Browse amazon.com results for "insomnia" and amidst all the self-help books is a slim, seductively titled volume: Insomnia: A Cultural History by Eluned Summers-Bremner. Summers-Bremner, like any good cultural studies major, draws on the teachings of Freud and Foucault and the mid-'90s popularity of those T-shirts emblazoned "You can sleep when you're dead" to posit that insomnia is a distinctly modern, post-industrial, capitalist Western malaise.
Scientific studies about American's sleep habits seem to point to a similar conclusion. An American Cancer Society survey conducted in 1960 reported that most participants received eight hours nightly; today the median has dwindled to 6.7 hours.
And an additional study conducted by the Centers for Disease Control reported that the number of American adults getting six hours of sleep or less nightly has increased since 1985.
Of course there are external pressures that keep adults with otherwise functional sleep habits or "sleep hygiene" up: deadlines, children, and social pressures and pleasures. But what about psychological or biological mechanisms that keep people awake when they're past the point of fatigue?
Nearly everyone experiences what is called transient insomnia at some point in his or her life: a brief period (perhaps a single night) spent tossing and turning, grappling with anxiety. However, for many Americans—an estimated 64 million, according to a report published by the U.S. Department of Health and Human Services in 2007—insomnia is recurrent and disrupts waking life significantly.
Some health effects are obvious and immediate. Amherst-based Dr. Brian Smith notes that insomniacs suffer "daytime irritability, mood change, cognitive impairment, worsening pain perception, and decreased work performance." But insomnia can also contribute to chronic afflictions like cancer and diabetes. Fortunately, insomniacs do have recourse. Though research into sleep disorders is fairly new, recent studies address insomnia and various treatments, from behavioral-modification therapy to new prescription medications, have been proven effective.
Defining the Disorder
"Insomnia" is, of course, one of those medical terms that is well entrenched in the lexicons of most Americans—a hint as to the frequency with which the condition occurs. However, though many individuals may refer to occasional sleeplessness as insomnia, the condition is described as persistent difficulty in falling or staying asleep in spite of the opportunity for rest. And, of course, it is followed by functional impairment when awake.
Medical professionals typically refer to three different "degrees" of the malady: transient insomnia, acute insomnia, and chronic insomnia. Transient insomnia lasts from days to weeks. Acute insomnia is described as the inability to sleep well consistently for a longer stretch of time (from three weeks to six months). And chronic insomnia may last from months to years.
Causes of these stages of insomnia vary. Stress, poor sleep hygiene (erratic sleep habits, changes in the sleeping environment) and other anxiety and mood disorders are the most frequent causes of transient insomnia. More long-term sleep deprivation may be caused by chronic physical pain or more severe psychological disorders.
And the pattern of insomnia, as well as its duration, also often hints at its origins. Initial insomnia, or difficulty falling asleep at the beginning of the night, may indicate the existence of anxiety disorder. Those who have difficulty maintaining sleep are often coping with physical pain and illness, whereas terminal insomnia, characterized by early morning waking, is frequently symptomatic of clinical depression.
Insomnia can also be caused by the use (or abuse) of various stimulants, from the obvious, legal and ever-so-mildly pernicious, like caffeine (caffeine fiends are advised not to ingest any of the substance six hours prior to bedtime) to methamphetamines and cocaine.
Ironically, the use and abuse of certain downers can also produce what is termed "rebound" insomnia. Those who rely on sleeping meds or who try to drink themselves to sleep may have difficulty weaning themselves off their sleep aid of choice. Those who advocate a night-cap should beware: recent research suggests that drinking before bedtime decreases the quality and length of deep-stage, restorative sleep.
A host of organic and physical conditions can also be responsible for insomnia: neurological conditions, brain injuries, hyperthyroidism, Wilson's syndrome, even premenstrual syndrome can result in prolonged difficulty sleeping.
And, as an interesting aside, women are more likely to suffer from insomnia than men (40 percent of women compared to 30 percent of men). While some researchers point to gender conditioning as a probable cause for this disparity (as a columnist for a women's magazine declared recently, "Forget fat—sleep is the new feminist issue"), it may have biological causes as well. Dr. Chris Idzikowski cites changes in hormonal fluctuations during women's menstrual cycles as potential sleep disrupters (and, in turn, acknowledges that disrupted sleep may contribute to premenstrual or menopausal fatigue) in The Insomnia Book; additionally, hormonal changes during pregnancy which affect sleep stages may result in the extreme fatigue that characterizes many women's first trimester of pregnancy.
Effects
And, well, before you forget fat, consider the links between sleep loss, obesity and general health. In The Insomnia Book, Dr. Chris Idzikowski claims that "being overweight often causes problems with breathing which may disturb sleep& and cause daytime sleepiness." And insomnia and sleep deprivation may, in turn, also influence feelings of hunger, satiety, and, resultantly, weight. According to a recent report on 60 Minutes, test subjects coping with "chronic partial sleep deprivation" (approximately four to six hours of sleep per night over a period of several days) showed pre-diabetic blood sugar levels.
Insomniacs (or the sleep deprived) may also experience a drop in a hormone called leptin, which sends neurological signals indicating satiety. Fatigue increases hunger, which increases overeating, which can lead to weight gain and, in extreme cases, obesity.
Other serious but less obvious health hazards for long-term insomnia sufferers may even include an increased risk for cancer. The IARC (International Agency for Research on Cancer) Monographs Program, which identifies carcinogenic environmental factors, released a study in 2007 that showed that "long-term nightworkers," whose schedules may either simulate or cause chronic insomnia, have a higher incidence of breast cancer than those whose work schedules do not disrupt circadian rhythms.
In spite of the T-shirt slogan asserting that "You can sleep when you're dead" that is so popular with upwardly mobile overachievers, sleep deprivation and other effects of insomnia are well documented and occasionally tragic. Both Chris Idzikowski and 60 Minutes correspondent Lesley Stahl point out that poor judgment and loss of psychomotor skills associated with a lack of sleep were possible causes of certain industrial catastrophes, notably the Exxon Valdez oil spill and the system failures at the Three Mile Island and Chernobyl nuclear power plants.
Drowsiness has been a factor in huge percentages of car accidents. Consider it a warning for those who dismiss the seriousness of prolonged periods of insomnia: as the director of the Sleep and Neuroimaging Lab at the University of California-Berkeley declares in the 60 Minutes report, "Sleep serves a whole constellation of functions&"
The Good News
So if insomnia is no laughing matter, what's the good news? Recourse and resources for sleep disorder sufferers are ever broadening and ever more sophisticated. The American Insomnia Organization (americaninsomniaorganization.org) provides a list of sleep clinics nationwide and documents the efficacy of various treatments.
Those with occasional mild insomnia might consider alternative therapies or supplements like valerian and melatonin (the relative effectiveness of the latter has been documented by the American Academy of Sleep Medicine). Dr. Brian Smith advocates a combination of "cognitive behavioral therapy and brief courses of hypnotic agents" as especially efficacious treatments for sleeplessness.
And the pharmaceutical industry, aware of the anxiety and despair (not to mention health hazards and lowered standards of performance) that accompany insomnia, offers various prescription and over-the-counter sleep aids. Finally, as with almost all aspects of human health, enacting common-sense lifestyle practices can improve the quality of sleep: exercising, eating well and participating in stress-reduction activities can all lead to a good (or better) night's sleep. In this life.
