Reasons for Insomnia
Insomnia is a problem for a large percentage of the general population. In one U.S. nationwide survey, performed in 1970 , which included more than 6,000 adults, insomnia was a problem “at least sometimes” for 40% of the women and for 30% of the men (US Dept. of Health, Education
And Welfare). The reasons for insomnia are many, and can be classified into several categories:
Physical reasons - It is well established that there are physical reasons for insomnia. The following physical reasons are commonly associated with insomnia:
• Parkinson’s disease
• Congenital heart failure
• Hypothyroidism
• Hepatic insufficiency
• Renal insufficiency
• Hypertension
• Endocrine disorders
• Intestinal parasites
• Restless leg syndrome
• Sleep apnea
Pain causing conditions - such conditions are also reasons for insomnia. Patients suffering from chronic pain often find that their problems are worsened by the additional difficulties that come with insomnia and sleeping disorders. Of those who report experiencing chronic pain (about 15% of the general U.S. population and 50% of the elderly), approximately 65% report having sleep disorders, including insomnia. When a chronic pain sufferer experiences fragmented sleep, a vicious cycle takes place – sleep disruption caused by chronic pain exacerbates the pain, which in turn interrupts sleep. In a study published on march 2005, which included almost 20,000 European subjects, researchers found that, among other reasons for insomnia, a chronic painful physical condition plays a major role on insomnia and is associated with a worsening of insomnia on several aspects including a greater number of insomnia symptoms, more severe daytime consequences and a more chronic insomnia situation.
Sleep disturbing substances – many medications are known to have a stimulant effect, which disrupts sleep, and can lead to insomnia. Such medications include theanorexigenics, some antidepressants, thyroid hormones and sympathomimetics (Kales et al., 1970). It was also shown that lipophilic beta-blockers that readily pass the blood-brain barrier may also induce insomnia (Kay et al., 1976). Some doctors argue that any drug penetrating the blood brain barrier may cause insomnia. Other popular stimulants such as much caffeine, nicotine and alcohol - all contribute to poor sleep. While it is true that alcohol may help people get to sleep, it can also make them wake up several times during the night, which results in a reduction in total sleeping time. You should also note that, if not managed carefully or stopped abruptly, sleep medications are also reasons for insomnia, as they can cause rebound insomnia.
Mental reasons – it is well established that certain mental conditions may lead to insomnia. A 1999 study by Washington State University researchers revealed that among patients seeking medical care for insomnia more than half were diagnosed with a mental disorder. The most common diagnosis was depression. The following psychiatric disorders have been found to be reasons for insomnia:
• Depression
• Anxiety
• Obsessive compulsive disorder
• Schizophrenia
• Hypomania
• Anorexia nervosa
• Chronic alcoholism
• Drug addiction
Psychological conditions might also lead to insomnia. Stress and anxiety are notorious to effect normal sleep patterns. Short term insomnia is common, and might occur to any person experiencing a real or perceived crisis or loss, such as death of a friend or an end of a romantic relationship (as demonstrated by Nicassio & Bootzin , 1974).
Behavior related reasons-Many times the roots of insomnia can be traced to one or more sleep disturbing behavior. For example, many people do not keep a fixed sleep-wake schedule thorough the week (particularly during weekends) or take naps during the day, which interfere with their need for a night sleep. Other activities which cause sleep disturbances include: engaging in sports activity or a stimulating mental activity close to bedtime, large consumption of caffeine and/or alcohol throughout the day, going to bed in a noisy environment, not keeping the bedroom environment dark enough, etc. Also regarding behavioral causes of insomnia, It is interesting to note that one of the most common forms of insomnia is called conditioned insomnia. This type of insomnia is caused by increased cognitive arousal which prohibits sleep. As demonstrated by Bootzin and Engle-Friedman in 1981 , Patients usually have an anxiety provoking situation which causes sleep difficulty on the first night. During the following nights, the harder the patient tries to sleep, the tenser he gets and the more difficult it becomes for him to sleep. After several nights of severely disrupted sleep, the patient develops conditioned arousal to his bedroom environment, which, in turn, prevents him from sleeping. A vicious cycle begins. However, this process of conditioned arousal, as well as other sleep disrupting types of activities, can be changed. Essentially, people can cure insomnia by remembering that sleeping and wakefulness are conditioned reflexes that can be learned or unlearned, at will. Therefore, one of the oldest, best proven methods to promote a descent night’s sleep in insomnia patients is by keeping the sleep hygiene rules. These are basically specific behavioral instructions, intended to promote a healthy and sufficient sleep.
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