National Sleep Foundation (NSF).
“There are many medical conditions (some mild and others more serious) that can lead to insomnia,” the NSF says. “In some cases, a medical condition itself causes insomnia, while in other cases, symptoms of the condition cause discomfort that can make it difficult for a person to sleep.”
Among the medical conditions that can cause insomnia are: nasal/sinus allergies, arthritis, gastrointestinal problems such as reflux, endocrine problems like hyperthyroidism, asthma, neurological conditions such as Parkinson’s disease, chronic pain, and low back pain.
Medications such as those taken for the common cold and nasal allergies, high blood pressure, heart disease, thyroid diseases, birth control, asthma, and depression can also cause insomnia.
Or, insomnia may be a symptom of underlying sleep disorders. “For example, restless legs syndrome – a neurological condition in which a person has an uncomfortable sensation of need to move his or her legs – can lead to insomnia,” the NSF explains. “Patients with restless legs syndrome typically experience worse symptoms in the later part of the day, during periods of inactivity, and in the transition from wake to sleep, which means that falling asleep and staying asleep can be difficult.”
Another sleep disorder linked to insomnia is sleep apnea. “With sleep apnea, a person’s airway becomes partially or completely obstructed during sleep, leading to pauses in breathing and a drop in oxygen levels,” the NSF says. “This causes a person to wake up briefly but repeatedly throughout the night.”
Depression can also trigger insomnia. “Psychological struggles can make it hard to sleep, insomnia itself can bring on changes in mood, and shifts in hormone and physiology can lead to both psychiatric issues and insomnia at the same time,” says the NSF.
Anxiety, too, can interfere with sleep on a regular basis. Among the anxiety symptoms that can lead to insomnia include tension, getting caught up in thoughts about past events, excessive worrying about future events, feeling overwhelmed by responsibilities, and a general feeling of being revved up or overstimulated.
Because sleep patterns change as people age, older people may think they have insomnia when in fact, they don’t have. “As people age, they tend to sleep less at night and to nap during the day,” explains The Merck Manual of Medical Information. “Also, older people awaken more during all stages of sleep.”
People normally cycle through distinct sleep stages five or six times during the night, the Merck manual states. Relatively little time is spent in deep sleep (stages 3 and 4). More time is spent in rapid eye movement sleep – when people dream – as the night progresses, but this stage is interrupted by brief returns to light sleep (stage 1). Brief awakenings happen throughout the night.
Insomnia comes in various types. Peter Crosta, in an article published by Medical News Today, enumerates three: transient, acute, and chronic. Transient insomnia occurs when symptoms last from a few days to a few weeks.
When symptoms persist for several weeks, it’s called acute insomnia (also known as short-term insomnia). Chronic insomnia lasts for months and sometimes years. The US National Institutes of Health says the majority of insomnia falls under this type.
Some people fall asleep at inappropriate times and then cannot sleep when they should. Sleep experts call this sleep-wake disorder. “These sleep-wake reversals often result from jet lag, working irregular night shifts, frequent changes in work hours, or excessive use of alcohol,” the Merck manual notes.
Aside from frequent travelers and shift workers, other people who are most likely to suffer from insomnia are the elderly, adolescent or young adult students, pregnant women, menopausal women, and those with mental health disorders.
At one time, a kid asked: “Why do we need to sleep? Why can’t we wake up all the time?” Good questions. The thing is: “Sleep is a vital indicator of overall health and well-being,” the NSF points out. “We spend up to one-third of our lives asleep, and the overall state of our’ sleep health’ remains an essential question throughout our lifespan.”
The Healthy Sleep book gives some points on why sleep is essential: “The quality of sleep directly affects your mental and physical health and the quality of your waking life, including your productivity, emotional, balance, brain and heart health, immune system, creativity, vitality, and even your weight. No other activity delivers so many benefits with so little effort!
“Sleep isn’t merely a time when your body shuts off. While you rest, your brain stays busy, overseeing biological maintenance that keeps your body running in top condition, preparing you for the day ahead. Without enough hours of restorative sleep, you won’t be able to work, learn, create, and communicate at a level even close to your true potential. Regularly skimp on ‘service’ and you’re headed for a major mental and physical breakdown.”
However, most sleep experts claim the amount of sleep a person needs varies on many factors, one of which is age. In an interview with “The Independent,” Dr. Ana Noia, a senior clinical physiologist in neurophysiology and Sleep at Bupa Cromwell Hospital, explained that sleep needs could vary according to the individual. Still, as a standard rule, sleep needs changes with age.
Dr. Noia, however, recommends that adult people – those more than 60 years old – sleep between seven to eight hours a night.
Getting a few hours of sleep as a result of insomnia may result in weight gain. “Sleeping less than five hours… a night appears to increase the likelihood of weight gain,” wrote Mayo Clinic’s Dr. Donald Hensrud, who cited a study about women sleeping less than six hours a night gained 5 kilograms compared to women who slept seven hours a night.
“One explanation might be that sleep duration affects hormones regular hunger – ghrelin and leptin – and stimulates the appetite,” Dr. Hensrud wrote. “Another contributing factor might be that lack of sleep leads to fatigue and results in less physical activity.”
Not getting a good night’s sleep can also affect the immune system, thus increasing the chances of getting sick. “Studies show that people who don’t get quality sleep or enough sleep are more likely to get sick after being exposed to a virus,” pointed out Dr. Eric J. Olson, another Mayo Clinic contributor. “Lack of sleep can also affect how fast you recover if you do get sick.”
Dr. Olson explains: “During sleep, your immune system releases proteins called cytokines, some of which help promote sleep. Certain cytokines need to increase when you have an infection or inflammation, or when you’re under stress. Sleep deprivation may decrease production of these protective cytokines. In addition, infection-fighting antibodies and cells are reduced during periods when you don’t get enough sleep.”
If you are regularly having trouble falling or staying asleep, make an appointment with your doctor. “Treatment depends on what’s causing your insomnia,” the Mayo Clinic says. “Sometimes, an underlying medical or sleep disorder can be found and treated – a much more effective approach than just treating the symptom of insomnia itself.”
For persistent insomnia, behavior changes learned through cognitive behavioral therapy can beat it. Sleeping regularly, exercising regularly, avoiding caffeine and daytime naps, and keeping stress in check are also likely to help.
But there are instances where sleeping pills may be helpful. “Although sleeping pills don’t treat the underlying cause of your sleeping problems, they may help you get some much needed rest,” the Mayo Clinic says.
Be sure to ask your doctor about potential side effects before deciding on which sleeping pills to consider taking. Among the side effects are as follows: dizziness or lightheadedness, headache, gastrointestinal problems such as diarrhea and nausea, prolonged drowsiness, severe allergic reaction, sleep behaviors (sleep-driving and sleep-eating), and daytime memory and performance problems.
Just a case in point: The death of Hollywood goddess Marilyn Monroe was attributed to overdosing on sleeping pills. Her insomnia was reportedly tied to long-standing emotional spells. Just before her untimely death, she was enraged when “she heard that one of her confidants had slept for 15 hours the previous night.”