Insomnia: A Biological Standpoint

Insomnia is a common enough term, at least as far as what it is goes. However, for a more clinical definition John Pinel, author of the psychology textbook Biopsychology notes that insomnia "...includes all disorders of initiating and maintaining sleep" (2006). An insomnia diagnosis can also be given due to a nonrestorative sleep, however, simply not getting enough sleep is not considered insomnia. Additionally, primary insomnia is not a disorder that can result from a mental disorder, medical disorder, or as a result of substance abuse. Instead, under the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders published by the American Psychological Association) insomnia resulting from the aforementioned is a secondary problem. These secondary causes will be discussed after primary insomnia causes are addressed.

Currently, there are three different causes of primary insomnia, and each are caused by different circumstances and factors. The first of these is called psychophysiological insomnia. As the name suggests, this form of insomnia deals with the interaction of the mind and body in preventing one from falling asleep or maintaining sleep during a sleep cycle. As such, this form of insomnia comes about as a result of high stress or anxiety. Instead of resolving one's stress in a constructive manner, allowing high stress or anxiety levels can lead some people to experience body dysfunction, pain, or physical illness. Additionally, this sort of dysfunction can lead to learned behaviors that also inhibit sleep. For example, according to Sleep Channel (2000), such behaviors as brushing one's teeth, turning off the light, and lying in bed, can replace the stress in one's life and inhibit sleep. Sleep Channel (2000) also notes that that because these environmental factors become a part of the problem, unfamiliar environments can sometimes lead to a better sleep for psychophysiological insomnia sufferers. It is important to note here that insomnia can result from stress and anxiety disorders, however, here we're merely addressing stress or anxiety experienced in daily life as opposed to a clinically diagnosed stress or anxiety disorder in which insomnia would be a secondary problem. A good way to remember psychophysiological insomnia is by associating it with learned behaviors that result in insomnia.

Other behaviors that inhibit sleeping are eating before bed, working on something heavy that can induce thought well into the night (finances, relationships, school, etc...), and exercising before bed.

Idiopathic insomnia is another form of insomnia, and includes insomnia due to neurological abnormalities. More specifically, this form of insomnia is often attributed to neurologic lesions which create abnormalities in control over sleep-wake cycles. An example of this is Non 24-Hour Sleep Wake Syndrome, a condition in which one's circadian rhythms naturally slip further and further back each night. Where sleep might come at midnight one night, the next night it is one am, and the next two am; creating a cycle of rotating sleep which can severely hinder one's ability to obtain a restorative and restive sleep. Imagine tying to work a 9 - 5 schedule when you're sleeping pattern is at a 1 pm sleep time!

Lastly, sleep misperception is a condition in which an individual feels that they are experiencing insomnia, when in reality they are not. This condition occurs when individuals report that they sleep less than they really do due to inconsistencies in the time it took to fall asleep, and/or the total amount of time they were sleeping. According to Doctor Ranjan, a writer for WebMD's Emedicine notes that doctor's believe that "discrepancy results from an unclear perception of consciousness and difficulty distinguishing sleep from waking" (2008).

Biopsychologists also note that insomnia can result from secondary sources such as sleeping pills, sleep apnea, or other medical conditions affecting the quality of one's sleep. The former is known as iatrogenic, meaning that the problem is created by one's physician (Pinel, 2006). Sleeping pills are generally effective in inducing sleep, however, they easily become a problem due to drug tolerance. Like alcohol, an individual progressively develops a tolerance to sleeping pills, and gradually higher doses of sleeping medication are necessary in order to obtain the same effects as those that were originally present. Withdrawal symptoms include trouble falling asleep and/or extreme disturbances during sleep, and because of this individual's tend to continue taking sleeping medication in higher and higher doses, which can ironically create problems with sleep, and with one's greater health.

Sleep apnea is a condition in which an individual stops breathing periodically throughout a sleep cycle causing the individual to awaken. While this is not insomnia, it is generally diagnosed as either insomnia or hypersomnia (excessive sleep or sleepiness). This is due to the fact that individual's experiencing sleep apnea are often unaware of their condition and the persistent waking during the night. Instead, they complain of a non-restorative or restive sleep and/or always feeling fatigued and sleepy even after a night of sleep.

Secondary insomnia can also be the result of depression, anxiety disorders, and stress disorders, among other mental disorders. As stated earlier, these are secondary reasons for insomnia.

Treating and Avoiding Insomnia

There are various ways of treating insomnia, and the form of treatment is determined by this. For the aforementioned mental disorders (depression, anxiety disorders, stress disorers, etc...), psychologists will treat the underlying causes. For example, an individual suffering from depression might be treated with anti-depressants.

For non secondary sources of depression there are both medications and therapies than can be used. Therapy techniques may also be used in conjunction with therapy for the primary problem if insomnia is a secondary problem. Medications prescribed are benzodiazepines. These drugs are quite powerful and can be addicting, so they are meant to be take in moderation and for a limited time. Most also carry over drowsiness and sedation into the morning hours, which can be bothersome or a downright problem for some. Over the counter medications are also available in less powerful doses. However, these often cause problems with memory, concentration, can cause blurry vision, and morning sickness (Sleep Channel, 2000). Furthermore, long-term use is not recommended due to a tendency to cause sleep disturbances.

Sleep therapies include sleep hygiene improvement and sleep restriction. The former is a type of therapy which encourages insomniac individuals to work on before sleep habits in order to maximize their sleep time and quality. These different life changes include standardizing sleep or waking times; eliminating stimulants such as coffee, nicotine, and alcohol; avoiding before bed exercise; setting worries aside; and limiting in-bed activities (working, reading, or studying in bed - separating these activities encourages a difference between bed time and work time and can encourage sleep while in bed) (Sleep Channel, 2000). Setting and maintaining good sleep hygiene can aid a person in getting sleep and/or maintaining sleep when they've had problems with insomnia. It is important for insomnia patients to remember that while other people may be able to sleep and wake at whatever time they want, good sleep hygiene may be one of the best ways to improve their sleepless nights. Additionally, a good way to avoid insomnia is through setting and maintaining good sleep hygiene.

Sleep restriction is a method in which a person regulates the amount of time in bed to actual sleeping time. If sleep is not possible they are encouraged to get out of bed until they feel tired again and then get back in bed. From their they will go on to sleep for the self-evaluated amount of time. The goal of the therapy is to get the patient to sleep around 90% of the time they are in bed (Sleep Channel, 2000).

References:

Pinel, J. P.J. (2006). Biopsychology, 6^th Edition. University of British Columbia. Pearson. (362 - 363).

Ranjan, A., MD. (2008). Primary Insomnia. Retrieved February 10, 2008, from http://www.emedicine.com/med/topic3128.htm#top

Sleep Channel (2000). Insomnia: Overview, Incidence, and Prevalence. Retrieved Feb 9, 2008, from http://www.sleepdisorderchannel.com/insomnia/index.shtml

*Reviewed by Swierzewski, S. (2007).