Henry Olders, an assistant professor of psychiatry at McGill University in Montreal who conducts sleep research, explains.
Most people encounter sleep difficulties from time to time, often related to stress or pain. Many of these bouts get better without treatment. Unfortunately, in a significant proportion of the population, sleep problems turn into insomnia, which is defined as the chronic inability to fall asleep or to enjoy uninterrupted sleep. Some research suggests that attitudes about sleep, and the sleep patterns and behaviors prompted by these attitudes, make certain individuals vulnerable to chronic insomnia. The good news is that behavioral treatments are highly effective.
Just how big a problem is insomnia? The National Sleep Foundation surveyed more than a thousand adults in 2002. Thirty-five percent said that, every night or almost every night of the previous year, they had at least one out of these four symptoms: difficulty falling asleep, waking a lot during the night, waking up too early and not being able to get back to sleep, or waking up feeling unrefreshed. About 15 percent of the survey group reported taking either a prescription sleep medication or an over-the-counter sleep aid at least a few times a month. A study of the Canadian population found that 24 percent of people ages 15 and older reported insomnia, defined in this study as a "yes" response to the question "Do you regularly have trouble going to sleep or staying asleep?" Some of the factors associated with insomnia in this study included being female, being widowed or single, having a low education level, low income, unemployment, smoking, life stress, physical health problems, and pain or activity limitation. Although age did not seem to be a factor in this survey, other studies have shown that insomnia increases with age. For example, 4 percent of a sample of older European adolescents met criteria for insomnia disorder as defined by the Diagnostic and Statistical Manual, 4th edition (DSM-IV) of the American Psychiatric Association. Compare this to a group of 330 elderly patients in a family practice, in which 57 percent met criteria for DSM-IIIR insomnia disorder. What¿s worse, insomnia is not a benign problem. Difficulty falling asleep or staying asleep is associated with an increased risk of dying in the elderly. Many elderly insomniacs take naps during the day; in addition to making insomnia worse, naps are related to higher mortality in this age group.
Although many people believe that psychiatric disorders such as depression and anxiety cause insomnia, the reverse may actually be true. The National Institutes of Mental Health Epidemiologic Catchment Area study found the risk of developing a new depression was 39.8 times higher for insomniacs than for those without sleep problems. Other research, however, suggests that too much sleep--in particular too much rapid eye movement (REM) sleep--can bring on a depressive state. We can reconcile these two seemingly incompatible findings by asserting that insomniacs who become depressed are getting too much sleep. Unfortunately, this flies in the face of conventional wisdom that holds that insomniacs are sleep-deprived.
Whereas many people with difficulty sleeping believe that they¿re not getting enough sleep (an opinion shared by a number of sleep researchers), evidence is mounting that people with insomnia are in fact getting at least as much sleep as they require, and possibly more. What is known is that insomniacs tend to get into bed early, stay in bed late, sleep during the day, spend more time in bed than non-insomniacs, and that they underestimate the amount they actually sleep even though they sleep as much as those people without insomnia. The amount of daytime sleep a person experiences is directly related to overall sleeping problems. Finally, voluntarily extending sleep is known to cause insomnia. Conversely, reducing time in bed is a very effective treatment for sleeplessness. Thus the hypothesis that primary insomnia is caused by attempting to sleep more than you need.
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Reply | Report Abuse | Link to thishttp://psychcentral.com/blog/archives/2007/03/12/light-and-dark/
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1600-079X.2007.00473.x
MINI REVIEW
Kristen J. Navara, Randy J. Nelson (2007) The dark side of light at night: physiological, epidemiological, and ecological consequences
Journal of Pineal Research 43 (3) , 215–224 doi:10.1111/j.1600-079X.2007.00473.x
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A bit more on spectra — here’s a secondary source that appears to be a copy from Brainerd’s 2001 article
http://www.lighttherapycanada.biz/images/LB/ResEng/Brainardcurve2.gif
That’s the band you want to _avoid_ to be able to fall asleep (and the band you want to get to wake up and stay alert, of course — daylight blue skylight as filtered through green leaves, more or less. I have a “Go Outdoors” sign to remind me of that at home!).
You know what really bugs me as an insomniac? Whenever people write about insomnia, there's always a section about how persistent insomnia is caused by other things, with an obligatory mention of depression. I've never seen someone end an article by saying:
Reply | Report Abuse | Link to thisScience is just beginning to understand the brain circuitry involved in sleep. No one knows how many people have faulty sleep circuitry and are in a state of constant sleep deprivation, the symptoms of which can be interpreted as depression, ADD,.... etc. If YOU have faulty sleep circuitry there is no cure for you right now and your life may be extremely painful while you wait.
Your depression is causing the insomnia.
I hear this repeated by doctors/people over and over again. And it is belittling to millions of us who can't sleep normally, suffer severe mental effects because of it, and are then fed a series of utterly ineffective and expensive anti-depressants. Depression is a category that people are put in. It is not an identification of biological disregulation, and cannot be the CAUSE of anything. The psychiatric categories (especially depression) have become a dumping ground for all patients who have problems that science doesn't yet understand.
For someone to be diagnosed with primary insomnia under its current definition (sleeplessness that cannot be attributed to a medical, psychiatric, or environmental cause), they'd have to be experiencing severe sleep problems and have NO mood problems whatsoever. Not only that, if we assume someone DOES have shoddy sleep regulation as a first cause, they will NOT be diagnosed with primary insomnia, because of course they will be exhibiting all sorts of psychiatric symptoms.
So what we have here is a definition created solely as a way for the industry to conceal medical ignorance regarding people who's brains won't sleep properly. If the orexin blockers are effective when they hit the market I guarantee you that suddenly everyone will be diagnosed with primary insomnia, and the definition will magically change.
Psychiatrist tell us that Primary Insomnia is very rare . And by their strange definition it is. But malfunctioning sleep circuitry in the brain as a root cause of a patient's problems may be extremely common.
This is the kind of garbage that is written--again and again --by people who haven't a clue about what insomnia is or what it's like to live with. Getting all the sleep we need--honestly, get real. Come and live in my body for a month, or even a few nights, see how it feels. Read my book INSOMNIAC .
Reply | Report Abuse | Link to thisI'm amazed this kind of article still gets published, when sleep science is so much more advanced and more interesting and nuanced in its discoveries than this pap indicates. Everybody's sleep system is different, some fragile and some robust, there are biological variabilities, physiological differences, that this one size fits all kind of psychobabble totally blurs, and no, we are NOT getting all the sleep we need! A brain scan tells you that. Why not read something about the science before you dish out the nonsense.
And Cherrywater (comment above)--right on!
And Sci Am--you can do better than this!
well im experiencing insomnia right now and let me tell you its living hell and its ruining my future for success
Reply | Report Abuse | Link to thisI believe that people just thinking to much can lead to insomnia.
Reply | Report Abuse | Link to thisAlso not owning a good <a href="http://www.sleepys.com">mattress</a> might lead to some insomnia.
Reply | Report Abuse | Link to thisI suffer from insomnia. I purchased a new mattress topped with memory foam. Helped my body relax but did not cure my insomnia. I was prescribed seroquel for sleep, made me too drowsy and caused me to sleep too long. I looked up the chemistry on seroquel and discovered an antihistamine in my cabinet would work just as well. I have been using chorpheneramine Maleate for a month with great success. What you eat before retiring has an influence on your sleep I have learned. Eating alot of protein before bed can increase brain chemicals like histamine that makes one alert. Also taking in some low glycemic carbs at bedtime works great for boosting adenosine that has a neuroinhibitory affect on the brain. I also have added 3-5 mgs melatonin under the tongue plus listening to Soma, track 2 for 30 minutes and I am back to getting my deep delta wave sleep again.
Reply | Report Abuse | Link to thisI suffer from insomnia. I purchased a new mattress topped with memory foam. Helped my body relax but did not cure my insomnia. I was prescribed seroquel for sleep, made me too drowsy and caused me to sleep too long. I looked up the chemistry on seroquel and discovered an antihistamine in my cabinet would work just as well. I have been using chorpheneramine Maleate for a month with great success. What you eat before retiring has an influence on your sleep I have learned. Eating alot of protein before bed can increase brain chemicals like histamine that makes one alert. Also taking in some low glycemic carbs at bedtime works great for boosting adenosine that has a neuroinhibitory affect on the brain. I also have added 3-5 mgs melatonin under the tongue plus listening to Soma, track 2 for 30 minutes and I am back to getting my deep delta wave sleep again.
Reply | Report Abuse | Link to thisI am an avid reader of SciAm and am usually impressed by your well written and balanced articles. You dropped the ball on this one. I have epilepsy and suffer from several sleep disorders as well. I get very little REM sleep because of my brains faulty circuitry so I went through about 21 years of sleeping problems and about 12 years of utter desperation before my diagnosis went from insomnia to anything else. It is only because of the epilepsy I got any help at all. How many people out there that do not see neurologist, see a doctor that knows much about sleep disorders? Not very many. I have been a sleep eater for 12 years and the first 3 doctors laughed at me, and one of them referred me to a psychiatrist.
Reply | Report Abuse | Link to thisInsomnia may sound like a benign and easily treatable condition. But insomnia can sometimes be a symptom of a larger problem. Just something to keep in mind.
Normally I disagree with Gayle Greene and what she suggest, but think she's partly right this time.
Reply | Report Abuse | Link to thisAs a former insomniac (who was 'cured' not by sleep restriction or any of the other suggestions in the article) he does come across as slightly patronizing.
From my own experience I don't think insomnia is usually am matter of worrying to much, although I doubt catastrophising about the effect insomnia has on your life helps either.