Underlying Causes of Insomnia
Insomnia is defined as the inability to fall asleep or maintain sleep throughout the night. People affected by insomnia are often unable to relax before bed. They may even complain of heart palpitations, excessive worry, or even anxiousness as they are trying to fall asleep. Some will even wake up feeling anxious or just simply feeling wide awake in the early hours of the morning.
According to the National Sleep Foundation the recommendations for sleep are the following, based on review of scientific studies evaluating the effect of sleep on health
Younger adults (18-25): Sleep range is 7-9 hours (new age category)
Adults (26-64): Sleep range did not change and remains 7-9 hours
Older adults (65+): Sleep range is 7-8 hours (new age category)
What these recommendations do not mention is that sleep quality is just as important as sleep duration. Many patients tell me they get 8 hours of sleep but are exhausted. This tells me that either their sleep quality is poor and or they have another condition that is making them tired.
Sometimes the solution to getting a good night sleep might involve simple changes such as turning off the TV or the computer earlier and dimming the lights in your room. Sleeping with your pets who disrupt sleep is a very common reason why people do not get enough sleep. For others the solution may not be quite as simple.
Thyroid disorders and Insomnia:
Any time a patient complains of insomnia and anxiety I always want to rule out a thyroid disorder. What a lot of doctors overlook, is the fact that underactive thyroid function and insomnia go hand-in-hand. Many people are under the impression that only hyperthyroidism (overactive) will cause insomnia. I commonly see patients who suffer from insomnia who also have varying degrees of anxiety. In some cases the anxiety, or just simply excessive worry, only comes into play at night, especially when they are lying in bed. For some people this is the only quiet time they have during the day where they can slow down. When free from other distractions some will then reflect upon what happened that day or worry about what they need to do in the coming day or days.
Anxiousness or actual anxiety disorders are a very common symptom amongst our population of patients. If someone has low thyroid function on top of having insomnia, they will be even more tired than the average person. Their ability to cope with stress will be further diminished. Patients who need thyroid medication and are given the medication at the proper dose will often report sleeping much better and also feel more calm throughout the day.
Sex Hormones and Insomnia:
Fluctuations in sex hormones can dramatically affect a woman's ability to sleep. This could be a fluctuation that occurs on a monthly, cyclical basis, or fluctuations as a woman approaches menopause. More often than not the culprit is low progesterone. This drop in progesterone can often result in insomnia. Progesterone affects GABA receptors in the brain which both shortens the time it takes to reach REM sleep but also prolongs the duration of REM sleep. (1) I also find that men of varying ages, even as young as their early 30's who have low testosterone will often complain of anxiousness among other symptoms. Testosterone is commonly thought to cause rage and mood swings, which it can if overdosed. The reality is, when dosed and monitored properly, testosterone can help men feel more calm, more energized and often help them sleep better.
Neurotransmitters (mood regulators in the brain):
Neurotransmitters are chemicals in the brain which affect our mood and sleep. Melatonin, which is available as a supplement is one of these chemicals which helps regulate our sleep. Melatonin levels naturally increase in response to darkness. For this reason we encourage those trying to get to sleep to dim their light to naturally increase melatonin production. Dopamine on the other hand inhibits the production of melatonin and is normally released from the pineal gland as daylight approaches. Another neurotransmitter affecting sleep is serotonin. Many antidepressant medications work on serotonin metabolism. Aside form affecting mood, serotonin can affect sleep and can calm the nervous system preventing anxiety. Those who suffer from anxiety and/or depression and insomnia often will respond well to serotonin targeted therapies whether they are natural or pharmaceutical.
Sleep Apnea
Sleep apnea is defined as episodes where a person stops breathing or breathes very shallow while asleep. These episodes can last anywhere from seconds to minutes and can occur as frequently as every two minutes. It is often the partners of those affected by sleep apnea that will notice that they snort or choke while sleeping but often do not wake up. Untreated sleep apnea can lead to severe health problems. According to http://www.nhlbi.nih.gov untreated sleep apnea can:
Increase the risk of high blood pressure,heart attack,stroke,obesity, and diabetes
Increase the risk of, or worsen,heart failure
Make arrhythmias, or irregular heartbeats, more likely
Increase the chance of having work-related or driving accidents
Telltale signs of sleep apnea may simply be morning or persistent fatigue which may or may not be accompanied by high blood pressure. It is important that those with suspected sleep apnea be evaluated by a sleep specialist.
For those who simply have a hard time falling asleep or are light sleepers, they may want to try using white sound machines to drown out noise which disrupts their sleep or calming sounds that can calm the brain as you get ready for sleep. Below are products that I have used and like. There are many similar products out there. Dr. Jeffery Thompson's other audio products can be found here.
