Insomnia
Tired but wide awake at night: Insomnia
Have you been wide awake thinking “when will I fall asleep?” - or back asleep? Having the odd bad night's sleep is common, but it can feel frustrating when we continue to experience them night after night leading to insomnia.
What is insomnia?
Medically, insomnia is defined as:
A dissatisfaction with sleep quantity/quality due to starting sleep, maintaining sleep or struggling to return to sleep despite having the opportunity for sleep.
It can causes distress and impacts daytime functioning, which might look like:
Fatigue/low energy
Daytime sleepiness
Impaired attention/concentration
Mood disturbances
To truly be classified as insomnia, the sleep disturbances nee to not be related to substance use, medical conditions, prescription drug use and must be present at least 3 night per week for 3 months.
What causes insomnia?
We don’t fully understand why insomnia takes place, but our current theories believe that it is a disorder of hyperarousal.
Hyperarousal means that we are physiologically and mentally activated. This may mean we have elevated cortisol, body temperature, and heart rate. New research is now also linking insomnia to an upregulation of neurotransmitters and chemicals that are wake-promoting; such as orexin, histamine, and catecholamines. These are the opposite to our sleep promoting and down-regulating neurotransmitters and hormones, which include; adenosine, serotonin, melatonin and GABA (more on these later)
Cognitively, if we suffer from insomnia, we may start to develop thinking patterns that create unhelpful associations around sleep. This may lead to behaviours that worsen insomnia. When it comes to related mood disorders, such as anxiety, depression and stress, it may be a bit hard to determine what comes first. We know stressful life events can trigger bouts of insomnia, but sleep deprivation can worsen anxiety, stress and depression.
What makes us sleep?
What drives our body to sleep is divided into two systems. The first is the circadian rhythm, or our internal body clock that uses melatonin as a hormone that peaks and declines in response to light stimuli to either make us alert or sleepy. The second is referred to as our homeostatic sleep drive.
The circadian rhythm can shift or be off balance when we travel (and experience jet lag, particularly worse when we travel eastwards), when we do shift work, or when we have a period of time where we stay up later. To address circadian rhythm issues with sleep we often use melatonin and light exposure to help retrain our body to the appropriate timing of melatonin release. Melatonin has great research in supporting shift workers, travellers and those who experience delayed sleep phase syndrome (DSPS), a condition where we have a hard time falling asleep and waking up at conventional times.
Homeostatic drive is the other body mechanism that drives our sleep. It physiological is a response to how long we have been awake. The longer we are awake, the more receptors in our nervous system are activated by a chemical called adenosine which causes us to feel sleepy. This can be manipulated to some degree through caffeine and medications that stimulate wakefulness (methamphetamines) which both act on adenosine receptors reversing the “sleepy” effect.
How much sleep do I need?
The amount of sleep we need depends on our age, with most adults requiring between 7-8 hours per night. While we may like to think we can function on less, chronically sleeping under 6.5 hours can have detrimental impacts to our health and functioning. Chronic sleep deprivation is associated with an increase in type II diabetes, hypertension, anxiety, depression, poor performance on activities while awake, an increase in accidents, and a decrease in quality of life.
How can we fix our sleep?
The first step to fixing our insomnia is to look at our behaviours around sleep. While this can be challenging, we ask all patients about their routine around sleep to help them maximise the benefits of sleep hygiene, or the behaviours and environmental factors around sleep.
Often in addition to working on sleep hygiene we urge patients to reflect on activities that will help with restoring the nervous system to a relaxed state. This may include activities they partake in on their own, such as; journaling, meditation, light yoga or stretching, or investing in their health care by attending regular massage therapy, acupuncture, or talk therapy.
From a naturopathic perspective, we may use targeted supplementation to support feelings of stress or anxiety that occur around bed-time, or to shift our circadian rhythm to reflect our desired sleep and wake time.
Another evidence based approach to supporting insomnia is encouraging patients to work with someone trained in Cognitive Behaviour Therapy for insomnia. These programs encompass education and reflection around sleep hygiene, as well as targeted therapy to address thought pattern and behaviours related to sleep. Often after completing these programs (with the addition of other therapies including light exposure or sleep restriction) patients find an improvement in their ability to fall asleep and stay asleep.
What else might be going on?
Depending on the individual, it is always important to rule out other potential drivers of insomnia. These may include:
Hormonal change of perimenopause/menopause
Restless leg syndrome
Sleep apnea
Pain
Anxiety/Depression/Life Stress
Deficiencies related to energy (iron deficiency, vitamin b12 deficiency, hypothyroidism)
I need more help!
Interested in learning more? Book a complimentary meet and greet appointment with one of our naturopathic doctors to discuss how we can support your sleep and overall health. We pride ourselves on taking an evidence based, human approach to your care, and love working in an integrative space with trusted practitioners to give you all the support you may need under one roof.