Insomnia covers a number of different sleep disorders and isn’t just how many hours of sleep you get.
Insomnia is a subjective complaint that can be defined as having difficulty getting enough sleep, either in terms of duration or of sleep that is of insufficient quality. As such, it can be accompanied by abnormal fatigue and sleepiness. More than just the number of hours of sleep, insomnia relates to the quality of sleep recovery and the ability to live normally without any impairment during the day time.
Insomnia must also be considered according to what type of sleeper you are. A small sleeper does not have the same needs as a big sleeper and each person’s perception of insomnia will be different.
Understanding your insomnia
There are multiple evaluation criteria for insomnia.
Different criteria make it possible to define insomnia beyond the number of hours of sleep:
- The quality of sleep and its duration
- The number of times waking up during the night
- Early awakening
- Nightmares or restless sleep
Other questions to ask yourself include:
– Is insomnia recent and due to poor sleep hygiene, the environment, or physical or psychological trauma?
– Has insomnia developed over a longer period of time? (This is often a disease that evolves from childhood, sometimes without cause (idiopathic – for example, Parkinson’s disease), often of psychological origin (psychophysiological), and worsens during stress).
To better understand your insomnia, you should also take into account your sleeping conditions, and look for any things that may disrupt them:
- Routine (fixed or variable) during the week and the weekend
- The environment of your room and the quality of your bedding
- Other toxicants whose negative effects on the quality and quantity of sleep are known
Other symptoms may contribute to insomnia or simply accompany it like
- Various pain or headache preventing you from falling asleep or waking you up
- Frequent urges to urinate especially in men with prostate problems
- Breathing difficulties leading to first sleeping in a sitting position and then preventing sleep: this is the case of heart or respiratory failure
- Digestive disorders (eg. gastroesophageal reflux, bloating)
- Anxiety or depression-related disorders (eg. hoarding disorder, obsessive-compulsive disorder, anthropophobia)
Specific conditions such as sleep apnea (breathing pauses during sleep) or restless leg syndrome are directly responsible for insomnia.
Keeping a sleep log and polysomnography are the two main tests to diagnose insomnia.
A sleep log is used to record sleep schedules for at least a fortnight. Then, we can use wrist equipment that measures the periods of rest and activity over several days. Psychological tests of personality, anxiety or depression may be used in conjunction to help the doctor better describe the psychological context. The doctor will also look for abnormal somnolence during the day with repeated sleep latency tests and wakefulness tests.
Polysomnography records a night’s sleep and is usually carried out in either a specialized unit or sometimes at home. This specialized test measures a number of criteria:
- Perception of sleep disturbance
- Sleep-related respiratory disturbance
- Periodic movements of limbs in sleep
- Abnormalities in the organization of sleep (awakenings, schedules and appearance of sleep cycles)
- Abnormalities of the microstructure of sleep (rhythm of awakenings mixed with those of sleep)
How is insomnia classified?
Insomnia is either acute or chronic.
First of all, the difference between acute insomnia and chronic insomnia is that the conditions are not the same, which will lead the doctor to propose different examinations and treatments.
Acute insomnia is common and caused by stress at home or work, or by recent traumatic events. It usually lasts from a few days to a few months. Chronic insomnia is usually more deep-rooted and caused my long-term psychological problems or unresolved childhood trauma.
In the context of chronic insomnia, it is also necessary to differentiate between:
- Those related to a somatic problem, such as pain or dyspnea, ie difficulty breathing, as for example in chronic respiratory insufficiency
- Those whose origin is psychological or psychiatric: anxiety or depression in particular
- Those that are of intrinsic origin and directly related to a problem of the organization or structuring of sleep of the person with insomnia
- Those of medicinal origin because indeed medications can be the cause of insomnia
More on acute vs chronic insomnia
Acute or transient insomnia is the most common.
Insomnia is acute (or transient) if it lasts a few nights but does not exceed three weeks.
Some possible causes include:
- Poor sleep hygiene: taking stimulants (coffee, alcohol, and tobacco in particular), irregular bedtimes, prolonged mornings, too long and too many naps, night shift work, jet lag
- Environmental factors: excessive noise in the room, high temperature, conflicts, stress, light, altitude
- Changes in medication: too fast or premature discontinuation of a hypnotic treatment
Chronic insomnia lasts for at least three months at least three days a week. Chronic insomnia can last for years and may begin in childhood. The symptoms are similar to acute insomnia, but it nearly always has a single cause: most commonly negative psychological associations with sleep, bedroom, and nighttime routines.
Primary and secondary insomnia
Different classifications have been proposed to understand insomnia. Primary insomnia is also known as ‘intrinsic’ insomnia and has internal causes. Secondary insomnia is caused by external factors.
It is relatively easy to find the cause and solution to the problem of secondary insomnia, whether it is the environment, a traumatic event or associated disease. Insomnia of the primary or “intrinsic” type is more difficult to study and treat.
Insomnia of intrinsic origin is grouped into three categories:
- Bad perception of sleep is when the person believes they have not slept but in fact have. This can be proved by normal sleep recordings.
- Idiopathic insomnia, which begins in childhood and for which we evoke an imbalance of chemical transmissions causing a disruption of the sleep system (states of hyper-arousal, difficulty transitioning from different types of sleep, and difficulty maintaining sleep).
- Psycho-physiological insomnia begins as a young adult, often a woman, on the occasion of a traumatic event or a change of life. Sleep difficulties are found in childhood. At first, not very disabling, this insomnia progressively evolves and the insomniac complains more and more of a difficult sleep, interrupted by many awakenings, wakes up tired and little by little the fear of going to sleep settles in.
In this type of insomnia the start of the day is difficult with a feeling of lowered sensory capacity (eg. sight, speech), difficulties of concentration, and memory problems. An electroencephalogram will show a shallow sleep with arousals. The subjects are in fact very often in a state of hyper-awakening (increased muscular tension, high heart rate, increased central temperature) that persists during sleep or even sleep. Personality tests often show traits of anxiety, depression.
Consequences of Insomnia
The consequences of insomnia are inevitable both physically and psychologically.
The insomniac, with a sleep never really restorative, has symptoms directly related to this lack of sleep in the first rank of which are fatigue and disorders of alertness. A new research paper suggests that sleep problems can lead to severe disorders like multiple personality disorder.
If the insomnia is often accompanied by a state of hyper-awakening (increased muscular tension, high heart rate, increased central temperature), very short phases of sleep are recorded during the day, without the subject’s awareness.
In the case of insomnia, it is difficult to separate what amounts to difficulty of concentration and what amounts to drowsiness, but both can sometimes have dramatic consequences including traffic accidents or industrial accidents.
The psychiatric repercussions of insomnia are constant after a few months of insomnia. The insomniac is likely to adapt poorly to the stresses of everyday life.
It is also now proven that the absence of sleep has a direct impact on weight gain and that in obese children, for example sleeping an hour more per night leads to losing weight.