The Agony Of Sleepless Nights: Understanding Insomnia And Its Causes

Sleep is essential for human health and well-being. Not getting enough sleep is known as sleep deprivation, sleep insufficiency, or sleeplessness. Sleep deprivation can have a range of negative effects on the body and mind, and can be either acute or chronic. Acute sleep deprivation occurs when a person sleeps less than usual or not at all for a short period, typically one to two days. Chronic sleep deprivation occurs when a person routinely sleeps less than the amount required for proper functioning.

Sleep deprivation

Stages of Sleep Deprivation

There are five recognised stages of sleep deprivation, each with increasing severity. These are usually divided into 12-hour or 24-hour increments.

• Stage 1: After 24 hours without sleep, a person will feel tired and exhausted, and their risk of errors and accidents in everyday tasks will increase.
• Stage 2: After 36 hours, an overwhelming urge to sleep will set in, along with increased appetite and extreme fatigue. Microsleeps may also occur at this stage.
• Stage 3: After 48 hours of no sleep, it becomes extremely difficult to stay awake, and a person is likely to experience microsleeps. They may also suffer from perceptual distortions, increased irritability and temporal disorientation.
• Stage 4: After 72 hours, the urge to sleep will strengthen and may become uncontrollable. Microsleeps will become more frequent and longer, and hallucinations may become more complex.
• Stage 5: After 96 hours or more, a person's perception of reality may be severely distorted, resembling acute psychosis, and their urge for sleep will feel unbearable.

Causes of Sleep Deprivation

Effects of Sleep Deprivation

• Mental impairment: Reduced alertness, slower reaction times, difficulty focusing attention, impaired logical reasoning, and poorer performance of tasks.
• Mood changes: Increased symptoms of anxiety and depression, negative changes in mood, reduced sex drive, and impaired judgement.
• Microsleeps and tiredness: Microsleeps are brief periods of sleep that can occur during the day, often while performing monotonous tasks. They can be very dangerous, especially when driving.
• Increased risk of accidents and errors: Sleep deprivation increases the risk of car crashes and workplace errors due to mental impairment and microsleeps.
• Health problems: Sleep deprivation is linked to various adverse health outcomes, including heart problems, reduced immune function, weight gain, high blood pressure, diabetes, depression, heart disease, and strokes. It can also increase the risk of developing chronic conditions such as obesity, cardiovascular disease and type 2 diabetes.
• Cognitive impairments: Sleep deprivation can negatively impact cognitive performance, including learning ability, memory, and attention. It may also lead to the permanent loss of brain cells.

Insomnia

Primary insomnia exists independently of any other condition. It can be further broken down into three types: psychophysiological insomnia, idiopathic insomnia, and sleep state misperception (also known as paradoxical insomnia). Psychophysiological insomnia is associated with excessive anxiety or worry about not being able to sleep. Idiopathic insomnia usually begins in childhood and lasts throughout a person's life, and is suggested to be a neurochemical problem in the part of the brain that controls the sleep-wake cycle. Sleep state misperception occurs when people get enough sleep but inaccurately perceive that their sleep is insufficient.

Secondary insomnia, or comorbid insomnia, occurs alongside another medical, neurological, psychological, or psychiatric condition. For example, anxiety may cause insomnia, and insomnia can also cause or worsen anxiety. Other causes of secondary insomnia include depression, personality disorders, and neurological disorders.

Sleep insufficiency

The recommended amount of sleep for adults is 7-9 hours per night, while children and teenagers require more. Acute sleep insufficiency occurs when a person sleeps less than usual or does not sleep at all for a short period, typically one to two days. If this sleepless pattern persists, it may lead to chronic sleep issues. Chronic sleep insufficiency occurs when a person consistently sleeps less than the amount required for proper functioning. The amount of sleep needed can depend on various factors such as sleep quality, age, pregnancy, and level of sleep deprivation.

There are several factors that can contribute to sleep insufficiency, including poor sleep habits, work schedules, social obligations, substance use, illnesses, sleep disorders, and medications. To treat and prevent sleep insufficiency, it is essential to prioritize getting enough sleep. This may involve maintaining a consistent sleep schedule, creating a relaxing bedtime routine, limiting the use of digital devices before bed, and improving the sleep environment.

In summary, sleep insufficiency is a common condition that can have significant impacts on overall health and daily functioning. It is important to address sleep insufficiency and make the necessary changes to improve sleep quality and duration.

Sleep restriction

SRT is a multistep, multi-week process that initially restricts the amount of time a person spends in bed overnight and then gradually increases that time. The goals of SRT are to increase sleep efficiency—the ratio of time spent asleep to time spent in bed—and to ensure that the person gets the amount of sleep they need.

Step 1: Record Your Sleep Patterns

Keep a sleep diary or use a sleep-tracking app for at least two weeks. This will help you better identify your sleep habits and patterns.

Step 2: Average the Hours of Sleep per Night

Using your sleep log, find the average number of hours of nightly sleep.

Step 3: Set Your Bedtime

Start by going to bed in time to achieve only the average number of hours that you calculated. For example, if you usually sleep 6 hours and need to wake up at 7:00 am, your initial bedtime should be 1:00 am. It is recommended that you do not restrict sleep time to less than 5.5 hours, even if that is more than your average sleep time.

Step 4: Maintain the Same Wake Time

Keep the same wake-up time every day of the week.

Step 5: Stick to this Schedule for at Least Two Weeks

The time spent in bed should not vary according to the amount of sleep you got during the night.

Step 6: Increase the Time Spent in Bed

When you are sleeping relatively well through the night and starting to feel tired during the day, gradually increase the time spent in bed. Move your bedtime earlier by 15 minutes each week.

Step 7: Find Your Ideal Bedtime

You will know that you have reached your ideal bedtime when you are sleeping better through the night and feeling rested during the day.

SRT is often used in conjunction with cognitive behavioural therapy for insomnia (CBT-I) and can be an effective treatment for insomnia disorder. This method helps to recalibrate your sleep schedule, making it easier to fall asleep and stay asleep through the night. SRT is widely prescribed to people with chronic insomnia and is generally considered safe, but because it may cause sleepiness, it may not be appropriate for everyone.

Sleep debt

You will also be at a higher risk of developing conditions such as hypertension, diabetes mellitus, coronary heart disease, and cardiovascular disease if you don't sleep as much as you should. Sleep debt can also lead to high anxiety, irritability, erratic behaviour, poor cognitive functioning and performance, and psychotic episodes.

To avoid sleep debt, it is important to learn how much sleep your body needs and improve your sleep hygiene. This includes keeping a sleep diary, developing a nighttime routine, reconsidering your daytime schedule, and making your bedroom more sleep-friendly. Taking short naps of 10 to 20 minutes can help you feel more refreshed and capable of taking on various tasks throughout the day, but they shouldn't interfere with your regular sleeping schedule.

It is worth noting that sleeping more on the weekends to make up for sleep debt during the week may not be effective in reversing the potential weight gain and metabolic dysregulation that can come with regular sleep loss.

Frequently asked questions