In medicine, insomnia is part of the large family of sleep disorders, which includes narcolepsy (sudden and unpredictable onset of sleepiness), hypersomnia (an excessive need to sleep), and circadian rhythms.

Insomnia is characterized by difficulty getting enough sleep, to the point where it interferes with activities of daily living (drowsiness, poor attention, irritability, etc.). Some people naturally sleep fewer hours a night than other people without bad repercussions: they are therefore not insomniacs.

Types of insomnia

There are 2 types of insomnia:

• Transient insomnia: the symptoms are linked to a one-off situation that is often easily identifiable (a more stressful period at the office, a divorce, a layoff, etc.). This type of insomnia can nevertheless last for several weeks;
• Chronic insomnia: difficulty sleeping must occur at least 3 nights a week, lasting at least 1 month.

Note that the line between these 2 types of insomnia is not always clear.

Who is affected?

According to the Health Resources & Services Administration, about 50 to 70 million American adults suffer from chronic sleep disorders. According to the another survey by Canadian researchers, 36.5% of insomniacs don’t usually feel rested when they wake up. The survey also found that people with insomnia sleep an average of 1 hour less per night than people who do not.

However, statistics on the prevalence of insomnia, however, vary from source to source, as the “criteria for insomnia” used in different surveys are not always the same. Some researchers rely on the duration of symptoms; others, on their degree of seriousness; still others, on their presence or not. The criterion most often used is the frequency of symptoms of insomnia.

Causes of insomnia

Insomnia is a symptom, not an illness in itself, much like a fever. Before thinking about treating it, we must therefore find the cause(s).

Some of the physical and environmental factors that have a major influence on sleep include ambient light and noise, as well as the content and timing of meals.

Psychological factors, such as stress or anxiety, also play an important role. They account for 50% of all cases of insomnia evaluated in a sleep laboratory.

In addition to factors related to lifestyle and the environment, all kinds of acute and chronic health problems can disrupt sleep:

• restless legs syndrome, which is characterized by an overwhelming urge to move the legs, especially during times of relaxation or inactivity;
• sleep apnea, which usually occurs in people who are overweight, obese, or who snore heavily; it causes breathing pauses of a few seconds or more several times during the night, which may or may not cause conscious awakenings;
• chronic pain caused by arthritis or cancer for example;
• Depression;
• difficulty breathing (in heart failure or lung disease), the need to urinate at night (nocturia), gastroesophageal reflux disease, hyperthyroidism, Parkinson’s disease or Alzheimer’s disease.

Sleep needs with age

Contrary to popular belief, seniors do not really need less sleep than other adults, even if many sleep less, according to sleep specialist Charles Morin, psychologist and researcher at Laval University in Quebec. With age, periods of slow deep sleep decrease continuously. Because sleep is more fragile, older people are more likely to be awakened by external stimuli, be it noise, light or body pain. However, by taking naps when necessary and following the rules of sleep hygiene, it is quite possible for them to get enough sleep.

Average sleep requirements by age

Possible consequences of insomnia

The consequences of insomnia are quickly felt and include: fatigue, drowsiness, irritability, memory loss, and difficulty concentrating during the day.

Insomnia also tends to exacerbate the symptoms of certain health problems: migraines, pain, digestive problems, etc.

While having a few sleepless nights occasionally isn’t worrisome, a chronic lack of sleep can disrupt daily activities and cause:

• academic difficulties, especially among primary school students;
• at work, absenteeism or presenteeism (being present in body and not in spirit);
• accidents at work and road accidents

Symptoms of insomnia

• Difficulty falling asleep.
• Intermittent awakenings during the night.
• A premature awakening.
• Fatigue upon waking up.
• Fatigue, irritability and trouble concentrating during the day.
• Decreased alertness or performance.
• Anxious anticipation of the coming of night.

People at risk of insomnia

• Women are more likely to suffer from insomnia than men, among other things due to certain hormonal changes before menstruation and during the years before and after menopause.
• People aged 50 and over.

Risk factors of insomnia

• Vulnerability to stress, a tendency to anxiety, depression, trauma or other psychological or psychiatric problems.
• An environment not conducive to sleep: an inadequate temperature, excessive lighting and noise, a night’s sleep at high altitude or with a snorer, etc.
• Jet lag, night work or frequent changes in the work schedule.
• Poor sleep hygiene (excessive napping during the day, lack of daytime physical activity, overly active evenings, irregular hours of sleep, etc.).
• Changes in night routine
• Excessive consumption of caffeine during the day or before bedtime: for example, consumption of tea, coffee, cola, energy drinks and chocolate. Mint herbal teas can also have an arousing effect.
• Alcohol consumption in the evening. Alcohol can make it easier to fall asleep. However, as the body metabolizes alcohol, sleep becomes fragmented and of poorer quality.
• Taking over-the-counter medications, such as certain decongestants, pain relievers, and weight loss products (often containing caffeine and other stimulants), or taking prescription medications, such as certain antidepressants, anti-stress medications hypertension and corticosteroids.
• Use of drugs that stimulate the central nervous system, such as methamphetamine (including crystal meth) and cocaine. These substances decrease the feeling of tiredness or the feeling of needing to sleep, as well as the appetite.
• Withdrawal (when you stop using tobacco, sleeping pills, antidepressants, anxiolytics, tranquilizers).
• Smoking, especially in the evening.
• For people with insomnia, anxiety about having trouble falling asleep exaggerates the problem.

Prevention of insomnia

Here are some tips that encourage sleep. The above risk factors should be avoided as much as possible.

Get 20 to 30 minutes of exercise per day

People who exercise regularly, even moderately, sleep better than others. A study from Stanford University (California) showed that adults aged 50 to 76 with moderate insomnia could improve the quality of their sleep with regular exercise of moderate intensity. Active subjects fell asleep twice as fast as sedentary subjects and slept 1 hour more per night.

However, many people sleep less well when they exercise vigorously less than 2 to 3 hours before bedtime.

Set up your bedroom to promote sleep

Sleeping on a good mattress and in a dark room helps sleep.

In the city, you can use curtains or blinds to cut off the exterior light Light acts directly on the pituitary gland, a gland that has a major influence on the body clock. A room that is too bright or too dark impairs the waking process.

If necessary, surrounding noises can be attenuated by arranging the bedrooms in the quietest rooms of the house or by soundproofing the walls, ceilings and floors. You can also simply use earplugs.

Some people sleep best when there is a light, constant background noise (such as a fan), which covers up louder noises coming from outside.

It is advisable to ensure that the temperature in the bedroom at night is slightly lower than the daytime temperature, and also to ventilate the room well. We generally recommend a temperature around 18 °C or 65 °F.

Pay attention to the evening meal

• Eat at regular times.
• Avoid eating late at night because digestion keeps you awake. This advice becomes more important with age, as digestion takes place more slowly.
• Eat a light, slightly spicy meal at dinner, which promotes sleep. To compensate, have a larger breakfast and dinner. Rich suppers help fragment sleep, especially if they are well watered.
• A supper rich in carbohydrates and low in proteins contributes to good sleep by stimulating the production of 2 hormones involved in sleep: melatonin and serotonin.

Avoiding the consumption of stimulants

• During the few hours before bedtime, avoid consuming stimulants, such as coffee, tea, chocolate, nicotine or colas. In general, it is recommended not to take more than 2 or 3 cups of coffee per day. Even if they only drink one coffee several hours before going to bed, some people, who are very sensitive to caffeine, will not be able to sleep overnight.
• Monitor the labels of the drugs consumed. Look for stimulants, such as pseudoephedrine. Check with your pharmacist if in doubt.

Relax before bed

• Certain relaxation routines can help you fall asleep. Relaxation of body and mind makes it easier to sleep.
• In the hours before bedtime, focus on calm activities that require little energy: a walk in the fresh air, a few yoga postures, a little reading or relaxation, a bath, a massage, meditation, etc.
• Calming music, inspiring reading or uplifting pictures are better than a newsletter or a violent movie.

Aim for regularity

Try to get up at around the same time every morning, even on days off. This habits helps to regulate the body clock and makes it easier to fall asleep at night.

Treatment of insomnia

Insomnia requires treatment tailored to each situation. The first step is to find the cause. Often, insomnia that has been present for several months requires reorganizing lifestyle habits to promote sleep.

To sleep better, start by changing your habits

The treatment with behaviors known as “stimulus control” is particularly effective. It aims to accustom the body to a routine conducive to sleep. It does, however, create sleep deprivation, which sometimes makes it difficult to apply. Once you regain deep, regular sleep, and the wake and sleep cycles are resynchronized, you can gradually return to a less restrictive routine.

Here are some behavioral rules to be scrupulously observed:

• Go to bed only when you want to sleep.
• Do not stay in bed when awake for more than 20 to 30 minutes. When this happens, get up, get out of your bedroom, do some relaxing activity, and go back to bed when you are sleepy. Repeat these gestures as often as necessary.
• Getting up in the morning at a fixed time, regardless of the day of the week, including Saturday and Sunday, and even if you did not sleep badly. It’s true that it cuts down on sleep time, but it helps to sleep all at once. In the beginning, you should not delay getting up to catch up with the hours that you were not able to sleep: in the long term, this may make the problem worse. When you finally have regular and uninterrupted sleep, you can slightly extend your nights (in 15-minute increments).
• Do not go to bed for less than 5 hours.
• Do no other activity in bed (ideally in the bedroom) other than sleeping or having sex.
• Regarding a nap during the day, opinions differ. Some experts ban it completely because it would meet part of the sleep needs. According to them, naps would make it more difficult to fall asleep. Others say a short 10-minute nap can be beneficial.

Several scientific studies show that this method has been proven. An improvement in sleep is observed from the end of the first month. Its downside is that it takes discipline and motivation. You can try it yourself, but it can also be done as part of cognitive-behavioral psychotherapy.

Medicines to fight against insomnia

If insomnia persists despite the method mentioned above, sleeping pills (also called hypnotics) may be prescribed. These drugs can be helpful in the short term to recover a little (not more than 3 weeks), but they do not treat insomnia or eliminate its cause. They work by slowing the activity of the brain. Note that after 1 month of use, they often lose a lot of their effectiveness.

• Benzodiazepines

These are the most commonly prescribed sleeping pills. If used regularly, they lose their effectiveness. These all have a sedative and anxiolytic effect, at various intensities. Benzodiazepines specifically indicated to treat insomnia are flurazepam (Dalmane®), temazepam (Restoril®), nitrazepam (Mogadon®), oxazepam and lorazepam (Ativan®). Diazepam (Valium®), marketed in the early 1960s, is hardly used any more, in part because it causes significant residual drowsiness the next morning.

• Non-benzodiazepine sleeping pills

Including zopiclone (Imovane®) and zaleplon (Starnoc®)), they have been on the market for several years. Their duration of action is shorter than that of benzodiazepines, which eliminates the drowsiness effect that can occur the next morning.

• Melatonin agonists

These help induce sleep by increasing levels of natural melatonin. They are used especially in cases of difficulty falling asleep.

• Antidepressants

In low doses, they can also be used to help sleep better.

Note: Benzodiazepine and non-benzodiazepine sleeping pills have several side effects. For example, they can slow reflexes and interfere with coordination during the day, increasing the risk of falls and fractures, especially in older people. In the long term, they risk causing physical and psychological dependence. Finally, the sleep induced by sleeping pills is less restorative, because these drugs shorten the period of REM sleep (the period during which dreams occur).

It is important to consult your doctor when you want to stop taking sleeping pills or tranquilizers to avoid suffering from a withdrawal syndrome. Cognitive behavioral therapy, according to one study, facilitates complete withdrawal from chronic insomniacs who have been taking benzodiazepines; it also improves the quality of sleep. The results were visible after 3 months of treatment.

Other treatments

For severe anxiety, depression, or any other psychological disorder, your doctor may prescribe antidepressants that will relieve insomnia. He or she can also refer the patient to a psychologist or psychiatrist.

If a physical health problem is the reason for insomnia, of course, you need to get adequate treatment for that particular problem.

In case of insomnia caused by pain, pain relievers may be used. However, some of them can cause insomnia. If so, don’t hesitate to ask your doctor to change the prescription.

Caution: When experiencing insomnia, it is not recommended to use antihistamines that cause drowsiness to sleep better. These drugs have little effect on chronic insomnia. They can even trigger a state of wakefulness.

• Behavior therapy

According to the most recent studies, cognitive-behavioral psychotherapy is often more effective than medication in controlling insomnia. This therapy helps to deconstruct mistaken associations or beliefs fueling the distress associated with insomnia.

A personalized therapy can include:

• advice on sleep habits;
• work on unrealistic beliefs and thoughts related to insomnia or on the psychological causes of insomnia;
• learning a relaxation technique.

The number of sessions varies from person to person, but generally improvement is seen after 2 to 3 months of weekly treatments (8 to 12 sessions). Its efficiency rate would be 80% on average. People who are already taking sleeping pills may also benefit.

Sleep is crucial… it’s anything but a waste of time!

Getting a good night’s sleep is important not only for feeling good and energetic, but also for enjoying good long-term health. During sleep, several physiological processes take place: liver and muscle tissues regenerate, the immune system rebuilds its strength, memory strengthens, etc. The secretion of growth hormones is highest during sleep. The brain also takes advantage of this respite to eliminate its “waste” thanks to antioxidants. However, not much is yet known about how sleep triggers these restorative mechanisms.