Daytime Sleep And Insomnia: What's The Connection?

Insomnia is a common sleep disorder that affects a person's ability to fall asleep or stay asleep, resulting in a lack of sleep that causes distress or difficulty with daily activities. It is characterised by trouble falling asleep, staying asleep, or both, even with a bedroom environment conducive to sleep. Insomnia can lead to daytime impairments such as fatigue, irritability, and impaired memory and concentration. It is usually treated by improving sleep habits, medication, or cognitive-behavioural therapy. While insomnia usually isn't dangerous, it can negatively affect one's life and cause sleep deprivation if left untreated. So, is it insomnia if you sleep during the day? The answer is, it depends.

Insomnia symptoms and diagnosis

Insomnia is a sleep disorder characterised by disruptions in how you feel or function due to insufficient or poor-quality sleep. About 10% of the world's population experiences insomnia that qualifies as a medical condition, usually not dangerous but often disruptive.

Symptoms

Insomnia has several potential symptoms, which fall into a few categories:

• Trouble falling asleep (initial insomnia)
• Waking up in the middle of the night (middle insomnia)
• Waking up too early and being unable to fall back asleep (late insomnia)

These disruptions can lead to a range of issues during waking hours, including:

• Feeling tired, unwell, or sleepy
• Delayed responses and slowed reaction times, which can be dangerous when driving
• Memory issues and trouble concentrating
• Mood disruptions, such as anxiety, depression, and irritability
• Difficulty with work, social activities, hobbies, or other routine activities

Diagnosis

A healthcare provider can diagnose insomnia using a combination of methods, including:

• Asking questions about your health history, personal circumstances, sleep habits, and symptoms
• Recommending tests to rule out other conditions with similar symptoms, such as sleep apnea or multiple sleep latency tests (MSLT)

There is no single test to diagnose insomnia directly, but these tests can help exclude other conditions.

Insomnia causes

Insomnia is a common problem, affecting around 1 in 3 adults worldwide. It is characterised by disruptions in sleep patterns and can be classified as acute (short-term) or chronic (long-term). While the exact causes of insomnia are not fully understood, several factors are believed to contribute to it.

One of the most common causes of insomnia is stress, anxiety, and depression. Life circumstances, such as stressful or challenging events, can also play a role. Additionally, physical health conditions, including temporary illnesses and chronic ailments like acid reflux or Parkinson's disease, can impact sleep. About half of those with chronic insomnia have at least one other mental health condition.

Insomnia may also be influenced by sleep habits and routines, such as napping during the day, caffeine consumption, and sleep timing. Other factors include room temperature, alcohol and drug use, and certain medications.

Genetics and brain activity are also believed to play a role, with sleep traits and conditions like insomnia often running in families. Brain chemistry differences may affect an individual's ability to sleep, though further research is needed to fully understand the underlying causes of insomnia.

Insomnia treatment

Insomnia is a common issue, with about 10% of the world's population experiencing insomnia that qualifies as a medical condition. It is usually not dangerous and can be treated in a variety of ways, including medications and mental health options.

Treatment Options

Lifestyle Changes

Insomnia is often treated by making changes to one's lifestyle and habits. This includes:

• Developing and practicing good sleep habits, also known as sleep hygiene.
• Adopting bedtime habits that promote sleep, such as making your bedroom sleep-friendly by keeping it cool, quiet, and dark.
• Maintaining a consistent sleep schedule, even on weekends.
• Avoiding caffeine, nicotine, and alcohol close to bedtime.
• Getting regular physical activity during the day, but not too close to bedtime.
• Avoiding naps, especially in the afternoon.
• Eating meals on a regular schedule and avoiding late-night dinners.
• Limiting fluid intake close to bedtime to avoid disrupting sleep.
• Learning new ways to manage stress, such as reading, listening to soothing music, or taking a hot bath.

Cognitive Behavioral Therapy (CBT-I)

CBT-I is a 6- to 8-week treatment plan that helps individuals fall asleep faster and stay asleep longer. It is typically recommended as the first treatment option for long-term insomnia and can be done in person, by telephone, or online. CBT-I includes:

• Cognitive therapy to reduce anxiety about not being able to sleep.
• Relaxation or meditation therapy to promote relaxation and faster sleep onset.
• Sleep education to learn good sleep habits.
• Sleep restriction therapy, which allocates a specific amount of time for sleep, even if one is unable to sleep during this period.
• Stimulus control therapy to establish a regular sleep-wake cycle, associating bed with sleep and getting out of bed if unable to sleep.

Prescription Medicines

Prescription medicines are also used to treat insomnia, with some meant for short-term use and others for longer-term use. It is important to discuss the benefits and side effects of these medicines with a doctor. Examples include:

• Benzodiazepine receptor agonists: zolpidem, zaleplon, and eszopiclone. Side effects may include anxiety, severe allergic reactions, or performing activities while asleep.
• Melatonin receptor agonists: ramelteon. Side effects include dizziness and fatigue, with rare cases of people performing activities while asleep or severe allergic reactions.
• Orexin receptor antagonists: suvorexant (not recommended for people with narcolepsy). Rare side effects may include performing activities while asleep or being unable to move or speak temporarily during sleep onset or wake-up.
• Benzodiazepines: May be prescribed if other treatments have been ineffective. Side effects include dizziness, confusion, and muscle weakness. Can be habit-forming and should only be taken for a few weeks.
• Antidepressants, antipsychotics, and anticonvulsants: May be prescribed off-label to treat insomnia.

Over-the-Counter Medicines and Supplements

Over-the-counter (OTC) products containing antihistamines are sold as sleep aids, but it is important to consult a doctor before using them to treat insomnia as they may be unsafe for certain individuals. Melatonin supplements are also commonly used to improve sleep, but their effectiveness for treating insomnia is not proven, and they may cause side effects such as daytime sleepiness, headaches, upset stomach, and worsening depression. They can also affect blood pressure regulation.

Insomnia risk factors

Insomnia is a common condition, affecting roughly 1 in 3 adults worldwide. While insomnia can happen to anyone, certain risk factors may make it more likely to occur in some people. These risk factors can be inherited, or they can be the result of aging or lifestyle choices. Here are some of the key risk factors for insomnia:

Advancing Age

The risk of developing insomnia increases as you get older. While insomnia can occur at any age, older individuals are more likely to experience it.

Family History and Genetics

Insomnia sometimes runs in families, and your genetics can play a role in predisposing you to insomnia and influencing the quality of your sleep. If you have a family history of insomnia, your risk may be higher.

Sex

Women are more likely to experience insomnia than men. This may be due in part to hormonal changes during pregnancy and menopause, which can cause sleep disturbances.

Lifestyle

Certain lifestyle habits can increase the risk of insomnia. These include taking long naps close to bedtime, consuming excessive caffeine, alcohol, or nicotine, and maintaining an irregular sleep schedule. Physical inactivity during the day can also contribute to insomnia.

Stress and Worry

Stress, anxiety, and worry about sleep or daily life can significantly increase the risk of insomnia. This includes worrying about getting enough sleep and watching the clock. Additionally, individuals who do not feel safe in their homes due to violence or abuse may be at higher risk.

Medical and Psychiatric Disorders

Medical conditions such as heart disease, asthma, acid reflux, and Parkinson's disease have been associated with insomnia. Psychiatric disorders, including depression and anxiety, are also often linked to insomnia. About half of the people with chronic insomnia have at least one other mental health condition.

Social and Environmental Factors

Social and physical environmental conditions can impact sleep duration and the risk of sleep disturbances. Insomnia symptoms are more prevalent in poorer neighborhoods, areas with higher crime rates, and urban settings with increased nighttime light exposure. Individuals with lower socioeconomic status and persons of color have higher rates of insomnia due to various health disparities.

Insomnia and mental health

The Link Between Insomnia and Mental Health

The relationship between insomnia and mental health is complex and bidirectional. Insomnia often coexists with mental health problems, and it can be challenging for doctors to determine which disorder came first. Approximately 50% of people with insomnia also have a mental health condition, and about one-third of those with chronic insomnia have a mental health disorder. Mental health conditions can affect sleep, and sleep deprivation can, in turn, increase the risk of developing or exacerbating mental health issues.

Impact of Insomnia on Mental Health

For individuals with insomnia, inadequate or poor-quality sleep can increase the likelihood of developing a mental health disorder, worsen existing symptoms, or hinder treatment effectiveness. Sleep deprivation can cause mood changes similar to those associated with anxiety and depression, leading to irritability, negative outlook, reduced libido, and impaired judgment. It can also result in lethargy, drowsiness, and a need for frequent naps.

Insomnia can strain relationships and cause individuals to withdraw from their usual activities. It may also negatively impact work performance, affecting career prospects. When coupled with a mental health condition, insomnia can further exacerbate symptoms and reduce the effectiveness of treatments for mental health disorders.

Mental Illness and its Effect on Sleep

Sleep problems are commonly associated with various mental health conditions, including depression, anxiety disorders, bipolar disorder, and substance use disorders.

Depression

Insomnia is a prominent feature of depression, with approximately 90% of depressed individuals experiencing sleep difficulties. Sleep disruptions increase the risk of developing depression, and episodes of depression can, in turn, worsen sleep quality. People with depression often take longer to fall asleep, leading to sleep deprivation. They may also experience changes in rapid eye movement (REM) sleep patterns and reduced slow-wave sleep.

Anxiety Disorders

A majority of people with anxiety disorders struggle with falling or staying asleep. While many people experience intermittent worry or anxiety that occasionally disrupts their sleep, anxiety disorders are characterized by persistent fear and worry that affect long-term sleep quality and disrupt various aspects of their lives.

Bipolar Disorder

Bipolar disorder is marked by fluctuations in mood, concentration, and energy levels, and these changes are accompanied by variations in sleep patterns. During periods of bipolar depression, individuals may experience insomnia or hypersomnia (excessive sleep). In contrast, during manic states, there is a reduced need for sleep, and individuals may go several days without sleep, appearing highly energetic despite the lack of rest.

Substance Use Disorders

Insomnia and substance use disorders often co-occur, and insomnia can increase the risk of developing a substance use disorder. Additionally, sleep disturbances are common during recovery from substance use and can contribute to relapse. Substance misuse can disrupt the body's processes that regulate sleep and wakefulness. Alcohol, for example, is often used as a sleep aid, but it can worsen insomnia symptoms and increase the risk of developing alcoholism.

Schizophrenia

Schizophrenia is a mental health disorder characterized by disturbances in thoughts, behaviors, and feelings. It is associated with a range of sleep problems, including insomnia and disruptions in circadian rhythm and sleep stages. Sleep difficulties in people with schizophrenia may also increase the risk of relapse.

Frequently asked questions